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The 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 2024, the Indiana Dental Association. All rights reserved.Journal IDAPersonnelOfficers 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 HouseScientific CommitteeDr. Vanchit John, Editor, JIDADr. 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 Affairs Advisory CommitteeDr. Lisa ConardDr. Rebecca De La RosaDr. Caroline DerrowDr. Steve EllinwoodDr. Elizabeth SimpsonDr. Tim Treat

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4 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3However, I would rst like to take a minute to thank Dr. Sarah Herd and Dr. Karen Ellis for their role as co-editors of the Journal. Sarah and Karen stepped into the role of being co-editors in 2020. This, as you know, was when the pandemic changed our lives. Keeping the Journal active with interesting articles along with the myriad of things that needed to happen as each issue was planned is a time-consuming task in normal times. This was made more challenging due to the pandemic. Sarah and Karen deserve a tip of the hat and our appreciation for a job well done. Thank you, Sarah, and Karen. We appreciate you for a job well done as you step down as co-editors of the JIDA.The JIDA is published four times a year. The person that does much of the work behind the scenes is Kathy Walden. Kathy has been the Director of Communications with the IDA for ve and a half years now. In working on the Journal, Kathy makes sure all the articles submitted and approved are formatted to t the layout of the Journal. Additional work is done in choosing appropriate photographs to embed in the articles while also ensuring that placements of the advertisements and the layout of the Journal are meticulously carried out. As the Journal is published four times a year, advance planning for each issue is a priority. Please extend a second tip of the hat to Kathy Walden for all she does for the Journal.Finally, Doug Bush, our Executive Director, is involved with the Journal usually in consultation with the Editor and the Director of Communications in making sure that each issue is reviewed one last time before it gets sent o to the printer. Please extend a third tip of the hat to Doug for all he does for the Journal and more.That in a nutshell is how the meal gets cooked with regards to the JIDA. A lot of work done by a small group of people to make sure the Journal serves and continues to serve as a benet to the membership of the IDA. Before I get into my plans for the Journal, I would like to take a moment to introduce myself to the membership. I joined the residency program in Periodontology at IUSD in 1992 after completing my dental and specialty training in Chennai, India. After completing my residency training, I spent a year working as a research fellow at Eli Lilly labs. Then I went on to complete my DDS in 1998. Upon graduating from IUSD, I was appointed to the role of Pre-Doctoral Director of Periodontics at IUSD. In 2007, I was selected to be the Department Chairperson in the Department of Periodontology. I have been Chairperson for the past 17 years and have been at IUSD for 32 years now.Dr. Vanchit John, Journal IDA editorEDITOR'S MESSAGE Taking Over as the EditorI AM VERY pleased to have been appointed as the Editor of the Journal of the Indiana Dental Association. I have a lot of plans for the journal which I would like to share with all of you. ABOUT THE AUTHORDr. Vanchit John is editor of the Journal IDA. Dr. John is an IUSD professor and chair of the Periodontology Department. He can be reached at vjohn@iu.edu.Plans for the JournalThe rst issue of the Journal of the Indiana Dental Association was published in 1899. Issues of the Journal were sporadic at that time. Regularly published Journals began in the 1940s. It has served as an excellent resource for the membership of the IDA since that time. Going forward, rst I would like to introduce Dr. Monica Gibson. Dr. Gibson is the Graduate Program Director of Periodontology at IUSD. She will serve as the Associate Editor

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5VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental Associationfor the Journal. Dr. Gibson completed her PhD at The Texas A&M University School of Dentistry and then her residency in Periodontology at The Ohio State University. She served as the Co-Director of the Graduate Program of Periodontology at the University of Alberta, Canada for seven years before joining us in August 2023. Dr. Gibson brings a lot of expertise to the scientic arena and will be an excellent asset for the Journal.Things I have been working on: a. Finalizing a ‘scientic editorial board’ that will help with reviewing articles submitted to the Journal for publication. b. Finalizing a ‘practice focused and governmental aairs board’ that will seek out relevant articles and updates to make sure our membership is updated on all the latest practice focused information.c. Rewrite the guidelines for articles that are submitted to the Journal.d. Keep up with all the deadlines needed to ensure timely publication of the four issues of the Journal.e. Add more features of our members through ‘Member spotlights’ and more. f. Develop periodic supplemental issues using a digital format. g. Continue to develop the Journal and its quality of articles so it can nd its way to being listed on PubMed. This is aspirational and will take focus and careful planning.As an update, Kathy Walden has joined American Association of Dental Editors and Journalists. This will increase our footprint and will provide us with ideas for future issues of the Journal among other things.A Question For Our Membership: Print vs Digital• One important point for discussion relates to the con-tinued presence of the Journal in a paper format versus a digital format. • Printing and postage vary by page count and quantity. Each issue of the Journal runs from 48-56 pages with about 2,500 Journals printed for each issue.• In general, the Journal costs $8,500-$10,000 to print and mail.• Advertising revenue varies by issue but is generally in the $12,000-$14,000 range.The question I am posing to our membership is: Should we continue to have a paper format of the Journal, or do you prefer a digital format? While there are nancial implications, it also has to do with the practicality of having our Journal published in a paper format. In general, today, there is a preference for digital formats for scientic Journals. What do you prefer? Please, take a second to tell us what you think. Your participation and response to this question will have important implications on how we choose to continue to format our Journal. So let us hear from you. You can contact Kathy Walden at Kathy@INDental.org. You can contact me at vjohn@iu.edu.Finally, I serve on the ADA’s Strategic Forecasting Committee. We have been discussing the issue of membership and engagement of our members. Most associations across the country are working on ways to address reduced and reducing membership. Creating value for members is a hot topic. The Indiana Dental Association and its component societies have done and continue to do a really nice job in this regard. I have been proud to share all the things we do with my committee, namely, the things the IDA has done over the course of the past 20 years and more in engaging young members through participating with various activities at the dental school as well creating avenues for participation for members who are the life blood of our organization. However, the younger generations today, Millennials, Gen Z and Gen Alphas see the world and the dental associations through dierent eyes. For the members in general but more specically if you belong to this age and thought groups (Millennials, Gen Z and Gen Alphas), what makes you want to join and stay engaged with our association? Tell us more. We want to hear from you. As I begin my journey as the Editor of this esteemed Journal, I am looking to create more value for our membership through timely updates, relevant scientic content as well as exciting new and relevant information. Thank you for the privilege of being elected as the Editor of the Journal of the Indiana Dental Association. May you be well.

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6 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3Though now a longtime Indiana resident, Dr. Conard was raised in Louisville, Kentucky. Her initial career goal was to become a M.D. psychiatrist, so she attended Spalding University (then Spalding College) in Louisville because of its high rate of acceptance to medical schools. Dr. Conard mentioned that she had never given much thought to dentistry other than enjoying Hermey the Elf from Rudolph the Red Nosed Reindeer, but while studying for the MCAT, she wanted to prepare by taking the DAT to become familiar with the type of testing. The day of the exam, while waiting in line to take the exam, a fellow test taker encouraged her to apply for the upcoming class. She applied, was granted an interview, and was accepted to the University of Louisville School of Dentistry class of 1987.Her career detour wasn’t the only unexpected aspect of her admission into dental school. While in high school, she took night classes at Spalding University. As an undergraduate at Spalding, Dr. Conard overloaded on credits during the semester, took summer, evening and weekend classes and completed all her dental school prerequisites in two years. Following her admittance score on the DAT, she was accepted into dental school at age 19, started her D1 year at age 20, and graduated with her DMD degree at age 23, all without completing her undergraduate degree. Dr. Conard’s younger sister, a recently retired Louisville orthodontist, did the same.An older sister also played a pivotal role in Dr. Conard’s personal life by introducing her to Barth Conard, M.D., an orthopedics resident in Louisville at the time. The couple married and after living in Florida for a short time, eventually settled in Indiana, where Barth opened his solo practice as an orthopedic surgeon and Lisa opened her solo dental practice in Lebanon. Watching her husband’s surgical career has made her grateful for her own choice of dentistry. “Being married to a physician and seeing the demands of medical world on the family, I don’t think I would have enjoyed the lifestyle of medicine.”Dr. Conard purchased a building in Lebanon, designed and remodeled the building and opened her current practice January 17, 1990. After the birth of her second child, she had the need for more ability to have her children with her in case of illness or childcare closures, so she built childcare accommodations on the back of her oce that allowed her children to be at the oce with her so that she could continue to do dentistry. “Being married to a surgeon, I was not able to lateral responsibility for transportation or care of the children. He was always working. I had to gure out how to make it work. Dentistry allowed me to be able to have my profession and raise my children. It has been good, a great profession.” Kathy Walden, IDA Director of CommunicationsPRESIDENT'S MESSAGE Meet Dr. Lisa Conard, 2024-25 IDA PresidentON SATURDAY, May 18, at the 2024 second House of Delegates, Dr. Lisa Conard was inaugurated as the 2024-25 IDA president. A dentist with a solo practice in Lebanon and an adjunct professor at IUSD, Dr. Conard brings to the IDA a valuable blend of organizational skills, business acumen and a eye on the long-term membership needs of the association.Dr. Lisa Conard, 2024-25 IDA President

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7VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationThe Conards went on to have three daughters and a son. Ashley received her PhD from Brown University, is living in Massachusetts and is a senior researcher with Microsoft Health Futures. Chelsea recently acquired her master’s from the Technical Policy Program at MIT, also lives in Massachusetts and works in cyber policy. Son Lars lives in Indiana and is a graphic designer working for IGT, a gaming company that creates entertainment ranging from gaming machines and lotteries to sports betting. Their daughter Aubrey, who was engaged to be married and had just been accepted to Harvard Law School, was fatally injured in a 2018 auto accident.The loss of her daughter Aubrey inspired Dr. Conard to become involved with mental health initiatives at IUSD, where she had begun as an adjunct instructor the year before. “I had never personally experienced depression or anxiety, but after that happened, you start to question everything in life,” she said. “It was Easter Sunday, and we were all together, and then the next day she was gone. I didn’t know if I was going to make it. My tribute to Aubrey’s life of always giving, is to help others in this time of surreal existence.” In addition to her eorts at IUSD, Dr. Conard helped expand wellness initiatives for IDA membership, including the Be Well Subcommittee, which was formed earlier this year.Dr. Conard had always been a member, but not actively involved in organized dentistry until fellow IDA member Dr. Sue Germain encouraged her to become a member of the IDA’s AIR leadership training program that Dr. Germain developed. The AIR experience helped open her eyes to the struggle that some women dentists were experiencing in getting connected and feeling successful in dentistry. She began collaborating with Dr. John Williams, then the dean of IUSD, on a program to help match female students with practicing dentists to bolster their condence and potentially nd practices. Dr. Germain has nothing but praise for Dr. Conard’s leadership in general and AIR contributions in particular. “I am proud of all she has accomplished and extremely proud to call her a colleague and a friend,” said Dr. Germain. “She is a perfect example of why the AIR program was developed, to mentor future dental leaders.”Dr. Conard’s AIR program was not only successful, but during her work with Dean Williams, he asked if she had interest in teaching. In 2017, Dr. Conard joined IUSD as an adjunct faculty member in the Restorative Department, working with preclinical D1 and D2 students. She found the responsibility and challenge of teaching and mentoring future dentists fullling. “You want to help them as much as you can,” she said. “It’s not just attending lecture and adjunct in lab. It is nding out how to best help each individual student understand concepts. Once it clicks, they can move forward.” Dr. Conard made the dicult decision to take the 2024-25 year o adjunct faculty to focus on her IDA presidential duties. IDA’s immediate past president, Dr. Tom Blake, has little doubt that Dr. Conard will be successful in her year as president. “Lisa is one of the most amazing leaders and one of the greatest friends I have ever made in dentistry. When you rst meet her, she’s so quiet and nice, but she’s a powerhouse.”The late Dr. Dave Holwager encouraged Dr. Conard to get more involved in her Ben Hur component activities and various IDA committees. She became Trustee for Ben Hur, and her years of participation on Membership, Leadership, IDEA Board, Insurance Services and other committees gave Left, the Conard children: Aubrey, Ashley, Lars and Chelsea. Right, Dr. Conard and her husband, Barth Conard, M.D.

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8 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3her the experience and condence to answer Dr. Blake’s ask of her to go through the chairs for president of the IDA. Dr. Conard states that all this encouragement helped bolster her interest in organized dentistry. She encourages all members to do the same for non-members or those who are uninvolved. “It makes you feel welcomed and more comfortable to be invited,” she said.Dr. Conard’s goals as president are aimed at ensuring the long-term success and stability of the IDA on several fronts. She and a recently established Task Force are establishing steps to ensure the nancial health of the association, establish a smooth long-term transition of IDA leadership, work with dental schools to spark and maintain interest in organized dentistry, and to demonstrate the value of tripartite membership to current members. Dr. Conard also wants to focus on the association’s volunteers by encouraging more member involvement, streamlining the volunteer process, and nding ways to ensure that IDA sta and volunteers work eciently together. “Lisa’s not afraid to address challenges in a very organized and kind way,” explained Dr. Blake. “She looks at the facts and tries to gure out how things need to work. She just wants everything to be better. I think she will go down as one of the best presidents the IDA has ever had.” Dr. Conard stays busy but still devotes time to her hobby, growing plants and owers, even in winter. Her favorite is Plumerias, the owers used in Hawaiian leis. She and Barth are also proud new grandparents: Daughter Ashley gave birth to her rst child, Madeleine, on May 31, so the Conards intend to travel to Massachusetts as often as possible to be a part of Madeleine’s life.Dr. Germain is eusive in her assessment of Dr. Conard’s leadership and vision for her presidential year. “Lisa is a gift to our profession and our professional organization. She entered the world of IDA politics in a not so traditional way, and oh how she has shined!”Above, photos of the plumerias grown by Dr. Conard. Right, Lars, Ashley and Chelsea at Ashley’s wedding.PRESIDENT'S MESSAGE

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10 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3It really is a love/hate relationship. There is no doubt that individuals with dental insurance are more likely to visit the dentist. And patients with insurance are more likely to accept needed treatment if dental benets help to defray the cost. But it’s so easy to hate insurance companies. They drive up the cost of care with burdensome administrative requirements. They deny legitimate treatment plans and question your professional judgment. They disrupt dentist/patient relationships with their provider networks. They pressure you into accepting outdated fee schedules and maximum annual benet amounts that have not been updated in decades. There has been an ongoing battle over who controls patient care. Insurance companies argue that they are wearing the white hats… that they are the guardians protecting patients from dentists who, without them, could charge anything they wanted for dental care. Yet they somehow ignore that insurance company prots are highest when they take in as much premium as possible, while paying out as little in claims as possible. For years, it has felt like dentistry has been losing the battle over who controls patient care. Federal antitrust law prohibits health professionals from collectively negotiating with insurers, so it has been an unfair battle. The one arena where dentists can plead their concerns about insurance overreach has been the legislature. But even there, dentistry has been at a dis-advantage. For example, one of Indiana’s largest employers is an insurance company, so it’s not surprising that the Indiana Chamber of Commerce, one of the State’s most inuential lobbying groups, has opposed every insurance reform bill that the IDA has introduced. Despite this unequal playing eld, it seems the insurance industry is now on the defense. In recent years, attitudes toward insurance have changed. The public in general, and legislators in particular, appear to be waking up to the possibility that insurance companies have achieved too much power to the detriment of the policyholders they claim to serve. While insurance companies tighten the nancial screws, the cost of dental education is going up, as is dental student debt. Thus, it is not surprising that the number of dental school applications has dropped, nor that new graduates are often forced Mr. Doug Bush, IDA Executive DirectorEXECUTIVE DIRECTOR'S MESSAGE Dentistry’s Ongoing Battle with Insurance CompaniesIN MY 35-PLUS years of working with dental associations around the country (the deep south, the west coast, the Midwest) one issue has consistently reigned supreme: How can dental providers combat intrusive interference from insurance companies?ABOUT THE AUTHORMr. Doug Bush is serving his 28th year as IDA Executive Director. He can be reached at doug@indental.org. to make practice decisions based on how they can pay o their student debt, not where they are needed the most. There is a shortage of dentist educators and dental public health practitioners. And especially in small towns, retiring dentists are often unable to nd young dentists to take over their practices, worsening access to care in rural areas. But the pendulum is swinging. In Indiana, and around the country, the public and legislators are waking up to the fact that the insurance industry has gained too much power and control. In recent years, IDA has been

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11VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental Associationsuccessful in advocating for several insurance reform mea-sures that limit the degree to which insurers can position themselves between patients and their dental providers. A few examples:2021 – Virtual Credit Cards: In Indiana, insurance compa-nies can no longer pay claims to dental providers exclu-sively with “virtual credit cards,” an electronic payment method that typically shifts banking transaction costs to the dentist. Virtual credit cards are still allowed, but the dental oce must also be oered a traditional payment option such as electronic funds transfer or a paper check. 2022 – Non-Covered Services: Dental provider networks can only set fees for dental procedures that are covered by their plan. They can’t dictate dental fees for services that they choose not to cover. 2024 – Assignment of Benets: Insurance companies are required to honor patients’ requests when they ask that benets be assigned to the dentist or dental oce that provided care.2024 – Network Leasing: Insurance companies are re-quired to notify dentist members of their provider networks before they sell or lease their networks to other carriers. They must allow dentists to opt out if they do not wish to be members of the sold or leased network.How have we achieved these successes? There are a num-ber of reasons, but chief and foremost, IDA members have stepped up in a number of ways.2022-2023 IDA President Dr. Jill Burns testies during a committee hearing during the 2023 Legislative Session. Dentists are taking time away from their practices to address legislative issues at the State House. IDA Director of Gov-ernment Aairs Shane Springer is an eective and inuential voice for Indiana dentists, but he would be the rst to tell you that most legislators would prefer to hear directly from dentists regarding how legislation impacts their practices. In recent legislative sessions, the following dentists have testied at Senate and House committee hearings to address dental issues: (my apologies to anyone I’ve overlooked.)Dr. Jill BurnsDr. Kevin BeedleDr. John BozicDr. Janet ClarkDr. Megan KeckDr. DeLayne LeFevreDr. Misti PrattDr. Je RectorDr. John RobertsDr. Mark StetzelDr. Paul FisherAdditionally, even more members have talked with their repre-sentatives at IDA and component society Legislative Forums held around the state.Add to that number dentists who have called, texted or emailed their Senate or House member to ask their support for IDA’s legislative position. I recall overhearing one Senator speaking to Shane before a hearing on an IDA-supported bill. He pleaded, “You’ve got my vote! Please tell your dentists they can stop calling me!” That is the kind of legislative inuence that money can’t buy. But that’s not to say money is not important. Three hundred dentists are members of IDPAC, IDA’s dental political action committee. And we have had the help of tremendous volunteer leaders. A huge thank you to Dr. Steve Holm, immediate past chair of IDA’s Governmental Aairs Committee, Dr. DeLayne LeFevre, current Governmental Aairs chair, and Dr. David Wolf, chair of IDPAC. Dave is not only an outstanding fund-raiser, he attends numerous legislative receptions and has become a recognizable and inuential presence at the State-house. We have accomplished much, but there is much more to do. Thank you for your membership in the IDA and for your sup-port of our eorts to be dentistry’s voice at the Indiana State-house.

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12 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3COVER STORYRole of Artificial Intelligence (AI) in Dentistry: A PrimerIN THE PAST few decades, signicant technological advancements have been observed in the elds of medicine and dentistry. One of these advancements is the ability to fashion and personalize technology which mimics function of the human brain. This technology has the ability to develop its own solutions for human problems, and also exhibit some human traits such as reasoning and experiential learning.1 This technology is what we call articial intelligence (AI), a branch of computer science that studies intelligent agents, devices that perceive environments and take action by solving simple and complex problems just as a human would.2 Articial intelligence can be thought as the ability of machines to perform tasks requiring human intelligence.The birth of AI can be credited to Alan Turing. In 1950, Turing questioned if machines were able to think the way humans would. He suggested that if humans can solve problems by utilizing available information, so can a machine. He then described the Turing Test, which was an imitation game in which a machine imitates a human. Such a machine was said to have “machine intelligence”.3The birth and advancements of modern-day AI has a tremendous benet in many elds, such as robotics, uses in the auto industry, smart city applications, and nancial analysis. More specically in medicine and dentistry, AI can be utilized for imaging, diagnostics, precision and digital medicine, drug discovery, robotic and virtual assistant roles and enhancing decision-making, therefore reducing unnecessary procedures. Additionally, AI is playing a growing role in dental laboratories and dental education.4, 5How Do Artificial Intelligence Models Work?AI can be classied as weak AI and strong AI (Figure 1). Weak AI, which is used commonly, uses a trained program to solve single or specic tasks. Examples of weak AI include reinforced learning, natural language processing, computer vision, data mining, and personalized content recommendation on social media.6 Strong AI, is when the intelligence of machines equals that of humans, in terms of having its own awareness and behavior. Caution is taken when utilizing strong AI, due to its possible dangers and ethical issues, therefore no extensive research and application is available yet.7Machine learning (ML) and expert systems are two subtypes of weak AI. ML can be classied as supervised, semi-supervised, and unsupervised learning. Supervised learning uses labeled Dr. Hawra AlQallafDr. Chandni BatraDr. Brett FreemanDr. Monica Gibson Dr. Celine CorneliusDr. Priya ThomasDr. Neetha SantoshDr. Halide NamliDr. Vanchit John

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13VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental Associationdatasets, known as the “supervisor of the algorithm” for training. The algorithm uses this labeled dataset to make predictions of unlabeled input.7 Unsupervised learning, on the other hand, works independently to nd various features of unlabeled data.8 Finally, Semi-supervised learning, utilizes both, labeled data and a large amount of unlabeled data during training.9Deep learning (DL) is a subset of machine learning and is currently a very prominent area of research. It includes both supervised and unsupervised learning. Deep learning networks, consist of input layer, hidden layer, and output layer. The process of passing data from one layer to another denes the neural network. Neural networks are networks inspired by how our brain works biologically and are considered the pillars of deep algorithms. The most common types of neural networks are articial neural networks (ANN) and convolution neural networks (CNN). Another more recent form of a neural network is generative adversarial networks (GAN).ANN is a basic model for deep learning (Figure 2a), which is composed of dierent neurons and at least three layers of activity. Inputs are processed in a forward manner, where data is extracted from the input layer and sent to the hidden layer. Data then moves through all the hidden layers and the results are summarized and shown in the output layer. Constant adjustments are made in the hidden layers after passing through every successive layer before it reaches the output layer.10 CNN, is a type of deep learning utilized in image recognition and generation (Figure 2b). Main dierence between ANN and CNN is that CNN has additional layers called the convolution layer. These layers are used to generate feature maps for the input data using convolution kernels. The input image is folded by the kernels to ensure reduction in the image complexity. The additional layers in this system allows for accurate feature extraction, which in turn help for categorizing dierent features and classication of images. CNN has been shown to have a higher eciency and accuracy in image recognition than ANN.11, 12 GAN is a method of unsupervised deep learning. It works by detecting patterns from input data and producing data with similar features or patterns to the input data. It is more widely used now, especially in 3D data generation.13Applications of Artificial Intelligence in DentistryThe use of AI in dentistry has increased signicantly in the past couple of years. Its main applications are in the eld of diagnosis, decision making, treatment planning and prediction of treatment outcome. Due to an increased reliance among dentists on using AI for diagnosis and decision making, AI enabled technologies are becoming more intelligent, accurate and reliable.14 The use of AI in dentistry is a rapidly evolving eld. Its adoption will vary but Figure 1: Diagram showing the relationship between the dierent classications and subclassications of AI. Figure 2: A) Articial neural network B) Convolution neural network

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14 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3it is inevitable that AI will signicantly impact future dental education and the practice of dentistry. Research shows that AI in dentistry is primarily used to evaluate digital diagnostic methods, particularly in interpreting oral and maxillofacial radiographs. Dental radiology and orthodontics are currently leading the way in implementing AI.AI in dentistry is currently being used in dental radiology/operative dentistry, periodontology, orthodontics, oral and maxillofacial surgery, and prosthodontics. Dental Radiology/Operative Dentistry: Conventionally, dentists rely on both radiographic images and visual/tactile sensation to detect caries. The challenging part is detecting early-stage lesions, which unfortunately leads to detecting many of these lesions in their advanced stages. This results in complicated treatments requiring root canal treatment, dental crowns or even extraction. Breakthroughs in image recognition using AI systems have moved science ction to reality in dental radiology over the last two decades. AI has been used in operative dentistry by assessing each pixel of the gray-scale two-dimensional (2D) radiographs. Dierent structures have dierent gray intensities, these distinctive characteristics can be fed to an AI algorithm, which learns the pattern and gives predictions on dierent tooth structures, detect caries, etc. Dierent researchers have developed CNN algorithms to detect dental caries on intraoral images and some compared the cost-eectiveness of AI in detecting proximal caries with dentists’ diagnoses and found that AI is more eective and less costly. CNNs used in radiology can be used for classication, detection, and segmentation of lesions. Many of these studies have shown promising results in early caries lesion detection with accuracy compared to that of a dentist. Forward progress will require continued collaborative work between computer scientists and clinicians.15, 16Summary of applications in oral radiology: A. Automated interpretation of radiographic lesions and dental radiographs, B. Caries detection, C. Diagnosis of vertical root fractures on CBCT images, D. Bone density evaluation to predict osteoporosis, E. Automatic segmentation of mandibular canal, F. Forensic dental imaging and more.Orthodontics: Applications of AI in orthodontics include treatment planning and prediction of treatment outcome. This includes having a graphic representation of changes in facial appearance before and after treatment. AI also aids in clearly identifying landmarks on lateral cephalograms, which aid in diagnosis and communication between the patient and the dentist.17 ANN models have also been used to evaluate whether extractions are needed from lateral cephalometric radiographs.18 Additionally, AI models to judge whether surgery is required using lateral cephalometric radiographs are also being utilized.19 Furthermore, AI algorithms have been utilized to automatically segment teeth on digitally scanned teeth models and CBCT images. Alveolar bone can also be segmented with an eciency that exceeds a radiologist’s work.20, 21Periodontology: Periodontitis is a biolm-induced, host-immune mediated, chronic inammatory disease that if undiagnosed and untreated leads to the destruction of the supporting apparatus of the teeth. Nearly 46 percent of US adults, ages 30 years and older, representing 64.7 million individuals, suer from periodontitis, with 8.9 percent or 12.3 million having severe periodontitis.22 Early detection and treatment are crucial in preventing severe periodontitis. Screening for the presence of periodontitis is still based on the dentist’s clinical experience and in some cases, localized areas of periodontal tissue loss go missing.23 AI in periodontitis has been utilized to diagnose and classify periodontitis. Some researchers have also utilized CNN to detect periodontal bone loss on panoramic radiographs.24Oral and Maxillofacial Pathology: AI in oral and maxillofacial pathology is currently being used for cancer and tumor detection using radiographic, microscopic and ultrasonographic imaging. Additionally, a CNN approach has been used in the detection of potentially malignant disorders and oral squamous cell carcinoma using optical images.25 COVER STORY“The use of AI in dentistry has increased significantly in the past couple of years. Its main applications are in the field of diagnosis, decision making, treatment planning and prediction of treatment outcome.

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15VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationProsthodontics: AI has been used in prosthodontics to generate crowns using designs made by technicians. It has also been used to increase workow eciencies and shade matching and debonding predictions of CAD/CAM restorations.26, 27Oral Medicine: AI has been used in diagnosis and treatment of lesions of the oral cavity.28 It is also being used in screening and classifying suspicious altered mucosa undergoing premalignant and malignant changes. A potential application includes testing for genetic predisposition for oral cancer for a large population. AI in Dental EducationThe role of AI in dental education is currently at a nascent stage. The impact of AI in dentistry will certainly increase the current emphasis on technology and data analytics in dental education. This will add another layer to the expectations of dental educators as they will soon have to learn to master these tools presented by AI.29As the use of AI in dentistry is a new and emerging eld in dental education, dental schools will need to invest in these new technologies while also looking for faculty expertise to help educate dental students on the applications of AI. Ethical implications of using AI in dentistry will also need to be an area of focus. Dental curricula will need to be updated to include AI learning and the new applications of AI in dentistry. Another area of focus will revolve around the role AI writing tools, and the nuances that surround academic integrity. Schwendicke et al.30 identied dierent domains of learning outcomes. These include, A. understanding AI and the principles of machine learning, B. the use of AI in case-based education, C. using examples to teach students the application of AI in the dierent elds of dentistry and d. nally, the accountability and governance of AI use in dentistry. The applications of AI in dentistry and its impact on innovations in education and diagnostic and therapeutic procedures are both exciting and frightening. Exciting because its potential is endless. Frightening because of that same potential and how AI can be used in ways that are unethical. It is important that we realize that AI has the potential to improve many aspects of dental education while also making sure we are cognizant of negative consequences of AI, which can include plagiarism and bias.Challenges and Future Directions of Artificial Intelligence AI systems are becoming a bigger part of our daily lives, both personal and professional, (Figure 3). As the progress with AI and its applications continue to evolve, dental schools and other organizations will be required to invest signicant amounts of money in their attempts at protecting data. Advanced encryption techniques, multi-factor authentication, and blockchain technology will be among the areas that the investment will be required. In this age of tight budgets especially in many educational institutions and dental schools, this will pose a serious challenge. However, with that, there is also an enormous upside to the role of AI in our professional lives. We are currently only scratching the surface on the potential role for AI in dental practice and dental education. Gaining the expertise and identifying those with the existing expertise among dental educators will be a focus for dental schools. The larger dental community will also play an important role as we move forward with learning more about AI and go about introducing the dierent roles in which AI can aid our education, teaching and practice in the future. Figure 3: A vision of the future roles for AI in dental education and clinical practice.

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16 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3References1. Russell, S.J. and P. Norvig, Articial intelligence a modern approach. 2010: London.2. El Joudi, N.A., et al., Review of the role of Articial Intelligence in dentistry: Current applications and trends. Procedia Computer Science, 2022. 210: p. 173-180.3. Turing, A.M., Computing Machinery and Intelligence/Können Maschinen denken?(Englisch/Deutsch): Great Papers Philosophie. 2021: Reclam Verlag.4. Nguyen, T.T., et al., Use of articial intelligence in dentistry: current clinical trends and research advances. J Can Dent Assoc, 2021. 87(l7): p. 1488-2159.5. Ding, H., et al., Articial intelligence in dentistry—A review. Frontiers in Dental Medicine, 2023. 4: p. 1085251.6. Fang, G., et al., Soft robotic manipulator for intraoperative MRI-guided transoral laser microsurgery. Science Robotics, 2021. 6(57): p. eabg5575.7. Hastie, T., et al., Overview of supervised learning. The elements of statistical learning: Data mining, inference, and prediction, 2009: p. 9-41.8. Hastie, T., et al., Unsupervised learning. The elements of statistical learning: Data mining, inference, and prediction, 2009: p. 485-585.9. Zhu, X. and A.B. Goldberg, Introduction to semi-supervised learning. 2022: Springer Nature.10. Agatonovic-Kustrin, S. and R. Beresford, Basic concepts of articial neural network (ANN) modeling and its application in pharmaceutical research. Journal of pharmaceutical and biomedical analysis, 2000. 22(5): p. 717-727.11. LeCun, Y., Y. Bengio, and G. Hinton, Deep learning. nature, 2015. 521(7553): p. 436-444.12. Nam, C.S., Neuroergonomics. 2020: Springer.13. Goodfellow, I., et al., Generative adversarial nets. Advances in neural information processing systems, 2014. 27.14. Chae, Y.M., et al., The adoption of electronic medical records and decision support systems in Korea. Healthcare informatics research, 2011. 17(3): p. 172-177.15. Lee, J.-H., et al., Detection and diagnosis of dental caries using a deep learning-based convolutional neural network algorithm. Journal of dentistry, 2018. 77: p. 106-111.16. Schwendicke, F., et al., Cost-eectiveness of articial intelligence for proximal caries detection. Journal of Dental Research, 2021. 100(4): p. 369-376.17. Junaid, N., et al. Development, application, and performance of articial intelligence in cephalometric landmark identication and diagnosis: a systematic review. in Healthcare. 2022. MDPI.18. Xie, X., L. Wang, and A. Wang, Articial neural network modeling for deciding if extractions are necessary prior to orthodontic treatment. The Angle Orthodontist, 2010. 80(2): p. 262-266.19. Choi, H.-I., et al., Articial intelligent model with neural network machine learning for the diagnosis of orthognathic surgery. Journal of Craniofacial Surgery, 2019. 30(7): p. 1986-1989.20. Cui, Z., et al., TSegNet: An ecient and accurate tooth segmentation network on 3D dental model. Medical Image Analysis, 2021. 69: p. 101949.COVER STORY21. Cui, Z., et al., A fully automatic AI system for tooth and alveolar bone segmentation from cone-beam CT images. Nature communications, 2022. 13(1): p. 2096.22. Eke, P.I., et al., Update of the case denitions for population-based surveillance of periodontitis. Journal of periodontology, 2012. 83(12): p. 1449-1454.23. Krois, J., et al., Deep learning for the radiographic detection of periodontal bone loss. Scientic reports, 2019. 9(1): p. 8495.24. Lee, J.-H., et al., Diagnosis and prediction of periodontally compromised teeth using a deep learning-based convolutional neural network algorithm. Journal of periodontal & implant science, 2018. 48(2): p. 114-123.25. Warin K, Limprasert W, Suebnukarn S, Jinaporntham S, Jantana P, Vicharueang S. AI-based analysis of oral lesions using novel deep convolutional neural networks for early detection of oral cancer. PLoS One. (2022) 17(8):e0273508. doi: 0.1371/journal.pone.027350826. Tian S, Wang M, Dai N, Ma H, Li L, Fiorenza L, et al. DCPR-GAN: dental crown prosthesis restoration using two-stage generative adversarial networks. IEEE J Biomed Health Inform. (2021) 26(1):151–60. doi: 10.1109/JBHI.2021.311939427. Yamaguchi S, Lee C, Karaer O, Ban S, Mine A, Imazato S. Predicting the debonding of CAD/CAM composite resin crowns with AI. J Dent Res. (2019) 98(11):1234–8. doi: 10.1177/002203451986764128. Singh P, Ajay P. Articial intelligence in oral medicine and radiology. Journal of Indian Academy of Oral Medicine and Radiology 31(4):p 285, Oct–Dec 2019. | DOI: 10.4103/jiaomr.jiaomr_7_2029. Impact of Articial Intelligence on Dental Education: A Review and Guide for Curriculum Update. Thurzo A, Strunga M, Surokova J et al. Educ. Sci. 2023, 13(2), 150; https://doi.org/10.3390/educsci1302015030. Schwendicke, F.; Chaurasia, A.; Wiegand, T.; Uribe, S.E.; Fontana, M.; Akota, I.; Tryfonos, O.; Krois, J.; IADR e-oral health network and the ITU/WHO focus group AI for Health. Articial Intelligence for Oral and Dental Healthcare: Core Education Curriculum. J. Dent. 2023, 128, 104363.

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17VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationAbout the AuthorsDr. Priya M. Thomas is the Vice Chair and Director of Comprehensive Care and Predoctoral Clinics in the Department of Biomedical Sciences and Comprehensive Care at Indiana University School of Dentistry. Dr. Brett Freeman is a graduate student in the Department of Periodontology at Indiana University School of DentistryDr. Monica Gibson is the Graduate Program Director in the Department of Periodontology at the Indiana University School of Dentistry.Dr. Vanchit John is Chairperson of the Department of Periodontology at the Indiana University School of Dentistry.Dr. Neetha Santosh is a Clinical Assistant Professor in the Department of Oral Pathology, Medicine and Radiology at Indiana University School of Dentistry. Dr. Halide Namli Kilic is a clinical assistant professor in the Department of Periodontology at Indiana University School of Dentistry.Dr. Hawra AlQallaf is a clinical assistant professor in the Department of Periodontology at Indiana University School of DentistryDr. Celine Joyce Cornelius Timothius is an Assistant Professor in the Department of Periodontics at the Dental College of Georgia, Augusta University. Dr. Chandni Batra is a Clinical Assistant Professor in the Department of Periodontology at Indiana University School of Dentistry.

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18 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3Jay DziwlikAssistant Executive Directorjay@indental.orgSupporting members since 2000Jay assists Doug with IDA operations, in addition to his work with membership recruitment and retention. He also serves as liaison to IUSD, component societies, Dental Practice committee and AIR Leadership Program. He is a frequent CE presenter on ethics and HIPAA.NEWS & FEATURES Meet the IDA Staff and Component Executive DirectorsSUPPORTING IDA MEMBERS at the local and state level is the main focus of IDA sta in Indianapolis and local executive directors around the state. From answering member questions to organizing events to assisting with larger Association policies, advocacy and goals, our state and local sta are here to serve our members.Doug BushExecutive Directordoug@indental.orgSupporting members since 1996Doug oversees the operations of the IDA Central Oce, including sta, IDA nances and overall Association and personnel poli-cies. He is the sta liaison to numerous committees and serves as secretary of the Board of Trustees. Doug also represents the interests of the IDA at ADA national and regional events.Ed RosenbaumDirector of Professional Servicesedr@indental.orgSupporting members since 2007Ed is responsible for professional services that support IDA mem-bers and their practices. He is the sta liaison to the Peer Review Committee for mediation of patient disputes. He also assists with the Well Being program, insurance claim disputes and Medicaid issues. Ed oversees the Indiana Dental Enterprise Associates (IDEA), which approves vendor partners that provide valuable products and services to members. Jody ClearyDirector of Membership and Financial Servicesjody@indental.orgSupporting members since 1984Jody’s responsibilities include membership dues collection and processing, budget management, accounts payable and receivable, and serving as sta liaison to the Finance Committee. Jody is the rst point of contact for new IDA members, membership renewals and general membership questions.

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19VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationWanda BargerMulti Lines Insurance Agentwanda@indental.orgSupporting members since 2013Wanda is the main member con-tact for the IDA Health Insurance Trust. She processes health insur-ance applications and manages customer service, billing issues and Medicare inquiries. Wanda is an Indiana Licensed Multi-lines agent.Ashley SnellDirector of Insurance Servicesashley@indental.orgSupporting members since 2009Ashley has worked in various roles at the IDA but now oversees IDA Insurance Services. Ashley is a licensed Indiana Life/Health and Property/Casualty agent and is the main contact for member malpractice coverage. Shane SpringerDirector of Government Aairsshane@indental.orgSupporting members since 2020Shane maintains a close relation-ship with state legislators on both sides of the aisle and monitors state and federal legislation that aects the Indiana dental community. He also organizes the activities of IDPAC.Kathy WaldenDirector of Communicationskathy@indental.orgSupporting members since 2018Kathy disseminates all manner of communications to IDA members and the general public. She is the IDA contact for member emails, the Journal IDA, digital and print materials and the IDA website and social media channels.Terri YarritoReceptionist/Oce Managerterri@indental.orgSupporting members since Feb. 2024 Terri is the friendly voice who answers the IDA phones. She also keeps the IDA Central Oce running smoothly in her capacity as the oce manager. Terri assists with membership, continuing education and radiology course orders.Andrea NewDirector of Volunteer Engagementandrea@indental.orgSupporting members since 2023Andrea assists in planning and coordinating the activities of the Board of Trustees. She manages volunteers, elections, vacancies and placements, oversees ADA Delegation tasks, and organizes the annual House of Delegates. Judy NeumanDirector of Professional Developmentjudy@indental.orgSupporting members since April 2024Judy keeps our members up-dated and on track with continu-ing education and professional development opportunities. She organizes and oversees our e-learning series, live courses around the state and helps plan the annual Midwest Dental Assembly.The IDA Central Oce is always available to help. Call us at 800-562-5646, or feel free to email sta directly.

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22 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3NEWS & FEATURES The Perils of Perfectionism in Dentistry: Striving for Excellence at the Cost of CareDr. Catherine MurphyDoes the strive for perfection correlate to our rising health concerns?Our pursuit of perfection often begins early in dental education. One of the rst critical moments I recall is the completion of the rst wax setup, a foundational exercise in dental school that demands precision and meticulous attention to detail. This experience can ignite a lifelong quest for perfection, setting the standard for future clinical work.However, the roots of this perfectionist drive may extend even further back to childhood. For many dentists, the journey toward perfectionism starts with early academic achievements, parental expectations, and/or personal aspirations to excel. This early conditioning can instill a mindset where only awless performance is deemed acceptable.The American Psychological Association denes perfectionism as the tendency to demand of oneself or others an extremely high or even aw-less level of performance, in excess of what is required by the situation. This relentless pursuit is linked to various mental health issues, including depression, anxiety, and eating disorders. In dentistry, while the quest for perfection aims to create excellent clinicians, it also poses signicant risks if it leads to excessive self-criticism and burnout.By understanding the origins and impacts of perfectionism, dental pro-fessionals can strive for excellence without succumbing to the detrimental eects of an unattainable ideal.The Strain of Perfectionism on Dental ProfessionalsPerfectionism isn’t about doing things perfectly. Perfectionism drives pro-fessionals to strive for excellence and uphold high standards while setting an unrealistic benchmark that is unattainable. This often leads to a cycle of overthinking, procrastination, self-criticism, anxiety, depression, loss of condence, and fear of failure.Studies have shown that dental students and practitioners with high levels of perfectionism experience increased stress and burnout. For instance, a study published in the British Dental Journal (2019) found that dental students who pursued per-fectionist standards reported higher levels of stress and burnout, attributing this to the constant pressure to deliver perfect clinical results. THE PERFECT MARGIN. The perfect ll. The perfect occlusion.

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23VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationThe implications of these ndings are signicant. Dental professionals are not only at risk of mental health issues such as anxiety and depression but also face a diminished capacity to recognize and appreciate their achievements. This relentless pursuit of perfection can lead to chronic dis-satisfaction and a failure to acknowledge a job well done.The Impact on Patient CarePerfectionism does more than just aect the mental well-being of dental professionals; it also compromises pa-tient care. When dentists become overly xated on achiev-ing perfect outcomes, they may lose sight of the patient’s overall experience and well-being. The emphasis shifts from providing compassionate and comprehensive care to focusing narrowly on technical perfection.Research published in the International Journal of Medical Education (2020) highlighted that medical professionals with perfectionist tendencies were assessed with higher levels of anxiety and depression. These mental health chal-lenges can impair their ability to communicate eectively with patients, make sound clinical decisions, and maintain a patient-centered approach to care. The pressure to be perfect can result in excessive treatment times, increased patient discomfort, and a lack of exibility in addressing individual patient needs.Recognizing the Cost of PerfectionismOne of the most concerning aspects of perfection paraly-sis is its impact on job satisfaction. The Journal of Applied Psychology (2018) study found that employees with higher perfectionism scores reported lower job satisfaction and higher burnout rates. The constant striving for an unattain-able ideal lead to emotional exhaustion and a diminished sense of professional fulllment.Moreover, perfectionism in dentistry can lead to maladap-tive coping mechanisms. Dental practitioners with per-fectionist traits may employ avoidance and self-criticism as coping strategies. These behaviors further exacerbate mental health issues and reduce overall well-being, creat-ing a vicious cycle that is dicult to break.Moving Forward: Embracing Excellence Without PerfectionTo mitigate the negative impacts of perfectionism, it is crucial for dental professionals to shift their focus from per-fection to excellence. Excellence involves striving for high standards while recognizing and accepting that perfection is rarely achievable. By setting realistic goals and cele-brating incremental successes, dental practitioners can enhance their job satisfaction and improve patient care.Fostering a supportive work environment that encourages open communication and provides mental health resources is also essential. Dental schools and professional organiza-tions should prioritize training on stress management and healthy coping strategies. Creating a culture that values progress over perfection can help dental professionals maintain their passion for their work and deliver the best possible care to their patients.ConclusionPerfectionism in dentistry is a signicant issue that aects both dental professionals and their patients. The pursuit of perfection can lead to increased stress, burnout, and a de-cline in the quality of patient care. By embracing a mindset of excellence rather than perfection, dental professionals can achieve a healthier work-life balance, improve their mental well-being, and provide compassionate, eective care to their patients. It is time to recognize that in dentist-ry, as in life, nothing is perfect, and that is perfectly okay.As Michael Law, crisis management counselor and expert corporate communicator, aptly puts it: “At its root, perfec-tionism isn’t really about a deep love of being meticulous. It’s about fear. Fear of making a mistake. Fear of disap-pointing others. Fear of failure. Fear of success.”Let’s let go of fear and perfectionism. Instead, let’s em-brace a culture of support and growth. By seeking help and utilizing available resources, we can break the cycle of perfectionism. Organizations like the IDA (Indiana Dental Association) and ADA (American Dental Association) oer valuable resources to assist dental professionals in manag-ing stress and maintaining mental well-being.Please scan the QR codes below for more information on these resources and take the rst step towards a healthier, more balanced approach to excellence in dentistry.Continued on page 24

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26 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3NEWS & FEATURES Question: Is uoride in drinking water recom-mended these days, especially for children’s teeth, and if so, why? Is there enough uoride in today’s toothpaste and possibly other sources that it’s not needed in town water, especially when there’s some naturally occurring in water. Answer: The addition of uoride to toothpaste (invented by researchers at Indiana University!) is certainly important, but research indicates that it supports, not replaces, uoride in drinking water. Even when uoride is available through toothpaste and supplements, optimal uoride in drinking water is shown to reduce tooth decay by an additional 25 percent. Question: What is the recommended amount of uoride for kids or adults? Answer: The EPA recommends community water uoridation be established at 0.7 mg/L. In some cases, natural occurring uoride is in water at a higher rate. If above 4.0 mg/L, deuoridation may be recommended to lower the concentration level to an optimal level. Question: Is there any potential harm to health if someone gets “too much” uoride through a combination of drinking water, toothpaste, etc.? Answer: In general, anything can be harmful in the wrong quantities. However, water uoridation when established at 0.7 mg/L is benecial. Additionally, it is important to note that too much uoride can create a condition in children known as uorosis. This is a discoloration of the teeth. The condition is cosmetic, causing no adverse health eects in the vast majority of cases. This is why the EPA recommends deuoridation in areas where natural occurring uoride is in concentrations that are too high. A very recent report (August 2024) titled ‘US government report says uoride at twice the recom-mended limit is linked to lower IQ in kids’ was just released. Careful analysis and understanding of the ndings will be important. Question: Is uoride access of particular concern to low-income communities, especially if kids aren’t getting enough toothpaste at home?Answer: Absolutely. There is a correlation between dental disease and social and economic status. Community water uoridation has been cited in numerous studies as a strategy for reducing dental disease in vulnerable populations.Fluoride FAQs and Talking Points for PractitionersFLUORIDE HAS MADE an appearance in the news frequently in recent months, with communities questioning the merits and cost of water uoridation. Below are FAQs and helpful talking points for addressing this issue with patients and local governments.

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27VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationThe following points are from the ADA and may be helpful in discussions regarding water uoridation.Key Messages• Fluoride is nature’s cavity ghter with small amounts present in all water sources such as lakes, rivers and wells. Community water uori-dation is simply the addition of uoride to water to a level that helps prevent tooth decay. • Fluoridation of community water supplies is the single most eective public health measure to prevent tooth decay. • Throughout more than 75 years of research and practical experience, the best available scientif-ic evidence has consistently shown that uori-dation of community water is safe. • The ADA supports community water uoridation as a safe, eective, cost-saving and socially equitable way to prevent tooth decay. • The ADA continues eorts to expand access to uoridation as it works to meet the Healthy People 2030 goal of providing uoridated water to 77 percent of the U.S. population on public water systems. Talking PointsWhat is community water uoridation?• Community water uoridation is simply the adjustment of uoride that occurs naturally in water up to the level recommended for prevent-ing tooth decay. • The optimal level of uoride in drinking water established by the U.S. Public Health Service is 0.7 milligrams per liter (or parts per million). That means the amount of uoride diluted in water is comparable to approximately 1 inch in 23 miles or 1 minute in 1,000 days.Key Fluoride Messages and Talking Points from the ADA• Water that has been fortied with uoride is sim-ilar to fortifying salt with iodine, milk with vitamin D, bread and cereal with folate, and orange juice with calcium – none of which are medications. Is uoridation safe?• Throughout more than 75 years of research and practical experience, the best available scientic evidence has consistently shown that uorida-tion of community water is safe. • With thousands of studies published in peer- reviewed, scientic journals, uoridation is one of the most studied public health measures in history. • The accumulated dental, medical and public health evidence concerning uoridation has been reviewed and evaluated numerous times by academicians, committees of experts, spe-cial councils of government and many of the world’s major national and international health organizations. The verdict of the scientic com-munity is that uoridation safely helps to prevent tooth decay. • Considering the extent to which uoridation has been implemented in numerous countries for decades, the lack of documentation of adverse health eects is remarkable testimony to its safety.Is uoridation eective?• Studies show that community water uoridation prevents at least 25 percent of tooth decay in children and adults even in an era with wide-spread availability of uoride from other sourc-es, such as uoride toothpaste. Continued on page 28

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28 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3• According to the best available scientic evi-dence, community water uoridation is an eec-tive public health measure for preventing, and in some cases, reversing tooth decay, in children, adolescents and adults. • Based on strong evidence of eectiveness, the U.S. Task Force on Community Preventive Services has strongly recommended that com-munity water uoridation be included as part of a comprehensive strategy to prevent or control tooth decay in communities.Who benets from uoridated water?• Water uoridation benets everyone in the com-munity regardless of income, education, race or access to dental care. NEWS & FEATURES • Community water uoridation benets every-one, but especially those without access to reg-ular dental care. Community water uoridation (CWF) is a powerful tool in the ght for social justice and health equity. • Former U.S. Surgeon General Dr. David Satch-er noted that water uoridation is a powerful strategy in eorts to eliminate health disparities among populations. • According to the CDC, in 2020, 74 percent of the U.S. population on public water systems, or a total of 211.4 million people, had access to uoridated water. The Healthy People 2030 Objective is to reach 77 percent. • From 2012 to 2018, communities voted to adopt or retain uoridation almost twice as often as they voted against it.

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29VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationWhat does uoridation cost?• The cost of a lifetime of water uoridation for one person is less than the cost of one lling. • By preventing tooth decay, community water uoridation has been shown to save money, both for families and the health care system. • An analysis of Medicaid claims in three states found that children living in uoridated commu-nities had lower treatment costs related to tooth decay than did similar children living in non-u-oridated communities. • The return on investment for community water uoridation varies with size of the community, and in general, increases as the community size increases. Community water uoridation is cost-saving, even for small communities. • Fluoridation not only saves money, but it saves time—less time lost from school or work be-cause of dental pain or visits to the dentist. Additional Messages• In addition to the ADA, a number of leading national health organization support uoridation including the American Academy of Pediatrics, American Medical Association, American Public Health Association and the World Health Orga-nization. • The Centers for Disease Control and Prevention has proclaimed community water uoridation has one of ten great public health achievements of the 20th century. • More than 100 national and international health, service and professional organizations recog-nize the public health benets of community water uoridation for preventing dental decay.

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32 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3NEWS & FEATURES Member Spotlight: Dr. Shelby KirtsTell us about your education backgroundI was a biochemistry major at Purdue for undergrad. I then went to IUSD for dental school and graduated in 2022.How long have you been an IDA member?I’ve been an IDA member since graduating dental school.Current practice type and locationI practice in Muncie with two other doctors in a private practice setting. We have two practices in Muncie, and I practice at both as an associate. I’ve been practicing at my current location since graduating. Why did you choose to be a dentist?The eld of medicine appealed to me for years. I decided dentistry was the best t for me because it allows me to build relationships with my patients, it oers a great work-life balance, and I like being able to work with my hands. What do you enjoy most about being a dentist?Being a dentist has numerous perks, but I think the most enjoyable moments are the ones where I get to see the positive impact I’ve made in someone’s life. I haven’t been practicing very long, but I’ve seen rsthand how powerful a healthy smile can be in changing an individual’s life. Being a part of that transformation is extremely rewarding to me. Why did you choose to join the ADA/IDA?It was a no-brainer to join IDA my rst year out since it was free, but now I can’t imagine not being an IDA member. Being from Lafayette, I didn’t really know anyone when I moved to Muncie, and I started going to our local component’s meetings as a way to meet other dentists in the area. After a couple months of attending meetings, I was asked if I’d be interested in taking on an executive role within our component to which I said sure! So now I am president of the East Central Dental Society and I’ve served as a delegate at the Midwest Dental Assembly the past two years. What are some of the benefits you’ve seen from ADA/IDA/local membership?I think dentistry can sometimes feel very isolating. We’re in an environment where we’re told daily that people don’t like seeing us, and obviously there’s a lot of stress involved with performing dentistry, managing team members, and in some cases trying to run a successful business. My membership with the ADA, IDA, and my local society has provid-ed me with an avenue to meet other dentists who can relate to just about everything I’m feeling or dealing with when it comes to dentistry, and it helps with my mental health tremendously. Some of the dentists and sta members of the IDA 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.

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33VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationIDA that I’ve met in the last two years have encouraged me to pursue opportunities outside of my comfort zone that have made me a better dentist and better leader. One such opportunity was the IDA AIR program which has helped greatly improve my condence in my leadership abilities. Other benets of I’ve taken advantage of through the IDA include discounted quality CE and disability and malpractice insurance.How do you plan to stay/become more involved in the IDA in the future?I enjoy attending the Midwest Dental Assembly each year and would like to continue serving as a delegate. I also plan to look into joining a committee or two. Any personal info you’d like to include.My husband, Taylor, and I have two dogs, Harper (chocolate lab) and Poppy (pit mix) who keep us entertained. I am happiest spending time with my husband Taylor, our dogs Harper and Poppy, and our families. Taylor and I enjoy traveling to places we’ve never been and are beginner mountain bikers. I love my Kindle and I’m a huge Sarah J Maas fan.

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34 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3Bleeding Disorders and the Role of the Dental ProviderBLEEDING DISORDERS CAN present a host of challenges in general dentistry and oral surgery settings due to these patients’ increased risk of acute bleeding and impaired hemostasis. Dental providers can help manage risk in direct partnership with the patient’s hematologist. There are also cases in which a dental provider could be the rst to identify a bleeding disorder in an undiagnosed patient prompting consultation with hematology. Knowing the signs, possible complications, and management guidance for bleeding disorders in dental settings can put general dentistry and oral surgery providers in a position to help identify and co-manage these cases to directly improve outcomes. Hemostasis and routine dental careHemostasis is an essential process that starts with reducing blood ow to the site of an injury followed by the body’s formation of a clot and maintaining a balance by the brinolytic system. Although hemostasis is compromised in this population, routine dental care and oral procedures should not be avoided simply because the patient has an inherited bleeding disorder. These patients are not at higher risk of developing oral health issues; however, oral hygiene among the bleeding disorder population is generally not as good as the general population due to fear of bleeding with daily brushing and ossing.1-4Abnormal hemostasis can present in several dierent ways, each which can help point to the specic compromised phase of the hemostasis process. This informs providers of what to look for and how to keep the patient’s condition from complicating procedures.Bleeding historyBefore caring for any dental patient—whether for routine care or surgical procedures—a full medical history must be reviewed, including a history of bleeding for the presence of any of the following:Newborn Period• Intracranial hemorrhage• Extracranial hemorrhage (e.g., cephalohematoma)• Umbilical stump hemorrhage• Bleeding during/post procedures (e.g., circumcision, heel-stick, venipunctures)Charles Nakar, M.D.CLINICAL FOCUS

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35VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationChildhood• Abnormal bruising • Multiple bruises, large, without associated injury, in unexposed area• Hematomas• Post immunizations abnormal bruising/hematomas• Epistaxis • More than 10 minutes, requiring packing or cauterization, causing iron deciency or anemia, requiring PRBC transfusion• Oral cavity bleeding (e.g., gums, teeth eruptions, exfoliation of deciduous teeth)• Hemarthroses (bleeding into a joint cavity)• Bleeding during/post procedures• Bleeding with injury • > 5 minutes or > 5 episodes, or requiring consultation, intervention, or surgeryYoung adult/adult• All of the above• Heavy menstrual bleeding (HMB) • Soaking through super size pads once every two to three hours lasting for three to four days, low iron stores, anemia, requiring PRBC transfusion• Dental extractionsFamily medical history• Consanguinity• Race• Ethnicity• Neonatal death in preceding generations• Bleeding post-surgery (includes circumcision and dental extraction procedures)• Heavy menstrual bleeding• Postpartum hemorrhage• Blood transfusionsIf any of the above are discovered in an evaluation, the patient’s status should be discussed. Have they been diagnosed with a bleeding disorder? Do they see hematology for specialty care? If any of the above are positive, hematology should be consulted prior to any procedure.However, it is important to note that negative medical and family histories does not rule out a bleeding disorder, underscoring the importance of a physical exam prior to a procedure.Dental care for the undiagnosed bleeding disorder patientEven after conducting a medical history with negative bleeding history, a patient could present to a dental setting with an undiagnosed bleeding disorder. For this reason, a physical exam should supplement the medical history prior to a procedure to determine the presence of any of the following: Mucocutaneous• Skin • Petechiae (pinpoint round spots on the skin; <4 mm) • Purpurae (4-10 mm) • Ecchymoses (at, purplish patch on the skin >1 cm) • Bruises (the common term for ecchymoses but usually refer to large palpable ecchymoses and are often abnormal) • Hematomas (large raised bruises with pool of blood) • Epistaxis (nose bleeding) • Oral cavity bleeding• Abnormal supercial blood vessels (e.g., telangiecta-sias on the skin/oral cavity)Musculoskeletal• Hemarthrosis• Arthropathy (joint disease)• Limited range of motion• Hypermobility• Deformities/abnormalitiesIf any of these symptoms are discovered, the patient’s status should be discussed, along with whether they’ve been seen by a specialty provider. If there are any concerns with these symptoms, the procedure should be delayed until hematology can oer guidance on how to proceed, likely including a bleeding diathesis blood work.What’s more, an initial diagnosis of hemophilia (especially patients with moderate or mild severity) might involve the dentist, as a common cause of bleeding in children with Continued on page 36

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36 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3all severities of hemophilia is mouth lacerations.5 There are also cases in which a dental procedure can unmask previously unknown mild bleeding tendencies. For example, patients with mild hemophilia might bleed infrequently and only in scenarios involving surgery or injury. Dental care for the diagnosed bleeding disorder patientDental procedures to treat a patient diagnosed with a bleeding disorder versus unaected individuals do not dier signicantly; however, the risk of routine dental care and surgical procedures in bleeding disorder patients should be proactively assessed. The dental provider should consult with the patient’s hematologist to assess and manage the risk prior to any procedure. Risk varies depending on:• Type (and subtype) of bleeding disorder• Severity of the bleeding disorder• Bleeding history• Procedure to be performedProactive dental planning for bleeding disordersConsultation with hematology prior to a patient’s dental procedure should include review of the patient’s type (including subtype) and severity of bleeding disorder. These details will help point to the specic phase of compromised hemostasis and thus proactive treatment guidance. The following is not an exhaustive list of conditions and treatments; these examples are meant to help illustrate the depth of review at which hematology will help guide each case to help prevent adverse outcomes because of the bleeding disorder.Von Willebrand DiseaseIn the case of von Willebrand disease (VWD), a disorder of primary hemostasis, bleeding symptoms are due to a quantitative or qualitative defect in VWF and are commonly mucocutaneous in nature. A VWD diagnosis is made if VWF levels are <50 percent with bleeding symptoms (e.g., easy CLINICAL FOCUS

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37VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationProductsAntibrinolytic* ε-aminocaproic acid Tranexamic acidDesmopressin acetate DDAVP® Desmopressin acetate nasal spray VWF Concentrates Plasma-Derived (examples) • Alphanate® • Humate-P® • Wilate® Recombinant • Vonvendi®Administration RouteIV, POIV, POSQ, IVIntranasalIVVWF: Factor VIII Ratio1.3:12:11:1VWF onlyIndications• Minor bleeding• Adjunctive hemostatic therapy for prevention of surgical bleeding in VWD• Hemostatic agent for prevention of surgical bleeding in very mild type 1 VWD • Minor bleeding• Hemostatic agent for prevention of surgical bleeding in type 1 VWD (not including severe type 1 VWD)• Can be used in type 2 VWD based on subtype and documented hemostatic response • For all types of VWD• Where inadequate response to desmopressin demonstrated/expected• Where desmopressin is contraindicat-ed due to an underlying condition, side eects, uid restriction not possible, or other risks for hyponatremia• Long periods of hemostatic VWF levels are required (e.g., major surgery)Hemostatic therapies for Von Willebrand Diseasebruising, nose bleeds, oral cavity bleeding, heavy menstrual bleeding, postpartum hemorrhage, bleeding after dental extraction and other procedures). It can be challenging to make the diagnosis in a child compared to adults due to stress/anxiety from blood draws and the fact that VWF and factor VIII are acute phase reactants and could potentially look normal in patients with mild VWD. Type 1 VWD is commonly considered a mild bleeding disorder, whereas types 2 and 3 VWD are commonly considered moderate and severe, respectively. Concern for the specic subtype of VWD is essential to provide an optimal therapeutic intervention:6-9HemophiliaHemophilia is a disorder of secondary hemostasis from a deciency or dysfunction of clotting factors VIII (hemophilia A) or IX (hemophilia B). The patient’s severity can be mild, moderate or severe, depending on the amount of decient factor in the blood. Common bleeding sites include joints, muscles and the skin. Continued on page 38

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39VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationHemophilia AStandard Half-LifeAdvate®NovoEight®Xyntha®Kovaltry®Nuwiq®Extended Half-LifeEloctate®Adynovate®Afstyla®Altuviiio®Hemophilia BStandard Half-LifeBeneFIX®Rixubis®Ixinity®Extended Half-LifeAlprolix®Idelvion®Rebinyn®Examples of Recombinant Factor Concentrates for HemophiliaFor dental patients with a hemophilia diagnosis, hemostatic therapy can be initiated on-demand (replacement therapy administered after a bleeding episode has occurred) or proactively (prophylactic therapy, factor concentrate administered on a schedule in advance of procedure to prevent or reduce bleeding). Hematology can advise on what percentage of procoagulant levels to reach; for example, an approximate level of 40-50 percent commonly achieves hemostasis and resolves the bleeding episode in early joint, soft-tissue and oral bleeds.10In addition to the above, additional hemophilia treatments can be considered including desmopressin acetate and emicizumab (the latter is bispecic monoclonal antibody that mimics activated factor VIII and is used for prophylaxis in patients with hemophilia A).Women with Bleeding DisordersFemales with bleeding disorders are not uncommon; however, female carriers of hemophilia A or B might have levels in the mildly decient range for factors VIII and IX and should carry the diagnosis of hemophilia. Any hemophilia carrier should be evaluated to determine their baseline factor activity level and be treated as a potential mild-decient patient.11-14 Hematology should be consulted before dental procedures.Acquired Bleeding DisordersMost patients with a bleeding risk seen by dentists are patients with acquired conditions due to medications like antiplatelet drugs such as aspirin or clopidogrel (Plavix), or anticoagulation drugs (blood thinners) such as warfarin or direct oral anticoagulants (DOACs) like dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis).Other patients with bleeding tendency are those with liver or severe kidney disease.Patients with acquired bleeding should be managed similarly by their dental providers in direct partnership with hematology.Tips for Practicing DentistsIn summary, consultation with hematology and following proper guidance can ensure most patients with congenital bleeding disorders can receive routine dental care and oral surgery on an outpatient basis. Some additional tips for practicing dentists include:• Encourage routine preventative care.• If patient needs additional treatment, it is imperative to contact their hemophilia treatment center (HTC) two to three weeks prior to treatment so that a personalized treatment plan can be put in place.• Appointments should be planned so that the maximum amount of dental care can be accomplished in a single visit. This can help minimize the need for multiple and costly factor infusions.15-17• Avoiding IAN (inferior alveolar nerve) block injections when possible will eliminate the need for infusions prior to procedures. Anesthetic given by local inltration can reduce hematoma risk associated with a block injec-tion. Avoid bilateral block injections to reduce risk of bleeding that could compromise the patient’s airway.• Please avoid the use of NSAIDS and Toradol in patients with bleeding disorders.• When performing dental extractions on patients with bleeding disorders, please maximize local hemostatic measure by placing gel-foam and suture.

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40 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3CLINICAL FOCUSAbout the AuthorCharles Nakar, M.D., is a pediatric hematologist at Innovative Hematology, home of the Indiana Hemophilia & Thrombosis Center in Indianapolis. Dr. Nakar has extensive clinical experience with individuals with coagulation disorders, with a special interest in rare bleeding disorders including hemophilia, specically surgical interventions, management and outcomes, inhibitor development and eradication.References1. Žaliūnienė, R., et al., Do hemophiliacs have a higher risk for dental caries than the general population? Medicina (Kaunas), 2015. 51(1): p. 46-56.2. Othman, N.A., S.N. Sockalingam, and A. Mahyuddin, Oral health status in children and adolescents with haemophilia. Haemophilia, 2015. 21(5): p. 605-11.3. Yazicioglu, I., et al., Parent’s report on oral health-related quality of life of children with haemophilia. Haemophilia, 2019. 25(2): p. 229-235.4. Sartori, M.T., et al., Contraceptive pills induce an improvement in congenital hypoplasminogenemia in two unrelated patients with ligneous conjunctivitis. Thromb Haemost, 2003. 89(01): p. 86-91.5. Sonis, A.L. and R.J. Musselman, Oral bleeding in classic hemophilia. Oral Surg Oral Med Oral Pathol, 1982. 53(4): p. 363-6.6. Nichols, W.L., et al., von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia, 2008. 14(2): p. 171-232.7. Berntorp, E., et al., von Willebrand’s disease: a report from a meeting in the Åland islands. Haemophilia, 2012. 18 Suppl 6: p. 1-13.8. Berntorp, E., et al., Third Åland islands conference on von Willebrand disease, 26-28 September 2012: meeting report. Haemophilia, 2013. 19 Suppl 3: p. 1-18.9. O’Brien, S.H. and S. Saini, von Willebrand Disease in Pediatrics: Evaluation and Management. Hematol Oncol Clin North Am, 2019. 33(3): p. 425-438.10. WFH Guidelines for the Management of Hemophilia 2ndEdition Table 7-1. 2012.11. Plug, I., et al., Bleeding in carriers of hemophilia. Blood, 2006. 108(1): p. 52-6.12. Street, A.M., R. Ljung, and S.A. Lavery, Management of carriers and babies with haemophilia. Haemophilia, 2008. 14 Suppl 3: p. 181-7.13. Hermans, C. and R. Kulkarni, Women with bleeding disorders. Haemophilia, 2018. 24 Suppl 6: p. 29-36.14. McLintock, C., Women with bleeding disorders: Clinical and psychological issues. Haemophilia, 2018. 24 Suppl 6: p. 22-28.15. Lee, A.P., et al., Eectiveness in controlling haemorrhage after dental scaling in people with haemophilia by using tranexamic acid mouthwash. Br Dent J, 2005. 198(1): p. 33-8; discussion 26.16. Dalati, M.H., et al., Bleeding disorders seen in the dental practice. Dent Update, 2012. 39(4): p. 266-8, 270.17. Anderson, J.A., et al., Guidance on the dental management of patients with haemophilia and congenital bleeding disorders. Br Dent J, 2013. 215(10): p. 497-504.

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42 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3MEMBER ZONEIN MEMORIAMDR. G. THOMAS CHILDES of Bloomington and a member of the South Central Dental Society passed away April 13, 2024. Dr. Childes graduated from Indiana University School of Dentistry in 1958.DR. CHARLES D. COBURN of Valparaiso and a member of the Northwest Indiana Dental Society passed away June 18, 2024. Dr. Coburn graduated from Indiana University School of Dentistry in 1967.DR. WILLIAM C. GILLIG of Fort Wayne and a member of the Isaac Knapp District Dental Society passed away August 24, 2024. Dr. Gillig graduated from Indiana University School of Dentistry in 1958.DR. STEVEN L. HODGES of South Bend and a member of the North Central Dental Society passed away June 23, 2024. Dr. Hodges graduated from Indiana University School of Dentistry in 1992.DR. JAMES C. JINKS of Indianapolis and a member of the Indianapolis District Dental Society passed away June 30, 2024. Dr. Jinks graduated from Indiana University School of Dentistry in 1962.DR. DAVID L. KESLING, originally of LaPorte and a member of the Northwest Indiana Dental Society, passed away October 23, 2023. Dr. Kesling graduated from Loyola University of Chicago in 1959.DR. WALTER LEUENBERGER, JR of Woodburn and a member of the Isaac Knapp District Dental Society passed away July 28, 2024. Dr. Leuenberger graduated from Indiana University School of Dentistry in 1958.DR. SAM ROBERTS LAUDEMAN of Elwood and a member of the East Central Dental Society passed away January 18, 2023, at the age of 101. Dr. Laudeman graduated from Indiana University School of Dentistry in 1949.DR. RONALD P. SCHEELE of Fort Wayne and a member of the Isaac Knapp District Dental Society passed away April 11, 2024. Dr. Scheele graduated from Indiana University School of Dentistry in 1959.DR. MICHAEL E. SOVANICH of Indianapolis and a member of the Indianapolis District Dental Society passed away August 29, 2024. Dr. Sovanich graduated from Indiana University School of Dentistry in 1982.DR. ROBERT W. WAGNER of Merrillville and a member of the Northwest Indiana Dental Society passed away March 9, 2024. Dr. Wagner graduated from Indiana University School of Dentistry in 1953.

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43VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationClassifiedsINTRAORAL 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 REPAIRASSOCIATE DENTISTRestore Dental Arts is a multi-doctor private practice where mentoring is part of the culture. We practice restorative, endo, surgery, seda-tion, implants, all on X, and full mouth reconstruction, with plenty of opportunity for bread-and-butter dentistry. Full time, long term position to accommodate growth. Non DSO, private fee for service practice. Compensation: 30 percent production with guaranteed minimum for the rst three months. https://www.restoredentalarts.comASSOCIATE DENTIST-LAKEWOOD FAMILY DENTALAs an Associate Dentist at Lakewood Family Dental, you will play a pivotal role in delivering exceptional dental care and contributing to the success of our practice. You will join a team of dedicated profession-als committed to providing the best possible patient experience and promoting healthy dentistry. Salary: $150k-300k/annually. Benets: Medical, up to $1500 for CE. To apply, please contact 317-735-6122.GENERAL DENTIST-FORT WAYNE Harrison Dental Group is looking for a skilled and passionate General Dentist to join our family-focused practice in Fort Wayne. We pride ourselves on our state-of-the-art facilities, which include fully digital x-rays, iTero and 3Shape intraoral scanners, and cone beam technol-ogy. We serve a diverse patient base with a healthy mix of FFS/PPO/Medicaid patients, allowing our dentists to keep full schedules and ex-perience a wide variety of procedures. We oer a competitive compen-sation package, including $150,000-$400,000 per year, with benets such as a 401(k) with matching, health and dental insurance, paid time o, and vision insurance. Email keithjharrison@gmail.comASSOCIATE DENTIST-INDIANAPOLISWest 38th Dental in Indianapolis is looking for an eager and enthusias-tic part time or full time Associate Dentist for our private practice. We have an experienced owner that can mentor newer doctors and we treat all scopes of dentistry to include oral surgery, dental implants, endodontics, orthodontics, and comprehensive dental care for all ages. We have a team of EDFA, dental hygienist and front desk and oce manager for a supportive environment and great team culture. We oer competitive pay, 401K, paid time o, and malpractice insurance cover-age. DEA license required. Send CV or resume to email sungkongdds@gmail.com.EMPLOYMENT OPPORTUNITIESGENERAL DENTIST-CROWN POINTJoin our well-established and growing private practice as an associate dentist! Our thriving and well-established private practice is seeking an Associate Dentist to deliver exceptional general dentistry services to patients of all ages. Attractive compensation, comprehensive bene-ts, inclusive practice, professional growth, supportive environment, advanced technology and experienced sta. $175,000.00-$300,000.00 per year plus benets. Email resume/CV to Dr. Rita Patel-Miller at rgpatel@beaconhilldentalcp.com.ASSOCIATE DENTIST-GRANGEROur Best Life Companies is hiring an Associate Dentist to join our team in Granger. As an Associate Dentist at Our Best Life, you will have the opportunity to work with some of the best in dentistry providing the best dental care. Practice is lled with the latest and greatest tech-nology and a growing patient base. One on one mentorship from our Chief Medical Ocer and other Associate Dentists, collaboration with in-house specialists, team-focused environment, high new patient rate, opportunity for growth. Competitive compensation and bonus packag-es. Email resume to marketing@ourbestlifeinc.com.EMPLOYMENT OPPORTUNITIESEQUIPMENT FOR SALE3SHAPE TRIOS 5 PROMOTIONTake advantage of Biotech Dental’s HUGE 3Shpae Trios 5 Promotion. Up to $7,000 o the retail price! Hurry, don’t miss this extraordinary oer. Email jim.crawford@biotechdentalusa.comPRACTICES FOR SALEGENERAL PRACTICE FOR SALE IN PLYMOUTHWell established 7 Op general dentistry practice in North Central IN. 70 percent PPO and 30 percent FFS. Collecting $1,816,000 with a strong hygiene program. Oce utilizes CBCT & iTero technology. Experienced sta. Real estate for sale or lease. 317.538.5314, mike@jrossiandasso-ciates.comFULLY EQUIPPED OFFICE IN EVANSVILLE3,364 SF dental oce available. Turn-key dental oce with 4 exam rooms and dental equipment, including chairs, x-ray and lab equipment and vacuum system. Dental equipment available for purchase separate-ly – Owner will negotiate sale of equipment outside of the real estate transaction. Building has a security alarm and includes a waiting room, records area, oce area, a restroom and 4 exam rooms, kitchenette, conference room, restroom with shower and a large open area. Storage space available. Summit Real Estate Services, Richard A. Clements, Managing Broker, rclements@summitrealestate.us

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44 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3New MembersEAST CENTRAL DENTAL SOCIETYDr. Kendra Holliger (IU 2024)Dr. Kylie Langdon (IU 2024)Dr. Carrie Runyon (IU 2024)FIRST DISTRICT DENTAL SOCIETYDr. Alex Liang (IU 2024)Dr. Digvijaysinh Parmar (Univ of CA 2022)Dr. Lakshmi Sravya Rallabandi (Rutgers NJ 2023)Dr. Jacob Rexing (IU 2024)INDIANAPOLIS DISTRICT DENTAL SOCIETYDr. Aatif Ansari (IU 2015)Dr. Matthew Beaverson (IU 2024)Dr. Ashley Blankenbaker (IU 2024)Dr. Margaret Broderick (IU 2024)Dr. Jordan Chlebowy (Univ of KY 2023)Dr. Miranda Cornejo (IU 2024)Dr. Sarah De La Cruz (IU 2024)Dr. Brenda De La Cruz (IU 2024)Dr. Mandeep Dhami (IU 2024)Dr. Sarah Dobson (Univ of NC 2024)Dr. Mohamed Baqer Ghandour (IU 2024)Dr. Sabrina Ghazi (IU 2024)Dr. Anastasia Golodaeva (IU 2024)Dr. Arshdeep Grewal (IU 2024)Dr. Julia Gruver (IU 2024)Dr. Mariam Hanna (IU 2024)Dr. Emily Hasik (IU 2024)Dr. Alexa Haulk (IU 2024)Dr. Jose Herrera (IU 2024)Dr. Abram Hess (IU 2016)Dr. Onkarpreet Jawanda (IU 2024)Dr. Danielle Kluttz (IU 2024)Dr. Balaji Kolasani (IU 2024)Dr. Brittany Lane (Marquette Univ 2011)Dr. Steven Mah (IU 2024)Dr. Julianna Masabni (Univ of TX 2022)Dr. Bruce Matis (Case Western Univ 1971)Dr. Gia Matsko (Univ of MN 2024)Dr. Armelle Metangmo (IU 2024)Dr. Cordin Mirise (IU 2024)Dr. Bradley Moon (IU 2024)Dr. Thomas Mullally (Univ Detroit-Mercy 2023)Dr. Ella O’Connell (IU 2024)MEMBER ZONEDr. Chase Perkins (IU 2024)Dr. Sylvette Ramos-Diaz (Univ of NC 2024)Dr. Cameron Rigley (IU 2024)Dr. Marly Rizkalla (IU 2024)Dr. Evan Robbins (IU 2013)Dr. Nilanchal Sahai (Univ of NV 2019)Dr. Alyssa Sanborn (IU 2024)Dr. Marissa Scheid (IU 2024)Dr. Babak Sen (Tufts Univ 2024)Dr. Anarita Sousa (Univ of MD 2023)Dr. Shalini Subramanyam (IU 2024)Dr. Michael Tellman (Tufts Univ 2024)Dr. David Van Winkle (IU 2021)Dr. Alec Weiss (IU 2024)Dr. Corey Wilson (Midwestern Univ 2017)Dr. Kapiolani Wisler (IU 2024)Dr. Tony Wren (IU 2024)Dr. Ariel Zalesin (IU 2024)ISAAC KNAPP DISTRICT DENTAL SOCIETYDr. Jordyn Caray (IU 2024)Dr. Justin Do (Univ of MI 2024)Dr. Lauren Goertzen (Midwestern Univ 2024)Dr. Yingqiao Mao (Univ of MI 2024)Dr. Andrew Ross (IU 2024)Dr. Warren Travis (IU 2021)Dr. Di Xie (Univ of MI 2024)NORTH CENTRAL DENTAL SOCIETYDr. Harshitha Alla (Univ of OK 2023)Dr. Kevin Bedford (IU 2024)Dr. Michael Brown (IU 2024)Dr. Jageer Chhina (IU 2024)Dr. Matthew Emrick (Univ of MI 2023)Dr. Patricia Flores (IU 2024)Dr. Jonathan Hollar (IU 2024)Dr. Blessing Ibikunle-Salami (IU 2023)Dr. Ezzat Makawi (Univ Detroit-Mercy 2023)Dr. Parker Pecina (Temple Univ 2023)

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45VOLUME 103 · 2024 · ISSUE 3 | Journal of the Indiana Dental AssociationNORTHWEST INDIANA DENTAL SOCIETYDr. Ejaz Ahmad (IU 2024)Dr. Isabel Bravo (IU 2024)Dr. Michael Drone (IU 2003)Dr. Indre Geneviciute (Marquette Univ 2023)Dr. Cody Holmgren (IU 2024)Dr. Devon Kutanovski (Univ of IL 2020)Dr. Sarah Nguyen (Midwestern Univ 2024)Dr. William Parks (Washington Univ 1990)Dr. Mariam Silman (IU 2024)SOUTH CENTRAL DENTAL SOCIETYDr. Bradley Frederick (Univ of Louisville 2014)Dr. Mina Iskander (Univ of Louisville 2023)Dr. Susheel Kumar (Case Western Univ 2023)Dr. Thu Nguyen (Univ of Louisville 2023)Dr. Madeline Poteet (IU 2024)Dr. David Taylor (Univ of Louisville 2006)SOUTHEASTERN INDIANA DENTAL SOCIETYDr. Ellie Smith (Univ of KY 2023)Dr. Garrett Wilson (Univ of Louisville 2023)WEST CENTRAL DENTAL SOCIETYDr. Noah Barrett (Univ of Colorado 2023)Dr. Lucy Wen (Univ of Pittsburgh 2024)Dr. Thomas Britton (Midwestern Univ-IL 2023)WESTERN INDIANA DENTAL SOCIETYDr. Alhaitham Abdullah (Univ of CO 2023)Dr. Pierce Ross (Tufts Univ 2024)Dr. Hasan Shahin (IU 2023)

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46 Journal of the Indiana Dental Association | VOLUME 103 · 2024 · ISSUE 3Journal IDA Submission Guidelines for AuthorsGeneral InformationWe encourage contributions on a variety of topics of interest to the Indiana dental community. Manuscripts that do not conform to JIDA submission requirements will be returned to the corresponding author for modications to ensure compliance with journal requirements.Articles • Manuscript title is limited to 15 words. • Articles should be submitted in Microsoft Word. Recommended word counts are between 2,000 and 3,000. Maximum word count is 3,000, excluding the abstract, gures and references.• Use double spacing throughout the article, including title pages, abstract, text, acknowledgments, and references.• There are no font or type size requirements, as all text will be placed into a publishing program and reformatted as needed.• Articles should be carefully reviewed for typographical errors and proper grammar prior to submission. • Authors should indicate conicts of interest and/or funding sources, if applicable.• All articles should be accompanied by an enumerated list of references at the end, if appropriate.• Please indicate references within the article with brackets. Example: [1]. Don’t exceed 20 references.• The IDA uses AP style: bit.ly/3M1dJnPImagesAuthors are welcome to submit images, charts and other graphics to accompany articles but are not required to do so. • Tables and gures should be placed at the end of the manuscript, following the reference list.• Images should be large and/or high resolution. Extremely small images generally are not suitable for print.• Manuscripts can have up to a combined total of six gures and tables (any combination). Figures can be multi-panel. • Acceptable image formats include .jpeg, .eps, or .tif. PNGs can usually be converted to jpegs for print, but again, should be a large size.• Any images or other graphics accompanying an article should include copyright information, if appropriate, and captions, especially for images of a technical nature.• The IDA may add images to articles to add visual appeal, break up text and/or ensure an even distribution of content across pages.• Studies on patients require approval from an Institutional Review Board and informed consent from patients and should be documented in the manuscript. Appropriate consent and media releases must be obtained to include case details or images of patients.Submission Process• Articles maybe submitted to the Editor (vjohn@iu.edu), Associate Editor (monigibs@iu.edu), or the IDA Director of Communications (Kathy@INDental.org) to begin the review process.• Upon receipt, the article will be reviewed by the JIDA Scientic Committee.• Once the review is complete, authors will be notied of the feedback and will need to make recommended changes prior to being approved for publication in the JIDA.Author BiographiesArticles submitted to the JIDA for review should be accompanied by the following:• Brief (two to three sentence) biography for each author.• Color headshot of each author.• Contact information, if desired. MEMBER ZONE

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