OREGON DENTAL CONFERENCE PREVIEW - Membership Matters - February 2022
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Membership Matters
A publication of the Oregon Dental Association • February 2022
OREGON DENTAL
CONFERENCE® PREVIEW
Also Inside CE Calendar, page 9 | Dental Foundation of Oregon, page 20
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Volume 27, Issue 2 | February 2022
INSIDE THIS ISSUE
FEATURES
12 OREGON DENTAL CONFERENCE® PREVIEW
18 MEMBERS OF ODA’S ANNUAL MEETING COUNCIL
SHARE THEIR EXCITEMENT TO RETURN TO AN
IN PERSON OREGON DENTAL CONFERENCE
20 DENTAL FOUNDATION OF OREGON
21 GOW-GATES MANDIBULAR BLOCK
(FROM THE HORSE’S MOUTH)
31
By Mel Hawkins, DDS, BSc AN, FADSA, DADBA
Connect Online
24 WHAT TO SET YOUR SITES ON WHEN STAGING Facebook “f ” Logo CMYK / .eps Facebook “f ” Logo CMYK / .eps
AND GRADING Oregon Dental Association
By Tim Donley, DDS
@OR Dentists
26 DIABETES AND THE DENTIST’S NEW ROLE IN RECOGNITION
AND SCREENING: A1C IN-OFFICE TESTING AS A NEW ADA OregonDental channel
PROCEDURE CODE (D0411) Oregon Dental Association
By Daniel G. Pompa, DDS (private group)
29 COVID-19 RESOURCES @oregondental
31 NEW DENTIST CORNER
32 STUDENT PATIENT ASSISTANCE PROGRAM Membership Matters accepts original
submissions for publication from member
dentists. For viewpoint articles, please
DEPARTMENTS limit to 800 words. For clinical articles,
please limit to 1,600 words. Membership
5 FROM THE EDITOR Matters is not a peer review publication.
Publication of any article is at the discretion
7 NEW MEMBERS of the Editor. Please disclose any financial
interests you may have in products or
9 EVENTS AND EDUCATION services mentioned in your article. Email
33 CLASSIFIED ADS ODA staff at info@oregondental.org
with any articles of questions.
34 INDEX TO ADVERTISERS
Membership Matters is an official publication of the Oregon Dental Association in support of its core purpose to advance the dental profession and promote the highest standard
of oral health and oral health care.
8699 SW Sun Pl, Wilsonville, OR 97070, 503-218-2010 | 800-452-5628, info@oregondental.org, www.oregondental.org.
PUBLISHED FEBRUARY 2022/ODA-M0222/3964 Membership Matters (ISSN 1082-4111) (USPS-905060) is published monthly (except January, July and October) by the Oregon Dental Association,
8699 SW Sun Pl, Wilsonville, OR 97070. All statements of opinion and of alleged fact are published on the authority of the writer under whose name they appear and are not to be regarded as the views of
the ODA or its subsidiaries or affiliates. Subscription to Membership Matters is a member benefit of the Oregon Dental Association. The annual subscription rate for nonmembers is $40. Single copies may
be purchased for $5 each.
Advertising. The acceptance of advertising for publication in Membership Matters should not be construed as endorsement by ODA of the advertiser or of the product or service being advertised. For advertising
rates and information, contact Robyn Mourant at 1-800-796-2638, ext. 4324, or rmourant@naylor.com.
The entire contents of this publication are copyrighted by the Oregon Dental Association, 2022. All rights reserved. No part of this publication may be reproduced, reprinted, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior written permission of the editor and the author.
Periodicals postage paid at Wilsonville, Oregon, and at additional mailing offices. POSTMASTER: Send address changes and all correspondence to: 8699 SW Sun Pl, Wilsonville, OR 97070; 503-218-2010
or 800-452-5628 (toll-free in Oregon).
Published by 1430 Spring Hill Road, 6th Floor, McLean, VA 22102, Tel: 800-369-6220 www.naylor.com, Account Manager David Freeman Editor Russell Underwood
Marketing Associate Najla Brown Book Leader Robyn Mourant Sales Representatives Bryan Agnes, Jason Currie, Krys D’Antonio Project Coordinator Hope Swindler Layout and Design Manish Dutt Sharma
COVER IMAGE: GRAPHICS COURTESY OF ODA
www.oregondental.org February 2022 3
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This Year, Get and
FROM
THE EDITOR Give Feedback By Alayna Schoblaske
AS I AM WRITING THIS EDITORIAL, book Dare to Lead, and is called The praise, do they prefer a candy bar or a
IT is January 8th and the world is Engaged Feedback Checklist.1 It asks Starbucks gift card?
settling into the new year and there is eleven questions that prepare you to Can I hold you accountable
a lot of talk of new year’s resolutions. give feedback. I will share some of without shaming or blaming?
Many resolutions are exciting and my favorite questions as well as my Am I open to owning my part?
ambitious…and ultimately lofty and reflections on what they mean to me. Growth opportunities are very rarely
unattainable. This year, I am focused Am I ready to sit down next to one-sided. If there is a problem you
on small habits that will help me you rather than across from you? are trying to solve, it is important to
take better care of myself. I want to Feedback is best when it is given first reflect to identify what role you
wake up when my alarm goes off from a collaborative, growth-minded may have had in it before blaming or
instead of pressing the snooze button way, and if you are not ready to share finger-pointing. Could I have provided
one-too-many times. And I want to feedback as a teammate (instead of better training? Could I have been
keep screens out of my bedroom… as a supervisor), then you may not more clear in communicating my
no TV, cell phone, or laptop use be ready. expectations? As you share feedback
before bed. Am I ready to listen, ask with your team members, be sure to
At work, though, I am focused questions, and accept that I be open and vulnerable about the
on giving and receiving excellent may not fully understand the areas where you want to improve, too.
feedback. The organization I work issue? Most of the time, feedback Am I aware of power dynamics,
for (La Clinica) has a set of 21 conversations end up going complete implicit bias, and stereotypes?
Foundations that define our employee differently than I expect them to. When As dentists, supervisors, and
culture. The first of those is that we I start with a rigid and fearful state business-owners, we often come
Get and Give Feedback Often. I have of mind, they often go worse than I into a conversation with power. It is
found that this practice of getting expect. But when I start with curiosity important that you are aware of how
and giving feedback—both positive and embrace the possibility that I have you use this power, and whenever
and improvement feedback—has not yet thought of the best solution, possible, that you use it for growth
allowed me to grow as a practitioner, they often go better than I expect. and connection instead of shame
as a leader, and as a person. I value Am I ready to acknowledge what and blame. You may also have
the perspectives of my coworkers, you do well instead of picking assumptions about another person
and I notice that when I tune my apart your mistakes? It is important based on previous interactions or
attention to seek out areas where my that we share positive feedback stereotypes. Take a few minutes
teammates are excelling and where just as often—or more often—than to think about what assumptions
we have room for improvement, my improvement feedback. Every one you are making, and prioritize
care is more excellent and my job of your team members wants to be asking clarifying questions in these
satisfaction is higher. praised in a different way, so I like areas instead.
So, if this is also an area that you to ask each person how they like to
would like to focus on in the year receive positive feedback. Do they Resource
1. Brown, B. “The Engaged Feedback
ahead, I want to offer a framework want it in person or via email? Do they Checklist.” Dare to Lead Hub,
that has helped me become more want public recognition or do they 8 January 2022, https://daretolead.
brenebrown.com/wp-content/
skilled in giving and receiving prefer one-on-one conversations? uploads/2021/09/DaringFeedback-
feedback. It is from Dr. Brené Brown’s If I want to include a gift with the EngagedFeedbackChecklist11.pdf.
The opinions expressed in this editorial are solely the author’s own and do not reflect the views of the Oregon Dental
Association or its affiliated organizations.
www.oregondental.org February 2022 5
Welcome
UP FRONT New ODA Members
WELCOME TO OUR NEWEST MEMBERS! Please reach out to these new members and
welcome them into the ODA community.
Thomas Bordieri, DMD Mariya Melnik, DMD
Central Oregon Dental Society Southwestern Oregon Dental Society
Michelle Graber, DMD Anne Purcell, DMD
Washington County Dental Society Multnomah Dental Society
Daryl Khaw, DMD
Multnomah Dental Society
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February 2022
11/01/22 11:06 PM
7
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Events & Education
CONTINUING
Component CE Calendar
E D U C AT I O N Calendar provided by Mehdi Salari, DMD
This calendar is current as of December 22, 2021.
Due to the COVID-19 pandemic, events may be altered or postponed.
Please visit the host dental society website for the most up-to-date information.
Host
Hours
Date Dental Course Title Speaker Location More Information
CE
Society
Functional Occlusion
Jim Sagawa, executivedirector@
03/15/22 Clackamas for Full & Removable 2 TBD
DMD clackamasdental.com
Partial Dentures
Cyber Crimes Safety,
Cory Roletto,
Social Media/Website
Chris Verbiest &
03/16/22 Multnomah Accessibility & 2 TBD Register: www.multnomahdental.org
a Cyber Security
Professional Insurance -
Attorney
What do I need?
The Current State of
John Van executivedirector@
04/26/22 Clackamas Practice Valuations 2 TBD
Leeuwen clackamasdental.com
and Transitions
The Kennedy
05/18/22 Multnomah Table Clinics - 1 Register: www.multnomahdental.org
School
Find this calendar online at www.oregondental.org. Click “Meetings & Events” > “Calendar of Events”.
Due to the COVID-19 pandemic, many component meetings were canceled or postponed. Looking for additional ways to
get CE? The American Dental Association has a large collection of webinars and on-demand video learning opportunities
available, many of which are free to members. Visit adaceonline.org to catch up on the latest offerings on your
own schedule.
www.oregondental.org February 2022 9
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ODA BOARD OF TRUSTEES NORTHWEST
PRESIDENT
GENERAL
Calie Roa, DMD DENTISTS AND
Southern Oregon Dental Society
SPECIALISTS
PRESIDENT-ELECT ENJOY:
Mark Miller, DMD
Yamhill County Dental Society
SECRETARY-TREASURER • Competitive base salaries and • An opportunity to become
additional incentive-based pay an owner in the business
Cyrus Javadi, DDS
Clatsop County Dental Society • Generous medical and dental • Camaraderie and
coverage professional growth that
• Rich employer-paid 401(k) a group practice offers
AT-LARGE MEMBERS
contributions
Jared Adams, DDS
• Market leading paid time-off
Central Oregon Dental Society
Normund Auzins, DDS
Multnomah Dental Society ONLINE: WWW.PDA-DENTAL.COM
Todd Beck, DMD PHONE: 503-813-4254
Multnomah Dental Society
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Well qualified dentists with a GPR or AEGD and/or 2-3 years of
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Clackamas County Dental Society
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Multnomah Dental Society
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February 2022 11
23/11/21 8:53 PMO R E G O N D E N TA L
CONFERENCE Welcome Back to the In-Person
Oregon Dental Conference!
A Place for the Dental
Community to Reconnect,
Learn and Grow!
FOR THE FIRST TIME IN THE EVENT’S 129-YEAR HISTORY, the 2022 Oregon Dental
Conference (ODC) will be offered as a HYBRID event! After a two-year hiatus due to the
COVID-19 pandemic, the ODC is returning to the Oregon Convention Center for three days of
learning paired with the Solutions Marketplace Exhibit Hall. In addition, the 2022 ODC will offer
a virtual component for those who can’t join in person!
The virtual component of the conference will include 10 on-demand courses that are
geared toward satisfying licensure renewal requirements. Course topics include infection
control, medical emergencies, risk management, cultural competency, nitrous oxide, suicide
prevention, and more! All virtual courses will be available 24/7 starting on April 7, with access
through May 15! Full conference, in-person attendees have access to these virtual offerings as
part of their registration. Attendees who cannot join in person can register for these offerings
as a stand-alone “virtual only” option.
In addition to live CE and access to the Solutions Marketplace, in-person attendees are
encouraged to join the ODC events! The General Session on Thursday, April 7 at 10:30 a.m.
will feature keynote speaker James Nestor. Mr. Nestor, an acclaimed journalist and New York
Times bestselling author, will be presenting his riveting and thought-provoking talk, “Breath:
The New Science of a Lost Art.”
The “All-In for Fun Game Night,” generously sponsored, in part, by Delta Dental of Oregon,
will be held on Friday, April 8 from 6:00 p.m.-10:00 p.m. at the Hyatt Regency Portland. After a
day of learning, gather your team for this evening of fun—there is something in it for everyone,
including the opportunity to win some excellent prizes!
The conference would not be the same without our excellent partner groups. We are
grateful to welcome back The Oregon Association of Dental Laboratories (OADL), the Oregon
Dental Assistants Association (ODAA), The Oregon Dental Hygienists’ Association (ODHA),
the Oregon Society of Oral & Maxillofacial Surgeons (OSOMS), the Oregon Society of
Periodontists (OSP), and the Oregon State Association of Endodontists (OSAE). Thank you for
your longstanding partnership and dedication to supporting the ODC community!
With 75 in-person courses and 10 virtual, on-demand courses and a Solutions Marketplace
filled with dental partners and fun events, the 2022 Oregon Dental Conference offers an
opportunity for the whole dental team to REconnect, Learn, and Grow! Register today at
www.oregondentalconference.org.
12 Membership Matters Oregon Dental AssociationO R E G O N D E N TA L
CONFERENCE COVID-19 Protocol
THE OREGON DENTAL CONFERENCE IS DEDICATED TO attendee safety and will comply
with all federal, state, and venue requirements. All event attendees, vendors, and staff age
two (2) and above at the Oregon Convention Center are required to wear masks. In addition,
attendees who are age five (5) and above must provide proof of full vaccination or a negative
COVID-19 PCR or rapid test result within 72 hours prior to the first day of the conference.
Please review our full COVID-19 protocol at www.oregondentalconference.org.
GET THE ODC APP!
STAY UP TO DATE WITH ALL 2022 ODC
information, the tool you need in the palm of
your hand!
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✓ Course & Speaker Info
✓ Handouts
✓ Locations & Maps
✓ Exhibitor Info
✓ CE Verification System
Find the app by searching ‘Oregon Dental’ in
your device’s app store.
My Show Planner
Maximize your Solutions Marketplace
shopping trip!
The Solutions Marketplace is a great place
to forge valuable connections with dental
partners; it’s also the perfect one-stop
shopping solution for all things dental.
Preview our list of exhibitors and plan
ahead for your Solutions Marketplace visit
by utilizing ‘My Show Planner’ and the
Exhibitor Directory in the ODC app or visit
ODC22.MapYourShow.com.
www.oregondental.org February 2022 13O R E G O N D E N TA L
CONFERENCE Thank You, Sponsors!
Our generous sponsors help make the ODC a success!
For information on becoming a sponsor, please contact
Angi Blue at 503.218.2010 or ablue@oregondental.org.
PLATINUM SPONSORS
GOLD SPONSOR
SILVER SPONSORS
BRONZE SPONSORS
SPEAKER SPONSORS
14 Membership Matters Oregon Dental AssociationO R E G O N D E N TA L
CONFERENCE Don’t Miss These Exciting
Offerings
General Session Solutions Corner
The LIVE, in-person 2022 ODC General The Solutions Corner is a brand-new,
Session will be on Thursday, April 7 at micro-learning opportunity offered right on the
10:30 a.m. to kick off the conference! Solutions Marketplace floor on Friday, April 8
New York Times bestselling author and from 11:30 a.m. to 1:30 p.m.! Each 30-minute
journalist James Nestor will be giving his course will offer a different topic such as health
thought-provoking keynote, “Breath: The New & wellness, restorative dentistry, and wealth
Science of a Lost Art.” You won’t want to miss management & retirement! Preregistration is
this event! Please note, this is not a scientific not available for Solutions Corner lectures, and
session and does not qualify for CE credit. seating is first come, first served. Please plan
to arrive early to guarantee a seat.
All-In For Fun Game Night
Join us for the All-In for Fun Game Night, New Dentist Council Event
which will be located at the Hyatt Regency Calling all New Dentists—you won’t want
Portland—right across the street from the to miss out on this new offering just for
Oregon Convention Center! This event will you! Join your colleagues 0-10 years out
feature a delicious dinner and lots of fun of dental school and re-connect during a
to be had! Come try your hand at some relaxed social gathering at the Stir Bistro
blackjack, roulette, or play giant Jenga with & Lounge at the Oregon Convention
your team! There is something in this event Center from 5:00 p.m.-6:00 p.m. on Friday,
for everyone! Tickets are $45.00 per person, April 8, 2022. There will be appetizers and a
which includes event admission, dinner, cash bar (1 complimentary drink ticket will
two drink tickets, free game play, and the be provided). This is a great way to network
opportunity to win some excellent prizes! with your peers and friends. Afterward, keep
the night rolling by heading over to the Hyatt
Expanded Solutions Marketplace Hours Regency for the All-In for Fun Game Night.
Come take advantage of one-stop Registration information will be shared with
shopping for all things dental! all New Dentists who sign up to attend the
Thursday: 11:30 a.m.-6:30 p.m. Oregon Dental Conference.
Friday: 8:00 a.m.-5:30 p.m.
New ODA Membership Booth!
Grand Opening Reception Stop by the Oregon Dental Association
Celebrate the return of the 2022 ODC Membership booth and pick up the latest
to the Oregon Convention Center and the member benefit information and fun swag.
wonderful dental community at the Grand ODA and local society staff look forward
Opening Reception! Join us in the Solutions to chatting with existing members and
Marketplace to network with colleagues, non-members to learn how we can better
catch up with friends, and make new serve our members and the dental community.
connections. Enjoy happy hour snacks and You’ll have the chance to play fun games
spirits, shop the Solutions Marketplace, and and enter into a drawing for complimentary
enter to win great prizes! registration to the 2023 ODC. We look forward
Thursday: 3:30 p.m.-6:30 p.m. to re-connecting with you!
www.oregondental.org February 2022 15O R E G O N D E N TA L
CONFERENCE Frequently Asked Questions
Will all ODC courses be viewed session, with a minimum score Will there be any live events?
offered virtually? of 70%, before CE will be awarded. Yes! We will be bringing back the
No. A special selection of 10 courses Once a quiz has been passed, the All-In for Fun Game Night on Friday,
geared toward licensure requirements virtual course credit will be added to April 8 from 6:00 p.m.-10:00 p.m. All
will be offered virtually on-demand your CE certificate. attendees are invited and encouraged
on the ODC virtual platform. All other For in-person courses, a course to attend. Tickets are $45.00 per
CE sessions will be offered in-person completion code will be given verbally person and will include dinner,
at the Oregon Convention Center. to attendees at the end of each two drink tickets, and fun casino and
In-person attendees who register for a session. Attendees will need to enter lawn games to play. Everyone will
full conference badge will have access all course completion codes online in have the opportunity to play games to
to these 10 virtual courses as well as the CE verification system in order to win prizes!
in-person courses. In addition, there is obtain a CE certificate.
a virtual-only registration category for If I am attending in person, do
those who only wish to access these How long are the virtual I have to pay extra to watch the
10 virtual courses. courses available? virtual courses?
The 2022 ODC virtual courses will No. All virtual courses are a part of
Is the Solutions Marketplace be available starting on April 7, 2022, in-person full conference registration.
(Exhibit Hall) being offered and run through May 15, 2022.
virtually, or just in person? Are you requiring attendees to
The 2022 ODC Solutions Will you be offering CPR? wear masks onsite or provide
Marketplace (exhibit hall) will be Yes. Due to the hands-on nature of proof of vaccination?
offered in person only. this training, we will be offering CPR The Oregon Dental Conference
courses at the in-person portion of is dedicated to attendee safety and
Are any virtual courses live? the 2022 ODC located at the Oregon will comply with all federal, state,
No. ODC virtual courses will only Convention Center. CPR courses will and venue requirements. All event
be offered on-demand. This means be available on Thursday, April 7 and attendees, vendors, and staff age
that all virtual courses were recorded Friday, April 8. two (2) and above at the Oregon
prior to the conference and will be Convention Center are required to
available to conference attendees Can I request a hard copy of the wear masks. In addition, attendees
April 7-May 15, 2022. 2022 ODC Preview Program? who are age five (5) and above must
No. The 2022 ODC Preview provide proof of full vaccination or
Will the process for claiming CE Program is only available digitally. Visit a negative COVID-19 PCR or rapid
be different for in-person and www.oregondentalconference.org test result within 72 hours prior to the
virtual events? and select the “Preview Program” first day of the conference. Please
Yes. For virtual courses, a quiz must quick link to download your review our full COVID-19 protocol at
be successfully passed following each copy today! www.oregondentalconference.org.
16 Membership Matters Oregon Dental AssociationWe help dental
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By Melody Finnemore
WITH THE OREGON DENTAL a focus on the wellness of dental “While we’ve been able to see many
CONFERENCE (ODC) SLATED to health professionals. He asked if good quality classes online the past
return to the Oregon Convention anyone in the audience knew how to two years, lectures that go beyond
Center in person April 7-9, 2022, dance, and one of Hogan’s longtime, an hour or so online can be fatiguing
several members of ODA’s Annual former colleagues raised her hand to watch. Most of the online classes
Meeting Council said they and their and volunteered that she knew how don’t offer a Q&A with the lecturer,
teams are looking forward to the to do the cha-cha. The presenter and it’s always valuable to be able to
guest speakers, quality continuing invited her onstage to dance the ask the speakers questions and hear
education courses and Solutions cha-cha together, thereby giving the things our colleagues ask and
Marketplace, a one-stop shop for Hogan one of her most memorable contribute in discussions,” she said.
all dental product needs in the large ODC moments. “I’m also excited to see our
exhibit hall. “I was so impressed she did that, vendors. As dentists, we’re hands-on
However, the biggest thing they are and he really energized the crowd,” in our work and being able to handle
excited about is seeing friends and she said. “It was really nice to go equipment, instruments and materials
colleagues face to face, interactions back to work that following Monday lets us better evaluate products and
with the guest presenters and CE and be refreshed and excited to equipment we’re considering for our
course leaders, lunches and dinners see patients.” offices,” Watts added.
with their fellow team members, and Now working with a newer team, Hogan was among those who said
fun activities such as the All-In for Fun Hogan said they branch out to the virtual format has its own distinct
Game Night. different courses and then come back merits, including allowing people
Rachel Hogan, DMD, M.Ed., together to share information. to access more courses online,
D. ABDSM, practices at Better Sleep As a mother, Hogan said the accommodating those with medical
Oregon in Lake Oswego and said she opportunity to attend the ODC in concerns or other commitments,
enjoys interacting not only with other person creates a buffer from family and providing greater convenience
dentists but also dental assistants, obligations and other distractions. for people in other parts of the
hygienists, and front office staff from “You park your car and you are at the state who have to make time and
throughout the state. convention center, and you can be pay for travel to Portland for the
“Oregon is a pretty small place in totally focused and present when you in-person conference.
a lot of ways, so it’s really nice to see are in person.” Yet, they overwhelmingly were
people from the east side of the state Renee Watts, DDS, practices excited for the in-person event to
that you only get to see once a year at general dentistry at Ardent Care come. Parisa Sepehri, DDS, opened
the conference,” said Hogan. in Springfield and said she also her Tigard practice, PS Dental,
She recalled a past guest looks forward to seeing and hearing in 2001 and said her team has
presenter with great energy and lectures live and in person. appreciated the daytime interactions
18 Membership Matters Oregon Dental Associationas well as evening events such as the with online courses, and his team For the first time ever, the 2022
All-In for Fun Game Night. appreciates being able to attend the Oregon Dental Conference is being
“We really had fun, and it’s a good conference each year. “Similarly, I offered as a hybrid event. Participants
way of getting away from the office think our team really enjoys improving have the opportunity to register for
and bringing the team together,” their fund of knowledge and skills in-person conference offerings or opt
she said, adding the Solutions by comparing notes with other for virtual only participation. Learn
Marketplace is always a favorite for members and attending lectures from more and register for the conference at
her team. “We love to go see the respected experts,” he said. www.oregondentalconference.org.
vendors and see what’s new. If we’re
in the market for something, it’s a
good place to go look and compare.”
Terrence Clark, DMD, FAGD,
founded Wilsonville Dental Group
in 1987 and has attended many
conferences during his career.
Throughout that time, he has always
appreciated the collegial nature of the
ODC.
“You are in your office so much
and there is only so much you can do
with computers and on the internet,
so it’s nice to be with peers you don’t
see much of the time. You also get to
meet new people,” he said. “There is
a decorum about it that I appreciate.
It’s more than just going to fill your
brain with new stuff. It’s having
interactions, talking about cases
with other people who have similar
issues, and you learn about new case
studies.”
Clark noted that dental health
professionals are, by nature, drawn
toward person-to-person interactions.
“We work with patients who are real
people with real lives, and I think
that’s the kind of people we are
personally as well or we wouldn’t have
gravitated to this profession.”
Most of his team attends the ODC,
and Clark pointed to the benefit of an
event that draws colleagues together
through a shared learning experience.
“People who are learning are growing
and they are more happy, confident,
enthusiastic and love what they do.”
Allen Cheng, MD, DDS, FACS, with
Head and Neck Surgical Associates
in Portland, said he looks forward to
completing his CE requirements with
engaging speakers during the ODC,
something he does not experience
www.oregondental.org 1060880_iCore.indd 1
February 2022 19
09/12/21 1:55 PMCREATING SMILES
FOR OVER 40 YEARS!
Since 2008, the Tooth Taxi has given
over $8.2 million dollars in free dental
care to Oregon's children and members
of our most vulnerable communities!
Be sure to visit us and the Tooth Taxi
in the Solutions Marketplace.
You can find us at the end of aisle 700!
We cannot wait to
RECONNECT, LEARN & GROW
with each of you in 2022!
ERIN E. KANE PHOTOGRAPHY
TOOTH TAXI STAFF
20 Membership Matters Oregon Dental AssociationGow-Gates Mandibular Block
ODC SPEAKER
(from the Horse’s Mouth)
HIGHLIGHT Condylar Neck or High Ramus Block
By Mel Hawkins, DDS, BSc AN, FADSA, DADBA
DR. GEORGE GOW-GATES REFERRED TO HIS
TECHNIQUE as a condylar neck mandibular block. The
UNPUBLISHED. PERSONAL – HAWKINS, JM
clinical reality is that this narrow bony area can be an
ASTRA PHARMACEUTICALS: CORPORATE
PROMOTION, ANNUAL SYMPOSIUM 1977.
elusive target. For purposes of this article, it will also be
described as a high ramus block. Astra Dentsply
Pharmaceuticals 3 Day
Dentists and hygienists have, perhaps unknowingly,
Annual Symposium
been administering this block for years. When we miss
a standard block, we instinctively re-inject higher and
Boston, MA 1977
deeper. Enter the Gow-Gates mandibular block.
How high is higher? Anatomically, the BEST location to
block the mandibular nerve would be at foramen ovale. Fig. 1: Dr. George Gow-Gates
Unfortunately, there’s a lateral pterygoid muscle on the
insertion pathway, AND it’s in very close proximity to clinician (Fig. 1) and joined us to demonstrate, teach, and
the brain. This is an intraoral block (NOT an extraoral promote his technique on one of his world tours.
block, which is not a practice builder) but uses extraoral When George injected me using 3% mepivacaine
landmarks. How do I know some of this? (Carbocaine®) plain (2.2 ml), I noticed a certain profundity
I was both his student and his patient over a three- that I had never experienced. The soft tissue duration was
day symposium. George Gow-Gates was the keynote 3 hr. 25 min.
Gow-Gates: Advantages Gow-Gates: Disadvantages
Perceptible end point with:
Vascularity ! Mouth must be wide open
Risk of nerve damage ! Extra-oral landmarks
! Post-injection, stay open 2 minutes
Good buccal nerve anesthesia? YES!
! Hemostasis needs to be added
Duration of anesthesia
Good vision
Fig. 2: Gow-Gates advantages Fig. 3: Gow-Gates disadvantages
COURTESY: DR. G. GOW-GATES, DR. J. WATSON, UNIVERSITY
OF SYDNEY. AUSTRALIA. PERSONAL COLLECTION. 1974
HAWKINS JM. PERSONAL COLLECTION. UNPUBLISHED.
V3 –
foramen
ovale
(yellow) to
Gow-Gates the
anatomical mandibular
landmarks
Mouth must be wide open foramen
Post-injection, stay open 2 minutes
Fig 4: Yellow line shows alignment Fig. 5: Positioning of superior of corner mouth—tragal notch
ramus and deposit area of LA solution
www.oregondental.org February 2022 21The mouth must be wide open to bring the ramus bone can occur. Also, the medial pterygoid muscle can
anteriorly to shorten the insertion distance of the needle. occasionally be penetrated when bone can’t be contacted,
Post-injection, the mouth should remain open for 2 minutes. possibly trismus inducing post-op.
This gives the pool of local anesthetic a 2-minute “head The Gow-Gates mandibular block is at this superior level
start” for diffusion anteriorly (and medially) toward the allowing easier diffusion of the LA through adipose tissue.
mandibular nerve. Lipid solubility promotes trans-lipid cell diffusion. Local
The changing histology within the pterygomandibular anesthetics (LA) are the most amazing compounds. The
triangle illustrates the diffusion barriers and diffusion time molecules can cross epineural membranes, like a ghost
differences between the conventional IANB, the Akinosi going through a wall, without any metabolic change.
closed mouth approach and the Gow-Gates blocks.
At the I.A.N. block level, observe the higher density of Clinical steps:
the tissue (Figure 7). Deflection of the needle away from
COURTESY: BASSETT KB PIERCE COLLEGE. CO-LECTURE
SERIES. PERSONAL COLLECTION. SEP 2021
Pterygomandibular Triangle: Histology
HAWKINS JM. PERSONAL COLLECTION. UNPUBLISHED
Angulation
Gow-Gates
Block
Kathy Bassett, BSDH, RDH, MEd | Dental Hygienist / Professor / Author Mel Hawkins, DDS, BScD AN | Dentist / Dentist Anesthesiologist
Lacey, WA USA Toronto, ON Canada
COURTESY: BASSETT KB, PIERCE COLLEGE. CO-LECTURE
Kathy Bassett, BSDH, RDH, MEd | Dental Hygienist / Professor / Author Mel Hawkins, DDS, BScD AN | Dentist / Dentist Anesthesiologist
Lacey, WA USA Toronto, ON Canada
Fig. 6: Histology: Tissue composition and density changes.
SERIES. PERSONAL COLLECTION. SEP 2021
Angulation and approx. diffusion regions for conventional block
(red), Akinosi closed mouth (black), Gow-Gates (green). White
circle represents close proximity of insertion points for the
Angulation
Akinosi and Gow-Gates blocks Gow-Gates
Block
Horizontal X-S,
UNIVERSITY OF SYDNEY. AUSTRALIA. PERSONAL
COURTESY: DR. G. GOW-GATES, DR. J. WATSON,
1 Conventional
I.A.N. Block
2
Kathy Bassett, BSDH, RDH, MEd | Dental Hygienist / Professor / Author Mel Hawkins, DDS, BScD AN | Dentist / Dentist Anesthesiologist
Lacey, WA USA Toronto, ON Canada
Courtesy:
Fig. 9: a. The extraoral angulation lines up the corner of the mouth
Dr. G. Gow-Gates
with the tragal notch b. Intraorally. Note the index finger on the
4 Dr. J. Watson
tragal notch. (PHOTOS COURTESY OF K. B. BASSETT)
COLLECTION. C. 1974
University of
3 Sydney
Australia Observe the structures in close proximity to the
Gow-Gates approach by landmarking the external oblique
ridge (EOR in green), the internal oblique ridge (IOR in yellow)
Fig. 7: Horizontal XS 1. IA nerve 2. IA artery 3. IA vein 4. and the pterygomandibular raphé (in red) (Figure 10).
Micro-vasculature (black) HAWKINS JM. LECTURE SERIES SLIDES. PERSONAL
2
UNIVERSITY OF SYDNEY. AUSTRALIA. PERSONAL
COURTESY: DR. G. GOW-GATES, DR. J. WATSON,
Horizontal X-S,
COLLECTION. SEP 2021. UNPUBLISHED
level of Gow-Gates
Mandibular Block
2 1
Courtesy:
Dr. George Gow-Gates
Dr. J. Watson
3
COLLECTION. C. 1974
University of
Sydney
Australia
Fig. 10: Gow-Gates landmarks for needle insertion noting
Fig. 8: 1. Horizontal XS 1. Fibers of lateral pterygoid muscle the external oblique ridge green internal oblique ridge yellow
2. Two small vessels 3. Honey combed adipose tissue pterygomandibular raphé red
22 Membership Matters Oregon Dental AssociationAkinosi
Gow-Gates Summary
HAWKINS JM. LECTURE SERIES SLIDES. PERSONAL
HAWKINS JM. LECTURE SERIES SLIDES. PERSONAL
Conv. IAN
Onset 5 - 15 minutes
Gow-Gates
COLLECTION. SEP 2021. UNPUBLISHED
COLLECTION. SEP 2021 UNPUBLISHED
Characteristic posterior [ anterior onset “wave”
1 - 1.5 hours pulpal
Duration
Soft tissue-variable
0.5% bupivacaine
Post-op analgesia 1:200K epinephrine
[ 2 carpules®
Fig. 11: Relative needle insertions: conventional (white), Akinosi Fig. 12: Gow-Gates: Summary/Post-op analgesia idea
(yellow), Gow-Gates (black) blocks
Split the distance visually between the IOR and the for 26 years, the math estimates that I have administered
pterygomandibular raphé, insert and advance the needle 13,104 Gow-Gates mandibular blocks in private practice.
toward the tragal notch. Patients, including myself, anecdotally, find it reasonably
Using a 27 gauge long (35 mm. or 1 3/8”) needle, the comfortable to receive, report frequently that they have
final depth approximates 25 to 27 mm (1”-1 ¼”). One “never been so numb” and have not reported any post-op
cartridge of 3% mepivacaine plain (1.8 ml) followed paresthesia. Why not?
3 minutes later by 1 cartridge of 4% articaine, 1:200,000 Speculation is that V3 is too large to be damaged
epinephrine (1.7 ml) are administered. A vasoconstrictor seriously or completely enough to cause persistent
is not required for this injection; however, articaine is only paresthesia. Anatomy shows that the mandibular nerve is
available with epinephrine. not trapped against bone at this height and if contacted,
Aspirate and inject each cartridge three minutes apart the nerve simply deflects away from the advancing
at this location. The low density of the tissue in this region needle tip.
(Fig. 8) results in a wider diffusion area of the LA, and the What about the unsupported, unscientific and
extra volume seems to help the success rate published by unresearched question of articaine neurotoxicity? A
Gow-Gates at 98.3%. (The Gow-Gates Mandibular Block: recently peer reviewed, in vitro scientific research study
Further Understanding, Gow-Gates G Watson JE Anesth has shown that articaine is no more neurotoxic than
Prog 1977). lidocaine (Albalawi, F, Hersh, EV, Effects of Lidocaine and
This technique provides anesthesia for the IAN, lingual Articaine on Neuronal Survival and Recovery, Anesth Prog
nerve and long buccal nerve because this is a true 65:82-88 2018).
mandibular block. A painless infiltration 5 minutes later
with 4% articaine, 1:100,000 epinephrine on the buccal Conclusion
shelf will provide hemostasis if required. Local anesthesia is still the primary functional means to
successfully treat patients pain free. The addition of the
Summary Gow-Gates mandibular block to your technique arsenal
Based on use of this technique since 1977 at 3X per day, may complement your success rate, while adding a
4 days per week, 42 weeks per year in private practice building “block” to your confidence.
Want to Learn More?
Dr. Hawkins is presenting on Thursday, April 7 at
the 2022 Oregon Dental Conference!
Mark your calendar and plan to attend!
www.oregondental.org February 2022 23What to Set Your Sites on
ODC SPEAKER
When Staging and Grading
HIGHLIGHT By Tim Donley, DDS
A SMALL STEP IN THE RIGHT easier. All of the past classifications Chronic inflammatory periodontal
DIRECTION is always a good thing. of the disease, (including the latest disease (CIPD) is a systemic disease
A large leap is even better. The recent iteration, which includes staging and with site-specific presentations.
“staging and grading,” certainly grading), have focused on collecting There is now overwhelming
moves the needle a bit further toward data that is not readily interpreted evidence that CIPD, in addition to
being able to define and discuss by the public and the profession. resulting in periodontal bone loss,
periodontal disease with a patient in As the economic screws of health contributes to the systemic burden
a way that motivates them to accept care continue to tighten, patients of inflammation. It is the systemic
care. However, for dentistry to claim need more education and motivation burden of inflammation that drives
its rightful place on the health care before deciding to follow through the progression of many of the
stage, dentistry needs to make a with recommended treatment. Dental chronic diseases of aging. Thus,
larger leap. practitioners wanting to improve rather than the traditional goal of
There are still too many patients periodontal disease awareness simply cleaning teeth and/or helping
and even some practitioners who and case acceptance among their patients save teeth, the new goal of
struggle to define periodontal patients need to be able to better dentistry should be to help patients
disease. The profession of communicate when a problem is achieve a functional and esthetic
periodontology has not made it any present and in need of a solution. dentition that is inflammation-free
ISTOCK.COM/HAILSHADOW
24 Membership Matters Oregon Dental Associationand maintainable as such by the the urgency and severity of disease reproducibly collect the basic data
patient. Life-long professional with an individual patient. However, necessary to make appropriate
monitoring and therapy aimed at staging and grading does not render diagnostic and therapeutic decisions.
minimizing oral inflammation over a diagnosis, nor does it provide a Every site should be assessed in
the life of a patient is an important clinician insight into which specific consistent evidence-supported
component of overall wellness. For sites need treatment. fashion rather than being subject to
certain patients who already have risk It is already challenging to one’s personal opinion. The desired
factors for the systemic conditions collect the necessary diagnostic endpoint must be clear. Treatment
that can be adversely affected by information within the confines of decisions should be based on
oral inflammation, aggressive therapy the typical maintenance/recall visit. scientific evidence and maximize the
aimed at eliminating periodontal What clinicians need when they are chance that the desired endpoint
disease and then keeping it at bay chairside is a clear decision pathway is reached.
has taken on added significance. for determining which sites need Clinicians who have a clear
To accomplish the new goal of therapy and which treatment options understanding of which patients and
dentistry, providers must be able are reasonable at that site. which sites need treatment can better
to efficiently and effectively identify Currently, there are seemingly allocate treatment resources, get
which sites in which patients need as many diagnostic and treatment better outcomes for their patients,
treatment. The old approach of giving decision pathways as there are and have their practices operate more
everything a few good scrapes (in clinicians. Many practitioners struggle efficiently. While potentially useful,
case there may be calculus present) to even describe the decision pathway staging and grading is only a small
has been replaced with a more that they follow to determine which step forward in our effort to operate
focused effort aimed at eliminating patients and which sites to treat. Too more efficiently. Fortunately, there
any clinically detectible etiology and many dentists and hygienists continue is an alternative: evidence-based
interrupting any potential microscopic to ignore critical evaluation of the protocols that allow clinicians to
etiology at sites where inflammation scientific literature and treat patients consistently determine which patients
is noted to create a root surface that with personal experience as its equal. and which sites need treatment…
can support healthy adjacent soft Practitioners collect varied amounts and which treatments maximize the
tissue. Converting diseased sites of data and then often make wildly chance for the desired result. It is
to sites that are maintainable by the different treatment decisions. In this time to take a leap forward in our
patient is similarly important. era of evidence-based medicine, management of CIPD.
Staging and grading was designed not having an efficient, standardized
as a matrix that can be utilized to approach makes no sense. References
describe periodontitis in an individual An accepted definition of 1. Tonetti, MS, Greenwell, H, Kornman, KS.
patient.1 Collecting staging and what constitutes a healthy site Staging and grading of periodontitis:
Framework and proposal of a new
grading data certainly has potential exists.2 Accordingly, sites not classification and case definition. J
merit when performing large-scale meeting the definition of health Periodontol. 2018; 89(Suppl 1): S159-S172.
delivery-of-care analyses. Staging must be considered as sites that 2. Lang NP, Bartold PM. Periodontal health. J
and grading can also aid in discussing need attention. There is a way to Periodontol. 2018; 89(Suppl 1): S9-S16.
Want to Learn More?
Dr. Donley is presenting on Friday, April 8 at
the 2022 Oregon Dental Conference!
Mark your calendar and plan to attend!
www.oregondental.org February 2022 25Diabetes and the Dentist’s New Role
in Recognition and Screening: A1c
ODC SPEAKER
In-office Testing as a New ADA
HIGHLIGHT
Procedure Code (D0411)
Reprinted with permission from New York State Academy of General
By Daniel G. Pompa, DDS Dentistry Journal, Spring 2018
Introduction that are pre-diabetic, and most are are overweight, and half of those
Diabetes mellitus (DM) is a unaware of this diagnosis.3 are considered obese. In the near
chronic hormonal metabolic Insulin resistance is a term used future, almost half of all Americans
disorder characterized by chronic for the pre-diabetic state defined by will be pre-diabetic. “Sugar is now
hyperglycemia. This results from an Impaired Fasting Glucose (over considered to be the tobacco of the
deficiencies in insulin secretion and/or 100 mg/dl) plus Impaired Glucose New Millennium.”6
the inability of receptor cells to utilize Tolerance (over 140 mg/dl). Fifteen More people have died from
the insulin that is secreted by the percent of adults in the U.S. have diabetes since 1900 than in all the
pancreas.1 insulin resistance4 with the pre-diabetic wars and conflicts in the same time
Insulin is required for the state defined as A1c levels between period. Because diabetes takes 10
metabolism of carbohydrates, 5.7% and 6.4% on two separate or more years to discover and the
fats, and proteins. When there is a occasions. The early diagnosis of complications develop so slowly,
deficiency of insulin or its inability pre-diabetes is essential for the it is not addressed with the level of
to function, there are multiple target prevention of diabetes complications.5 commitment and interest it should
organs that are damaged, leading On average, diabetes will lower life be given.6
to their dysfunction and potential expectancy by 13 years. This is Dentists will now be able, with
failure. Diabetes affects more than especially true when both pre-diabetes a simple in-office screening
10% of the U.S. population and is and diabetes are not diagnosed early. test, to detect diabetes as well
rising at a dramatic rate. Of these Diabetes is more prevalent today as pre-diabetes. With a medical
30 million people, one-third are not than in the past. It is now considered referral, a full workup, an evaluation
diagnosed.2 Presently, there are a pandemic throughout the world. for treatment can be initiated.
almost 100 million people in the U.S. Two-thirds of all adults in the U.S. Dentists see more people today than
physicians. The many complications
associated during this pre-diabetic
stage may possibly be avoided,
leading to a greater quality of life
and longevity for these patients who
were unaware of their pre-diabetic or
diabetic status. This could result in
significant savings to our healthcare
system, where we are now spending
over 250 billion dollars in Medicare
costs for patients with diabetes.7
Delta Dental has done studies where
they reimbursed for the A1c testing
in dental offices in New Jersey and
may be considering covering this in
the future. Other dental insurance
ISTOCK.COM/JARUN011
companies have not as of yet
approved a reimbursement for this
ADA procedure code, but hopefully will
do so in the future. Before starting an
26 Membership Matters Oregon Dental AssociationA1c in-office point of care program, be days nearer to the test contribute Delayed healing
sure to consult with regulatory experts substantially more to the test than Hypo-salivation
and your local dental society. glucose levels days further from the Periodontal disease in diabetic
test date. Since pre-diabetes has no patients may be more severe and
D0411: HbA1c: In-office point of consistent signs and symptoms, the progress more rapidly due to the
service testing A1c test is the most reliable test that is associated impaired immunity and
As of January 1, 2018, dentists will easily available today. In addition, A1c healing challenges.8 This is due, in part,
be able to test A1c levels in their office, testing does not require a fasting state. to the hyperglycemia and ketoacidosis
by offering a simple in-office test. People without diabetes usually that changes the phagocytosic
CDT 2018 marked the addition have an A1c level of between 4.5% to activity of the macrophages
of “D0411 HbA1c in-office point 5.6%. For every 1% decrease in A1c and the chemotactic effect of
of service testing”—a chair-side levels, the incidence of complications polymorphonuclear neutrophils.9
screening procedure that, along from diabetes decreases up to 40%. As dentists, we have a unique
with appropriate referral, aids in Ideally, a diabetic patient with an A1c opportunity to detect these many early
the diagnosis of pre-diabetes and level of 8.5% who can get to 6.5% warning signs that may lead to an early
diabetes. This procedure, also known can reduce their complication rate by diagnosis and now, with the addition
as finger-stick random capillary up to 80%.7 of this new code for in-office testing
HbA1c glucose testing, is relevant to The American Diabetes Association for A1c, an even greater opportunity to
dentists as diabetes is a risk factor now suggests that all adults who help in the fight against diabetes.
related to periodontal disease. are overweight or obese be tested,
HblAc testing enables a dentist along with anyone who has one or Three important considerations
to amend the patients treatment more risk factors for diabetes, such when treating diabetic patients:
planning depending on whether the as high blood pressure or close family 1) Hypoglycemia Unawareness
results are the first indicator of a new members who have diabetes. At age Over time, repeated episodes
diabetic condition, or if the results 45, all adults should be screened for of hypoglycemia can lead to
indicate a change in the existing pre-diabetes or diabetes. hypoglycemia unawareness.
diabetic condition. Dentists can often be at the The body and brain no longer
D0411—ADA Guide to Point of Care forefront of detecting the early signs produce signs and symptoms that
Diabetes Testing and Reporting is of the disease just by observing warn of low blood sugar, such as
available at no cost for you to view how patients heal after a surgical sweating, shakiness, or irregular
or download. (ADA CDT—Current procedure. Poor or delayed heartbeats. When this happens,
Dental Terminology book) healing is a first sign of diabetes the risk of severe, life-threatening
• Guide to Reporting D041l (PDF) or pre-diabetes. This, along with hypoglycemia is increased. If
A1c levels can be falsely elevated early periodontal disease in a young this occurs in the dental office,
when there is low red blood cell patient, is another red flag that should it can be a crisis as the dentist
(RBC) turnover, as in untreated iron heighten your index of suspicion to has no warning of the impending
deficiency or anemia and can be rule out pre-diabetes and diabetes. hypoglycemic event before the
falsely depressed with increased patient becomes unconscious.
RBC turnover such as in hemolysis, Other possible dental A thorough history is required
recently treated iron, B12 or folate manifestations of DM include: to determine if your patient with
deficiencies, with hemodialysis, and Granulomatous polyps on the DM may present with this sign of
with RBC transfusions. gingiva hypoglycemia. Your “situational
The test is limited to a three-month Candidiasis awareness” should be heightened,
look back because the lifespan of Parotid gland enlargement especially if your patient is a
an RBC is approximately 4 months Taste impairment recently diagnosed diabetic
(117 days for men and 106 days Xerostomia Type II, is not compliant with
for women). Since RBCs do not Traumatic ulcers medications or lifestyle changes,
undergo lysis at the same time, the Geographic tongue and has experienced frequent
HBA1c is taken as a limited measure Burning mouth syndrome hypoglycemic episodes.
of three months. It is formed as a Fissured tongue 2) Diabetic Patients on Beta
non-enzymatic glycation pathway of Benign migratory glossitis Blockers Diabetic patients on
hemoglobin’s exposure to plasma Lichen planus beta blockers will not necessarily
glucose. The glucose levels on Angular cheilitis show sweating and shaking, as
www.oregondental.org February 2022 27You can also read
