NDA JOURNAL Summer 25 Volume 27, Issue 2 Official Magazine of the Nevada Dental Association and Component Societies A Peer Reviewed Journal
SUMMER 25 NDA JOURNAL Editor’s Message Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD 2 Featured Articles Single Shot Against Both Influenza and COVID-19 6 Manuscript Draft: Yellow Mass of Buccal Mucosa in a 67 Year-Old Male 8 Paradigm Lock: Associations of American Physicians and Surgeons 12 Reports NDA President Patrick R. Silvaroli, DMD 14 NDA Executive Director Marianna Kacyra 16 NNDS President Garrett Swanson, DMD 18 SNDS President Sonal S. Shah, DDS 20 Sections Event Calendars 21 Administrative Offices & NDA Committees 22 Nevada Dental Association 600 E. William Street, Ste 202 Carson City, NV 89701 PH 775-558-9404 FAX 702-255-3302 EMAIL info@nvda.org WEB www.nvda.org NDA Journal is published four times each year by the Nevada Dental Association and state component societies. All views expressed herein are published on the authority of the writer under whose name they appear and are not to be regarded as views of the publishers. We reserve the right to reduce, revise, or reject any manuscript submitted for publication. Materials: All articles, letters to the editor, photos, etc. should be sent to Daniel L. Orr II, DDS, via email to EditorNDA@nvda.org. All chapter and committee reports and business communications should be sent to Marianna Kacyra, Executive Director, Nevada Dental Association, 600 E. William Street, #202, Carson City, NV 89701. Ph: 775-558-9404. Materials may be reproduced with written permission. Subscription: Members receive each publication as a membership benefit paid by membership dues. Non-members may subscribe to the Nevada Dental Association Journal for $50 annually. Advertising Policy: All advertising appearing in the NDA Journal and other Nevada dental publications must comply with the advertising standards of the Nevada Dental Association and its component societies. The publication of an advertisement is not to be construed as an endorsement or approval by the publishers of the product or service being offered in the advertisement unless the advertisement specifically includes an authorized statement that such approval or endorsement has been granted. The publishers further reserve the right to cancel any and all contractual advertising agreements should an advertiser be engaged in litigation concerning their product or service, or should the product or service be in conflict with the standards of the NDA or its component societies. Advertising rates and specifications are available upon request. Contact, Kara Mortl, Big Red M, at 248-250-3655 or email kara@bigredm.com. Mailing: Send address changes to: 600 E. William Street, #202, Carson City, NV 89701. © 2025 Nevada Dental Association Editor Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD EditorNDA@nvda.org Publisher Big Red M www.bigredm.com Design: Shelby Bigelow NDA JOURNAL
NDA Journal 2 Dr. Orr practices Anesthesiology and OMS in Las Vegas, is an Adjunct Professor (Surgery) at UNLV SM and Touro University SM (Jurisprudence), Professor Emeritus at UNLV SDM, and a member of the CA Bar and Ninth Circuit Court of Appeals. Editor’s Message Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD EditorNDA@nvda.org NDAJ Exclusive Why Politically Correct DEI Is Anything but Diverse, Equitable, and Inclusive; and How Organized Dentistry Had It Wrong for 100 Years I am always grateful when a thinker correctly validates and objectifies my undefined feelings about an issue. As Carl Jung has been quoted, “Thinking is hard. That is why people simply judge.” Before Jung, poet Mary Torrans Lathrap (1838–1895) wrote: “Pray do not find fault with the man who limps, Or stumbles along the road. Unless you have worn the moccasins he wears, Or stumbled beneath the same load.” As with most moral subjects, the Bible also proffers a caution in Matthew 7:1–6: “Judge not, that ye be not judged.” But there is something discordant with the continuing academic, political, societal, trendy, etc. DEI initiatives being foisted upon us. It seems like the new, improved status quo is not new at all; it is virtually always based on the relative amounts of melanin in one’s skin. Rarely is race a definitively optimal trait to consider. It is irrelevant. Many understand that the Civil War effort to confirm the revelatory Constitutional promise to establish not equal outcomes, but equal opportunities to be unequal, based only on individual effort. Melanin-challenged soldiers died in record numbers to promote the rights being denied to those that had plenty of melanin. Subsequently, Amendments XIII, XIV, and XV were incorporated into the Constitution to emphasize the principles our country was founded on applied to everyone. Of course, ignorant tyrants from elementary school bullies to elected officials continued to ignore basic human rights principles in spite of Lincoln’s Emancipation Proclamation, the Civil War, and the Amendments. I remember seeing the smoke from the tragic Watts Riots in 1965, but also the orderly 1970 USC at Alabama football game that correctly is credited Of course, ignorant tyrants from elementary school bullies to elected officials continued to ignore basic human rights principles in spite of Lincoln’s Emancipation Proclamation, the Civil War, and the Amendments.
Summer 25 www.nvda.org 3 opportunity. The National Dental Association (NDA) was formed in direct response to that. Thankfully, today, neither the NDA nor the ADA restrict membership based on a dentist’s particular epidermal reflection of light. These changes came about largely because of former ADA Editor’s Message in large part for breaking an artificial skin color barrier in Southeastern Conference athletics. That game was a historic effort for all moral people. Integrated USC prevailed 42–21 at segregated Alabama.1 (Figure 1, Turning of the Tide) There is a huge difference between the Watts Riots and USC at Alabama, a difference not generally considered in today’s DEI “dialogues” that are actually more akin to punitive lectures. Modern DEI reprimands are virtually always one-sided. Today’s slavish DEI devotees and apparatchiks are not interested in honest discussions, but would rather censor or ban opponents. Even well-known media personalities have been fired for agreeing, but just not enthusiastically enough.2 Heaven help the poor journalist who has a contrarian’s opinion about politically correct issues.3 Ironically, today the former victims and tyrants have assumed each other’s pulpits, again, based on shades of skin. Well into the 1960’s, some of the paler folks attempted to restrict those whom were darker. Nowadays however, a few of those blessed with the most melanin loudly seek to punish others with less. Either way, the controlling verbiage is false, discounts out-ofhand different points of view, and is actually, not nominally, racist. What DEI should be based on is a respectful discussion in the arena of ideas, with a priority on truth, not subjective, emotional, or financially conflicted opinions. Sadly, organized dentistry was somewhat late to the game in recognizing equality of opportunity for everyone. For decades before and even during my time in dental school, a frank exclusion from the American Dental Association (ADA) of a large group of dentists based on skin color existed, thus artificially restricting equal » Figure 1. Turning of the Tide. Figure 2. The Hillenbrand Era, Organized Dentistry’s Glanzperiode (heyday). Figure 3. The Editor and his Mentor Clifton O. Dummett, 2006.
NDA Journal 4 Editor’s Message » Executive Director Harold Hillenbrand, a Caucasian DDS, as documented by my USC SD mentor Clifton O. Dummett, DDS (plenty of melanin) in his and wife Lois’ 1986 celebratory tome The Hillenbrand Era, Organized Dentistry’s Glanzperiode.4 (Figure 2) So, why has political level DEI always been so divisive? Perhaps the reason is that selfish individuals with some degree of authority attempt to exert dominion and control over others in order to maintain their illusory political advantage and power. This is nothing new and has been occurring for thousands of years, although historically not always most dependent on racism, but other artificial constructs. Thankfully, people can still choose to exchange ideas respectfully with those different from themselves. Many have been blessed by others superficially dissimilar from themselves. I am honored to gratefully acknowledge having been taught by many mentors so superficially different from me physically, intellectually, religiously, politically, etc. (Figure 3.) Paraphrasing Martin Luther King: “I look forward to the day when my children are judged by the content of their character, not the color of their skin.” As dentists, we know what is moral and ethical. All we have to do is perform. Fight On! 0 Reference 1. Yeager D, Turning of the Tide, Center Street, New York, 2006. 2. Pettersson E, Radio host fired for tweeting “all lives matter” can pursue retaliation claim, Courthouse News Service, July 26, 2023, https://www. courthousenews.com/radio-host-fired-for-tweeting-all-lives-matter-canpursue-retaliation-claim/, accessed August 14, 2024. 3. Orr D, Why Lives Matter, Refining the Validations, NV Dent Assn J, 22:3, 2–6, 2020. 4. Dummett, CO and LD, The Hillenbrand Era, Organized Dentistry’s Glanzperiode, American College of Dentists, 1986. June 2, 2025 Dear Dr. Daniel L. Orr II, I am delighted to inform you that the USA-ICD Journalism Committee has selected your entry for the 2025 Journalism Awards to receive the prestigious Special Citation. This recognition is a testament to the excellence and impact of your work, and we are honored to celebrate your achievement. We look forward to seeing you in San Diego on Wednesday, September 10, 2025, for the awards presentation ceremony. Details for this ceremony will be sent to you by the AADEJ. Congratulations once again on this well-deserved honor! Eliot Painer, DMD USA-ICD 2025 President NDA Exclusive ICD Special Citation
Summer 25 www.nvda.org 5 For more information, please contact Kara Mortl at 248.250.3655 or kara@bigredm.com. ADVERTISING RATES STARTING AT $590! ISSUE DEADLINE Fall 2025 August 06 Advertise in the NDA Journal! The NDA Journal is published four times each year by the Nevada Dental Association and state component societies. All advertising appearing in the NDA Journal and other Nevada dental publications must comply with the advertising standards of the Nevada Dental Association and its component societies.
NDA Journal 6 Single Shot Against Both Influenza and COVID-19 Edited by: Shreyasi Asthana, June 03, 2025, Medscape A novel multicomponent messenger RNA (mRNA) vaccine, mRNA1083, demonstrated noninferiority to standard influenza and COVID-19 vaccines in adults aged 50 years or older, eliciting higher immune responses against most influenza strains (A/H1N1, A/H3N2, B/Victoria, and B/Yamagata) and SARS-CoV-2 (Omicron XBB.1.5), according to a pivotal phase 3 study. Methodolgy • The mRNA-1083 is an investigational, multicomponent vaccine that combines the components of a hemagglutinin-based influenza vaccine (mRNA-1010) and a second-generation SARS-CoV-2 vaccine encoding the spike glycoprotein’s N-terminal and receptor-binding domains. • Researchers present interim findings of a phase 3 trial that assessed the immunogenicity and safety of this vaccine in adults aged 50 years or older across the United States, enrolling participants between October 19, 2023, and November 21, 2023. • They randomly assigned 8061 participants to receive either the mRNA-1083 vaccine plus placebo or the active comparator vaccines for seasonal influenza or COVID-19. • Participants were stratified into those older than 65 years (n = 4017; 54.2% women) and those aged 50–64 years (n = 3998; 58.8% women). • The primary objective was to demonstrate the noninferiority of humoral immune responses— measured by antibody levels—to mRNA-1083 vs active influenza and COVID-19 vaccines against vaccine-matched strains, 29 days post-vaccination. Takeaway • The mRNA-1083 vaccine demonstrated noninferiority to the active comparator vaccines against the four influenza strains and SARSCoV-2 in both age groups, as determined by a 97.5% CI lower bound greater than 0.667 for the geometric mean ratio and more than −10% for the seroconversion rate difference. • In adults aged 50–64 years, mRNA-1083 elicited superior immune responses to all four influenza strains relative to the active comparator influenza vaccines, whereas in adults aged 65 years or older, superiority was observed for three strains (A/ H1N1, A/H3N2, and B/Victoria). • Most local and systemic adverse reactions were grade 1 or 2 across vaccine groups. Grade 4 adverse reactions, all of which were systemic events (fever), were reported by two participants in each age group. • In both age groups, no severe or serious adverse events or adverse events of special interest were deemed vaccination-related. No deaths or cases of myocarditis or pericarditis were reported. In Practice “As such, an annual vaccination campaign with a multicomponent vaccine could occur during the seasonal period when the burden of respiratory hospitalizations is the greatest, while allowing for a standalone COVID-19 vaccine option for additional doses or if the vaccine is updated in the interim should any antigenically divergent strain emerge,” the authors wrote. Source This study was led by Amanda K. Rudman Spergel, MD, Moderna Inc., Cambridge, Massachusetts. It was published online on May 7, 2025, in JAMA. “As such, an annual vaccination campaign with a multicomponent vaccine could occur during the seasonal period when the burden of respiratory hospitalizations is the greatest, while allowing for a standalone COVID-19 vaccine option for additional doses or if the vaccine is updated in the interim should any antigenically divergent strain emerge.” Featured Article
Summer 25 www.nvda.org 7 Featured Article Limitations The efficacy of mRNA-1083 was not established in the study and requires further investigation. Although the diversity of the study population mirrored that of the general U.S. population, the results may not be generalizable to other geographic areas. Disclosures This study was funded by Moderna, Inc. Many authors were employees of Moderna and may hold stock or stock options. Editor’s Note: Many have been waiting for Big Pharma to combine something with the COVID-19 experimental formulations (they never fit the definition of a traditional vaccine), which are still experimental as the long-term studies continue. The last test group was enrolled less than two years ago; that is not enough time to see what the potential “noninferiority” results will actually be. How does Moderna define “noninferiority?” As less death from this novel experimental formulation? Insurance industry actuarial analyses show an increase in all-cause death dating from the introduction of earlier COVID-19 experimental formulations. “No deaths from myocarditis or pericarditis were reported.” Neither were they reported 18 months after the first experimental formulations, but certainly are now years later, along with many other fatal maladies such as “turbo cancers.” This study was funded by Moderna, a heavily conflicted non-meritorious advisor. At least Moderna states the study requires further investigation. But not on the Editor…
NDA Journal 8 The Challenge A 67 year-old African-American male patient presented to the dental clinic for a comprehensive dental examination with a growth in his right buccal mucosa. The patient reported that the lesion first appeared about 20 years prior and that aside from occasional accidental biting, the lesion has had remained asymptomatic. The review of his systems was significant for hypertension, anxiety, depression, and a history of back and neck surgery managed with multiple analgesics. The patient denied current tobacco and/or alcohol consumption. The clinical exam revealed a yellow, soft, sessile and smooth-surfaced mass approximately 1.4 x 1.2 x 1.0 cm involving the right buccal mucosa (Figure 1). An excisional biopsy was performed for diagnostic and therapeutic purposes. On surgical exposure, a well-demarcated yellow mass was encountered that could be separated with relative ease from the surrounding tissue. Upon excision and placement in 10% formalin, the lesional tissue floated in the fixative medium. Microscopic examination demonstrated surface mucosa overlying a dense fibrovascular connective tissue containing a welldelineated tumor (Figure 2A). The tumor was composed of lobules of mature adipocytes separated by thin and delicate fibrous septa (Figure 2B). Can you make the diagnosis? A. Lipoma B. Granular cell tumor C. Epidermoid cyst D. Schwannoma The Diagnosis A. Lipoma Lipomas are benign tumors of mature adipocytes. Representing the most common mesenchymal neoplasm in Manuscript Draft: Yellow Mass of Buccal Mucosa in a 67 Year-Old Male by: Mohammad Reza Movahedi, BS, Andrew F. Bowers, DMD, Moni Ahmadian, DMD Mohammad Reza Movahedi, BS Andrew F. Bowers, DMD Moni Ahmadian, DMD Mr. Movahedi is a fourth-year dental student at University of Nevada, Las Vegas School of Dental Medicine. Dr. Bowers is a former graduate of predoctoral and general practice residency programs at University of Nevada, Las Vegas School of Dental Medicine. Dr. Ahmadian is an associate professor of oral and maxillofacial pathology in the department of Clinical Sciences and director of the UNLV Oral Pathology Biopsy Service, University of Nevada, Las Vegas School of Dental Medicine, 1001 Shadow Lane MS 7413, Las Vegas, NV 89106, e-mail: moni.ahmadian@unlv.edu. Address correspondence to Dr. Ahmadian. Disclosure: None of the authors reported any disclosure. Featured Article
Summer 25 www.nvda.org 9 humans, most lipomas arise in the trunk and proximal extremities (1). Approximately 15% to 20% of lipomas occur in the head and neck region and of these, only 1% to 4% arise in the oral soft tissues (2). While the etiopathogenesis of lipomas remains largely unclear, several factors have been previously implicated ranging from trauma and endocrine factors to cytogenetic alterations and hereditary factors (3). Although lipomas are more frequently reported in obese individuals, their metabolism is independent of the normal body fat (4). Uncommon in children, most lipomas arise after the age of 40 years with a relatively balanced gender distribution (4, 5). The appearance of multiple lipomas may be associated with underlying hereditary conditions and syndromes such as multiple hereditary lipomatosis, Gardner syndrome, Cowden syndrome, and Madelung disease (5). Clinically, oral lipomas commonly present as a painless, soft and doughy, slow-growing nodular mass that seldom exceeds 3.0 cm in diameter (4, 7). Oral lipomas often exhibit a characteristic yellow hue which may be masked by the overlying soft tissue in deeplylocated tumors (4–8). Oral lipomas may arise in various anatomic locations including buccal mucosa, lip, tongue, palate, and oral floor. The buccal mucosa and buccal vestibule represent the most common intraoral anatomic locations accounting for nearly 50% of these cases (6). On surgical exploration, lipomas appear as well-circumscribed and rounded mass that has a uniform pale yellowto-orange greasy surface (5). The term lipoma encompasses several histological variations which include the conventional lipoma along with other subtypes such as fibrolipoma, myxoid lipoma, angiolipoma, intramuscular lipoma, spindle cell lipoma, sialolipoma, osteolipoma, and chondrolipoma (1–6). Vast majority of oral lipomas are classified as conventional subtype characterized by lobules of monotonous mature adipocytes that are separated by thin fibrovascular connective tissue septa (8). The individual cells are large, exhibiting peripherally-positioned nuclei and prominent lipid vacuoles, and are otherwise indistinguishable from the normal adipocytes. Oral lipomas are best treated with conservative local excision and recurrence is rare (4–8). For the most part the histopathologic variants do not affect the overall prognosis and treatment preference of lipomas (4). Malignant transformation to liposarcoma is exceedingly rare (5). Differential Diagnosis B. Granular Cell Tumor Granular cell tumor (GCT) is an uncommon benign soft tissue neoplasm (9). Originally termed granular cell myoblastoma, it was previously postulated that GCT arises from the skeletal muscle origin (7). However, it is now widely accepted that the tumor is likely neurogenic in nature and of Schwann cell origin (9, 10). Although GCT can arise anywhere in the human body, over 50% of all the cases occur in the head and neck region with a predilection for the dorsal tongue (10). Buccal mucosa represents the second most common intraoral site for GCT (4). Most frequently reported in females, GCT commonly occurs between the fourth to sixth decades of life (7, 9, 11, 12). Usually presenting as an isolated finding, oral GCT appears as a slow-growing, non-ulcerated, firm sessile submucosal nodule exhibiting a yellow to pink hue (7, 9–11). Cases of multiple GCTs have been reported and these may arise synchronously or metachronously (7). Oral GCT is best treated via conservative local excision » Figure 1. Clinical exam reveals a sessile, smooth-surfaced, soft nodular mass with yellow hue involving the right buccal mucosa. Featured Article
NDA Journal 10 and recurrence is uncommon even with incomplete removal (4, 10). Rare examples of malignant GCT have been reported in the literature (7). Histologically, GCT is characterized by large polygonal cells with abundant eosinophilic granular cytoplasm, and small nuclei (10). The granular cells may be arranged in sheets or ribbons, often with a syncytial appearance characterized by indistinct cellular borders (7). The tumor cells typically demonstrate a strong immunohistochemical expression of S-100 protein. The tumor is not capsulated and the tumor cells are often found infiltrating the underlying skeletal muscle (11–12). Furthermore, in as many as 50% of the cases, the overlying surface epithelium exhibits pseudoepitheliomatous hyperplasia which can potentially be mistaken for squamous cell carcinoma (13). Although GCT is included in the differential diagnosis of slow-growing yellow nodules of oral soft tissues, the present case did not demonstrate the characteristic histopathologic features of GCT and was ultimately ruled out. C. Epidermoid Cyst First classified by Meyer and colleagues in 1955, epidermoid, dermoid, and teratoid cysts are benign dysontogenic cystic entities that are derived from the germiniatve epithelium (14). These cystic lesions usually arise in midline structures in areas where embryonic elements fuse together particularly in the ovaries and testes (14, 15). About 7% of cases may occur in the head and neck region with oral cavity only representing 1.6% of the cases (14). Midline floor of the mouth and the sublingual regions are the most common intraoral sites, although rarely they may arise in other oral anatomic locations such as buccal mucosa (14–16). Epidemiologically, dermoid and epidermoid cysts may be present at birth or later in the adulthood with peak incidence during the second to third decades of life (14). Clinically, they usually appear as a slowgrowing, painless sessile-based nodular swelling with an overall » Featured Article doughy and soft consistency (17). The size can vary from a few millimeters to more expansile examples measuring a few centimeters (14). Expansile sublingual cases may clinically displace or elevate the tongue or expand into the submental space creating a double-chin appearance (15). Although the overlying mucosa may have a normal color, the cyst has a characteristic yellow color attributed to the presence of cheesy keratin scales within the lumen (17). Dermoid and epidermoid cysts are typically treated by surgical removal and recurrence is uncommon. Histologically, dermoid cysts are characterized by cystic epithelial lining that resembles epidermis of the skin and contain skin appendages such as sebaceous glands, hair follicles, and sweat glands within the connective tissue wall (16). In contrast, epidermoid cysts lack the skin appendages within the wall (14). Although the clinical appearance of this case with its yellow hue and soft texture along with its long duration and slow-growth, prompted Figure 2. A. Microscopic examination reveals intact surface mucosa overlying a vascularized fibrocollagenous connective tissue containing a well-delineated tumor composed of lobules of adipocytes (H&E stain, original magnification x40). B. The lobules of tightly-packed mature adipocytes are separated by fibrocollagenous tissue septa (H&E stain, original magnification x100).
Summer 25 www.nvda.org 11 Featured Article consideration of epidermoid cyst in the differential diagnosis in spite of its rarity in the buccal mucosa, the microscopic features ultimately ruled out this consideration. D. Schwannoma Also known as neurilemoma, schwannoma is a benign neoplasm arising from the proliferation of Schwann cells of the nerve sheaths (18). Schwannoma can occur anywhere in the human body in association with the peripheral nerves and approximately 25 to 40% of all schwannomas arise in the head and neck region (19). Intraoral schwannomas are uncommon representing only 1% of these tumors. Although, oral schwannoma may occur in any oral soft tissue sites, tongue is the most common location followed by the palate, floor of the mouth, and buccal mucosa (20). Furthermore, extremely rare examples of intraosseous schwannomas arising in the mandibular bone in association with the inferior alveolar nerve have been reported in the literature (21). Schwannoma typically presents as a solitary, slow-growing submucosal nodule or mass with peak incidence in between the third to sixth decades of life and no specific gender predilection (4, 19, 20). Pain is an uncommon finding unless the tumor attains a large size (22). Multiple and multifocal tumors may occur in the setting of neurofibromatosis and schwannomatosis syndromes (4). Schwannomas almost never undergo malignant transformation and they are usually treated with local surgical excision (20). On excision, schwannoma often appears as a white-yellow oval and firm mass with smooth, shiny, and glistening external surface (18, 22). On microscopic examination, schwannoma is typically an encapsulated tumor exhibiting two prominent variable patterns known as Antoni A and Antoni B (4). Antoni A pattern is characterized by streaming fascicles of spindle-shaped Schwann cells with elongated nuclei that palisade around acellular eosinophilic zones known as Verocay bodies (18). In contrast, Antoni B pattern is far less cellular and less organized with spindle-shaped Schwann cells arranged within a loose myxoid stroma (4, 20). The tumor cells demonstrate strong immunoreactivity with S-100 protein (18). Although the clinical appearance of the present case and particularly its characteristic yellow color are less characteristic of schwannoma, this entity was included in the differential diagnosis of a welldelineated and slow-growing soft tissue tumor. However, this case lacked the definitive histopathologic features of schwannoma. Conclusions Oral soft tissues may host a diverse group of pathologic entities ranging from developmental conditions to inflammatory, reactive, and neoplastic processes or manifestations of a background systemic disease. Of these, only a small subset of conditions demonstrate characteristic yellow hue. In formulating the differential diagnosis, the clinical color is often overlooked by the clinicians. However, when applied in the appropriate clinical context, the color can significantly narrow down the differential diagnosis and ultimately pave the way for proper clinical diagnosis. This diagnostic challenge highlights the importance of correlating the color with the history, anatomic location, clinical presentation, and histopathologic features in establishing a definitive diagnosis. 0 References 1. Naruse T, Yanamoto S, Yamada S, et al. Lipomas of the oral cavity: clinicopathological and immunohistochemical study of 24 cases and review of the literature. Indian J Otolaryngol Head Neck Surg. 2015; 67 (Suppl 1): S67-73. 2. Bandeca MC, de Padua JM, Nadalin MR, et al. Oral soft tissue lipomas: a case series. J Can Dent Assoc. 2007; 73(5): 431-434. 3. Pires FR, Souza L, Arruda R, et al. Intraoral soft tissue lipomas: clinicopathological features from 91 cases diagnosed in a single oral pathology service. Med Oral Patol Cir Bucal. 2021; 26(1):e90-96. 4. Neville BW, Damm DD, Allen CM, Chi AC. Soft tissue tumors. In: Oral and Maxillofacial Pathology. 4th ed. Elsevier; 2016. p. 473-526. 5. Goldblum JR, Folpe AL, Weiss SW, editors: Benign lipomatous tumors. In: Enzinger and Weiss’s soft tissue tumors. 6th ed. Elsevier; 2014. p. 418-449. 6. Fregnami ER, Pires FR, Falzoni R, et al. Lipomas of the oral cavity: clinical findings, histological classification, and proliferative activity of 46 cases. Int J Oral Maxillofac Surg. 2002; 32: 49-53. 7. Tavakoli Hoseini A, Razavi M, Khabazian A. Lipoma in oral mucosa: two case reports. Dental Research Journal. 2010; 7(1): 41-43. 8. Schafer DR, Glass SH. A guide to yellow oral mucosal entities: etiology and pathology. Head and Neck Pathology. 2019; 13: 33-46. 9. Serpa MS, Costa-Neto H, Teixeira de Oliveira P, et al. Granular cell tumor in two oral anatomic sites. Eur Arch Otorhinolaryngol. 2016; 273:3439-3441. 10. Tobouti PL, Pigatti FM, Martins-Mussi MC, et al. Extra-tongue granular cell tumor: histological and immunohistochemical aspect. Med Oral Patol Oral Cir Bucal. 2017; 22(1):e31-35. 11. van de Loo S, Thunnissen E, Postmus P, van der Waal I. Granular cell tumor of the oral cavity; a case series including a case of metachronous occurrence in the tongue and the lung. Med Oral Patol Oral Cir Bucal. 2015; 20(1): e30-33. 12. Seki N, Kameyama T, Kihara T, et al. A granular cell tumor of the buccal mucosa- a case report. The Kurume Medical Journal. 1993; 40: 229-232. 13. Ferreira JCB, Oton-Lite AF, Guidi R, Mendonca EF. Granular cell tumor mimicking a squamous cell carcinoma of the tongue: a case report. BMC Res Notes. 2017. http://doi.org/10.1186/s13104-016-2325-7. 14. Dammak N, Chokri A, Slim A, et al. Epidermoid cyst of the buccal mucosa- an uncommon entity: case report and literature review. Clin Case Rep. 2021; 9. doi: 10.1002/ccr3.4853. 15. Teszler CB, Abu El-Naaj I, Emodi O, et al. Dermoid cysts of the lateral floor of the mouth: a comprehensive anatomo-surgical classification of cysts of the oral floor. J Oral Maxillofac Surg. 2007; 65(2): 327-323. 16. Costa FWG, Carvalho FSR, Chaves FN, et al. Epidermoid cyst arising in the buccal mucosa: case report and literature review. Acta Stomatol Croat. 2015; 49(1): 65-73. 17. Daban RP, Diez EG, Navarro BG, Lopez-Lopez J. Epidermoid cyst in the floor of the mouth of a 3-year-old. Case Reports in Dentistry. 2015. https://doi.org/10.1155/2015/172457. 18. Arwade RV, Prakash N, Karjodkar F, et al. Oral schwannoma- an unusual oral presentation: case report and literature review. J Orofacial Research. 2014; 4(1): 55-58. 19. Sharma S and Rai G. Schwannoma on the base of the tongue: a rare clinical case. American J Case Rep. 2016; 17: 203-206. 20. Moreno-Garcia C, Pons-Garcia MA, Gonzalez-Garcia R, Monje-Gil. Schwannoma of tongue. J Maxillofac Oral Surg. 2014; 13(2): 217-221. 21. Nakasato T, Katoh K, Ehara S, et al. Intraosseous neurilemoma of the mandible. Am J Neuroradiol. 2000; 21(10): 1945-1947. 22. Goldblum JR, Folpe AL, Weiss SW, editors: Benign tumors of peripheral nerves. In: Enzinger and Weiss’s soft tissue tumors. 7th ed. Elsevier; 2020. p. 885-958. 23. Manor E, Joshua BZ, Brennan PA, et al. Chromosomal aberrations in minor salivary gland pleomorphic adenoma. J Oral Maxillofac Surg. 2012; 70: 2798-2801. 24. Mendenhall WM, Mendenhall CM, Werning JW, et al. Salivary gland pleomorphic adenoma. Am J Clin Oncol. 2008; 31: 95-99. 25. Khandekar S, Dive A, Munde P, et al. Pleomorphic adenoma of the buccal salivary gland. Journal of Oral and Maxillofacial Pathology. 2015; 19(1): 111-115. 26. Umemori K, Ono K, Kanemoto H, et al. Lip pleomorphic adenomas: case series and literature review. Gland Surg. 2022; 11(10): 1730-1740. 27. Fredrich RE, Li L, Knop J, et al. Pleomorphic adenomas of the salivary glands: analysis of 94 patients. Anticancer Res. 2005; 25: 1703-1705. 28. O’Brien CJ. Current management of benign parotid tumors- the role of limited superficial parotidectomy. Head Neck. 2023; 25:946-952.
NDA Journal 12 Paradigm Lock: Associations of American Physicians and Surgeons For two thousand years, the paradigm of the four humors (blood, phlegm, yellow bile, and black bile) ruled medicine. Disease resulted from an imbalance, which might be corrected by methods such as blood- letting or purging. Galen’s model of human anatomy, based on Hippocratic theory, became the point of reference for all medical theory and practice for the next 1,300 years (https://tinyurl. com/y66mkwdj). Galen’s monopoly was challenged, in the 1600s, by one of the most important discoveries of the scientific revolution: William Harvey’s elucidation of the circulation of the blood (https://tinyurl.com/yccv6wm2). Harvey’s approach, based on experimentation and the accumulation of evidence, became standard practice in science thereafter—although members of the London College of Physicians balked for decades at the idea of overturning Galen’s long-established theories. The method led to many more disruptive ideas, such as the germ theory of disease. We now imagine ourselves to live in the era of scientific and “evidence-based” medicine. But are we really locked into a different, authoritarian paradigm with science as window-dressing? What was once a spirited exploration of the nature of reality by iconoclastic Renaissance men has been debased into “a careerist parlour game for oversocialized nerds,” writes John Carter. In the statistical pettifoggery brought to attention by epidemiologist John Ioannidis in his book Why Most Published Biomedical Research Is Wrong, papers were drawing conclusions from such low levels of statistical significance that even a couple more datapoints can invert the results. This can create headlines of “Vitamin E Causes Cancer” or “Vitamin E Cures Cancer,” both of which papers may have gotten someone a job or a grant (tinyurl.com/2s3teyzk). Featured Article
Summer 25 www.nvda.org 13 “Academia has become a latifundium planted with overbred genetically engineered monocrops, dependent on everincreasing industrial inputs in the form of chemical fertilizer (federal research funding) and herbicides (campus speech controls), producing high-calorie/lownutrient yields (******** papers) from its mineral-stripped soil (diversity hire faculty and diversity admit student bodies).” Featured Article The federal government has a near monopoly on grant funding. Sabine Hossenfelder writes: “Academia has become a latifundium planted with overbred genetically engineered monocrops, dependent on everincreasing industrial inputs in the form of chemical fertilizer (federal research funding) and herbicides (campus speech controls), producing highcalorie/low-nutrient yields (******** papers) from its mineral-stripped soil (diversity hire faculty and diversity admit student bodies)” (ibid.). Peer review is supposed to prevent malinvestment of the public treasury in lunatic ideas and to serve as an error-correction system. It has utterly failed to achieve its nominal purpose. But we no longer have public debates: “the science is settled.” Additionally, in medicine there are pervasive conflicts of interest with immensely profitable private industries. There have been amazing strides in certain areas, such as imaging, chemical diagnostics, medical devices, and surgical techniques. Yet there is a stultifying paradigm lock on population medicine—that just happens to benefit Big Pharma. This has the stated goal of preventing or eliminating disease and keeping people healthy. Much of primary care practice is devoted to vaccines or treatment of risk factors by normalizing “the numbers” (blood pressure, blood glucose, BMI, and lipids). Sick people are referred to specialists, with increasingly long waits. Distressing symptoms that don’t fit a guideline (or might be a vaccine or drug adverse effect) may be written off as “anxiety” or “functional” illness. “Sickness Care” vs. “Wellness Care” A “sickness care system” or “sickness insurance” is often criticized, especially by “universal healthcare” advocates. But the idea that “they that be whole need not a physician, but they that are sick” (Matthew 9:12) is a loser for Big Pharma. A sick person who is cured need not return. A person whose risk factors are being “managed” must be checked regularly. And what more profitable product than annual injections of the whole population? Compliance measures for both patients and “providers” can be required entries in the electronic health record. Galen is replaced by credentialed Experts, and rebalancing humors in the ill is replaced by efforts to permanently alter the immune system in the vaccinated, or to block key metabolic steps as with statin drugs or neurotransmitters with SSRIs. “Insufficient Evidence” An unprecedented atrocity during the COVID pandemic was to block the treatment of sick patients with safe, long-used repurposed drugs, such as hydroxychloroquine and ivermectin, citing “insufficient evidence,” while subjecting them to non-treatment, lethal hospital protocols, or new drugs like remdesivir and Paxlovid, despite evidence of harm. The time-honored approach to discovering new treatments by repurposing existing drugs has evolved from a serendipitous and random practice to a rigorous method grounded in bioinformatics. This improved paradigm can provide safe, effective, and cost-effective treatments for a variety of serious diseases. While previously endorsed enthusiastically by mainstream academia and regulators, it inexplicably lost their support during the COVID-19 pandemic (https://tinyurl.com/38jddcz5). The NY Times hails the idea of repurposed drugs—as long as you are treating a rare disease and not COVID (tinyurl.com/yc28xejd). The scientific paradigm has been corrupted and has become as rigid and authoritarian as the four humors. Like Galen, it is vigorously defended by professional societies. Worse, instead of healing the sick, its purpose is to empower the ruling elite. 0 Editor’s Note: The NDAJ thanks the AAPS for permission to republish this work.
NDA Journal 14 NDA President’s Summer 2025 Message DEAR COLLEAGUES, As I reflect not just on this past year, but really on the past four years serving on the Executive Committee, I’m truly in awe of how much we’ve accomplished… together. There’s a saying that goes: “When you’re chopping wood and no chips are flying, you’re probably not hitting it right.” At times, it felt like we were swinging hard with little to show. But when we found our rhythm, when we started hitting it right, the chips began to fly. And to me, the word that best defines this past year is team. I have never been more confident in the future of the NDA. We are not just on a new path, we’re on the right path. Over the years, I’ve come to know many of my fellow EC and Council members well, and through that journey, I’ve made a lot of personal discoveries too. I’ve seen firsthand the intelligence, passion, grit, and collaboration that define this Association. It has been profoundly inspirational. As I leave this presidency, I take with me not only deep gratitude, but a renewed sense of purpose. We began this year by welcoming our new Executive Director, Ms. Marianna Kacyra, and what a force she has been! Her energy, leadership, and relentless dedication have been transformative. From growing our Patrick R. Silvaroli, DMD membership to building bridges with the State Board of Dental Examiners, strengthening ties with the ADA, and helping to advance our legislative goals, Marianna has been a driving force behind our momentum. Her presence has laid a powerful foundation for the future of organized dentistry in Nevada. She’s the captain of our hockey team, and we’re lucky to have her leading the charge. This year, the NDA rose to meet some of the greatest challenges our profession faces: workforce shortages, insurance reform, and the defense of our clinical standards. In times of uncertainty, we chose action. We chose unity. We reaffirmed our role as the voice of organized dentistry in Nevada. Even when conversations were uncomfortable, or when opinions diverged, we listened. We stood together, not to serve personal agendas, but to do what’s right for Nevada’s dentists and our future dentists. That, to me, is leadership. We forged strong partnerships with UNLV, held critical town halls to confront the workforce crisis. I also want to thank our powerhouse lobbying team Eddie Ableser and Paul Klein of Tri Strategies, for making sure our voice was heard loud and clear at the Capitol. We are Nevada. We are the 14th District. And the ADA knows exactly who we are. That recognition is NDA President’s Article Together, we will continue to elevate dentistry in Nevada and ensure our state is recognized as a national leader in oral health.
Summer 25 www.nvda.org 15 NDA President’s Article hard-earned. And honestly, I’ve never been more excited to be a member of this Association. For the first time in a long time, we’ve created real, tangible value. And we’re just getting started. Most importantly, I want to thank you, our members. Whether you showed up to town halls, wrote letters, challenged the Dentist/Dental Hygiene Compact, stood tall for EFDA or SB495, or simply stayed engaged, you helped shape the direction of our Association. Member voices have always been the compass of our work. Your courage, advocacy, and belief in the mission of organized dentistry made this year what it was. The 2025 legislative session has come to a close. I’m proud to share that several key pieces of pro- dentistry legislation are advancing. You will see policies that protect our profession and support the patients we serve throughout Nevada. Now, more than ever, we must stay united. This is our moment to think boldly, strategically forecast, and lead with intention. Together, we will continue to elevate dentistry in Nevada and ensure our state is recognized as a national leader in oral health. Keep chopping. The chips are still flying. 0 With humble and sincere gratitude, Patrick R. Silvaroli, DMD NDA President
NDA Journal 16 Marianna Kacyra Celebrating a Successful Legislative Season: Thank You, NDA Members! lobbyists, and volunteers, we passed key bills that will directly benefit members and patients across Nevada: • AB202: Creates an external review process for unfair dental claim denials, protecting patients and dentists from improper claim rejections. • AB334: Allows for the immediate licensure of out-of-state hygienists, helping address Nevada’s hygienist shortage and making hiring easier for dental practices. • AB52: Requires prompt payment of dental claims, ensuring faster reimbursements and improved cash flow for dental providers. • AB463: Streamlines prior authorization processes—insurers must respond quickly, and preventive care is exempted from prior authorization. • SB280: Funds a new cleft and craniofacial program at the UNLV School of Dental Medicine, expanding training opportunities and access to advanced care for Nevada families. NDA Executive Director’s Message The success we achieved this year would not have been possible without the collective efforts of our members, leadership, CGA team, lobbyists, and volunteers. It is a testament to the strength of our dental community when we speak with a unified voice. As we conclude the 2025 legislative season, I want to take this opportunity to thank each and every member of the Nevada Dental Association for your involvement, dedication, and support. We just wrapped up an amazing legislative session, one marked by collaboration, advocacy, and meaningful progress for our profession and for oral health in Nevada. Your participation—whether through attending meetings, engaging with legislators, writing letters, or supporting our advocacy efforts behind the scenes—made a significant difference. The success we achieved this year would not have been possible without the collective efforts of our members, leadership, CGA team, lobbyists, and volunteers. It is a testament to the strength of our dental community when we speak with a unified voice. Advocacy Highlights This year’s legislative session was a huge success for the NDA. Thanks to strong teamwork with our CGA team,
Summer 25 www.nvda.org 17 NDA Executive Director’s Message In addition to these wins, we also successfully protected dentists’ interests in several other key bills (SB78, SB268, SB378) and advocated strongly on scope-of-practice issues and workforce priorities. Engagement at the Capitol One of the highlights of this season was our recent Julie Muhle Dental Health Day in Carson City. It was truly inspiring to see dentists, hygienists, and dental assistants from Reno and Las Vegas advocating side by side with us at the Capitol. Their presence and voices were critical in helping us advance our legislative priorities and educate lawmakers about the important role dental professionals play in our communities. Looking Ahead As we look forward to the future, our advocacy work continues year-round. Your ongoing engagement will remain vital as we prepare for future opportunities and challenges. Together, we will keep advancing the interests of our profession and improving access to quality dental care for all Nevadans. Thank you again for your commitment, passion, and support this legislative season! 0 Warm regards, Marianna Kacyra NDA Executive Director
NDA Journal 18 NNDS President’s Message Garrett Swanson, DMD NNDS President’s Summer 2025 Message GREETINGS FROM NORTHERN NEVADA, As summer approaches and we have a changing of the guard in leadership, I want to give an update on the news and events happening here at the NNDS. It has already been a busy start to the year, and we have several exciting events on the horizon! Read on for more. First, I want to recognize Past Presidents Drs. Chris Galea and KC Gilbert for their dedication and support of our society over the last two years. Their tireless work has helped drive the continued success of the NNDS. Second, I cannot express enough gratitude to Lori Murphy, our Executive Director, for her ongoing commitment to organized dentistry. Lori has been the heart and soul of the NNDS for over two decades and has continued to be a treasured resource for us in the north. Lastly, in her relatively new tenure as Executive Director for the NDA, Marianna Kacyra has been doing an excellent job for dentists all across Nevada. Keep up the great work! If you see any of these individuals at upcoming CE dinners or events, please let them know how much they are appreciated. We recently held the highly anticipated event, the Mario Gildone Lifetime Achievement Gala, where we celebrated the exceptional career and accomplishments of Dr. Donna Hellwinkel. This year, for the first time, we also recognized the outstanding contributions of young leaders in dentistry. The 2025 Young Leader Award was granted to the deserving Dr. Kellie McGinley, with nominations including Drs. Whitney Bryant and Scott Sutter. We thank you all for your gracious support and volunteerism toward our profession, our local society, and state. We are so fortunate to have the mix of esteemed veteran and young leaders that we do. If you are looking to get more involved in organized dentistry, our local NNDS is a great place to start! We have a terrific group, and we welcome any dentist in the area who is interested—feel free to come to one of our monthly Executive Committee meetings! The NNDS has continued hosting excellent monthly CE meetings, providing value, convenience, and a chance for our members to catch up with friends and colleagues. We have several more CE meetings coming so be on the lookout for those. Additionally, we held the inaugural Q & A panel discussion with the UNR Pre-dental club in April. This event Importantly, membership in the tripartite associations helps to fund and drive our advocacy efforts in dentistry.
Summer 25 www.nvda.org 19 was a tremendous success, giving prospective dental school applicants insight into the daily lives of dentists and specialists from around our area. The comradery of our members has always been the strength of the NNDS, and we have several upcoming social events we hope you join us at! Mark your calendars for Cheers & Beers at Beer NV on June 26, our annual NNDS Picnic (families NNDS President’s Message welcome!) on August 14, and… back by popular demand, the Mystery Bus Trip on September 12! Importantly, membership in the tripartite associations helps to fund and drive our advocacy efforts in dentistry. Most recently by garnering support for the governor’s bill (AB495) which aims to address the hygienist shortage in NV. Monitoring this and other important pieces of legislation is how we strive to make positive changes for our patients and our profession. Thank you to all our members for being the best part of the Northern Nevada Dental Society. We’ll see you soon! 0 Garrett Swanson, DMD NNDS President
NDA Journal 20 SNDS President’s Message Sonal S. Shah, DDS FAAOMPath, FAAOMed SNDS President’s Message HELLO AND GREETINGS TO ALL! I am honored to be your new SNDS president for this year. I would like to briefly introduce myself. I am an Associate Professor of Oral Pathology and Oral Medicine at UNLV as well as an active oral medicine clinician at the UNLV Faculty Dental Practice. I was previously at NYU and moved from New York City to Las Vegas almost four years ago. I was very active with the ADA tripartite in New York and have brought that same energy and enthusiasm with me. Since moving here, I have been actively involved with SNDS as secretary, vice president and CE Chair. I also proudly serve as one of the SNDS delegates for the Nevada Dental Association House of Delegates. The SNDS has been quite active so far in 2025. We have had several successful happy hour social events to attract new members and reach the younger dentist population. We have delivered high quality required CE such as the opioid and controlled substance course and the infection control course. We are pleased to have added CPR certification to our member offerings. These were all very well attended events. We had presentations by the UNLV and Nellis GPR residents at our April in-person membership dinner meeting. Your SNDS is currently hard at work preparing for the summer NDA House of Delegates meeting to represent the interests of all Southern Nevada dentists. I am so excited to work with the SNDS Executive Board, Executive Director Esther Yosef and the Nevada Dental Association to promote the voice and power of organized dentistry in our state. My immediate goals are to increase membership and renewals by promoting the value, member benefits and unparalleled camaraderie that SNDS offers as well as actively engage our current members. It is not too late to renew or join our SNDS family at discounted mid-year rates that are all-inclusive with CE and peer review to name a few key benefits. Please feel free to reach out to me at any time. I am looking forward to a great year for the SNDS! 0 Sincerely, Sonal S. Shah, DDS, FAAOMPath, FAAOMed SNDS President We have had several successful happy hour social events to attract new members and reach the younger dentist population.
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