Journal 01 2025 : simplebooklet.com

e Journal is owned and published by the Indiana Dental Association, a constituent of the American Dental Association.The editors and publisher are not responsible for the views, opinions, theories, and criticisms expressed in these pages, except when otherwise decided by resolution of the Indiana Dental Association. The Journal is published four times a year and is mailed quarterly. Periodicals postage pending at Indianapolis, Indiana, and additional mailing oces.ManuscriptsScientic and research articles, editorials, communications, and news should be addressed to the Editor: 550 W. North Street, Suite 300, Indianapolis, IN 46202 or send via email to kathy@indental.org.AdvertisingAll business matters, including requests for rates and classieds, should be addressed to Kathy Walden at kathy@indental.org or 800-562-5646. A media kit with all deadlines and ad specs is available at the IDA website at www.indental.org/adverts/add.Copyright 2025, the Indiana Dental Association. All rights reserved.Journal IDAPersonnelOcers of the Indiana Dental AssociationDr. Lisa Conard, PresidentDr. Rebecca De La Rosa, President-ElectDr. Lorraine Celis, Vice PresidentDr. Will Hine, Vice President-ElectDr. Jenny Neese, Speaker of the HouseScientic CommitteeDr. Vanchit John, EditorDr. Monica Gibson, Associate EditorDr. Kelton StewartDr. Angela RitchieDr. Hawra AlQallafDr. Neetha Santosh Dr. Joseph Platt, Vice Speaker of the HouseDr. Nia Bigby, TreasurerDr. Vanchit John, Journal IDA EditorDr. Thomas R. Blake, Immediate Past PresidentMr. Douglas M. Bush, Executive Director, SecretaryPractice and Governmental Aairs Advisory CommitteeDr. Lisa ConardDr. Rebecca De La RosaDr. Caroline DerrowDr. Steve EllinwoodDr. Tim Treat

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4 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1There have been a lot of changes that have been taking place at the national level with new administration in place. These changes may have an impact on our clinical practice along with how we teach certain topics like the use of uorides in dentistry. In this regard, we feature two articles on the topic. The article by Dr. Jennifer Fontaine from the Indiana Department of Health looks at reevaluating community water uoridation. Dr. Gerardo Maupomé, faculty at the Fairbanks School of Public Health, adds a commentary in response to Dr. Fontaine’s article, two well-written articles that I know you will enjoy reading. One of the topics of concern across dierent organizations is membership. The ADA and the IDA are acutely aware of the need to work on creating value for new members to join the organization as new members are important for any organization to continue in a positive direction. Explaining all the benets of membership is an important and necessary part of any organization. In this regard, Dr. Manny Chopra, District 7 Trustee, has written an informative article titled “What Has the ADA Done for You Lately?” We plan to make articles like these more routine to emphasize the value of being involved with organized dentistry. Dr. Maupomé reects on his experiences with dental public health by giving us a post-COVID assessment along with things to think about as we care for dental health of our population in the Hoosier state. Dr. Maupomé’s article focuses on a post-pandemic perspective on the state of dental health, while envisioning potential public health strategies to promote equitable dental care access and resilience in future healthcare crises.Abrielle Lamphere, a dental hygienist, who is a clinical assistant professor at Indiana University Fort Wayne, writes about Indiana’s Access Practice Agreement in her thorough article on the topic. The IDA Be Well Subcommittee interviewed Dr. Brett Kessler, ADA President and highlights his inspiring story of overcoming addiction and the challenges involved. This interview is a must-read, as it oers a ‘prole in courage’ experience and helps us to better understand the challenges Dr. Kessler faced along his way to becoming the ADA President. Along these lines, Dr. Catherine Murphy discusses the links between sleep and mental wellness. Good advice for all of us, especially when dealing with a challenging professional career such as dentistry. Finally, we feature Dr. Austin Hixenbaugh in our member spotlight. Dr. Vanchit John, Journal IDA editore Latest for Our Members2025 IS NOW well upon us. A new year and with it possibilities to change and grow. Along with the vein of growth, my goal is to develop themes for each issue of the journal. Each issue will revolve around a particular theme. This issue of the Journal can be described as focusing on current aairs. EDITOR’S MESSAGE

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6 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1What Has the IDA Done for You Lately?IT’S A LEGITIMATE question. Especially during dues season when dentists contemplate whether they continue their investment in organized dentistry. When Dr. Manny Chopra, the new trustee representing Indiana and Ohio at the American Dental Association, committed to write on page 34 about what the ADA has done for you, it seemed appropriate to include a companion piece on what the IDA has done for you. Your Voice at the StatehouseIDA members consistently point to legislative advocacy as the most important service IDA provides them. As Dr. Denny Zent, a retired endodontist and former member of the Indiana General Assembly, regularly reminds us, “Technology can change your profession over time, but legislation can change it overnight.” Dr. Zent is right. Nowhere is that more evident than what’s going on in Utah. The State legislature recently passed a measure that prohibits community water uoridation in the state, even when local water districts wish to continue it. At the time of this writing, the ADA and Utah dentists are encouraging the Governor to veto the bill.Not only must we guard against misguided public health policy, we must also monitor the legislature for less obvious concerns. Dentistry is a highly regulated profession. The ADA lobbying team looks after the interests of you and your patients in Washington, while the IDA monitors legislation at the Indiana Statehouse and the proceedings of regulatory agencies, such as the Indiana State Board of Dentistry. Each year, Government Aairs Director Shane Springer reviews hundreds of proposed bills to assess their potential impact on dentistry. Together with our Governmental Aairs Committee and Board of Trustees, the decision is made to support or oppose these measures. But we don’t just play defense. Often, we bring our proposals to the legislature. In recent years, IDA has made remarkable progress in reining in insurance company overreach that drives a wedge between dentists and their patients:• In 2021, IDA passed legislation prohibiting insurance companies from using Virtual Credit Cards as the sole method for paying dental claims. • In 2022, IDA passed Non-Covered Services legislation that prohibits insurance companies from setting fees for dental procedures that their plans exclude from coverage. • In 2023, IDA obtained $200,000 in annual funding for Donated Dental Services, a program that connects special needs Hoosiers with dental issues with dentists who donate their services. • In 2024, IDA passed two important bills. We prevailed in a multi-year battle to require Indiana insurance companies to honor Assignment of Benets requests from patients who ask that claims payments be made directly to the dental oce that provided their care. We also passed a Network Leasing measure that prohibits insurance companies from selling their networks to other carriers, without rst allowing dentists to opt out of the new network. Doug BushEXECUTIVE DIRECTOR’S MESSAGE

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7Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1As important as these legislative successes are to dentists and their patients, some out-of-state employers and insurance companies claim exemption from Indiana insurance laws. So we’re supporting ADA eorts to pass federal law that would require all plans, whether based in or outside of Indiana, to abide by these measures. Convenient, Quality, Aordable CEWhile many dentists consider legislative advocacy the most important benet of membership, others point to the continuing education available through the IDA. This spring’s IDA Midwest Dental Assembly, May 15-17 in beautiful French Lick, Indiana, oers 65+ courses with over 100 hours of instruction on clinical topics, including: Medical Emergencies, Sleep Apnea, TMJ, Dental Implants and Oral Pathology; on practice management topics, including: AI, Recall Strategies, and Peak Performance; wellness topics, including Gratitude, Goal Setting and Healthy Communication; and required CE programing , including HIPAA, Ethics and Jurisprudence and OSHA. Dentists and hygienists can meet their entire March 2, 2026, license renewal CE requirements at this single three-day meeting.IDA also continues to expand virtual learning opportunities with free monthly e-learning webinars, an expanding menu of On Demand CE programing, special sessions such as the Center for Excellence full-day programs, and regional OSHA and BLS workshops. Helpful Friendly Support When You Need ItPerhaps the least apparent benet IDA oers its members is helpful supportive counsel when you need it. Each week, IDA sta respond to hundreds of phone calls and email questions from dentists ranging from “Explain again how prescriptive supervision works,” to “What do I do when my patient’s service dog is growling at other patients?” We’re not dentists and we’re not attorneys, so we can’t oer clinical or legal advice. However, the IDA sta have over 140 years of association experience and we’re very good at helping members nd the resources to address their questions. Thank you for your membership in the IDA. Reach out to us and let us know how we can serve you today. About the AuthorMr. Doug Bush is serving his 28th year as IDA Executive Director. He can be reached at doug@indental.org.

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8 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Why Bobby Kennedy Is Right About Reevaluating Community Water FluoridationAS A DOCTOR of Dental Surgery and a graduate of Indiana University’s School of Dentistry in 2004, I have long been an advocate for practices that enhance the oral health of my patients and our communities. My professional experience includes owning three dental practices, two of which became part of a group dentistry corporation in 2020. Additionally, I raised ve children who have all beneted from uoride treatments. I’ve always supported the use of uoride as a critical tool in combating tooth decay. However, recent research compels us to pause and reassess our approach to uoridation in public water supplies, not as opponents of uoride but as advocates for a science-based, cautious, and balanced strategy.Having had in-depth discussions with members of secretary of Health and Human Services Bobby Kennedy Jr.’s sta on this topic, I fully support his stance on prioritizing the health and safety of our nation. As a dental professional, I believe it is crucial to advocate for public gures like him who are committed to policies that benet the greater good of our communities.Fluoride has been hailed as one of the greatest public health achievements of the 20th century, dramatically reducing cavities and improving oral health worldwide. Yet, as with any public health measure, it is vital to continuously evaluate its safety and ecacy in light of new evidence. In recent years, credible scientic studies have raised concerns about potential risks associated with uoride exposure, particularly for developing brains. For instance, a series of peer-reviewed studies published in reputable journals such as Environmental Health Perspectives and JAMA Pediatrics have linked higher uoride exposure during pregnancy to slight reductions in IQ among children. While these ndings are not denitive, they warrant closer examination and underscore the need for a cautious approach.Kennedy, a longtime environmental lawyer, has also raised concerns about uoride’s potential links to other health issues, including arthritis, bone fractures, cancer, and IQ loss, among other illnesses. While some of these claims remain controversial and are still the subject of ongoing research, they highlight the need for transparency and further investigation. As a dentist, however, I believe it is important to stay within my area of expertise: the eects of uoride on teeth and oral health. My recommendations are rooted in the science of dentistry, and I defer to experts in other medical elds to evaluate these broader health concerns.An important consideration is the variability in individual uoride exposure through water uoridation. Since water consumption varies widely among individuals based on factors like age, activity levels, and personal habits, some people may be exposed to much higher levels of uoride than others. Measuring uoride levels in urine is one of the more accurate ways to assess individual exposure, as it accounts for the actual uoride intake rather than assuming a uniform level of water consumption. Current water uoridation guidelines are based on estimated daily water intake and recommended uoride levels, which do not reect these individual dierences. This lack of precision further emphasizes the need for a more controlled approach to uoride exposure.Dr. Jennifer FontaineCOVER STORY

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9Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1In addition to these concerns, international comparisons reveal that several countries without water uoridation programs report similar, if not better, levels of dental health compared to uoridated regions. Data from countries like Sweden, the Netherlands, and Germany—which do not uoridate their water—show comparable rates of tooth decay to those in the United States, according to studies published in Community Dentistry and Oral Epidemiology and the British Medical Journal. These countries have achieved strong oral health outcomes through alternative strategies, such as improved access to dental care, public education on oral hygiene, and the use of uoride in controlled, topical forms like toothpaste. Such evidence suggests that water uoridation may not be the sole or even the most eective means of improving dental health on a population-wide scale.To be clear, I am not advocating for the wholesale removal of uoride from our lives. My own children received uoride treatments, and I continue to recommend its use for adults and children in controlled and appropriate doses. However, water uoridation presents a unique challenge. Unlike uoride toothpaste or dental treatments, which allow individuals to control their exposure, water uoridation is a one-size-ts-all approach. This method does not account for variations in individual consumption, body weight, or developmental stages, particularly for vulnerable populations such as pregnant women and young children. More patients are also expressing concerns about uoride exposure from sources like uoridated toothpaste and dental materials, highlighting the growing need for transparency and alternative options.The core of this discussion is not whether uoride is inherently good or bad but whether our current policies reect the best available science. Emerging evidence suggests that we may need to revisit the assumption that uoridation is entirely without risk. It is worth considering a temporary pause in expanding or initiating water uoridation programs until further long-term studies can clarify the relationship between uoride exposure and neurodevelopmental outcomes. This pause would not undermine decades of progress in oral health; instead, it would demonstrate our commitment to evolving public health policies that prioritize safety and informed decision-making.Moreover, the safety concerns associated with uoride are largely developmental, and the evidence suggests that adults face far less risk from exposure. This distinction is critical. We can continue to support uoride use in targeted dental applications—such as toothpaste, mouth rinses, and professional treatments—while reevaluating its role in systemic water uoridation. One promising alternative is hydroxyapatite, a naturally occurring mineral and the main component of tooth enamel. Hydroxyapatite has been shown to be highly eective in remineralizing teeth, preventing cavities, and even reducing tooth sensitivity. Unlike uoride, hydroxyapatite is biocompatible and poses no known systemic risks, making it an excellent option for in-oce treatments and at-home oral care products. Incorporating hydroxyapatite into dental practice provides patients with a safe and eective alternative to uoride, addressing their concerns while maintaining high standards of oral health care.Continued on page 10

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10 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1About the AuthorDr. Jennifer Fontaine is a mother of ve with over three decades in dentistry. She practiced dental hygiene for six years. As a dentist, she has served as a clinic director in an FQHC, and has experience as both a private practice owner, and in group practice. She advocates for science-driven, patient-centered approaches to oral health.Indiana’s Non-Fluoridated CommunitiesAccording to the Indiana State Department of Health, there are 97 Hoosier public water supplies that do not uoridate. Those that serve more than 900 customers include: • Aberdeen-Pate Water Corporation• Akron• Alexandria• Arcadia• BBP Water• Bicknell• Brookston• Carthage• Cataract Lake Water Corporation• Cayuga• Clinton• Crawford County Water Company• Dugger• Eaton• Elizabeth• Everton Water Corporation• Farmersburg• Fayette Township Water Corporation• Fowler• Gas City• Jennings Water Inc.• Jennings Northwest Regional Utility• Jonesboro• Kentland• Knightstown• Ligonier• Linton• Lyford• Montezuma• Odon• Painted Hills• Paxton• Remington• Rossville• Shelburn• St. Paul• Switz City• Suburban Utilities-El Paco• Tri-Township Water Corporation• Troy• Van Bibber Lake• Veedersburg• Waynetown• West Terre HauteIt is also worth noting that uoride is not the only means of achieving good oral health. Modern dentistry oers a variety of eective tools, from improved dental sealants to enhanced education on oral hygiene and diet. By investing in these alternatives, we can ensure that communities maintain high standards of oral health while minimizing potential risks.As a dentist, I’ve dedicated my career to improving the health and well-being of my patients, and I remain committed to advancing public health. Advocating for a pause in water uoridation is not a rejection of uoride’s benets but an acknowledgment of our responsibility to constantly reevaluate public health measures in light of new evidence. By doing so, we can build a future where every public health policy is both safe and scientically sound.Read Dr. Gerardo Maupomé’s counterpoint article on page 12.COVER STORY

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12 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1The Scientic and Public Health Case for Community Water Fluoridation: A Commentary to Reevaluate Concerns About Eectiveness and SafetyCOMMUNITY WATER FLUORIDATION CWF has long been recognized as one of the most eective public health measures to prevent dental caries. Dr. Fontaine’s opinion on page 8 advocating for a reevaluation of uoridation policies raises concerns regarding potential risks associated with uoride (F) exposure and suggests alternatives to the current system. While the intention to ensure public safety is commendable, the arguments presented require careful scrutiny. As dental professionals, it is our responsibility to uphold policies supported by robust scientic evidence and clarify misconceptions; the present commentary proposes to step back from the clinical environment and look at CWF as the population-level, health promotion / preventive measure it was designed to be.Dr. Fontaine highlights international comparisons, suggesting that countries (e.g., in Europe) without CWF achieve similar oral health outcomes. This argument, however, overlooks critical dierences in public health systems, socioeconomic factors, and access to dental care between European countries and the U.S. It is essential to clarify that countries like Germany and Switzerland, which Dr. Fontaine cites as non-uoridating, often utilize alternative public health uoridation methods, such as uoridated table salt. Fluoridated salt has also been in use in Latin America for decades. These strategies are similarly “one-size-ts-all” and serve the same public health goals. Public health uoridation remains a globally endorsed strategy, albeit implemented dierently depending on local contexts.1 Overall, studies have consistently shown that CWF reduces dental caries by 26–35 percent across populations.1,2 Unlike individualized uoride treatments in the dental oce, CWF ensures equitable access, particularly beneting underserved populations who do not have regular access to dental care or uoride products.2The eectiveness of F is not solely tied to the individual levels of water consumption, which can be extremely dicult to measure accurately (mean consumption, overall, bottled, tap, in the summer, etc.). As demonstrated in the Cochrane’s systematic review, CWF continues to provide a baseline level of caries prevention across diverse demographic groups and consumption patterns.3 While alternative strategies, such as extensive use of uoride toothpaste and increased awareness of oral health’s importance through education, have emerged over decades and play an important caries preventive role, they do not oer the same widespread, cost-eective impact as CWF.1,2 Under CWF, the individual does not have to pay out-of-pocket costs, does not have to remember to make an appointment, and very small F amounts are present in most water resources. Other sources of uoride today such as rinses and toothpaste help create a halo eect whereby total F exposure increases. The low levels at which F is available in North America through CWF are low risk, compared to other areas with endemic, severe dental or even skeletal uorosis (e.g., some parts of India and China).Dr. Gerardo MaupoméCOVER STORY

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13Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Dr. Fontaine references recent studies linking uoride exposure to neurodevelopmental outcomes, particularly IQ. While these studies have garnered attention, their ndings are neither conclusive nor directly applicable to uoride levels used in CWF.4 For instance, systematic reviews, including Kumar et al.’s meta-analysis, emphasized that the observed associations often stem from studies conducted in regions with endemic uorosis, where uoride levels far exceed those used in CWF.1,2 High-quality, population-based research, such as Do et al.’s longitudinal study, has demonstrated no signicant eect of uoride exposure from CWF levels on cognitive development.1,3 This aligns with conclusions from the National Academies of Sciences, Engineering, and Medicine, which found insucient evidence to label uoride as a neurodevelopmental hazard at the levels used in public health programs. Perhaps more importantly, the biological mechanism that links F from CWF to neurodevelopmental outcomes remains to be characterized.CWF is criticized for being a “one-size-ts-all” approach, but this criticism misunderstands the nature of public health interventions. Like chlorination of water and iodization of salt, uoridation aims to address population-wide needs through standardized measures. CWF is not medical practice and F is not medication. Adjusting uoride levels based on individual consumption is neither feasible nor necessary, as the established optimal uoride concentration was designed to balance ecacy and safety across diverse populations.1,2 Dr. Fontaine’s suggestion to monitor individual uoride exposure through urinary uoride levels, while technically accurate, would transform a simple preventive public health measure into an unnecessarily complex and costly medicalized intervention.While advocating for transparency in research is always valuable, the portrayal of CWF as lacking transparency undermines decades of public health oversight. Studies and reviews on uoride’s ecacy and safety are publicly accessible and regularly updated by reputable organizations, such as the Centers for Disease Control and Prevention and the World Health Organization.1,3 More research should be done. It is indeed necessary to conduct research evaluating CWF eectiveness in this day and age, now that water consumption is markedly dierent from the times CWF was originally designed. But such evaluations going forward should be predicated on gauging CWF eectiveness as a public health measure in 2025 and thereafter, not as a preamble for replacing it with dental oce treatment courses. Under the latter approach, existing barriers to access and aordability of dental care could then hinder F benecial coverage, compared to CWF. Continued on page 14

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14 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1About the AuthorDr. Gerardo Maupomé is Chancellor’s Professor in the Department of Epidemiology at the Richard M. Fairbanks School of Public Health, Indiana University Indianapolis. He has multiple adjunct/aliated positions within and outside IU, including associate director of the Community Health Partnerships with the Indiana Clinical and Translational Sciences Institute. He is an aliated professor with the Department of Periodontology in the School of Dentistry. A long-standing dental researcher, his work focuses on dental public health, population health, dental health services, global/immigrant health, minority health, social and behavioral sciences and health disparities. Dr. Fontaine’s well-intentioned call for reevaluating CWF policies risks diverting attention from the proven benets of this public health intervention. The evidence generally supports the safety and ecacy of CWF at recommended levels, aiming to ensure equitable protection against dental caries. Reevaluating policies should always be grounded in rigorous science, and collecting and updating epidemiological data should be the basis for ne-tuning the impact of CWF as a tool in promoting good dental health in the public.The dental community must continue to advocate for evidence-based practices, addressing concerns with clarity and fostering public trust in health interventions. Let us rearm our commitment to protecting community health through scientically sound measures, recognizing CWF’s critical role in reducing disparities and improving oral health outcomes.References1. Do LG, Sawyer A, Spencer AJ, et al. Early childhood exposures to uorides and cognitive neurodevelopment: A population-based longitudinal study. J Dent Res. 2024; doi: 10.1177/00220345241299352.2. Kumar JV, Moss ME, Liu H, Fisher-Owens S. Association between low uoride exposure and children’s intelligence: a meta-analysis relevant to community water uoridation. Public Health. 2023. 219 73e84. https://doi.org/10.1016/j.puhe.2023.03.011.3. Iheozor-Ejiofor Z, Walsh T, Lewis SR, Riley P, Boyers D, Clarkson JE, Worthington HV, Glenny A-M, O’Malley L. Water uoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews 2024, Issue 10. Art. No.: CD010856. DOI: 10.1002/14651858.CD010856.pub3.4. Guichon JR, Cooper C, Rugg-Gunn A, Dickinson JA. Flawed MIREC uoride and intelligence quotient publications: A failed attempt to undermine community water uoridation. Community Dent Oral Epidemiol. 2024;00:1-10. doi:10.1111/cdoe.1295Overall, studies have consistently shown that CWF reduces dental caries by 26–35 percent across populations.1,2 Unlike individualized uoride treatments in the dental oce, CWF ensures equitable access, particularly beneting underserved populations who do not have regular access to dental care or uoride products. COVER STORYRead Dr. Jennifer Fontaine’s counterpoint article on page 8.

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16 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Expanding Access to Oral Healthcare for Hoosiers: Understanding Indiana’s Access Practice AgreementORAL HEALTH DISPARITIES remain a signicant public health concern across the United States, disproportionately aecting populations with limited access to care, including racial and ethnic minorities, individuals with low incomes, rural communities, and those facing systemic barriers such as workforce shortages and socioeconomic inequities.1 Despite advancements in preventive care and treatment technologies, these disparities persist due to a combination of nancial, geographic, and structural challenges. As of 2024, approximately 57 million Americans reside in designated dental health professional shortage areas, with rural communities comprising nearly 67 percent of these regions.2 In Indiana, 44.6 percent of counties are classied as dental healthcare professional shortage areas, indicating an insucient number of providers to meet the oral health needs of residents.2 These federal designations are determined by factors such as population-to-provider ratios, the proportion of residents living below 200 percent of the federal poverty level, and the availability of dental services.2To help address provider shortages and improve access to preventive oral healthcare, Indiana introduced the Access Practice Agreement (APA) in 2018. This legislative framework permits licensed dental hygienists to deliver specic services in designated settings without direct or general supervision, aligning with national eorts to expand the role of dental hygienists in addressing oral healthcare needs.3 The adoption of direct access agreements has grown over time, beginning with Colorado in 1987, where dental hygienists were authorized to perform most hygiene services without requiring a dentist’s supervision.4 As of 2024, 42 states have implemented direct access models, with varying scopes of practice and regulatory requirements.4 The American Dental Hygienists’ Association denes direct access as the ability of a dental hygienist to assess a patient’s needs, provide care without a dentist’s prior authorization or presence, and maintain an ongoing provider-patient relationship.4 These agreements aim to increase access to preventive and therapeutic oral healthcare, particularly in communities where traditional dental services are limited.Understanding the Access Practice Agreement The APA is a legal framework in Indiana that enables a licensed dental hygienist to provide preventive dental services without requiring the physical presence or prior authorization of a dentist. These agreements are structured to enhance access to care in underserved settings, including schools, long-term care facilities, and community health centers, where traditional dental visits may be less feasible. Within the scope of an APA, dental hygienists are permitted to perform services such as oral prophylaxis, uoride treatments, sealant applications, and oral hygiene education [5]. However, procedures considered more invasive—such as the placement of periodontal dressings or the administration of local anesthesia—continue to require direct supervision by a dentist (Table 1).5Abrielle Lamphere, RDH, MSDHCOVER STORY

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17Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Supervision TypeDirect Supervision General Supervision(known as prescriptive supervision)Direct AccessSupervision Prohibited ServicesRequirementsDentist must be physically present.Dentist must authorize services in advance through a comprehensive or periodic exam within the past seven months but does not need to be physically present. The hygienist must have two years of experience and the prescrip-tive supervision must be noted in the patient’s health record.Dental hygienist must hold an active Indiana license, have at least two years of clinical expe-rience, and establish a signed Access Practice Agreement (APA) with a dentist. The dental hygienist does not need to be employed by the APA dentist, and the APA can be established independently of any clinical practice. These services cannot be per-formed by dental hygienists in Indiana under any supervision level, even if the dental hygien-ist is licensed in a state where these services are permitted.Services ProvidedServices such as local anesthesia, topical anesthesia, administration of nitrous oxide, making case impressions, placing and removing periodontal dressings, and removing sutures can be provided only under the dentist’s immediate oversight.Services such as oral prophylaxis and periodontal maintenance, scaling and root planing, uoride treatments includ-ing silver diamine uoride, sealants, and x-rays can be provided by a dental hygienist without the dentist being physi-cally present.Preventive and therapeutic services, in-cluding oral prophylaxis and periodontal maintenance, x-rays, uoride treatments including silver diamine uoride, sealants, and scaling and root planing,* can be provided by a dental hygienist if these services are specied in the APA. The dentist is not required to give prior autho-rization or be physically present during treatment. While a periodic or compre-hensive exam is not necessary for the dental hygienist to provide care, the APA dentist should be available for referrals as needed. Soft tissue curettage, placement of Su-tures, and prescriptive authority.Independent practice. *Dental hygienists in Indiana do not have the authority to make a formal dental hygiene diagnosis. Therefore, a dentist must diagnose active periodontitis before scaling and root planing can be performed. This diagnosis can be made through a review of radiographs, comprehensive periodontal charting, and other assessments, including those conducted via telehealth.Table 1: Supervision Type and Allowed Services for the Dental Hygienist in the State of Indiana

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18 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1To enter into an APA, both the dental hygienist and the collaborating dentist must meet specic eligibility criteria to ensure the delivery of safe and eective care. The dental hygienist must hold an active Indiana license and have a minimum of two years of clinical experience.4 The agreement must be documented in writing, outlining the scope of services, approved care settings, and treatment protocols.6 Additionally, a structured referral process must be in place to ensure patients requiring advanced care are directed to a dentist or other appropriate provider, and the hygienist must maintain malpractice liability insurance (IC25-13-1-10).6A common misconception is that an APA applies to general or private dental practices in the absence of a dentist. However, in these settings, care falls under general supervision rather than direct access.5 Under Indiana’s general supervision guidelines, dental hygienists may provide services without a dentist’s presence, provided the patient has a documented medical history on le and has received an oral examination by a dentist within the past seven months.7 While general supervision requires prior authorization from a dentist, it does not mandate their physical presence during treatment.By contrast, an APA does not impose specic intervals for patient examinations by a dentist. Instead, the legislation emphasizes the establishment and periodic review of the APA itself. The agreement must include collaboratively developed treatment protocols and must be reviewed, signed, and dated by both the dental hygienist and the collaborating dentist at least every two years.3 The frequency of patient examinations under an APA is determined by the protocols outlined in the agreement rather than by state statute. Additionally, while the collaborating dentist oversees the APA, patient examinations and further treatment can be provided by any licensed dentist. Though not legally required, periodic chart reviews and meetings between the dental hygienist and the collaborating dentist are encouraged to promote continuity and quality of care.6For billing and regulatory compliance, a dental hygienist practicing under an APA must obtain a National Provider Identier (NPI).5 Currently, 19 states have statutory or regulatory provisions allowing Medicaid reimbursement for services provided by dental hygienists.5 However, Indiana does not permit dental hygienists to receive direct Medicaid reimbursement, meaning claims for Medicaid-covered patients must be submitted using the APA dentist’s NPI.6,7 Despite this, the hygienist’s NPI must still be included on claims to ensure transparency and accurate service tracking. Payments for services are typically directed to the APA dentist or the employing organization. To support APA programs and improve access to preventive dental care, several grant opportunities are available through professional organizations.Comparing Indiana’s APA to Direct Access Models Nationwide Indiana’s APA shares similarities with direct access models in neighboring states but also has distinct dierences in terms of oversight and practice settings. COVER STORY

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19Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Michigan’s Public Act 161 program, established in 2005, allows dental hygienists to provide preventive care in public or nonprot settings, such as schools and nursing homes, without requiring a dentist’s physical presence or prior authorization.4 However, Michigan mandates that dental hygienists maintain direct communication with a collaborating dentist for emergency situations and patient record reviews, reinforcing a structured professional connection. Similarly, Ohio’s Oral Health Access Supervision Permit Program, implemented in 2010, permits dental hygienists to work in public health settings under a written agreement with a dentist.4 Under this arrangement, an initial clinical evaluation by a dentist is required, along with periodic follow-ups, which may be conducted in person or via telehealth. Illinois adopted a public health dental hygiene model in 2015, allowing dental hygienists to provide care to Medicaid-eligible or low-income patients in designated public health settings without a prior examination by a dentist.4 However, Illinois requires additional educational and clinical experience qualications for dental hygienists to practice under this model. These variations in direct access models highlight diering approaches to expanding access to care, with states balancing levels of dentist oversight and specic professional requirements.Oregon’s direct access legislation, introduced in 1997, takes a broader approach by allowing Expanded Practice Dental Hygienists (EPDHs) to provide care in an extensive range of settings. These include public and nonprot community health clinics, extended care facilities, facilities for individuals with mental illness or disabilities, correctional institutions, schools, preschools, hospitals, medical clinics, medical oces, job training centers, and facilities staed by nurse practitioners (NPs), physician assistants (PAs), or midwives.4,8 This model facilitates the integration of oral health services into nontraditional and interprofessional healthcare settings, broadening access to care for underserved populations. Although EPDHs operate with greater autonomy, they are still required to maintain a collaborative agreement with a dentist to ensure continuity of care.Independent practice models, established in states such as Colorado (1987), Maine (2008), Alaska (2022), and California (1998), dier signicantly from direct access agreements like Indiana’s APA.4 These models grant dental hygienists’ full professional autonomy to diagnose oral health conditions, develop treatment plans, provide preventive and therapeutic care within their licensed scope, and bill directly for services—without requiring collaboration or oversight by a dentist.9 Under this framework, dental hygiene diagnosis involves the identication of unmet oral health needs that fall within the conceptual model of dental hygiene practice.10 Studies indicate that expanding the autonomy of dental hygienists improves access to care and reduces costs.11 Research examining the eects of dierent supervision models suggests that transitioning from direct to general supervision leads to improved access and cost reductions, while full independence has the most signicant impact—associated with a 39 percent increase in the likelihood of receiving dental care and a 74 percent reduction in out-of-pocket expenses.11For a comprehensive list and descriptions of all 42 states with direct access agreements and/or independent practice, visit the American Dental Hygienists’ Association (ADHA) website at https://www.adha.org/advocacy/scope-of-practice/direct-access/Impact of Direct Access Models Innovative workforce utilization strategies play a critical role in expanding access to high-quality, aordable, and culturally responsive oral healthcare, particularly for vulnerable populations. Recognizing the need for improved access, the U.S. Departments of Health and Human Services, Treasury, and Labor published Reforming America’s Healthcare System Through Choice and Competition in 2018, which emphasized eliminating unnecessary regulatory barriers that limit healthcare delivery, including oral health services.12 The report specically recommended that states reassess restrictive collaborative practice and supervision agreements for allied health professionals, such as dental hygienists and physician assistants, particularly when these requirements lack evidence-based justication related to patient safety.12 Direct access models, which reduce restrictions on care delivery by allied health professionals, have been associated with increased access to dental care in nontraditional settings without compromising patient safety.13,14 Additionally, expanding the scope of practice for dental hygienists has been linked to improved oral health outcomes.15 A multilevel modeling study found that states with broader dental hygiene practice regulations experienced signicant improvements in oral health indicators, including lower rates of tooth extractions due to decay or disease.15 Aordability remains another important consideration, as preventive care services—often provided under direct Continued on page 20

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20 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1access models—are typically covered by Medicaid. While all states are required to provide preventive dental coverage for children enrolled in Medicaid, access remains limited due to low reimbursement rates and a shortage of providers willing to participate in the program. In 2024, the national average Medicaid fee-for-service reimbursement rate for adult dental services was 29.9 percent, with Indiana’s rate slightly higher at 49.6 percent.16 However, provider participation varies; in some areas, only a limited number of dentists accept Medicaid without restricting patient numbers, resulting in overburdened providers and extended wait times. In other areas, while more dentists participate in Medicaid, many limit the number of Medicaid patients they accept, restricting access despite broader program availability.17 Direct access providers, such as dental hygienists, can help alleviate these challenges by delivering preventive services directly within underserved communities, thereby complementing the existing provider network and reducing reliance on overextended Medicaid-participating dentists. Beyond access and aordability, direct access models allow dental hygienists to practice at the top of their license, enabling dentists to focus on complex restorative, surgical, or specialized care. This approach increases system eciency, expands overall capacity to meet growing dental care demands, and provides dental hygienists with greater professional opportunities.14,15 Research also supports the eectiveness and safety of direct access models:• Cost-Eectiveness: Regulatory changes that allowed dental hygienists to receive direct reimbursement result-ed in a 12 percent reduction in prices for basic dental services and a 3-4 percentage point increase in service utilization rates.18 • Patient Safety and Satisfaction: A 2017 study found that dental hygienists were able to accurately identify dental caries in children aged 4–7 years using photographs, with accuracy comparable to that of dentists in clinical settings.19 This highlights the critical role dental hygien-ists play in early disease detection and their ability to refer patients for further evaluation and treatment when necessary. Additionally, a systematic review of eight studies indicated high patient satisfaction with direct access providers, demonstrating that patients value the care received, regardless of the provider’s specic role.13 • Workforce Retention: Increased autonomy and pro-fessional recognition have been linked to higher job satisfaction, reduced burnout, and a lower likelihood of dental hygienists considering leaving the profession.20Conclusion Indiana’s APA expands preventive dental services in underserved communities, but its full potential depends on increased provider participation, improved Medicaid reimbursement, and the integration of teledentistry. Dental providers can support these eorts by establishing APAs, collaborating with community programs, and exploring innovative care models.Rooted in community health, dental hygienists have the potential to transform oral healthcare delivery through direct access models, fullling Dr. Alfred Fones’ vision of integrating preventive care with general practice. By leveraging Indiana’s APA and advocating for evidence-based policies, the dental community can help reduce barriers and improve oral health statewide.References1. National Institute of Dental and Craniofacial Research (NIDCR). “Oral Health in America: Advances and Challenges.” U.S. Department of Health and Human Services, 2021. Section 1, Eect of Oral Health on the Community, Overall Well-Being, and the Economy.2. Health Resources & Services Administration (HRSA). “Health Workforce Shortage Areas: Explore HPSAs.” U.S. Department of Health and Human Services, 2025. Accessed Jan. 28, 2025. https://data.hrsa.gov/topics/health-workforce/shortage-areas.3. Indiana Code § 25-13-3-6-14. “Access Practice Agreement Requirements.” Indiana Legislature, 2024. Retrieved from https://iga.in.gov/legislative/laws/2024/ic/titles/025/#25-13-3-6.4. American Dental Hygienists’ Association (ADHA). “Direct Access States.” 2024. Retrieved from https://www.adha.org.5. American Dental Hygienists’ Association (ADHA). “Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State.” 2024. Retrieved from https://www.adha.org.6. Indiana Dental Hygienists’ Association. “Access Practice Agreements.” Accessed Jan. 28, 2025. https://www.indiana-hygienists.org/access-practice-agreements.7. Indiana Dental Association. “Prescriptive Supervision Law in Indiana.” Accessed Jan. 28, 2025. https://indental.org/professional-resources/prescriptive-supervision-law-in-indiana/.8. Falcon, C. I., Coplen, A. E., Davis-Risen, S., Korte, D., Fontana, M., & Furgeson, D. “Impact of an Interprofessional Education Intervention and Collaborative Practice Agreements of Expanded Practice Dental Hygienists in Oregon.” Journal of Dental Hygiene, vol. 94, no. 3, 2020, pp. 6–15.9. National Governors Association Center for Best Practices. “The Role of Dental Hygienists in Providing Access to Oral Health Care.” National Governors Association, 2014. https://www.nga.org.10. Swigart, D. J., Gurenlian, J. R., & Rogo, E. J. “Dental Hygiene Diagnosis: A Qualitative Descriptive Study of Dental Hygienists.” Canadian Journal of Dental Hygiene, vol. 54, no. 3, 2020, pp. 113–123.11. Chen, J., Meyerhoefer, C. D., & Timmons, E. J. “The Eects of Dental Hygienist Autonomy on Dental Care Utilization.” Health Economics, vol. 33, no. 8, 2024, pp. 1726–1747. https://doi-org.proxy.ulib.uits.iu.edu/10.1002/hec.4832.COVER STORY

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21Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1About the AuthorAbrielle Lamphere, MSDH, RDH, is a Clinical Assistant Professor at Indiana University Fort Wayne, specializing in educational research, interprofessional collaboration and community health. She holds degrees from Ferris State University and the University of Michigan and previously taught at Lansing Community College while providing care at a Federally Qualied Health Center. She mentors dental hygiene students in research and teaches courses in community health, ethics and preventive dentistry.12. U.S. Department of Health and Human Services, U.S. Department of the Treasury, & U.S. Department of Labor. “Reforming America’s Healthcare System Through Choice and Competition.” U.S. Department of Labor, 2018. Accessed Jan. 27, 2025. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/aordable-care-act/for-employers-and-advisers/reforming-americas-healthcare-system-through-choice-and-competition.13. Innes, N. P., & Evans, D. J. “Evidence of Improved Access to Dental Care with Direct Access Arrangements.” Evidence-Based Dentistry, vol. 14, no. 2, 2013, pp. 36–37. https://doi-org.proxy.ulib.uits.iu.edu/10.1038/sj.ebd.6400926.14. Turner, S., Tripathee, S., & Macgillivray, S. “The Risks and Benets of Direct Access.” BDJ Team, vol. 1, 2015, p. 14025. https://doi.org/10.1038/bdjteam.2014.25.15. Langelier, M., Continelli, T., Moore, J., Baker, B., & Surdu, S. “Expanded Scopes of Practice for Dental Hygienists Associated with Improved Oral Health Outcomes for Adults.” Health Aairs, vol. 35, no. 12, 2016, pp. 2207–2215. https://doi-org.proxy.ulib.uits.iu.edu/10.1377/hltha.2016.0807.16. American Dental Association. “Medicaid Reimbursement for Dental Care Services.” 2024. Accessed Jan. 27, 2025. https://www.ada.org/resources/research/health-policy-institute/medicaid-reimbursement-for-dental-care-services.17. Logan, H. L., Guo, Y., Dodd, V. J., Seleski, C. E., & Catalanotto, F. “Demographic and Practice Characteristics of Medicaid-Participating Dentists.” Journal of Public Health Dentistry, vol. 74, no. 2, 2014, pp. 139–146. https://doi.org/10.1111/jphd.12037.18. Wing, C., & Marier, A. “Eects of Occupational Regulations on the Cost of Dental Services: Evidence from Dental Insurance Claims.” Journal of Health Economics, vol. 34, 2014, pp. 131–143. https://doi-org.proxy.ulib.uits.iu.edu/10.1016/j.jhealeco.2013.12.001.19. Daniel, S. J., & Kumar, S. “Comparison of Dental Hygienists and Dentists: Clinical and Teledentistry Identication of Dental Caries in Children.” International Journal of Dental Hygiene, vol. 15, no. 4, 2017, pp. e143–e148. https://doi.org/10.1111/idh.12232.20. Patel, B. M., Boyd, L. D., Vineyard, J., & LaSpina, L. “Job Satisfaction, Burnout, and Intention to Leave Among Dental Hygienists in Clinical Practice.” Journal of Dental Hygiene, vol. 95, no. 2, 2021, pp. 28–35.

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22 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1A Post-COVID-19 Pandemic Perspective: Dental Public Health and Dental Health Status of the PublicTHE COVID19 PANDEMIC fundamentally altered healthcare systems worldwide, including impact on the oral health of the public in the United States. This opinion piece examines the roles and challenges in response to the pandemic and explores shifts in the dental health care patterns of the American public. We discuss how healthcare access disparities, economic impacts, and changes in public health policies inuence dental care utilization, patient behavior, and outcomes. The aim is to provide a post-pandemic perspective on the state of dental health, and to envision potential public health strategies to promote equitable dental care access and resilience in future healthcare crises.IntroductionThe COVID-19 pandemic created unprecedented challenges for healthcare services, signicantly disrupting routine and emergency clinical care in the United States. While eorts were directed toward managing SARS-CoV-2 spread, dental care systems had to adapt to maintain essential services while ensuring safety. The pandemic underscored the existing inequalities in healthcare access and highlighted the benecial role of preparedness in safeguarding oral health during crises.4 This opinion piece reviews the impact of the pandemic on dental health care in the U.S. and explores the clinical care and public health strategies to address systemic issues within post-pandemic dental healthcare.Impact of COVID-19 on Dental Health ServicesThe COVID-19 pandemic caused signicant disruptions in dental care services, particularly during its early phases. Routine dental visits declined dramatically, with a 35 percent reduction in private dental insurance claims in early 2020 compared to 2019 levels.2 These interruptions disproportionately aected vulnerable populations, particularly those reliant on Medicaid or without insurance.3 Emergency and urgent dental procedures were prioritized during the peak of the pandemic, underscoring the limited access to preventive and restorative care.2Because the pandemic inuenced the nature of dental services utilized, emergency treatments took precedence as non-urgent procedures were deferred, reecting a shift toward prioritizing acute care needs. The relative proportion of dental insurance claims categorized as urgent or emergency remained largely unaltered, while preventive services, such as cleanings and routine exams, declined during the pandemic’s peak. By 2021, a signicant portion of dental care utilization remained in the emergency category, which started being more diverse as the pandemic subsided.2 As of 2022, the recovery had continued but was not attaining the pre-pandemic dental health care utilization levels. Analyses to describe trends in 2023 and 2024 are underway.Dr. Gerardo MaupoméCOVER STORY

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23Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1e Role of Dental Systems During the PandemicPublic health initiatives aimed to address gaps in healthcare access and promote COVID-19 vaccination awareness. Many dental professionals advocated for vaccination, playing a role in vaccine education and, in some cases, administering vaccines to reduce the burden on medical facilities. Studies suggest that trust in healthcare professionals, including dentists, was a critical factor in vaccine acceptance.4 This role underscored the importance of dental professionals as trusted public health communicators, and they may remain a useful resource in other epidemic outbreaks.The pandemic amplied existing disparities in healthcare access among minority groups and low-income populations. Research revealed that individuals from underserved communities are more likely to delay dental care due to nancial and logistical barriers; such well-established patterns were exacerbated by the pandemic. These disparities were especially pronounced among racial and ethnic minorities who already faced systemic inequities in healthcare.4,2 Dental public health professionals have continued to prioritize initiatives aimed at improving access to aordable dental care and mitigating barriers related to socioeconomic status.Economic Factors and eir Inuence on Dental HealthFinancial instability caused individuals to prioritize essential expenses, often deferring dental visits even when clinics reopened. COVID-19 contributed to an overall decrease in dental care utilization. The reduction in demand aected both insured and uninsured populations, with the latter likely experiencing a more pronounced decline in dental care due to the lack of nancial support or insurance coverage.2 Loss of employment due to the pandemic resulted in the loss of dental insurance coverage for many Americans: employment-based insurance, a primary source of dental coverage, was directly impacted by job cuts and furloughs. Even as employment levels began to recover in 2021, dental insurance claims indicated continued lower-than-expected dental service utilization, possibly due to lingering economic uncertainties.2 Economic hardships faced by dental practices led to workforce reductions and clinic closures. These nancial strains, coupled with increased costs for infection control, hindered the ability of practices to completely recover post-pandemic.2Changes in Patient Perceptions and Health BehaviorsThe shift towards emergency dental services highlights a trend where individuals used dental care mainly for clinical conditions that could not be delayed, once symptoms became severe enough.4 It is unclear whether such postponement of care led to an increased demand for emergency treatments.Trust in dental professionals became particularly relevant as public health programs engaged in vaccine education eorts. Vaccine hesitancy remained a challenge in large swaths of the population. Surveys indicated that some people who were skeptical of healthcare institutions or those with lower educational backgrounds were less likely to trust or accept vaccines, suggesting the need for targeted education eorts in future public health initiatives.4 Recommendations for Strengthening Dental Care and Dental Public Health Post-Pandemic To address the backlog in preventive dental care, public health programs must emphasize the importance of routine visits and screenings, especially among high-risk populations. Policies facilitating aordable and accessible preventive services could prevent the progression of untreated dental conditions, ultimately reducing the burden on healthcare systems. Dental public health programs should focus on reinforcing preventive measures, including uoride programs, dental sealants, and oral health education.1 Above and beyond preventive services, dental public health must advocate for expanded access to aordable care to address disparities exacerbated by the Continued on page 24

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24 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1About the AuthorDr. Gerardo Maupomé is Chancellor’s Professor in the Department of Epidemiology at the Richard M. Fairbanks School of Public Health, Indiana University Indianapolis. He has multiple adjunct/aliated positions within and outside IU, including associate director of the Community Health Partnerships with the Indiana Clinical and Translational Sciences Institute. He is an aliated professor with the Department of Periodontology in the School of Dentistry. A long-standing dental researcher, his work focuses on dental public health, population health, dental health services, global/immigrant health, minority health, social and behavioral sciences and health disparities. pandemic. This includes, for example, improving Medicaid dental coverage and enhancing community-based care initiatives.1,3 Public education campaigns promoting oral health as an integral component of overall health would be a critical component of the overall strategy to expand access to preventive and rehabilitative care. Integrating telehealth and mobile health services with community health clinics, particularly in underserved regions, could improve healthcare equity. This hybrid model may be particularly eective in rural areas where dental care resources are limited.2Collaboration between dental and medical professionals is essential for early detection and management of oral diseases linked to systemic conditions. Integrating oral health into primary care settings could facilitate comprehensive care.3 Dental health care systems can benet from greater interdisciplinary collaboration with medical health sectors to promote overall well-being. By integrating dental and medical care services, particularly in community health settings, patients can receive more holistic care, including preventive screenings and health education.To mitigate the impact of future health crises on dental care, policies should incorporate preparedness protocols that maintain essential dental services. This could involve establishing safety guidelines that enable continued operations of dental clinics during pandemics and creating nancial safeguards to support clinics facing economic strain during crises.Challenges Ahead: 2025–2027There are several challenges ahead of dental care and dental public health, with three being the most salient. A) Persistent socioeconomic disparities continue to inuence access to and utilization of dental services. Structural inequities, including dierences in Medicaid coverage across states, must be addressed to ensure equitable oral health outcomes.1,3 B) The shortage of dental professionals, particularly in underserved areas, remains a signicant barrier. Innovative models, such as utilizing mid-level dental providers and enhancing training programs, are needed to meet demand,5 both during and in the absence of exceptional public health situations such as pandemics. C) The increasing prevalence of chronic conditions, including diabetes and cardiovascular diseases, underscores the need for integrated care approaches. Dental public health must adapt to this growing intersection between systemic and oral health.3 ConclusionThe COVID-19 pandemic highlighted both the vulnerabilities and potential of the U.S. dental care and dental public health systems. The systemic disparities, shifts in patient behavior, and economic pressures underscore the need for robust interventions to improve dental care access and resilience against future public health challenges. Emphasizing preventive care, adopting telehealth and mobile health solutions, and supporting economically marginalized populations are essential steps in promoting a healthier dental outlook post-pandemic. Continued eorts from dental and public health professionals to address these challenges will be instrumental in fostering equitable and sustainable oral healthcare in the United States. References1. Currie, R. B., Pretty, I. A., Tickle, M., & Maupomé, G. (2012). Conundrums in health care reform: Current experiences across the North Atlantic. Journal of Public Health Dentistry, 72(2), 143-148.2. Maupomé, G., Scully, A. C., Yepes, J. F., Eckert, G. J., & Downey, T. (2023). Trends in dental insurance claims in the United States in the context of the COVID-19 pandemic. Journal of Public Health Dentistry.3. Maupomé, G., Peters, D., & White, A. (2004). Use of Clinical Services Compared with Patients’ Perceptions of and Satisfaction with Oral Health Status. Journal of Public Health Dentistry, 64(2), 88-95.4. Osuji, V. C., et al. (2022). COVID-19 vaccine: A 2021 analysis of perceptions on vaccine safety and promise in a U.S. sample. PLOS ONE, 17(5), e0268784.5. Maupomé, G., Holcomb, C., Schrader, S. (2016). Clinician-patient small talk: Comparing competent students and expert dentists in a standardized patient encounter. Journal of Dental Education, 80(11):1349-56.COVER STORY

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26 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1A Path to Wellness: Dr. Brett Kessler’s JourneyIN AN INSPIRING, candid, and heartfelt interview with members of the IDA’s Be Well Subcommittee, ADA President Dr. Brett Kessler shared his powerful story of addiction, recovery, and mental health advocacy. “Dentistry is one of the most demanding professions, yet many dentists suer in silence. Burnout, addiction, and mental health struggles are more common than we realize, yet seeking help remains stigmatized.” – Dr. Brett KesslerDr. Brett Kessler story—marked by resilience, transformation, and a deep commitment to service—is not just an inspiration but a call to action for dental professionals facing addiction, burnout, or mental health challenges. The following is the essence of the interview along with the lessons that Dr. Kessler learned on his journey.Overcoming Addiction: Dr. Kessler’s StoryDr. Kessler’s struggle with addiction began in dental school and worsened as he launched his career.“I entered dental school with a substance use disorder, and I left dental school with a much worse substance use disorder.” Despite achieving professional milestones—graduating from the University of Illinois at Chicago School of Dentistry, then completing a General Practice Residency at Northwestern Memorial Hospital before moving to Michigan in 1997, and starting a family with his wife, orthodontist Dr. Gina Kessler—his addiction escalated.His wake-up call came after a four-day binge that left his sta and family fearing for his life. His wife, who had witnessed his battle for years, reached a breaking point. His colleagues, once unaware of the severity of his addiction, now saw the cracks in his carefully maintained façade. “I had a moment of clarity. I realized I was on a path that would either end my career or my life.”Determined to change, Dr. Kessler sought help through Michigan’s dental well-being program, a decision that he says ultimately saved him. With the support of his boss, professional treatment, recovery meetings, and his family, Dr. Kessler surrendered the addiction. He describes learning that he wasn’t a bad person, but instead acknowledging that he had a brain problem. “I’m so grateful for Jim Oles, my Well-Being contact at the Michigan Dental Association, and many of his contemporaries who paved the path for people like me in recovery to walk on. It is imperative for me to ensure that the path is wider for those Andrea NewNEWS & FEATURES

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27Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1who are coming behind me. I’ve worked with hundreds of dentists with substance abuse disorders and other mental illness and have been able to share my experience, strength, and hope and guide them positively. But addiction is a disease. Sometimes, even with the best treatment and the best support, the disease still wins. I know at least ve dentists I worked with who died of addiction. They could not nd their way out.”With professional treatment, recovery meetings, and the unwavering support of his family, he confronted his addiction head-on. Dr. Kessler explained the true nature of his problem and emphasized the need to view addiction as a disease, not a moral failing. “I wasn’t a bad person; I had a brain problem.”Now, with 26 years of sobriety, Dr. Kessler is the President of the American Dental Association (ADA) and a beacon of hope, dedicating his life to helping others navigate their own recovery journeys.A Journey of Recovery and LeadershipAs ADA President, Dr. Kessler has made mental health and addiction recovery a central part of his advocacy. He is a passionate supporter of the ADA’s Wellness Ambassador Program, which trains individuals to provide peer support to dental professionals in need. Dr. Kessler frequently emphasizes the importance of open conversations: “Humility, not humiliation, is the key to recovery.”His leadership is shaping the future of mental health in dentistry, ensuring that no dental professional has to struggle alone. Moving Forward with Wellness in MindThe IDA Be Well Subcommittee is committed to turning these insights into meaningful action. Dr. Kessler’s journey serves as a blueprint for change, inspiring new initiatives that prioritize mental wellness in the dental profession.Using Dr. Kessler’s story to strengthen support for dental professionals, we advocate for:Promoting Open Conversations about Mental HealthWellness Talks: The Be Well Subcommittee will host discussions at local dental societies, using Dr. Kessler’s story as a case study to create safe spaces for sharing and seeking support.Creating Resources for Colleagues and FamiliesRecognizing the importance of family support, the Subcommittee is developing guides and workshops to help teams and loved ones recognize signs of addiction and oer compassionate intervention.Encouraging Early Intervention and Preventative CareThe Subcommittee will provide self-assessment tools, stress management strategies, and educational resources to help members maintain mental and physical wellness before reaching a crisis point.Building a Peer Support Network through the Wellness Ambassador ProgramEstablishing a local network of trained Wellness Ambassadors who can provide condential guidance and direct members to professional support.Expanding Access to Professional ResourcesPartnering with Talkspace, the ADA’s free mental health platform, the Subcommittee will ensure members can access aordable and condential therapy services when needed.Eliminating Barriers to Care Through Policy ReformThe Subcommittee will advocate for removing stigmatizing questions from state licensure applications, ensuring dentists can seek help without fear of professional repercussions.Conclusion: A Community Committed to WellnessDr. Kessler’s journey is more than a personal triumph, it is a testament to the power of community and compassion in addressing mental health and addiction within the dental profession.As the IDA Be Well Subcommittee moves forward, its mission is clear: to create a supportive, stigma-free environment where every dentist feels empowered to prioritize their well-being.Through open conversations, strong peer networks and accessible resources, we are building a future where no one must navigate these challenges alone.Together, we can redene success—not just as professional achievement but as a life of health, fulllment and resilience.Continued on page 28

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28 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1ResourcesADA Well Being Indexwww.ada.org/resources/practice/wellness/well-being-indexADA Wellness Resourceshttps://www.ada.org/resources/practice/wellnessIDA Well Being Programwww.indental.org/about/well-being-programProvides condential support for dentists with Substance Use DisordersCandace Backer, LCSW, LCAC, coordinatorWellBeing@indental.orgInterview with Dr. Kesslerhttps://youtu.be/DMAwl5MGCAcAn in-depth interview with Dr. Kessler about his journey through SUD and his agenda as ADA president. Use the link above or scan the QR code.IDA Be Well Subcommitteewww.indental.org/be-wellDr. Lisa Conard, Chair Andrea New, IDA sta liaisonLeslie FlowersDr. Shafer GarrettDr. Krestina JohnsonDr. Catherine MurphyEd RosenbaumDr. Valerie SeifertDr. Je Stolarz “Dentists are trained to care for others, but we often neglect our own well-being. We must change the narrative. Seeking help is a sign of strength, not weakness.” If you or a colleague are struggling, know that help is available. Join us in building a profession where seeking help is a sign of strength. Visit the resources below or reach out to the Be Well Subcommittee today, because together, we can redene what it means to thrive in dentistry. NEWS & FEATURESTop: Dr. Kessler with his daughters Riley and Sydney.Bottom: Dr. Kessler addressing the ADA House of Delegates. About the AuthorAndrea New is the IDA’s director of volunteer engagement and the sta liaison for the Be Well Subcommittee. She can be reached at andrea@indental.org.

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30 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1The Profound Link Between Sleep and Mental WellnessDr. Catherine MurphyThis striking statement from Dr. Matthew Walker, author of “Why We Sleep,” highlights the profound link between sleep and mental health.With nearly 30 percent of adults experiencing anxiety at some point in their lives, according to the American Psychiatric Asso-ciation (APA), sleep should be a central focus in mental health discussions. Yet, it is often the rst thing we neglect, treating it as a luxury rather than a necessity. Sleep is just as vital as exercise and nutrition for overall wellness and well-being.The Centers for Disease Control and Prevention (CDC) reported in 2020 that 35 percent of U.S. adults experience short sleep duration (less than seven hours per night). In total, approximately 50-70 million Americans struggle with sleep-related issues. Yet, despite its impact on physical and mental health, sleep often remains an overlooked pillar of wellness.1e Impact of Sleep on Mental HealthFor adults, poor sleep impacts far more than just energy levels. Chronic sleep deprivation is closely linked to anxiety, depres-sion, and a higher risk of neurodegenerative diseases. It disrupts mood regulation, cognitive function, and decision-making abilities. The phrase “I’ll sleep when I’m dead” has no place in a healthy mindset. Neglecting sleep not only accelerates aging but also reduces overall quality of life.Sleep is not just about rest—it’s about restoration. Dr. Walker explains, “Sleep deprivation fractures the brain mechanisms that regulate key aspects of our mental health. Sleep appears to restore our emotional brain circuits, preparing us for the next day’s challenges and social interactions.” Without adequate sleep, we deprive ourselves of one of the most vital ingredients for self-compassion and empathy toward others.Part of the challenge is that sleep medicine is a relatively young eld. The discovery of rapid eye movement (REM) sleep in 1953 set the foundation for modern sleep science, and sleep medicine was only recently recognized as a medical specialty. Research into sleep disorders, circadian rhythms, and their connection to mental and physical health is rapidly evolving.2Dentistry’s Role in Sleep HealthDentists play a crucial role in identifying sleep-related breathing disorders (SRBD). In 2017, the American Dental Association (ADA) ocially recognized the importance of dental professionals in screening for these conditions.3 Many oral signs, such as inamed gums, frequent cavities, dry mouth and malocclusion, are already well-known indicators of mouth breathing. By rec-ognizing the connection between mouth breathing and disrupted sleep, dentists can help bridge the gap between oral health and airway function, guiding patients toward proper diagnosis and treatment. “No major psychiatric condition occurs with normal sleep.” NEWS & FEATURES

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31Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1The ADA recommends that dentists screen patients for SRBD as part of a comprehensive medical and dental history. Symptoms such as daytime sleepiness, snoring, choking during sleep or a history of witnessed apneas can indicate underlying issues. If identied, these patients should be referred for further evaluation and treatment. In children, early screening can help address developmental concerns and optimize airway health (ADA Position State-ment, 2017).Recognizing and screening for SRBD in our patient is only part of the equation. We must also turn that same aware-ness inward. In our profession, one of the most signicant sources of frustration and burnout is communication hur-dles with our patients.4 Research shows that sleep depri-vation impairs our ability to interpret facial expressions and emotions, making meaningful interactions even more dicult.5 If we are committed to identifying these issues in our patients, we must also acknowledge their impact on our own well-being. Prioritizing sleep not only enhances our cognitive and emotional resilience but also allows us to show up as better, more empathetic providers. By taking steps to improve our own sleep, we can foster clearer com-munication, reduce stress, and cultivate a healthier, more fullling career.Recent research further emphasizes the crucial link be-tween sleep and mental well-being. As Scott et al. (2021) found, “We also found a dose response relationship, in that greater improvements in sleep quality led to great-er improvements in mental health.”6 Their meta-analysis supports the view that sleep is causally related to mental health diculties and that improving sleep can provide signicant benets, regardless of the severity of mental health conditions. Poor sleep is nearly universal within mental health services and represents a key treatment target. Consequently, equipping healthcare professionals with greater knowledge and resources to support sleep is an essential next step.Practical Steps for Better SleepSleep is often viewed as something that should come nat-urally, yet the high prevalence of sleep disturbances tells a dierent story. Achieving restorative sleep requires more than just good intentions—it demands a thoughtful, multi-faceted approach. While long-term improvements take time and collaborative care, incorporating these practical steps tonight may help set the foundation for better sleep quality, consistency, and overall well-being.• Dim the lights 1–2 hours before bedtime to signal your body that it’s time to wind down.• Avoid meals before bed, as digestion can interfere with sleep quality.• Limit screen time at least an hour before bed—not just to reduce blue light exposure, which can disrupt mela-tonin production, but also to avoid stimulating content that can trigger anxiety or keep the brain engaged in a dopamine-driven scrolling cycle, making it harder to unwind and fall asleep.• Take a warm shower or bath before bed—adding Ep-som salts can help relax muscles.• Limit caeine intake in the afternoon and evening to avoid disrupting the sleep cycle.• Avoid alcohol before bed, as it can fragment sleep and reduce overall sleep quality.Continued on page 32

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32 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Scan the codes below to access helpful resources:ADA Council on Dental Practice Wellness ResourcesADA Wellness Resources(including self-assessment)Take 3 for Me: drcatherinemurphy.comIDA Be Well Committee and ResourcesAbout the AuthorDr. Catherine Murphy takes a holistic approach to dentistry and her specialty, orthodontics. She is proud to be a Fellow of the American College of Dentists and an American Dental Association Wellness Ambassador. Dr. Murphy speaks nationwide on patient-centered orthodontics, myofunctional therapy, and wellness. A Call to Action: Prioritizing Sleep for Ourselves and Our PatientsThe quote by Ryan Hurd, “Sleep deprivation is an illegal torture method outlawed by the Geneva Convention and international courts, but most of us do it to ourselves,” serves as a powerful reminder of just how essential sleep is to our well-being. When we deprive ourselves of rest, we are eectively sabotaging our own health, which can have far-reaching consequences for both our physical and men-tal states. As Hurd points out, we would never knowingly subject ourselves to such harm, yet many of us overlook the critical role sleep plays in our lives. By prioritizing rest, we not only enhance our own health but also improve our ability to serve those around us—whether it’s our patients, friends, or families. Quality sleep is a key ingredient to functioning at our best, both personally and professionally.References1. Hyun S, Hahm HC, Wong GTF, Zhang E, Liu CH. Psychological correlates of poor sleep quality among U.S. young adults during the COVID-19 pandemic. Sleep Med. 2021 Feb;78:51-56. doi: 10.1016/j.sleep.2020.12.009. Epub 2020 Dec 10. PMID: 33385779; PMCID: PMC7887075.2. Shepard JW Jr, Buysse DJ, Chesson AL Jr, Dement WC, Goldberg R, Guilleminault C, Harris CD, Iber C, Mignot E, Mitler MM, Moore KE, Phillips BA, Quan SF, Rosenberg RS, Roth T, Schmidt HS, Silber MH, Walsh JK, White DP. History of the development of sleep medicine in the United States. J Clin Sleep Med. 2005 Jan 15;1(1):61-82. PMID: 17561617; PMCID: PMC2413168.)3. ADA Position on Sleep-Related Breathing Disorders.4. Mellor AC, Milgrom P. Dentists’ attitudes toward frustrating patient visits: relationship to satisfaction and malpractice complaints. Community Dent Oral Epidemiol. 1995 Feb;23(1):15-9. doi: 10.1111/j.1600-0528.1995.tb00191.x. PMID: 7774171.5. van der Helm E, Gujar N, Walker MP. Sleep deprivation impairs the accurate recognition of human emotions. Sleep. 2010 Mar;33(3):335-42. doi: 10.1093/sleep/33.3.335. PMID: 20337191; PMCID: PMC28314276. Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021 Dec;60:101556. doi: 10.1016/j.smrv.2021.101556. Epub 2021 Sep 23. PMID: 34607184; PMCID: PMC8651630.NEWS & FEATURES

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34 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1AS I BEGIN my role as your 7th District Trustee, at the American Dental Association (ADA), I want to address a question I often see on social media: “What has the ADA done for me lately?” It is a fair question—and one I look forward to answering regularly with this newsletter. The ADA is committed to advocating for dentists, their practices, and the oral health of the public. From inuencing legislation to providing valuable member resources, your ADA membership delivers tangible benets. Let us look at a few upcoming changes that were discussed at our November Board of Trustee meeting that demonstrate the value of your concerns: The ADA has updated its software platform using Salesforce/Fonteva to oer a more robust and future relevant platform to the tripartite; to assist with our future membership goals, member engagement and updating the products and services that are valuable to our members. Please give us time, as we work to fully engage every user in the software conversion process and address issues that arise along the way. The ADA app is actively being updated, with improvements guided by input and feedback from volunteers. This upgrade is essential, as we envision the app becoming a centralized hub for job opportunities, charitable giving, volunteer openings, social connections, and much more. There are new membership engagement pilot programs that we will introduce this year to study and address the steady drop in membership that we have observed for years. The most signicant of these is the Member Engagement Model Pilot Program, which is launching in ve states in 2025 and will hopefully provide quantiable data to the House of Delegates for consideration, this fall. We further aim to simplify membership categories and see opportunities to enhance membership oerings while strengthening partnerships with our aliated dental organizations to achieve common goals. As you may have heard, the ADA is developing a credit union service to provide nancial services to members, without competing with our state and component society oerings. The business development plan focuses on oering competitive rates for practice equipment loans, practice purchases, mortgages, and business vehicle nancing. I will share more details as these plans progress forward. The ADA is looking to change how we get more people to attend our annual scientic sessions. We are looking at ways to generate more excitement, member engagement and energy. These ideas are developing, I will share more with you as they are nalized. The ADA has sold its Chicago Avenue building and will move to a new Michigan Avenue location this spring, creating opportunities for better council and committee discussions at future meetings. If you are traveling to Chicago for ADA volunteer work, please check your email for information about the hotel room reservation block. ADA’s new multi-year strategic forecast, approved by the 2024 House of Delegates, will help us set clearer priorities. Progress on these priorities will be shared through the Quarterly Business Report (QBR), which, along with the Financial Operating Plan, will also provide insights into ADA’s nancial position. What Has the ADA Done for You Lately?Dr. Manny ChopraNEWS & FEATURES

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35Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1About the AuthorDr. Manny Chopra is the 7th District Trustee (Ohio and Indiana) at the American Dental Association.The ADA Forsyth Institute (AFI) brings together the ADA and the Forsyth Institute, working collaboratively to advance dental research, education, and innovation aimed at improving oral health outcomes. It focuses on innovative research, professional training, and collaboration to bridge the gap between science and clinical practice while addressing public health challenges in oral care. This fall, we will be introducing an AFI certication process for dental materials and services. The AFI will strengthen the ADA Seal program by updating product evaluation criteria trusted by both dental professionals and consumers. As we transition to new leadership in Washington, the potential for new challenges or opportunities may arise, and our DC-based team remains watchful. The board has decided that, as a science-based organization, we will focus our eorts on educating legislators on the value of evidence-based data to assist with our public oral health initiatives. We have identied numerous priorities for the new administration and will continue the dialogue on such topics as publicly funded dental care, community water uoridation, expiration of the tax cuts and Jobs Act, eects of taris on PPE, workforce initiatives, continued nancial support for NIDCR, and such. The ADA is guided by its members, and as your Trustee, my role is to ensure your voice is heard and represented. I invite you to share your comments, questions, and concerns with me. You can reach me at chopram@ada.org or on my cell at 513-252-4300.Your membership is about more than just what the ADA does for you—it is about what we can accomplish together. Thank you for placing your trust in me. I look forward to serving you and sharing the ways the ADA continues to work on your behalf.

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36 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Member Spotlight: Dr. Austin HixenbaughIDA MEMBERS COME from all corners of the state and from around the world, with a variety of backgrounds and practice philosophies. Some have winding paths to dentistry, but all share a passion for helping patients and improving oral health in Indiana. Get to know your dental colleagues in this and future issues of the Journal.MEMBER ZONETell us about your education background.I have an undergraduate degree in biology from Asbury College in Wilmore, Kentucky and went on to University of Kentucky School of Dentistry, where I graduated 2017. After graduating, I completed my GPR residency at the University of Kentucky in 2018.How long have you been an IDA member?I have been a member of the ADA since my rst year of practice. After my GPA residency, I started my career in Bowling Green, Kentucky. My wife and I moved to Evansville to be closer to her family in northern Kentucky.What is your current practice type and location?I am a dentist at Evansville Main Street Family Dental. In 2019 I joined the practice of Dr. Pat Tromley, who is the current First District trustee. Why did you choose to be a dentist?My dad is a recently retired surgeon, and I’ve always known that I wanted to go into healthcare in some form. I shadowed our local dentist and found that I liked the one on one with patients. The personal aspect of dentistry was really appealing to me.What do you enjoy most about being a dentist?I like knowing that I’m making a dierence. I saw a lot of examples of that while I was shadowing my hometown dentist. Den-tistry can change someone’s life. I saw that a lot when I was on a dental mission trip to Nicaragua. Something as simple as removing a single tooth can change someone’s life by getting them out of pain. Here in Evansville, I like the private practice feel of getting to know sta, having a strong patient relationship, being part of the community by getting involved.What is unique about your practice?Our practice is in downtown Evansville and was started by Dr. Bromm and was later purchased by Dr. Tromley. We still have quite a few patients who have been coming to this practice the entire time, to all three generations of us dentists. For them to be committed to an oce like this, it means a lot. I like that we’re a small oce and that patients trust us with their care

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37Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1What are some of the benets you’ve seen from ADA/IDA/local membership?Especially on the local level, my membership allows me to connect with a lot of First District members. My membership gives me a circle of colleagues I can rely on, someone to talk to and consult on cases. My experience with owning a practice and taking over a practice have been supported through my First District colleagues. From my beginning years in Evansville, Dr. Tromley stressed the importance of organized dentistry. He got me into being a continued member. I saw his passion with the IDA and it really encouraged me. He introduced me to many of his colleagues and I hope to do the same for younger dentists in the future.Any personal info you’d like to include?I’m originally from Lima, Ohio. I’ve been married to Chelsea for seven years. Chelsea was the executive director of the First District Dental Society until she resigned to stay home with our son, Owen, who is now two years old. I don’t have a lot of hobbies these days, but learning to be a parent is denitely one of my hobbies! I’m involved in church whenever I can, and I serve the community wherever I can.Dr. Hixenbaugh with his wife Chelsea and their son, Owen.

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38 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1EACH YEAR the IDA membership renewal includes an option to donate to several worthwhile programs, including the IDA Foundation for Dental Health and our Well Being program. The IDA Foundation oers grants to nonprot dental clinics in Indiana, organizes educational outreach programs to inform the public about issues related to oral health and supports uoridation eorts throughout Indiana. The Well Being program provides support to dentists with Substance Use Disorder. These important programs would not be possible without the generosity of our donors:IDA Thanks Members for IDA Foundation, Well Being DonationsIDA Foundation DonorsDr. Taite AndersonDr. Chase AndreasonDr. Theodoros AnezirisDr. Leonard AnglisDr. Mary Ellen ArgusDr. Chad AshleyDr. John AustinDr. Gary BaconDr. Chad BaileyDr. James BaileyDr. Kenton BaileyDr. Lisa BakerDr. Avis BarkerDr. Merneatha BazilioDr. Gregory BergerDr. Daniel BerquistDr. Thomas BlakeDr. Jerey BonaDr. Christine BorkowskiDr. Robert BouggyDr. Zachary BozicDr. Krieger BrassealeDr. Lorie BrinsonDr. Christopher BrodowiczDr. Bradley BroughtonDr. George BulfaDr. Jason BunchDr. Angela BurkeDr. Jonathan BurkeDr. Jill BurnsDr. Diane BuyerDr. Aaron CardinalDr. Timothy CarlsonDr. Mara Catey-WilliamsDr. Lorraine CelisDr. Christopher ChislerDr. John CoghlanDr. Sean CookDr. Stephen CookDr. Bryce CordellDr. Robert CornsDr. Jonathan CoudronDr. William CoulterDr. Viktoria CoxDr. Rachel DayDr. Jeanne De GraziaDr. Caroline DerrowDr. Dave DiehlDr. Ryan DiepenbrockDr. Steve DouglasDr. David DouglasDr. Bruce DragooDr. Christopher DunnDr. Molly DwengerDr. John EmhardtDr. Scott FindleyDr. Owen ForbesDr. James FreyDr. Mark FriedrichDr. D FrounfelterDr. Jason GlassleyDr. Georey GlogasDr. Lauren GoertzenDr. Allan GoinsDr. James GordonDr. Michael GradelessDr. Jerey GrasserDr. Elizabeth HagertyDr. Tasha HallDr. Sean HartDr. James HeckDr. Brian HenryDr. Dennis HeritierDr. Jerey HiesterDr. Willam HineDr. William HughesDr. Heather IrelandDr. Stanley JachimowiczDr. Ellen JohnsDr. Pamela JohnsonDr. Todd KaminskiDr. Kenneth KaneshiroDr. Patrick KellyDr. Kurt KingseedDr. John KirkpatrickDr. Trent KirkwoodDr. Brian KirkwoodDr. Jennifer KittleDr. Ross KnepperDr. Matthew KolkmanDr. Cynthia LedermeierDr. Steven LedfordDr. Dwight LeeDr. Christopher LefebvreMEMBER ZONE

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39Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Dr. DeLayne LefevreDr. Lisa LeniskiDr. Robert LongDr. Clarence LoppDr. Tod LovanDr. Mulokozi LugakingiraDr. Briana MaddoxDr. Mark MaguraDr. Wendy MapleDr. Bryan MarrDr. Melissa McHenryDr. Alison MeadDr. Emma MeyerDr. Mark MihaloDr. Lorre MishlerDr. Matthew MollDr. David MosserDr. Catherine MurphyDr. Richard NewtonDr. Matthew NondorfDr. Richard NowakowskiDr. Michael O’NeilDr. Gregory PhillipsDr. Julie PlagensDr. Joseph PlattDr. Jerey PlattDr. Louie PlumleeDr. Alexandra PolusDr. Philip PolusDr. Tyler PotterDr. James PottsDr. Nancy PruettDr. Scott PrusinskiDr. L PulverDr. Anthony PuntilloDr. Richard PyleDr. Savithri RajuDr. Lisbeth RandallDr. Lucas ReedDr. Douglas ReedDr. Suzanne ReedyDr. Torie RichardsonDr. Whitney RichmondDr. Philip RoachDr. Terrence RobertsDr. John RobertsDr. Stacey RochmanDr. Janet RuckerDr. Adrienne RuprightDr. Chester RycroftDr. James SchaeferDr. Steven SchimmeleDr. Jasmine SchlittDr. Kenneth SchneiderDr. Sonya ShivelyDr. Chanbo SimDr. Michael SmithDr. Harold SmithDr. Susan SnyderDr. Katherine SoDr. Jaime SteeleDr. Julie SteinmetzDr. Kristin StevensDr. Elizabeth StewartDr. Michael StronczekDr. George SurguyDr. Jack SwartoutDr. Samuel TancrediDr. William TellmanDr. Scott TerryDr. Jill TorkeoDr. Patrick TromleyDr. Mark Van BuskirkDr. Kurt VanWinkleDr. Randy VollmerDr. Gary WaltonDr. Kevin WardDr. Curt WarrenDr. James WeaverDr. Lauren WeddellDr. Craig WislerDr. Michelle WittlerDr. James WoodyardDr. David YatesDr. Benjamin YoderDr. Kristin YorkWell Being DonorsDr. Benjamin AdamsDr. Elizabeth AlbaDr. Taite AndersonDr. Theodoros AnezirisDr. Mary Ellen ArgusDr. John AustinDr. Gary BaconDr. Chad BaileyDr. James BaileyDr. Avis BarkerDr. William BarnesDr. Gregory BergerDr. Robert BergmanDr. Daniel BerquistDr. Thomas BlakeDr. Scott BoltzDr. Jerey BonaDr. Christine BorkowskiDr. Robert BouggyDr. Zachary BozicDr. John BozicDr. Krieger BrassealeDr. Christopher BrodowiczDr. Bradley BroughtonDr. Steven BuedelDr. George BulfaDr. Jason BunchDr. Angela BurkeDr. Jonathan BurkeDr. Jill BurnsDr. Jerey ButtrumDr. Diane BuyerDr. Aaron CardinalDr. Mara Catey-WilliamsDr. Lorraine CelisDr. Christopher ChislerDr. David ClarkDr. John CoghlanDr. Julie CombsDr. Stephen CookDr. Bryce CordellDr. Robert CornsDr. Jonathan CoudronDr. William CoulterDr. Rachel DayDr. Jeanne De GraziaDr. Rebecca De La RosaDr. Kevin DeardorfDr. Caroline DerrowDr. Dave DiehlDr. J DownieDr. Bruce DragooDr. Christopher DunnDr. Molly DwengerDr. Scott FindleyDr. James FisherDr. Owen ForbesDr. James FreyDr. Mark FriedrichDr. D FrounfelterDr. Charles GabetDr. Jason GlassleyDr. Georey GlogasDr. Lauren GoertzenContinued on page 40

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40 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1Access the Journal Anywhere, AnytimeIDA members can also read the Journal online: www.indental.org/digital-jidaDr. Joseph PlattDr. Louie PlumleeDr. Alexandra PolusDr. Philip PolusDr. Tyler PotterDr. Scott PrusinskiDr. L PulverDr. Anthony PuntilloDr. Richard PyleDr. Savithri RajuDr. Lisbeth RandallDr. Thomas RectorDr. Suzanne ReedyDr. Jill ReitmeyerDr. William RiskDr. Philip RoachDr. Terrence RobertsDr. John RobertsDr. Janet RuckerDr. Adrienne RuprightDr. James SchaeferDr. Jasmine SchlittDr. Daniel SchmidtDr. Kenneth SchneiderDr. Sonya ShivelyDr. Chanbo SimDr. Susan SnyderDr. Katherine SoDr. Jaime SteeleDr. Julie SteinmetzDr. Kristin StevensDr. Elizabeth StewartDr. George SurguyDr. Jack SwartoutDr. Scott TerryDr. Michael TomDr. Jill TorkeoDr. Patrick TromleyDr. Mark Van BuskirkDr. Randy VollmerDr. Kevin WardDr. Curt WarrenDr. James WeaverDr. Lauren WeddellDr. Christiaan WilligDr. Craig WislerDr. Michelle WittlerDr. James WolfeDr. James WoodyardDr. David YatesDr. Kristin YorkDr. Steven LedfordDr. Dwight LeeDr. Christopher LefebvreDr. DeLayne LefevreDr. Lisa LeniskiDr. Clarence LoppDr. Tod LovanDr. Stephen LucasDr. Mulokozi LugakingiraDr. Briana MaddoxDr. Wendy MapleDr. David MaydenDr. Melissa McHenryDr. Alison MeadDr. Gary MetzlerDr. Mark MihaloDr. Kenneth MillerDr. Matthew MillerDr. Lorre MishlerDr. Catherine MurphyDr. Terry NelsonDr. Matthew NondorfDr. Richard NowakowskiDr. Michael O’NeilDr. Kimberly ParsonsDr. Gregory PhillipsDr. Julie PlagensDr. Allan GoinsDr. Lawrence GoldblattDr. James GordonDr. Kurt GossweilerDr. Michael GradelessDr. Jerey GrasserDr. Alice GreenDr. Elizabeth HagertyDr. Jonathan HaleDr. Tasha HallDr. Valerie HaughtingtonDr. Brian HenryDr. Dennis HeritierDr. Willam HineDr. Steven HollarDr. Arlen HorsewoodDr. Bartholomew HottDr. Heather IrelandDr. Ellen JohnsDr. Todd KaminskiDr. Patrick KellyDr. Kurt KingseedDr. John KirkpatrickDr. Christopher KirkupDr. Trent KirkwoodDr. Ross KnepperDr. Cynthia LedermeierMEMBER ZONE

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42 Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1ClassiedsINTRAORAL X-RAY SENSOR REPAIR/SALESWe repair broken sensors. Save thousands in replacement costs. Specializing in Kodak/Carestream, major brands. We buy/sell sen-sors. American SensorTech 919-229-0483 www.repairsensor.comEQUIPMENT REPAIRFT ASSOCIATE-BLOOMINGTONAre you a motivated and patient-focused Associate Dentist looking for a high-tech, high-growth practice with strong earning potential? Join our thriving private dental practice in Bloomington. Compensation & Benets: 30% of Collections, access to cutting-edge technology and continuous CE opportunities, a team-oriented environment with ded-icated support sta, opportunities for growth and mentorship. Apply now by sending your resume to drnney@bloomdentist.com or text/call 812-583-3077.LOCUM DENTIST NEEDEDLooking for experienced locum dentist to cover from 04/14-07/31 for a busy hi-tech practice in South Bend. Practice has good support sta. Owner Dentist going on Army duty. 574-291-8022ASSOCIATE DENTIST/POTENTIAL PARTNER OPPORTUNITY Scheumann Dental Associates is seeking a passionate and skilled Associate Dentist to join our thriving practice in Auburn. We are com-mitted to providing exceptional, patient-centered care in a comfortable and modern environment. Qualications: DDS or DMD degree from an accredited dental school, valid dental license in Indiana, excellent clinical skills and a commitment to providing high-quality care. Please submit your resume, cover letter and contact information to pickarddds@scheumanndental.comASSOCIATE DENTISTDawson Family Dentistry in Danville seeking an associate dentist starting June 2025. 4 per week, Monday/Tuesday/Thursday/Friday. Will always be working with an owner doctor and EFDA assistants when available. Daily Guarantee: $700 per day or 30% of collections. 401K match after 6 months, employer HSA contribution, $250 yearly uniform allowance, malpractice and License renewal covered by employer, CE allowance within reason. Email Droce73@gmail.comASSOCIATE DENTIST-INDIANAPOLISWe are a multi-doctor group practice. Excellent opportunity for a wide range of procedures. Fully updated digital oces with CBCT on site. Opportunity for ortho cases and implant placement. Friendly and well trained sta. Excellent compensation including CE allowance, 401K, healthcare and more. Email indydentalteam@gmail.comEMPLOYMENT OPPORTUNITIESPRACTICES FOR SALERURAL PRACTICE FOR SALE Doctor retiring, practice for sale located in Williamsport, a friendly com-munity 40 minutes southwest of Lafayette. Bread-and-butter dentistry, opportunity for growth with specialty procedures, low overhead, 3 chairs, strong demand for dental services. Doctor will assist purchaser to make a smooth transition. Community ocials anxious to welcome the next dentist. jinmandds@comcast.netPRIVATE PRACTICE OWNERPart-time or full-time Associate Dentist opportunity located in Terre Haute. Contact Dr. Tyler Richey at tjrichey.tr@gmail.com.GP PRACTICE & REAL ESTATE FOR SALE-NW INDIANAExtremely motivated seller! Priced to sell at below market value! Any & all reasonable oers considered. Great cash ow. Located in a free-standing well maintained beautiful building with ample parking in a downtown setting. 2,300 sq ft with room to expand. 5 operatories. Team has been together for many years and live in the community. May lease or purchase real estate. S.Hicks@WyndsorDental.comBEAUTIFUL PRACTICE FOR SALEComplete turnkey dental practice for sale in sought after Southern Indi-ana near Louisville, Ky. Sales will include complete oce ready to see patients. All Adec equipment. Electric handpieces throughout. 7 rooms in total. If you are looking to start your own practice then this is the ab-solutely least expensive way to get in the market with great equipment and a beautiful practice. $375,000. Drchrisjdmd@gmail.comSOUTH BEND/MISHAWAKA MULTI-LOCATION PRACTICEThis multi-location practice generates $1M in annual revenue with $460K in net income, oering strong nancial performance and growth potential. Across two locations, it features 12 fully equipped operatories and 2,000 active patients in the past year. Real estate is available for purchase. With an established market presence, this is a rare oppor-tunity to step into a well-positioned practice with immediate upside. Contact Dr. Robert Uhland for more info at 847-814-4149 or email at chicagodentalbroker@gmail.com.MEMBER ZONE

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43Journal of the Indiana Dental Association | Volume 104 | 2025 Issue 1IN MEMORIAMDR. GREGORY C. BELL of Logansport passed away January 25, 2025. Dr. Bell graduated from Indiana University School of Dentistry in 1961.DR. ROBLEY E. EVANS of Bluton passed away February 18, 2025. Dr. Evans graduated from Indiana University School of Dentistry in 1975.DR. JAMES D. FREY of Fort Wayne and a member of the Isaac Knapp District Dental Society passed away March 11, 2025. Dr. Frey graduated from Indiana University School of Dentistry in 1962 and was the 1994-95 president of the IDA.DR. CHERYL LYNN HAMILTON of Floyds Knobs passed away February 21, 2025. Dr. Hamilton graduated from the University of Louisville School of Dentist-ry in 2004.DR. PHILIP N. HELLER of Indianapolis and a member of the Indianapolis District Dental Society passed away March 13, 2025. Dr. Heller graduated from Indiana University School of Dentistry in 1979.DR. CHARLES A. HOLLAR of Warsaw and a member of the North Central Dental Society passed away March 2, 2025. Dr. Hollar graduated from Indiana University School of Dentistry in 1964.DR. JON D. INGLEMAN of Fort Wayne and a member of the Isaac Knapp District Dental Society passed away January 16, 2025. Dr. Ingleman graduated from Indiana University School of Dentistry in 1966.DR. WILLIAM M. RECORD of Plymouth and a member of the North Central Dental Society passed away February 14, 2025. Dr. Record graduated from Indiana University School of Dentistry in 1976.

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