Bill Klaproth (Host): Today, I am joined by three experienced oral and maxillofacial surgeons who serve on their state dental boards. With an understanding of the intersection between dental practice and policy, we will discuss the vital role dental boards play in shaping healthcare regulations and how OMSs serve a vital function in their operations.

With me today, I am very pleased to have with us Dr. Bobby McNeill of the Texas State Board of Dental Examiners, Dr. Mark Roszkowski of the Minnesota Board of Dentistry, and Dr. Scott Van Dam of the South Dakota Board of Dentistry. Welcome gentlemen.

And before we get into today's discussion, I want to qualify that none of you are here in your professional capacity as members of your state dental boards and any comments made here are your own.

Again, welcome gentlemen. I really appreciate your time today. So let's jump into the first question. Dr. Van Dam, we're going to start with you, but I do want to hear all three of your journeys on this question. Dr. Van Dam, can you share your journey to becoming a member of your state dental board and what motivated you to pursue this role?

Scott Van Dam, DDS, MD: I'd be glad to. I was contacted in 2020 by a representative of our governor, and just informed that my name had been put forward, and if I would be willing to serve on our state dental board.

At the time, I was in a group practice. I'm still in that same group practice in Rapid City, South Dakota. I started practice here in 2007, straight out of my residency training. And one of the senior members of our practice, who's now retired, Dr. Roger Wilson, had been serving on the State Board of Dentistry. And he was transitioning out of that role after serving nine years.

And my name was put forward, and I accepted a nomination to serve. And it's been five years now since I've been a member of the board, and I'm currently serving as the President of the board.

Host: So you came first, you were nominated, you were elected to the board. How long have you been President now?

Scott Van Dam, DDS, MD: Just this past year, since January.

Host: Alright. Well that's wonderful. I love that. Well, thank you Dr. Van Dam. I appreciate that. Dr. McNeill. Let's move to you. Let's share your journey with us.

Robert McNeill, DDS, MD: I had the opportunity to be a consultant with the Texas State Board of Dental Examiners for several years, and then from that had the opportunity to be on the Blue Ribbon panel dealing with sedation safety. And that was about a year and a half, two-year process. And then shortly after that, I had the opportunity and was asked to submit my application for the board, and so it's been about eight years now that I've been on the state board, and it's been a wonderful learning adventure to say the least.

Host: I bet. Well, thank you for that. We appreciate it. And Dr. Roszkowski, how about you?

Mark Roszkowski, DDS, PhD: I had a similar kind of history as Bobby did where a good friend of mine had served on the board, Dr. Angie Rake. She is an oral surgeon also, and served on the board for eight years and brought me in as a consultant about two years ago. And, through working as a consultant, I got to see kind of how the board worked and kind of the breadth of what they did. And it became very interesting.

So when Dr. Rake finished her term in December, I applied for the open position. So I've really only been on the board since January of this year, but I've had exposure to the board through the last two years.

Host: Yeah, so we've got a wide range of experience here, which I think is great. So let me start with you, Dr. McNeill, on this next question. I think many providers may unfairly view the dental boards as punitive and only looking to correct them or to collect fines. Can you set the record straight for us? What are the primary responsibilities of a state dental board and how do its decisions positively impact oral healthcare in your state?

And then maybe, Dr. Van Dam and Dr. Roszkowski, you could chime in on that as well.

Robert McNeill, DDS, MD: That's a terrific question. The main priority is protecting the public, and that's through making rules, sort of – I referenced the Blue Ribbon panel – sort of looking at data and seeing: Do we need to make any modifications?

But then also aside from sort of enforcement and rule-making, most of the state boards also have an obligation to provide pure assistance. Basically, help our licensees, guiding them through various rules that we set up.

Host: Yeah. Dr. Van Dam, any thoughts on that?

Scott Van Dam, DDS, MD: Yes, the board serves a variety of functions. Of course, mentioned already is you're protecting the public so that there's a high quality of dental practice in all aspects of practice that we're holding up a standard in the state.

But you're also having to balance the interests and the needs of a whole variety of stakeholders, and finding good balance in policy to keep advancing dentistry and staying with the times and adapting the rules by which we practice, the statutes that we can satisfy all these a whole variety of needs, and that's what was been really eye-opening for me is the importance of that balancing act and all that communication that goes on between stakeholders and how important it is to have a really highly functioning board and support to do that well. And I'm very fortunate in our state to have really incredible support, as we've gone through a host of challenging issues, and we can get into that later.

But you're helping everyone in the state practice well, and that's general practice and various specialty practices and of course we interface with independent anesthesia practice and how do you do all that and make sure that the rules are appropriate to do it safely.

And, then also to deal with issues when they do arise of questions of appropriate practice and investigations and disciplinary matters, of course.

Host: Right. Absolutely. Well, you need a well-functioning board to keep things on track. And Dr. Roszkowski, just curious, your thought on how what you do there positively impacts oral healthcare in Minnesota?

Mark Roszkowski, DDS, PhD: Well, being just recently on the board, I haven't had a lot of experience. I've probably had four committee meetings so far. And it seems to be that, according to Dr. McNeill and Dr. Van Dam also, you know, having a very cohesive board really helps and if you can just always keep the public safety first and foremost and have a well-functioning board that can address these issues.

Because they come up quickly and they need to be addressed very quickly and being efficient in coming up with a resolution is always the important thing.

Host: Yeah. A lot of decisions need to be made in an effective and efficient manner. So, Dr. Roszkowski, let me stay with you. I know that you've only been on the board since January, but from your own perspective of being a newly elected board member, why is it important for oral and maxillofacial surgeons to serve on dental boards, and how do their expertise contribute to the decision making, as we were just talking about?

Mark Roszkowski, DDS, PhD: Well, I think where I've stood out from all of our other board members is having expertise in some of the advanced surgical techniques that a lot of people just don't know a lot about. And there are a lot of dentists of different levels of specialties doing very advanced procedures. And if you're asked to review those cases, having the knowledge base to be able to do that efficiently.

And of course, anesthesia is always central to what we do as oral and maxillofacial surgeons and kind of overseeing the state anesthesia – you know, how the licenses are granted and how everyone's doing on their reviews. We're kind of the buck stops here with at least our reviews. So that's very important as well.

Host: Yeah, being up on the latest technology and procedures is important, and the board certainly can bring that. I'm wondering, Dr. McNeill, you've been on the state board the longest at eight years so far. Can you share your thoughts on why it's important to be on a dental board, being that you've been on a board for eight years now?

Robert McNeill, DDS, MD: It's really interesting. As was just mentioned, anesthesia is certainly a big issue and it's a big issue for governors and state legislators. Unfortunately, especially if there is a problem. And so having an OMS with the anesthesia knowledge that we have is quite critical. And really just, you know, it's an adventure to be on a board for many years and there's certainly things I wish I knew one or two years in. And you just develop as you learn the process. You learn more information about your own rules for your individual state, and you talk to people and you learn and you're able to function a little better with stakeholder groups as Dr. Van Dam had mentioned.

Host: State dental boards. It's not just a job, it's an adventure.

Robert McNeill, DDS, MD: It is.

Host: That's what it sounds like. Well, Dr. Van Dam, let me ask you, you're actually the President of your dental board in South Dakota. Let me ask you this. So what challenges do dental boards typically face, and how do they balance the interests of different specialties? You have to think about that. Policy makers, that's another thing. And the public. So you've got three big stakeholders there that you have to manage.

Scott Van Dam, DDS, MD: Yeah. When it comes to making policy, I've gained a real appreciation for what legislators have to do in communicating with all of the stakeholders, the delicate, but really important balancing act of putting good laws into effect in your state and it's the state dental board that does that for dentistry.

And right when I started on the board, we jumped immediately into a two-year process. It was, I guess it was more an 18 month process, but a very dynamic and intense time of completely rewriting our state anesthesia guidelines. That was necessitated by legislation that allowed – for the first time – licensed anesthesia providers to practice in dental offices in our state. And up until that point, that had not been a reality in South Dakota and that required us to adapt our rules. And so that requires you to open the Practice Act and everything involved with that. It was also high time to do that. I had had some experience with our state laws related to anesthesia, also having served on an anesthesia credentials committee for a couple years before my appointment to the board. I failed to mention that. But when I started as a board member, we had to, as I said, rewrite all of our rules and it was a most interesting process. Somewhat contentious at times, but our board with the help of very good administrators and a very cohesive board, really did a great job of that.

And I think we navigated all of the challenges well, and we came up with a good product. I could share more about that, but just the complexity of putting forth new rules and getting all the feedback from the stakeholders and going through various revisions and satisfying competing interests and needs.

There's no one organization that can give South Dakota a perfect set of anesthesia rules. Every state is unique, I would say, in some ways. And there's lots of organizations that would like to give you a blueprint for how they think you should write your anesthesia rules.

In the end, we came up with some great solutions, even some creative ones I felt. We developed a new permit called a host permit in South Dakota that allows individuals, practitioners to contract with licensed anesthesia providers; still keeping them responsible for being part of a team that delivers high quality anesthesia, while not having those individuals have to be licensed themselves to deliver anesthesia.

In our state, it's what we did and it worked out well. And that means we still have access to those offices. And we can do inspections and they can have, do team-based training. And there is education required of those host permit holders as well in our state, so that they are an integral part of the anesthesia delivery team, even though they're not anesthesia providers themselves.

So, you have to find creative solutions and work towards those things with a lot of good communication. And it was, like I said, just a really fascinating process for 18 months to step-by-step get to that finish line.

And now, I really think our state has a very appropriate set of rules for now, that is in place.

Host: Yeah, that sounds like a heavy lift. Redoing your rules and regulations, it took 18 months. That is a major project. And then having to think about the different specialties and the public interests and policymakers, et cetera. Great example, and thank you so much for sharing that with us. Really interesting.

And Dr. McNeill, I'm wondering what advice you would give to an OMS or other dental professional who's considering applying for a board position?

Robert McNeill, DDS, MD: That's a really good question. I think sort of understanding the process for your individual state makes sense. I would certainly talk to leadership within the state. The local OMS Society would make sense. But also talk to other leaders in the state. Each state's a little bit different as far as governor-appointed or some other type of appointment, so you really have to understand the rules of the game, so to speak.

And talk to people. Learn from others, just as Dr. Roszkowski was mentioning earlier about him coming on as a consultant and working with Dr. Rake in Minnesota. Just interact with your colleagues.

Mark Roszkowski, DDS, PhD: Just recently having been through the process, I know every state is a little different in how things are set up, but in our state, the executive director and the assistant executive director of the board itself was a really good touch point for me to be able to get access to the board and ask questions. And they were very open to, is this even something feasible? Should I be applying?

So from that end, kind of doing the end-around and going to the leadership of the board itself was very helpful for me.

Host: Yeah, that seems, uh, right. And Dr. Van Dam being President, do people reach out to you? Is that how they get on the board?

Scott Van Dam, DDS, MD: No. Our governor plays a large role in selecting individuals. And I'm not exactly sure how that process works. We do provide feedback and recommendations, though. And I think those are heard and listened to. But we add an example of appointments that seem to come straight from the governor.

Host: Well, it sounds like different states have different policies, but there's probably a universal truth of talk to other officials, other board members. It seems like that might be a great way in. Talk to everybody you can. Talk to the leaders, talk to the president, find out what it's going to take to get on the board if you are interested.

And Dr. Roszkowski, let me ask you this. I know you've only been on the board shortly, but can you share a recent issue or policy decision that the board addressed where it was valuable to have in OMS on the board?

Mark Roszkowski, DDS, PhD: Yes. Similar to Dr. Van Dam, we recently totally redid our pediatric sedation criteria. So Dr. Rake, who had finished up last year, really was instrumental in doing that. But I had to kind of implement it and in that, a few people had asked for changes to specific wording and it was just difficult. You have to jump right in and really get to know the legislation and stick to it and all the work that's been done, honoring that. So that was important for me.

Host: Anybody else want to share a story or situation where it was valuable to have you – an OMS – on the board, Dr. McNeill or Dr. Van Dam?

Robert McNeill, DDS, MD: What I would say there's just some unique things that we face as oral and maxillofacial surgeons regarding reporting of hospitalizations, as an example. And oftentimes our patients do become hospitalized for a variety of reasons, and sort of outlining and clarifying that process to make sure that it's not overly burdensome on oral and maxillofacial surgeons from a compliance standpoint is issues that we've addressed in Texas.

Host: Yeah. Well, that makes sense. Yeah. This has really been interesting. A few more questions. I want to thank you for your time. Dr. Van Dam, for OMSs and other dental professionals who may not serve on a board, how can they still engage in advocacy and support fair dental regulation?

Scott Van Dam, DDS, MD: I would say the first thing is to just be informed. Attend your local, state district dental society meetings. I think the engagement of individuals and really knowing what's going on is just really important. And there's decisions being made all the time and, unfortunately, if you're not at the table, your voice isn't heard and things can happen that don't make sense. And if you're not learning about the issues, staying tuned to the discussions and debates, then you won't have an opportunity to let your voice be heard and help shape things in helpful ways.

Every state has things that they're dealing with, whether it's expanded functions or specialty advertising or other things that we've had to deal with here recently, and I'd be glad to share more about those specific issues perhaps, but be involved. Serve. There's so many opportunities to serve, whether it's through the SDDA or the AAOMS. We just need people that are tuned in and being aware of the issues.

Robert McNeill, DDS, MD: And I completely agree with Dr. Van Dam. If you're not at the table, then you're on the menu. And we really do need people to participate at the board level, at the state society level, the local dental association, nationally with the American Dental Association. If we are going to function at our best as a specialty of oral and maxillofacial surgeons, we need people to participate throughout.

And even as Dr. Van Dam said, get educated. You have to be aware of the issues and talk to people. Talk to people. The worst thing we can have are members of our specialty that sit in the office and are not educating themselves on the issues and not being part of the process because, as Dr. Van Dam mentioned earlier, boy, at the board level, we're trying to get stakeholders and legislators and the public to sort of come together in a way that we can have a functioning dental profession. And that is really, really difficult. And just being part of that process is just absolutely key.

Scott Van Dam, DDS, MD: Yeah. Perhaps just an example that can illustrate what is being talked about. Expanded functions became an issue in South Dakota last year, where some individuals in the state were keen to push through some changes to rules related to expanded functions. And it's interesting to me to see how that happened and how it was then put to the board.

It was sort of pushed through our local dental association, where there were some activist people with good ideas, interesting ideas, you know, that were pushing for change. And, to make a long story short, the board was asked to rule on a set of proposals that clearly did not have yet the support of the broad membership in our state.

And there were some real issues also with how that legislation would work and whether it was really enforceable the way it was written, and other issues related to protecting the public that were significant. And as a board looked at that issue and had to rule on something that wasn't ready for prime time. We took a step back and decided to release this petition to the public for feedback.

And in the process, we really received feedback from a lot of stakeholders through a very open deliberative process where we just took some extra time. And we really learned more from people who were not yet tuned in to the issue, who didn't show up to the annual meeting or, when the vote came from our dental association to put this forward, it passed just by the slimmest of margins. And that's why it got to the board the way it did.

But as I said, after stepping back for a while and getting more stakeholder feedback, it became apparent to pretty much everyone involved – aside perhaps from some activist people who were pushing for those changes – that it wasn't the right time to make those changes. That there wasn't broad support, that it wasn't the right solution yet.

And so, we were able to kind of walk that back and it might be that another iteration of those changes is going to be something that has broader support in the future. But we maintain a very good relationship with our state dental association and the leaders there. And I think those who paid attention to this process recognized that, as a board, we did the right thing and unanimously put that to sleep for now.

But that's the kind of thing where it's tricky and you need to make sure that in this case, did we really know what the broad membership felt about these changes? And did they understand what it would really mean to implement those changes? And the answer was a pretty resounding no, it wasn't the time to do that.

Host: Well, it sounds like you had a very deliberative and thorough process to investigate and examine this issue, and that's exactly what this podcast is about, all the things that state dental boards do, and as you mentioned. And that's why it's important for OMS members to stay involved and pay attention and have their voices heard when issues like this come up that you were just talking about, Dr. Van Dam.

And Dr. McNeill, when you said it kind of takes everybody, you know, the local boards, state, local, national, all of those different platforms to be involved to make sure that everyone's voices are being heard and can weigh in, and help shape the narrative for the specialty going forward.

So before we wrap up, I'd love to get closing thoughts from each of you on this as we finish up on talking about the vital role dental boards play in shaping healthcare regulations and how OMSs serve as vital functions in their operations. Dr. Roszkowski, let me start with you, final thoughts.

Mark Roszkowski, DDS, PhD: Well again, as a new board member, I've realized just how important OMSs really are on the board and how much unique knowledge base we have compared to the other people on the board and how much they really rely on your expertise. That's been very important, and I realize I'm doing an important job with that.

And there are a lot of people out there that may have interest in that and either contributing to your state OMS society or state dental society, the committee on AAOMS, anything like that is always going to be positive inputs into the board itself too.

Host: I like how you say it's an important job. It is important that we have people that are willing to take the time to be on a board and really do what they can to help move the specialty forward. So I like how you said that. So thank you for sharing that, Dr. Roszkowski. I appreciate it. Dr. McNeill, how about you? Final thoughts?

Robert McNeill, DDS, MD: I think all of us as oral and maxillofacial surgeons are served well when people just find your role. Whatever that is going to look like will be up to you. Whether it's at a state board, whether it's nationally with the AAOMS, or nationally with the American Dental Association, or locally.

Just find your role and participate. Connect to others. Be a representative of the specialty and the unique things that we're able to do. If we don't sort of help promote and protect what we do, that can go away and there's some risks there. So I'm very thankful to my colleagues here on the call for doing what they do. It is a busy job being a state board representative. And we get a lot of support and a lot of help from others such as AAOMS.

Host: Find your role. I like how you said that. And I also like to promote and protect, because really you're doing both of those. You are trying to promote the specialty, but you're also trying to protect it as well. So, I like how you said that. I think that really puts it in a good perspective, Dr. McNeill. So thank you for sharing that. And Dr. Van Dam, if we could wrap up with you, final thoughts.

Scott Van Dam, DDS, MD: You know, you've said it all very well. It's a privilege to serve on the board. It’s challenging. But it's very rewarding. And, when I talked to our executive director recently, I mentioned that I was going to be participating in a podcast and she actually herself sent me a little, some information and what she also sent in there I thought was just perhaps good to leave with and she said, “I hope their takeaway is how important OMFS representation on the board is. I can speak from personal experience. Having that specialist that you can turn to as a resource when those challenging questions and issues arise is so incredibly helpful.”

We do need OMSs to serve on the board. Our state has prioritized always having an OMS on the board. It's not formal in our state, but it's understood and recognized, and I think appreciated. I do know that if we had not had my partner in practice serving on the board for the years that he did, and now me having that opportunity and in the future, someone else from our specialty, on the board, I think it would be difficult to achieve the same type of quality results that I think we are achieving.

Host: Yeah, I think it is really important to have an OMS on the board for sure. And I think all three of you have presented  the reasons why that is important. So thank you all for joining me today. This has been a great podcast. I've loved speaking with all of you. Once again, Dr. Bobby McNeill, Dr. Mark Roszkowski, and Dr. Scott Van Dam. Thank you so much for your time today.

And for more information on advocacy issues affecting the specialty, visit AAOMS.org/Advocacy. And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss an episode. Thanks for listening.