NDA Journal Winter 2025

NDA JOURNAL Winter 25–26 Volume 27, Issue 4 Official Magazine of the Nevada Dental Association and Component Societies A Peer Reviewed Journal

WINTER 25–26 NDA JOURNAL Editor’s Message Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD 2 Featured Articles Three System Resets to Strengthen Your Practice for 2026 12 When Evidence-based Medicine Goes Full AI 16 Medical Groups Are Suing the HHS Over Vaccine Policies—and It’s a Good Thing 18 COVID-19 Injections: Harms and Damages, a Non-Exhaustive Conclusion 21 Sections Event Calendars 32 Administrative Offices & NDA Committees 33 On the Cover Capt. A. Ted Twesme, United States Navy Dental Corps OMS, 1948–2025 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. © 2026 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 The Twesme Family including: Lee, Erika, Mary, Ted, Joe, and Christine

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 Second to None Mary Twesme called me Thanksgiving week advising that our NDA colleague Dr. Ted Twesme was hospitalized with an aggressive metastatic lesion. I was able to visit Mary and Ted that afternoon, November 25th. He didn’t look well, but was lucid and articulate. True to our usual irreverent exchanges, I asked him what he was doing in bed because I needed his help on a case. I left, hoping the awful prognosis was inaccurate; it was not. Ted passed away just days later, December 5th. The family asked me to help fill in some professional blanks from 1979 through 2025 for his obituary, which was published December 7th., Ted was a singularly positive force in dentistry as a local, state, regional, and national leader for the better part of 50 years. In all our NDA-related adventures together, I only remember one remotely critical query about Ted, although it was repeated a few times: “How do you pronounce his name?” More often than not, the guess was Tweeesme or Twesum. Ted arrived in Las Vegas shortly before I did in 1979. We got to know of each other quickly and began to work our major hospital cases together immediately, a paradigm we continued for decades. I was always grateful when Ted was across the OR table from me for the crazy stuff we used to do. (Figures 1,2,3 (with patient permission), 4) When we arrived, we both applied for privileges at Southern Nevada Memorial Hospital, now University Medical Center (UMC), Humana Hospital Sunrise (HHS), and Valley Hospital Medical Center (VHMC). Las Vegas hadn’t seen dentists requesting our scope of privileges before and a few competitors in other specialties were concerned. UMC was actually pretty straightforward. My office was on campus and I was offered that space when I agreed Figure 3. Post-op Figure 2. Preped Figure 1. Pre-op Viewer Discretion Is Advised Viewer Discretion Is Advised

Winter 25–26 www.nvda.org 3 Editor’s Message I was offered that space when I agreed to make sure facial trauma was not sent to Southern California anymore, as was common at that time. I established a scheduled call with myself, Ted, and stalwarts such as Richard Hamilton, Juel Parker, and Gerry Hanson. We kept the cases in Las Vegas. Next, OMS friendly VHMC General Surgeon Terry Banich agreed to convene a panel to interview Ted and I. The Chief of Plastic Surgery (PSx) advised the group that he had personally managed twelve major facial fractures during his residency. He then wanted to know what we had to say about that. I lifted my shoebox full of operative notes (Ted was also ready with his) from the floor and shared that I had personally managed over 300 major OR cases ,and “here they are.” Dr. Banich confirmed there were no other questions or comments, we received our privileges, and moved on. HHS was the last OMS privilege holdout. This time ENT was our primary adversary. The panel now had a series of questions they wanted to ask. Since I had applied for cleft palate privileges, ENT wanted to know my operative technique. I reported that I had worked with OMS James Bertz, of Phoenix. Dr. Bertz had trained with Dr. Ralph Millard, a historical PSx guru. I then explained my Millard-ish method. Then HHS Chief of Surgery, Richard Colquitt, advised the panel that since OMS was being asked questions, it was only fair that OMS be able to pose questions too. He had asked Ted and I before the meeting if that would be OK.☺ I asked the ENT doctor to describe what was going on histologically at 3–4 months in utero for a cleft patient. That session ended without an answer offered. We received our privileges again: bone and skin grafts, TMJ, salivary glands, vessel and nerve microsurgery, cancer, tracheostomy, etc. » However, at that time, dentists were not specifically granted privileges for hospital admission H&Ps. Drs. Hanson, Twesme, and myself decided to divide and conquer, with Gerry taking on Sunrise and Ted Desert Springs, leaving me with VHMC and UMC. I simply started completing H&Ps at VHMC and UMC. By the time any naysayers saw what was happening, three months-worth of OMS admissions had been perfected, and the question was moot. Over at HHS, Gerry convinced the ADA to draft a letter to Sunrise threatening anti-trust issues and “heavy damages.”3 The letter follows this editorial. The ADA missive was effective, and Sunrise quickly acquiesced. Unfortunately, at DSH, Ted had been trying to go through regular protocol channels but was having trouble making any progress. I could see the issue dragging out for a year or more so started my same treatment plan of just doing H&Ps for trauma admissions. It didn’t take long for both Gerry and Ted to call, and both were upset with me for cutting Ted’s assigned DSH grass. Fortunately, because the ADA’s letter was making hospital rounds in Las Vegas, it soon became a non-issue again. Even though Gerry, Ted, and I had developed different treatment plans for H&Ps, the three-pronged approach proved effective again in the end. Soon, Senator-Doctor Ray Rawson spearheaded the law that recognizes the right of qualified dentists to perform H&Ps for entities such as hospitals,4 school sports physicals, etc. Later, the Boy Scouts of America welcomed dentists H&Ps.5 (Figure 5) That was not the first, nor last, time we three had disagreed about political treatment plans, but we always worked things out, never burning bridges. Ted and I had both applied to take the 1981 ABOMS oral examination to become board certified. That exam was given during a dreary winter at the Drake Hotel in Chicago where we were room partners. Board certification was singularly difficult, not as bad as my 1978 NSBDE exam at UOP where only six of 36 Figure 4. Drs. Twesme and Orr, UMC 1994

NDA Journal 4 Editor’s Message » applicants passed, but close enough. The evening before our multiple one-hour oral examinations, we saw a colleague reading the index of a two-volume OMS tome “to see if there was anything he didn’t know.” Speaking of esoteric facts, one thing Ted was ready for was knowing the components of local anesthetic carpules, because I had quizzed him on it the night before. At that time there were nine things in the carpule from the local to the vasoconstrictor to the preservative and so on up to the nitrogen bubble antioxidant. I was pleased I knew something Ted didn’t know, a rare occurrence. (Figure 6) The next day as we recovered from our tests, we shared our experiences. I had been asked to deal with a lady in active labor with a broken jaw, but my examiners didn’t care about the fracture, just the labor. Fortunately, after about 60 epidurals for deliveries during my anesthesiology residency, I stumbled through the OB case somehow. Ted, with his trademark smile, shared that he had been asked what was in local anesthetic. I thought he was kidding, but he was dead serious. What awesome timing, everything is a miracle. Ted told me he expounded with eloquence for 25–30 minutes. Ted always had great timing. Also in the 1980s, Dr. Hanson proposed that the NSSOMS establish an Anesthesiology Committee to societally accredit OMS and their offices for the provision of general anesthesia (GA). I was Chair as the only dentist in Nevada that had completed an Anesthesiology residency. Dr. Tom Myatt from Reno and I were the first evaluators, and continue to perform that function for the NSBDE today. Ted was put in charge of writing language for the expected statutes to follow. Sure enough, the NSBDE soon wanted to coordinate our NSSOMS GA paradigm and I transferred all our records and materials to the Board to copy. Ted developed language for the NRS and the efforts were quickly adopted by the legislature. This all proved providential to dentistry later in 2008 secondary to the Endoscopy Center of Southern Nevada hepatitis crisis.6 During the Endoscopy Center civil and criminal trials, the explanation of the etiology of suspected hepatitis transmission was a convoluted theory involving multi-use Propofol vials. That was nonsense. I received validation of that conclusion from the Epidemiology RN Nevada retained to oversee state interests in the investigation. She had become my patient and advised me that the cause of any hepatitis transmission would have been ineffective sterilization of colonoscopy instruments. However, the plaintiff attorneys involved convinced the jury that the problem was the unsafe administration of Propofol, which is where the deep-pocket dollars resided. This is where Dr. Twesme’s legislation proved heroic. The Nevada Legislature then reflexively Figure 5. AAOMS Forum, BSA H&Ps Figure 6. 2% Lidocaine Carpule

Winter 25–26 www.nvda.org 5 Section Header Editor’s Message proceeded to propose banning all GA unless the facilities were nationally accredited, a virtually impossible task for dental offices. Ted and I then pointed out to the legislature that the NSBDE had been accrediting dentists and dental facilities for decades and that Nevada dentists held a safety record second to none, including accredited hospitals. Dental offices then became exempt from the resulting statue and continue to provide sedation and GA safely to tens of thousands of patients annually. We dentists must remain vigilant self-regulators to avoid future third-party intrusions.7 Ted and I disagreed another time during a NSBDE GA evaluation. One of the required drugs “expired” on the date we were visiting. Ted opined that meant it was unacceptable at the beginning of the day, while I opted for at the end of the day. During later research I found there was no official answer. What I did find was that expiration dates are actually marketing tools enabling drug manufacturers to move product. I wrote an editorial which included how hypocritical the government is with the SLEP (Shelf-Life Extension Program) that warehouses millions of doses of drugs after expiration dates because, indeed, they are still safe and effective.8 For years, we were each other’s primary OMS back-up. That relationship helped UNLV Basketball win its National Championship in 1990. Greg Anthony fractured his mandible six weeks before the Final-Four. Everyone thought we had lost him for the season. But I had a high-schooler in Moapa effectively playing basketball while in intermaxillary fixation (IMF), so knew playing was possible. (Figure 7) Greg wanted to play, so after obtaining consent from Greg, his mom, and UNLV, I opined, as the UNLV Sports Med OMS, that Greg could play, but only if an OMS was immediately available in case an airway needed to be emergently established, such as secondary to a nasal fracture while in IMF. I was in my normal seat at the Thomas & Mack, with advanced airway instrumentation at hand, for the last games in 1990 and then UNLV was scheduled for the PCAA Tournament in Long Beach. Head UNLV Trainer Jerry Koloskie called to tell me that the PCAA and NCAA would not give UNLV permission to have an extra seat on the floor. But more timing is everything coming…at a Loyola-Marymount practice, heart patient All-American Hank Gathers collapsed and died at a practice. There was a defibrillator courtside but no one knew how to use it. The next morning Jerry called me back urgently to make sure I could come to the PCAA and NCAA tournaments which had both now insisted emergency personnel be available. But, I had now scheduled patients. I couldn’t make it down…but…I kindly offered to check if Dr. Twesme could make it. Ted stepped-up, was Figure 8. Dr. Twesme demonstrated great timing yet again working with Greg Anthony Figure 7. Greg Anthony »

NDA Journal 6 Editor’s Message » functional at the PCAA, (Figure 8) and UNLV progressed to win the Championship. At times, Ted even acquiesced to cover out-oftown events, such as football vs. Wisconsin at Camp Randall Stadium. In 1999 I lost tooth #1 into a patient’s infratemporal fossa (IF). Retrieving a foreign body from the IF is not a straightforward proposition and generally requires a bicoronal flap. I attempted to retrieve the tooth for over an hour on a sedated office patient. Fortunately, I was able to figure things out and successfully effected the aberrant extraction. The patient recovered with no memory of the incident and without complication. Two to three weeks later I received a call from Ted asking for my help on a hospital case that required a bicoronal flap. I confirmed the case involved a displaced third molar and offered to help Ted with a different technique. Later, in Ted’s office we recovered the patient’s tooth in less than two minutes. Ted explained he was “happy as a clam,” and that I should publish the procedure. Once again, Ted had motivated me to do something productive. The work has been referenced for decades now.9 Generally, I don’t disclose the entire story, although I did with Ted the day we saved his patient a hospital admission. After accomplishing nothing for over an hour with my patient, I asked for a “time-out” from my assistants and turned towards the wall where I petitioned Heavenly Father in a few seconds prayer. By the time I turned back to my patient I knew the answer to the dilemma. I told my Lutheran pal Ted about the LDS prayer, proving it wasn’t “my” idea. I knew I could trust Dr. Twesme, both to understand the process and keep the confidence. Now I’ve written my confession to the entire NDA. Ted inspired my writing frequently. The editorial in last issue of the Figure 9. 1974 Marine Corps Base Dental Clinic, Twentynine Palms, California Figure 10. 1964 Eagle Court of Honor, Dr. Twesme, Judge and Mrs. Twesme, Parents

Winter 25–26 www.nvda.org 7 Section Header NDAJ revolved around something he taught me in surgery with one of his countless pithy idioms: “The enemy of good is better.” In addition, Ted made me laugh with: “payday on the Wabash,” “socks on a rooster,” and “jumbo shrimp.” Sometimes I had no idea what his point was, but his delivery was enough to make me crack up.10 In spite of occasionally joking about the irony of the phrase “naval intelligence,” Captain Twesme was grateful for the opportunity to serve his country for over three decades as a respected active duty and reserve OMS in the Dental Corps of the United States Navy. (Figure 9) NDAJ readership knows of Ted’s service to our profession as President of the SNDS, NDA, and NV SSOMS, among other entities. Matters were in good hands when Ted was in charge. Thank heavens Ted was never interested in being an Editor, although he was gracious enough to report actually reading the NDAJ from time to time. Nationally, the ADA would frequently visit Las Vegas for its Annual Meeting and Ted was always part of the NDA’s Local Organizing Committee (LOC). In 1995 he was the LOC Chair for the most attended ADA Annual Meeting in history. In the regulatory sphere, he was also the President of the Nevada State Board of Dental Examiners and a Member of the American Board of Dental Examiners. His regulatory goal was to effect reasonable and legitimate licensure of dentists nationwide. He never abused his positions of power and authority, always doing the right things in kind ways. Ted’s impressive career was somewhat foreseeable when he became one of 2% of all Boy Scouts to achieve the rank of Eagle Scout as a youth in Wisconsin. “Teddy” also earned the Lutheran faith’s “Pro Deo et Patria” religious award. (Figures 10,11) Ted left us quickly, barely a month passed between his illness manifesting and his passing. That may have been a blessing for our friend and his family. In early October, before anyone knew Ted was ill, I felt a prompting that I should nominate Ted for the National Outstanding Eagle Scout Award (NOESA). A day later the idea recurred but in a much more compelling fashion, which caught my attention. Prior to submitting Ted’s nomination to the Las Vegas Area Council (LVAC) and the national office of Scouting America, I needed Ted’s updated CV. Typical of Ted, when I called, he asked: “Am I in trouble?” During our hospital visit November 25, I made the decision to modify NOESA guidelines that nominations be kept confidential and share with Ted that NOESA paperwork for him was progressing. I shared with Mary that this award is presented at the LVAC Annual Dinner in the spring. I was not confident Ted would last that long in mortality. When I checked in with the LVAC office that day, I was told that his application had been approved unanimously by the Council and had been forwarded to National for approval there. I requested that the paperwork be perfected as soon as possible. I checked the next day and the LVAC confirmed it was being expedited at National. Time was of the essence because the NOESA is not awarded posthumously. Mary called me again early on the morning of December 5 to say Ted had passed on. I had followed up with the Scouts the afternoon of December 4 and learned his application had been approved that day, less than 24 hours before Ted moved on to the next sphere. The award can be presented posthumously, and Dr. Twesme will now be recognized as a 2025 National Outstanding Eagle Scout. Yet again, Ted had great timing. Scouting America will be consulting with the Twesme Family to determine when and where they would like the NOESA ceremony to take place and that information will be provided to the NDA. Goodbye my Friend, with a boatload of gratitude for enriching my life, and putting up with me. Fight On! 0 And, as a courtesy to you, Dr. Twesme, Go Wisconsin! Dan II. References 1. Twesme Family, Orr D, Obituary A Ted Twesme, LaCrosse Tribune, https://www.legacy.com/us/obituaries/lacrossetribune/name/alberttwesme-obituary?pid=210463412&utm_source=MarketingCloud&utm_ medium=email&utm_campaign=GBNewEntryAlert_ 053024&utm_content=%%%3dRedirectTo(%40ObitUrl)%3d%%&sfmc_ id=72949607&env=22145d19621934db22cd6e3e17ac8c4dccad 045fe0fd256bf96a2de1309e3333&et_rid=72949607, accessed DEC 15, 2025. 2. Twesme Family,, Orr D, Obituary, Dr. Albert Twesme, Las Vegas Review Journal, https://obituaries.reviewjournal.com/obituary/albert-twesme- 1093367778, accessed DEC 15, 2025. 3. Sifkis PM, ADA Letter to Sunrise Hospital 4. NRS 631.267, 1984. 5. AAOMS, Boy Scouts of America Recognize Dentist’s Right to Perform H&P, Forum Autumn 1993. 6. Wikipedia, Endoscopy Center of Southern Nevada, https://en.wikipedia. org/wiki/Endoscopy_Center_of_Southern_Nevada, accessed DEC 17 2025. 7. Orr, Cottages No More, J Am Dent Assn, 140, 960–964, August 2009.+ 8. Orr D, Diet Dr. Pepper™ and SLEP, NDA Journal, 18:4, 3–4, 2016. 9. Orr D, A Technique for Recovery of a Third Molar From the Infratemporal Fossa, J Oral Maxillofac Surg, 57:1459–1461, 1999. 10. Pumbing for Daughters…or Dr. Twesme was Correct, NDA Journal, 27:3, 2–5, 2025. Figure 11. Teddy Twesme Pro Deo et Patria Editor’s Message

NDA Journal 8 Editor’s Message

Winter 25–26 www.nvda.org 9 Editor’s Message

NDA Journal 10 Editor’s Message

Winter 25–26 www.nvda.org 11 More Members. More Sponsors. More Revenue. More of What You Need to Grow. Grow Your Business. Give Back to the Industry. ADVERTISE NOW! Follow us on: Visit our website at: www.bigredm.com Put your brand in front of the people who matter most while supporting the association that brings them together. Advertising in your association’s magazine helps you grow your business, strengthen your industry presence, and contribute to the resources members rely on. It’s targeted, trusted, and truly impactful. For more information, please contact: Kara Mortl • 248-250-3655 • kara@bigredm.com

NDA Journal 12 Featured Article Three System Resets to Strengthen Your Practice for 2026 Running a dental practice today is demanding. Dentists are expected to provide excellent clinical care while also managing staffing shortages, unpredictable insurance reimbursements, and rising operational costs. Some of the most powerful levers for stability, growth, and reduced stress lie not outside one’s practice, but within it. By strengthening core systems, practices can: 1. Achieve financial stability, where predictable revenue replaces month-to-month stress. 2. Support healthier patients by better long-term outcomes. 3. Build a stronger reputation. Year-end is an ideal time to reset three foundational systems. The three areas that matter most are recall and reactivation, case acceptance, and follow-up treatment. 1. Recall and Reactivation Patients miss hygiene appointments for many reasons, and these potential gaps accumulate into a large revenue leak. That is why recall and reactivation systems are the first place to look. Strong recall systems do more than fill the schedule; they keep patients healthier and reinforce your practice’s role as their trusted partner in oral health. Consider This: the average dental office loses about 17% of its patients each year, yet practices that implement proactive recall strategies can boost retention by as much as 25% (Arini.ai). Other research shows most practices operate with 60–70% recall effectiveness, while Melissa French* top performers can achieve 10–30 percentage-point improvements with better systems (PracticeAnalytics. com). A patient retention rate of 85% or higher means that nearly nine out of ten patients should be returning for hygiene and preventive care (DentalBilling.com). Questions to ask one’s team: • Who specifically owns the responsibility for overdue patient outreach? • How are patients being reminded—phone, text, email, or a combination? • Is recall performance measured monthly and discussed in team meetings? Best Practice: Practices that set monthly reactivation goals, assign specific staff to carry them out, and review results regularly, see immediate gains in both chair utilization and patient outcomes. One of the most overlooked revenue leaks occurs when patients begin treatment and fail to complete it. Incomplete treatment affects both patient outcomes and practice performance. Incomplete care also has a deeper consequence: it signals to the patient that their continuity of care isn’t being actively monitored. This erodes trust and reduces the likelihood of referrals and repeat business. While less publicized than recall or case acceptance, the growth potential here is enormous. Practices that

Winter 25–26 www.nvda.org 13 Featured Article improve workflows for case acceptance and treatment follow-up can grow by 30–50% in revenue within three to five years—even without adding new hours or major technology investments (DentalEconomics.com). Strengthening follow-up requires: • A clear protocol for tracking incomplete treatment in the practice management system. • Designated staff responsible for contacting patients with reminders. • Use of secure communication channels (text, portal, email) to make follow-up easier for patients. • Integration of follow-up into team meetings so progress is reviewed. Best Practice: Some practices assign each treatment coordinator a caseload of “open cases” to manage, with weekly progress updates. This creates accountability and helps ensure no patient slips through the cracks. 2. Case Acceptance Workflows: From Diagnosis to Scheduled Care When treatment plans go unscheduled, practices lose significant revenue. In many cases, recommended care is left unrealized each year, not because patients reject treatment, but because the acceptance process is inconsistent or poorly managed. Industry statistics reveal the hidden cost of inefficiency. Average case acceptance rates sit at just 50–60% for established patients and only 25–35% for new patients, far below the industry target of 90% (Truelark. com). A Levin Group survey found that two-thirds of U.S. practices operate in the 20–50% range, underscoring how widespread the performance gap really is (DentalIntel.com). On the other hand, top-performing practices demonstrate what’s possible when systems are optimized: practices in the top quartile achieve case acceptance rates of 75–90%(Truelark.com). Improving case acceptance isn’t about “selling.” It’s about ensuring patients clearly understand the why, the how, and the next step of their treatment. A strong workflow makes this seamless for the patient and predictable for the practice. Key elements of effective workflows: • Clarity: Patients must understand the health benefits of treatment. • Consistency: Every patient should have a similar, professional experience when a plan is presented. • Financial Transparency: Cost is often the biggest barrier. Having financing options explained immediately removes hesitation. • Ownership: One person should be responsible for following up. Best Practice: Many successful practices create a “handoff” system. The dentist explains the treatment’s importance, then a designated team member discusses planning and finances, and finally another staff member ensures scheduling happens before the patient leaves. The ROI impact: Moving case acceptance from, say, 55% to 70% can be transformative. For a practice recommending $1 million in treatment annually, that is an additional $150,000 in scheduled care. 3. Treatment Follow-Up: Closing the Loop One of the most overlooked revenue leaks occurs when patients begin treatment and fail to complete it. Incomplete treatment affects both patient outcomes and practice performance. Incomplete Care Also Has a Deeper Consequence: it signals to the patient that their continuity of care isn’t being actively monitored. This erodes trust and reduces the likelihood of referrals and repeat business. While less publicized than recall or case acceptance, the growth potential here is enormous. Practices that improve workflows for case acceptance and treatment follow-up can grow by 30–50% in revenue within three to five years—even without adding new hours or major technology investments (DentalEconomics.com). Strengthening follow-up requires: • A clear protocol for tracking incomplete treatment in the practice management system. • Designated staff responsible for contacting patients with reminders. • Use of secure communication channels (text, portal, email) to make follow-up easier for patients. • Integration of follow-up into team meetings so progress is reviewed. Best Practice: Some practices assign each treatment coordinator a caseload of “open cases” to manage, with weekly progress updates. This creates accountability and helps ensure no patient slips through the cracks. The ROI Impact: Closing even a fraction of open treatment plans can add significant production. For a mid-sized practice, recovering just 20 incomplete crown or implant cases could be $30,000–$50,000 in additional revenue, while simultaneously delivering better patient outcomes.»

NDA Journal 14 A Practical Checklist Consider presenting this checklist in team meetings: • Generate a list of overdue patients and assign reactivation calls or texts. • Review your case presentation process: who explains, who discusses finances, who schedules, who follows up. • Audit incomplete treatment reports and assign ownership for follow- up outreach. • Set monthly goals for recall, acceptance, and follow-up—and review results as a team. • Recognize team members who contribute to system improvements. Looking Ahead Continued challenges for dental practices: staffing pressures, changing patient expectations, and ongoing financial uncertainty, don’t have to dictate whether a practice thrives. By resetting these three systems—recall and reactivation, case acceptance workflows, and treatment follow-up—controllable factors that influence both patient care and financial health are being directly addressed. These systems do not require expensive technology or major investments. What they require is focus, accountability, and consistency. Taking these steps now can be a powerful way to differentiate in a competitive market. When these processes run smoothly, your practice benefits in three ways: • Financial Stability: predictable revenue replaces month-to-month stress. • Healthier Patients: fewer people fall through the cracks, leading to better outcomes. • Stronger Reputation: patients feel cared for, finish their treatment, and refer others. Consider taking the time to strengthen these foundations. Doing so can protect a practice against uncertainty and position it with growth. *Melissa French is the Founder and Principal Consultant of Perspective Consulting Group, www.perspectiveconsults.com Featured Article » 65% 55% 30% 83% 90% 90% 75% 85% 100% 95% 85% 92% 0% 20% 40% 60% 80% 100% 120% Recall Effectiveness Case Acceptance (Existing Patients) Case Acceptance (New Patients) Patient Retention Percentage (%) Practice Performance Gaps Chart Current Avg Industry Target Top Performers Revenue Insights (ROI Impact): +10% Recall → More hygiene visits Case Acceptance 55%→70% → +$150k/year (on $1M in treatment plans) 20 Crown/Implant Cases → $30k–$50k/year Sustained Gains → 30–50% growth (3–5 years)

Winter 25–26 www.nvda.org 15 ADVERTISE TO SUPPORT YOUR ASSOCIATION! For more information, please contact: Kara Mortl 248-250-3655 kara@bigredm.com

NDA Journal 16 When Evidence-based Medicine Goes Full AI by: Patrick Wood Artificial intelligence (AI) is envisioned by many to be the future of medicine, and it is critical to understand its implications and the background of technocracy, which AI will serve. As defined by The American Heritage® Dictionary of the English Language, 5th Edition, “Technocracy is government controlled by technicians; where people in certain fields govern in their areas of expertise, for example lawyers, engineers, psychologists, climatologists, doctors.” Technocracy is an old idea. As described in a 1934 study course:1 Technocracy is dealing with social phenomena in the widest sense of the word; this includes not only actions of human beings, but also everything which directly or indirectly affects their actions. Consequently, the studies of technocracy embrace practically the whole field of science and industry. Biology, climate, natural resources, and industrial equipment all enter into the social picture. Under technocracy, its advocates state there will be no place for politics or politicians, finance or financiers, rackets or racketeers. The means of distribution of everything will be a certificate of distribution available to every citizen from birth to death. The goal is to micromanage everything in the universe. The worldview is purely mechanistic. There is no place for the sanctity of human life. In 1992, the Biodiversity Convention2 implicitly equated the diversity of life—including animals and plants—to the diversity of genetic codes. Thus, diversity becomes something that modern science can manipulate. Additionally, the Convention promotes biotechnology as being “essential for the conservation and sustainable use of biodiversity.” The key issue is ownership and control over biological diversity. The major concern was protecting the pharmaceutical and emerging biotechnology industries, which was not mentioned in the press coverage. One Health What started as conservation policy morphed into an alien, encompassing justification for managing human health, behavior, and land use under the single umbrella of biospheric health—a core and overlapping tenet of Gaianist ideology. Previously, man ruled over nature. Now, nature rules over man. As “planetary” health became a unifying policy narrative, environmental treaties and public health policies began to merge. Surveillance and intervention regimes expanded to cut across environmental, agricultural, and health sectors. The protection of “ecosystem integrity” has become a justification for behavioral and economic controls. The “One Health” concept was articulated in 2004 by the Wildlife Conservation Society in the Manhattan Principles. The “One World, One Health” conference, hosted by Rockefeller University, was widely attended by high-level representatives from the Centers for Disease Control and Prevention (CDC), the UN Food and Agriculture Organization (FAO), the World Health Organization (WHO), the International Union for Conservation of Nature (IUCN), the United Nations Environment Programme (UNEP), and others. Twelve “recommendations” to merge human health into the ecosystem were proposed for universal adoption. “Global problems need global solutions.”3 “In a nutshell, One Health means that the health and wellness of all living things on this planet is interconnected.”4 In one image,5 an individual human is pictured in a small circle inside a larger one with a group of people (labeled “Public Health”) inside one showing several groups of humans (“Global Health”) inside one showing humans and animals (“One Health”) inside and overlying a very large one depicting land masses, ocean, and clouds (“Planetary Health”). According to One World—One Health:6 “No one discipline or sector of society has enough knowledge and resources to prevent the emergence AI already oversees the automated office. It is in charge of intake data, and provides AI diagnosis, AI treatment options, AI prescriptions, medical coding, and billing. Featured Article

Winter 25–26 www.nvda.org 17 Featured Article or resurgence of diseases in today’s globalized world. • “We are in an era of ‘One World, One Health’ and we must devise adaptive, forward-looking and multidisciplinary solutions to the challenges that undoubtedly lie ahead. • “Solving today’s threats and tomorrow’s problems cannot be accomplished with yesterday’s approaches. • “Only by breaking down the barriers among agencies, individuals, specialties and sectors can we unleash the innovation and expertise needed to meet the many serious challenges to the health of people, domestic animals, and wildlife and to the integrity of ecosystems.” In the One Health view, a human being has no more value than a fish in a stream or a rock on the hill. Humans are now part of the mix of resources. Federal agencies are saturated with this view. The U.S. Department of Agriculture (USDA), National Institutes of Health (NIH), CDC, Environmental Protection Agency (EPA), National Library of Medicine (NLM), and the Climate Program Office all have a One Health policy department. Artificial Intelligence (AI) in Medical Practice AI has emerged as the primary tool of technocracy. Chat GPT hit the world like a storm, and new releases are leapfrogging each other. It is now emerging to take over human health, and physicians are poised to be squeezed out altogether in accordance with One Health. AI already oversees the automated office. It is in charge of intake data, and provides AI diagnosis, AI treatment options, AI prescriptions, medical coding, and billing. It leads the process to preconceived conclusions. Doctors accept the default options during the encounter. They are absolved from responsibility for bad outcomes because “AI said….” If they do not follow the AI-recommended protocols, doctors risk loss of billing income, job loss, and even loss of their medical license. Extensive data is collected on every patient and encounter. It goes to Big Tech, including Google, Amazon, and Microsoft, which are critical infrastructure providers and increasingly are becoming quasi- healthcare companies. Electronic health records vendors control the clinical workflow data. Payers and pharmacy benefits managers (PBMs) own claims and pharmacy data. Health Information Exchanges (HIEs) connect disparate systems. Data brokers monetize large data sets. The Palantir Foundry is in control of all U.S. government intelligence data and now is becoming the master umbrella, with silos removed, of all health data. This includes EHRs, claims data from insurers and HMOs, pharmaceutical and clinical trials data, public health databases, and genomics and biomedical research databases. A promised benefit of Trump’s Project Stargate is described by Larry Ellison, founder of Oracle, who has no medical background. He states that tiny pieces of early cancers circulate in the blood. It should be possible to diagnose a developing cancer by blood test, sequence the cancer, and robotically prepare an mRNA vaccine for the individual patient within 48 hours.7 A potential worrisome outcome is that AI predicts that you will get a certain cancer(s) or other diseases during your lifetime, and you cannot get a second opinion. If you refuse treatment, you will lose future benefits, and your insurance ratings will fall. Informed consent is a failed concept. If you accept treatment, you will promptly receive your first “vaccine.” Your DNA is sequenced, exposing you to repeated predictions of future diseases. Then you remain on the treadmill until you die. Possible consequences of the triumph of technocracy are portrayed in the new movie: The Agenda: Their Vision, Your Future. The destruction of representative government, national sovereignty, and ethical medicine could be irreversible. This article is based on a presentation at the 43rd annual meeting of Doctors for Disaster Preparedness in Tucson, Ariz., Jul 5, 2025. Available at: https://www. youtube.com/ watch?v=zxYdRwaXuUA/. Patrick Wood has studied technocracy for 34 years and authored several books on the subject. See https://technocracy.news. Contact: pwood@coherent.pub. References 1. Hubbert MK. Technocracy Study Course. Technocracy, Inc.; 1934. Available at: https://archive.org/details/TechnocracyStudyCourse1945/ TechnocracyStudyCourse/. Accessed Aug 12, 2025. 2. De Chazournes LB. Convention on Biological Diversity. Audiovisual Library of International Law. Available at: https://legal.un.org/avl/ha/ cpbcbd/cpbcbd. html. Accessed Aug 12, 2025. 3. One World, One Health. Conference Summary: Building Interdisciplinary Bridges to Health in a Globalized World. Rockefeller University; Sep 29, 2004. Available at: https://oneworldonehealth.org/sept2004/owoh_ sept04.html. Accessed Aug 21, 2025. 4. Kessler R. What We Mean When We Say ‘One Health.’ EcoHealth Alliance. Available at: https://www.ecohealthalliance.org/2017/09/whatwe-mean-when-we-say-one-health. Accessed Aug 12, 2025. 5. Drake J. What is planetary health? Forbes, Apr 22, 2021. Available at : https:// www.forbes.com/sites/johndrake/2021/04/22/what-is-planetaryhealth/. Accessed Aug 12, 2025. 6. One World—One Health. Mission. Available at: https:// oneworldonehealth.wcs. org/About-Us/Mission.aspx. Accessed Aug 5, 2025. 7. Hoffman M. Stargate AI project could help create cancer mRNA vaccine, Oracle CEO Larry Ellison says. WPTV; Jan 25, 2025. Available at: https://www.wptv. com/news/technology/stargate-ai-project-could-helpcreate-cancer-mrna-vaccine-oracle-ceo-larry-ellison-says. Accessed Aug 6, 2025.

NDA Journal 18 Medical Groups Are Suing the HHS Over Vaccine Policies—and It’s a Good Thing by: Simone Gold, MD, JD After decades of escalation, the HHS is reducing the number of vaccines recommended for American children. Predictably, the MedicalIndustrial Complex is not taking it well. The American Academy of Pediatrics (AAP), along with several allied medical organizations, is now asking a federal court to undo recent changes to the CDC’s childhood immunization schedule, and to stop the upcoming February meeting of the CDC’s Advisory Committee on Immunization Practices (ACIP). The organizations first filed a lawsuit last year after the CDC removed the experimental COVID-19 shots from the childhood schedule. That case is still ongoing. Now they want the court to go further and reverse the broader changes altogether. Those changes are significant. The U.S. childhood vaccine schedule no longer resembles the aggressive 71-shot regimen it once did. Instead, it now looks more like the more moderate schedules used in countries like Featured Article

Winter 25–26 www.nvda.org 19 That’s why this case matters. It forces the public to look closely at what modern medicine has become—and to accept a hard reality: not every doctor is worthy of the title. And it challenges Americans to choose their physicians more carefully, starting with one essential question: what is a doctor? Featured Article Denmark, Japan, and Germany. The HHS narrowed vaccine recommendations for meningococcal disease, hepatitis B, and hepatitis A to children who are broadly at higher risk. It also shifted flu, COVID-19, and rotavirus shots to “shared clinical decision- making”—meaning families who want them are encouraged to discuss it with their doctor rather than be railroaded by a blanket mandate. I’m glad these organizations filed this lawsuit. Not because they’re right, but because the complaint exposes what they actually stand for. And it isn’t medicine. For one thing, the complaint contains virtually no medical science. None. The plaintiffs repeatedly claim that HHS “does not follow the science,” but they fail to show “the science.” They assert that the directives contradict a “wealth of data and peer-reviewed studies” proving the safety and efficacy of COVID vaccines for children and pregnant women, yet they never actually show this supposed wealth of data. Instead, they pivot to a familiar historical story—and it doesn’t hold up. The complaint says that vaccines turned the tide against measles, mumps, and rubella in the 1960s, and that by the end of the century vaccines had eradicated smallpox and virtually eliminated measles. This is the same argument Americans have heard for decades: disease rates went down after vaccines were introduced, so the vaccines must be the reason. That is classic post hoc logic—and it’s been debunked over and over. Deaths from infectious diseases dropped sharply in the mid-20th century primarily because of better nutrition and sanitation, not vaccines. Take measles. Though it killed tens of thousands in the 1800s, measles mortality had already fallen by 98% by 1960—before the MMR vaccine even existed. Why? Because nutrition and sanitation improved. Clean water spread. Indoor plumbing became common. As RFK Jr. has pointed out, deaths were dropping before vaccines. The plaintiffs then mock RFK Jr. for suggesting that vitamin A can prevent measles deaths—apparently unaware that the World Health Organization, which they cite repeatedly in the complaint, openly acknowledges the same thing. When it comes to actual evidence, things only get thinner. The groups attack RFK Jr. for directing the CDC in March to study possible links between vaccines and autism, claiming that “more than two dozen studies” have already settled the question. And what do they cite? Not the CDC’s own webpage, which carefully explains why the issue isn’t settled—but an article from the Washington Post. Legacy media propaganda. Most of the complaint avoids medical science altogether and leans heavily on appeals to authority. Doctors affiliated with the plaintiff organizations offer their opinions that the HHS directives are wrong, unscientific, and dangerous. In other words: trust us, we’re doctors. It’s a shame they didn’t ask us at America’s Frontline Doctors. We could have introduced them to hundreds of physicians at the top of their fields who can explain exactly why the childhood schedule must be trimmed. Our doctors would have pointed out that as of early 2025, VAERS— the CDC’s own safety reporting system—listed 38,476 deaths and millions of adverse events from the COVID-19 mRNA shots in the United States alone. And that’s with VAERS being underreported by at least a factor of 20. We would have cited Pfizer’s own trial data showing 42,086 injuries within four days of vaccination and 1,223 deaths within 90 days of rollout. We would have noted that the trial used to justify vaccination for children under five involved just 10 COVID cases total—prompting even the CDC to admit a “very serious concern for imprecision.” We would have highlighted the FDA’s recent admission that healthy children died from the shots and that, contrary to what the public was told, the benefits did not outweigh the risks. We would have shown a study of nearly one million children finding myocarditis and pericarditis only among the vaccinated. Or the censored Henry Ford Health study showing a 57% increase in chronic disease »

NDA Journal 20 Featured Article among children who kept to the CDC’s schedule—329% more asthma, 203% more atopic disease, 496% more autoimmune disease, and 453% more neurodevelopmental disorders, including 228% more developmental delays and 347% more speech disorders. We would have pointed to similar findings from Dr. Paul Thomas, showing that even partially vaccinated children returned with sharply higher rates of anemia, eczema, behavioral issues, eye disorders, ADHD, infections, and allergies. But instead of seeking out both sides of the debate and searching for evidence, the plaintiffs complained about something else entirely: inconvenience. “That Directive has caused physician members to spend more time counseling patients regarding the effectiveness of the Covid vaccines, which adds up to time and resources diverted from other patients,” the complaint read. Translation: instead of vaccinating compliant patients and collecting insurance and Medicaid kickbacks, doctors now have to educate patients about what goes into their children’s bodies. The American Public Health Association (APHA) made a similar complaint, saying its members must now “correct misinformation” and answer questions: “APHA members are required to spend more time correcting misinformation with individuals and families regarding the effectiveness of the Covid vaccines, which diverts time and resources away from other important health care or public health duties.” Translation: educating patients so they can give their informed consent is very inconvenient. Another complaint warns that doctors are now forced to contradict the HHS secretary’s guidance, which “erodes trust” and threatens their practices: “The Directive has put all AAP members (and, indeed, all other physicians in this country) in the untenable position of telling their patients that the country’s top-ranking government health official’s advice and recommendations are wrong and that we are right. This erodes trust, which is the foundation of a healthy physician- patient relationship and vital to the success of AAP members’ medical practices.” Translation: patients are hearing different viewpoints and no longer treating doctors as unquestioned authorities. “Parents are now distressed and unsure about Covid vaccines where they were not before,” the complaint adds. Translation: parents are waking up and thinking for themselves. Some doctors were even more direct. Dr. Jason Goldman, president of the American College of Physicians, complained that “ACP physicians who now administer the Covid vaccine face financial harm because some insurers do not cover vaccines that are not on the CDC immunization schedules.” Translation: informed patients hurt our bottom line. Another physician worried that the new policy makes it harder to run vaccine clinics, order shots in bulk, and secure reimbursement. Translation: informed consent is less profitable. Most troubling of all were complaints that relationships with patients have “deteriorated” because parents chose to trust HHS guidance and declined the COVID shots for their children: “Several patients, such as parents of young children, have decided to trust the Secretary’s advice and refused to get the Covid vaccine for their child. [This doctor’s] relationship with these patients has deteriorated as a result of the Secretary’s May 19, 2025 Directive,” says the complaint. Think about that: these doctors are allowing—or causing—their relationships with patients to sour because families made a medical decision. This lawsuit lays it all bare. Informed consent, once the foundation of ethical medicine, is now treated as a nuisance. Patients who ask questions are seen as a problem. Parents who take responsibility for their children’s health are viewed as a threat. That’s why this case matters. It forces the public to look closely at what modern medicine has become—and to accept a hard reality: not every doctor is worthy of the title. And it challenges Americans to choose their physicians more carefully, starting with one essential question: what is a doctor? Editor’s Note: Originally published January 2026 by The Gold Report, republished by permission of the author. The NDAJ wonders when the AAP will sue to maintain the ability to electively remove sexual organs from confused teenagers. Contrary opinions are welcome. »

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