MDDS Articulator Volume 19 Issue 1 by Metro Denver Dental Society

ARTICULATOR FALL ISSUE MDDS

Connections for Metro Denverâ&#x20AC;&#x2122;s Dental Profession

Fall 2014 Volume 19, Issue 1

A Farewell to Barbie Arms 6 Diagnosis Challenge: Verrucous Carcinoma Case 10 Building a Great Practice Means Building a Great Team 14 Cannabis: Legalized; Now What? 28

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ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

Volume 19, Issue 1

MDDS Articulator

Creative Manager & Managing Editor Chris Nelson Director of Marketing and Communications Jason Mauterer Communications Committee Brandon Hall, DDS, Chair Maria Juliana DiPasquale, DMD Karen Franz, DDS Kelly Freeman, DDS Anil Idiculla, DMD Jeremy Kott, DDS Maureen Roach, DMD Jennifer Thompson, DDS MDDS Executive Committee President Larry Weddle, DMD President-Elect Ian Paisley, DDS Treasurer Sheldon Newman, DDS Secretary Nicholas Chiovitti, DDS Executive Director Elizabeth Price, MBA, CDE, CAE Printing Dilley Printing The Articulator is published bi-monthly by the Metropolitan Denver Dental Society and distributed to MDDS members as a direct benefit of membership. Editorial Policy All statements of opinion and of supposed fact are published under the authority of the authors, including editorials, letters and book reviews. They are not to be accepted as the views and/or opinions of the MDDS. The Articulator encourages letters to the editor, but reserves the right to edit and publish under the discretion of the editor. Advertising Policy MDDS reserves the right, in its sole discretion, to accept or reject advertising in its publications for any reasons including, but not limited to, materials which are offensive, defamatory or contrary to the best interests of MDDS. Advertiser represents and warrants the advertising is original; it does not infringe the copyright, trademark, service mark or proprietary rights of any other person; it does not invade the privacy rights of any person; and it is free from any libel, libelous or defamatory material. Advertiser agrees to indemnify and hold MDDS harmless from and against any breach of this warranty as well as any damages, expenses or costs (including attorney’s fees) arising from any claims of third parties. Inquiries may be addressed to: Metropolitan Denver Dental Society 925 Lincoln Street, Unit B Denver, CO 80203 Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com ©2011 Metropolitan Denver Dental Society

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Fall 2014

Inside This Issue:

A Letter From Our President ............4

Salud Family Health Center - A Valuable Resource for Underserved Patients ......... 20

Member Matters ..............................5 MDDF’S Smile Again Program® Partners A Farewell to Barbie Arms.....................6

With Warren Village To Change Smiles And Change Lives.................................. 21

Dig Deeper Into Your Disability Policy....8 Silver Bullets: CU-SDM Diagnosis Challenge: Verrucous

Commencement 2014................... 22

Carcinoma Case.......................................10 Event Calendar..............................24 TEDxMileHigh .......................................11 Cannabis: Legalized; Now What? ..28 The Dentist's Business Plan and Personal Financial Plan Must Coincide...............13

Why is So Much Attention Given to Rate of Return? ....................................31

Building a Great Practice Means Building a Great Team ..................................14

Classifieds.............................................35

Screw-Access Marking: A Technique to Simplify Retrieval of Cement-Retained Implant Prostheses ............................................. 16

Get To Know Your MDDS Staff

Marlene J. Pakish, MBA – Finance & Operations Manager Marlene joined MDDS in May as the Finance & Operations Manager. She has called Colorado home since 1990 after moving from upstate New York. Marlene received her BS and MBA from Regis University, but not consecutively – there were many years in between each degree. Marlene and her partner share a home in Golden with a puppy and kitten and enjoy the lifestyle of living in a small town. When not taking care of the house, they enjoy sea kayaking in combination with back country camping. Their many adventures have taken them to Yellowstone National Park (twice), Minnesota’s Voyageurs National Park and river trips in Colorado and Utah. They recently returned from an ocean kayaking experience in Maine. Marlene has worked in small businesses and non-profit organizations for 20+ years. Her position with MDDS encompasses a range of duties from accounting, assisting with meeting room set-up and acting as staff liaison for the Peer Review Committee. You can reach Marlene Pakish at (303) 488.9700 ext. 3268 or finance@mddsdentist.com.

A LETTER FROM OUR PRESIDENT

Larry Weddle, DMD, MS

hhAhhhh fall… you can smell it in the Colorado air. The leaves are changing, football season is in full swing, and the cool breeze in our mountains that was tinged with the fragrance of summer barbeques now smells of chimneys burning firewood. I have always enjoyed fall and the changes it brings. Change is a welcome and imperative force that relieves us of our old antiquated habits. Change is an important part of our dental society as well. The leadership of our tripartite is actively discussing changes we need to make on the local, state and national levels. Many of our discussions involve the phrase "The Power of Three." Our society has the unique advantage of membership on all three levels. There are certain benefits that a local

society can bring that a national cannot (and vice versa). The fact that we belong to a local, state and national society that have the capability to work in sync towards a common goal is such an advantage to the field of dentistry.

"Our leaders are committed to maximizing our members’ dollars and are tirelessly working on improving our three level dental society." The Power of Three’s purpose is to focus on the strengths that the local, state and national levels can bring. Our leaders are working to eliminate redundancies in the three levels. Eliminating redundant benefits will be done by identifying the

Dental Construction Specialists Ask us how we can save you time and money on your next office project.

level of the tripartite that naturally excels at offering a particular member benefit. Successfully doing this can lead to elimination of any membership confusion, reducing needless competition between the levels, and increases overall membership value. For example, our national society excels at lobbying efforts with our nation’s senators and congress people. Our local society excels at networking opportunities and in-person continuing education. Our leaders are committed to maximizing our members’ dollars and are tirelessly working on improving our three-level dental society. I am honored to lead MDDS during this time and am excited about the new changes that we will be making to further strengthen organized dentistry through the Power of Three. Sincerely Larry Weddle, DMD MDDS President

2014-15 MDDS Board of Directors Induction (July 30, 2014)

Phone: (303)637-0981 Web: www.bvgci.com (Top row; left to right) Drs. David Klekamp, Michael Scheidt, Kevin Patterson, Karen Franz, Walt Vogl and Brian Gurinsky (Bottom row; left to right) Drs. Nicholas Chiovitti, Ian Paisley, Larry Weddle and Sheldon Newman

MDDS New Member Welcome Event (August 21, 2014)

A great turnout for this networking event at Forest Room 5.

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Fall 2014

MEMBER MATTERS

Obituaries President 2000-2001 Dr. Roberta Shaklee passed away on August 29, 2014 after battling ovarian cancer for over two years. Dr. Shaklee was President of the Metropolitan Denver Dental Society from 2000-2001 and was the first woman to hold an executive office for MDDS. Dr. Roberta Shaklee's enthusiasm for life and energy were contagious. She was truly an amazing lady and she will be missed by us and everyone who knew her.

Dr. Jean-François Bédard passed away on September 8, 2014. He graduated from dental school at the Universite de Montreal in 1993 and maintained a successful prosthodontic practice in Denver, CO from 2001 until his death.

Dr. Sandra Bujanda-Wagner suffered from stomach cancer and passed away peacefully on August 12, 2014 at the young age of 46. Dr. Bujanda-Wagner regularly contributed to Kids in Need of Dentistry, The Johnson Clinic and Make-a-Wish Foundation.

New Members, Welcome! Dr. Kyle R. Griffeth Dr. Amanda D. Hallinan Dr. Scott A. Hamilton Dr. Namrata G. Hardy Dr. Ryan T. Haywood Dr. Alberta M. Hernandez Dr. Kevin C. Hoth Dr. Jacqueline M. Kramer Dr. Pearl Lai Dr. Ihsan B. Larsen Dr. Mark E. Leedy Dr. Brett W. Lopez Dr. Tran Marvinh Dr. Shaheen M. Moezzi Dr. Lananh T. Nguyen

A Boost for COMOM (July 27, 2014)

Dr. Angela T. Phan Dr. Patrick J. Reilly Dr. Grace E. Rudersdorf Dr. Manpreet S. Sarao Dr. Keith B. Shaw Dr. Andrew R. Stubbs Dr. Aram C. Sun Dr. Aaron P. Van Wyk Dr. Sara M. Weinstein Dr. Douglas K. Whetten Dr. Matthew Whiteley Dr. Cory J. Williams Dr. Benjamin P. Yucha

Platte Valley Hospital presenting Dr. Nicholas Chiovitti, 2014 COMOM Site Chair, a check for $15,000 to help with the upcoming COMOM.

Congratulations,

Dr. Tom Zyvoloski! Dr. Zyvoloski has been a general, full-service, and cosmetic dentist for over 20 years. He graduated from the University of Minnesota Dental School and recently moved from Minnesota to Colorado for the outdoor lifestyle. He has won multiple awards including being voted as “Top Cosmetic Dentist” by Minneapolis St. Paul Magazine. Recently, he opened his 4,027 sq ft office, Studio Z Dental,

mddsdentist.com

ሺ͵Ͳ͵ሻ ͸͵͹ǦͲͻͺͳ ̷ Ǥ

in Louisville, CO. It features a waiting room, reception, manager office, private waiting area, two restrooms, adminstrative area, doctor’s office, staff lounge, consult, imaging, lab, four open bay hygiene chairs, four open bay ops, sterilization, chart room, and space for two additional private ops. The office was built in 9 weeks. Dr. Zyvoloski offers cosmetic, family, and holistic dental services at his office.

Articulator

Fall 2014

REFLECTIONS A FAREWELL TO BARBIE ARMS By Jason Mauterer, CDE

aise your arm if you’ve been on the edge of your seat waiting for the next Reflections letter from Dr. Carrie Seabury. Me too! Unfortunately, I drew the proverbial short straw. It is my solemn duty to notify you that Dr. Seabury is no longer with us…as the Editor of the Articulator. Instead she is focusing her “spare” time representing all dentists as an alternate delegate to the ADA (AKA Wonder Woman). She’s actually not totally gone, as she’s still kicking it with the Communications & PR Committee and ready to help train the next one of YOU ready to embark on a journey to the glamorous and rewarding world of dental editing (wink wink nudge nudge). Whew…I’m glad that part’s over with. With that sad news out of the way, let’s move on to what’s likely going to amount to a clip show of the last few years of our talented and entertaining (possibly circuitous at times) MDDS Editor. When I came to MDDS late in 2010, there had been a fairly major change in staff and that turbulent year yielded only three of the usual five Articulator issues. Dr. Seabury’s second issue went to press that same week, and just as old Murphy warned us, something went wrong. Her cover article on mid-level providers that was printed was not the final version. Ugh! So then she had to grovel for your forgiveness in her third issue. Rough start for the only female editor MDDS has ever had. But then came the Disneyesque magic that we all fell for – the reason our arms are still in the air. Let’s avoid a cramp and find some good arm place-holders, maybe some Barbies would like to reach for the heavens in support of Dr. Seabury, while we reminisce about the Amelia Earhart of MDDS dental editors. I think it’s fair to say that she had a way with colorful metaphors. It might also be fair to say that each issue under her contained a lesson in 80’s and 90’s pop culture that could not only connect your ears with a grin, but somehow made her point perfectly clear. The last so-called fair claim I’m going to make is that she gave us

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PDF of all her letters. And of course there’s a reference table. You’re welcome, again. (Queue the Dr. Carrie Seabury clip show… and William Shatner’s version of Rocket Man.) “Change is universal (except in Ozzy Osbourne’s case – that dude hasn’t changed in 30 years).”1 “Truth be told, and I know this comes as a shock, Will Smith is hilarious and Carlton Bank’s dances are truly inspirational, but it hasn’t really helped me stay fresh in my practice.”2

"Dr. Seabury truly captured our imaginations with her writing while being a champion for MDDS. She will be missed." ~Dr. Larry Weddle a candid insight into her life. We’ve gotten to know Dr. Seabury quite personally over the last four years; she’s shared everything from her new-baby-sleep-deprivation (that was her first Reflections, btw) to her kids’ Jamba Juice “vomitorium” aboard Flight 342. The insight into her home and practice were offered from more than just an editor, but a friend (albeit a quirky friend who apparently watched a LOT of TV back in the day). Instead of just making references to all the hilarious, yet deep and thoughtful, fodder she provided us over the years, I’ll just get to the heart of it. Following are ten of my favorite quotes from the Dr. Carrie Seabury Articulator Reflections letters collection. It wasn’t easy limiting myself…you’re welcome. Your homework is to go reread the articles and figure out what deep message lies within each quote, but I’ll make that easy on you – check the MDDS Facebook page for a consolidated

“My more experienced colleagues need to grow a meticulously coiffed white beard and find a young warrior to teach the skill set needed to catch a fly with a pair of chopsticks.”3 “They couldn’t dance, they couldn’t rap, and to be brutally honest, their Shufflin’ skillz would make LMFAO throw up in their mouths a little.”4 “Captain Kirk taught us the true meaning of bravery, audacity, tenacity, and… smarmy.”5 “Hey Jay-Z - Can I get a woop woop for docs who see Medicaid patients?”6 “Bacon works hard for me and most importantly, bacon promises to save me should there ever be a zombie apocalypse. I speak the truth. This is my serious face. My game-on face. My Crispy Bacon face.”7 “You and I both are acutely aware of Daisy Duke’s incredible talent of assembling a carburetor in the dark.”7 “We have all heard him crooning about ‘When a Man Loves a Woman’ but why has he never given thought to ‘When a Woman Loves a Man’s Longer Than Shoulder Length Permed Bleach Blonde Hair?’”8 “As my shock turned into apologies to our surrounding passengers, and my efforts to contain the vomitorium of row 36 proved ineffective, I was reduced to a few rounds of hysterical snort giggle type laughter.”9

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Wipe those tears (of laughter, of course) away and let’s finish this 21 Barbie arm salute to the greatest female editor MDDS has ever known! After four years and 19 issues of the Articulator, Dr. Seabury’s legacy is laser-etched into the annals of our history and has certainly raised the bar of our beloved journal. MDDS would like to thank and salute you, Dr. Seabury – may your invisible jet continue to soar high, Dr. Wonder Woman.

3. Seabury, Carrie, DDS (2012, RMDC). Wax-On, Wax-Off. Articulator, 16(2), 6-7

References

7. Seabury, Carrie, DDS (2013, RMDC). Crispy Bacon. Articulator, 17(3), 6-7.

1. Seabury, Carrie, DDS (2011, March/April). Can You Spare Some Change? Articulator, 15(3), 6-7. 2. Seabury, Carrie, DDS (2011, June). New - It’s Like a Mogwai turned Gremlin. Articulator, 15(4), 6-7.

4. Seabury, Carrie, DDS (2012, Summer). Access to Care Shuffle. Articulator, 16(5), 6-7. 5. Seabury, Carrie, DDS (2012, Fall). Foundation of Giving Back. Articulator, 17(1), 6-7. 6. Seabury, Carrie, DDS (2012, Winter). Fat Squirrels and Hibernating Bears - Winter is Coming. Articulator, 17(2), 4-5.

8. Seabury, Carrie, DDS (2013, Fall). The Hair That Should’ve Stayed. Articulator, 18(1), 6. 9. Seabury, Carrie, DDS (2014, RMDC). Mayday Mayday Mayday...Flight 342 Just Got Jamba’d. Articulator, 18(3), 6.

UNLEASH YOUR INNER AUTHOR! MDDS is seeking an editor for the award-winning Articulator! This volunteer position is open to MDDS members and is an integral part of MDDS communications as well as the Board of Directors. Please contact Jason Mauterer, MDDS Director of Marketing & Communication, at (303) 957-3270 or jmauterer@mddsdentist.com for more information about the position.

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Articulator

Fall 2014

PRACTICE MANAGEMENT

DIG DEEPER INTO YOUR DISABILITY POLICY By David M. Richards

tatistics show that most dentists and dental specialists in the US (approximately 75%*) carry an individual disability insurance (IDI) policy to protect their incomes from a disabling injury or illness. Such a high participation rate suggests they realize the importance of the coverage because of the physical nature of the occupation and the fine motor skills required to practice. Many of today’s younger dentists and specialists learned about these policies as they were leaving school and were approached by an agent giving a seminar. IDI policies are issued by a handful of companies and they all appear similar on the surface. If you dig deeper into the contracts, however, you will discover there are major differences in contract language from policy to policy that could mean millions of dollars to the insured in a real-life claim. When comparing today’s policies, go beyond the familiar discussion of the “own occupation” language in the contract as most major carriers are offering “true own occupation” plans today. Look instead at the following riders or options to make sure you have adequate protection: *** 1) Student Loan Protection: Today’s average general dentist leaving school has a student loan debt burden of $241,097.** This is a major concern for long-term financial planning as such debts are not forgiven for most disability claims. Make sure your IDI policy pays an additional tax-free benefit to cover these monthly payments. This benefit rider provides coverage for a period of 10 or 15 years from the policy date. When a qualifying total disability occurs, benefits are payable during the remaining portion of the 10 or 15-year term that has not elapsed when the disability begins. 2) Catastrophic Disability Coverage: This optional policy feature pays additional tax-fee benefits in the event of a severe injury or illness requiring assistance with two out of six named “activities of daily living.” Combined with the base monthly indemnity the policy can replace up to 100% of pre-disability income if it includes this feature. 3) Retirement Plan Contribution Protection: Did you know that if you become totally disabled you can no longer contribute to your qualified retirement plan? This optional feature pays an additional monthly

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benefit to a trust account in your name to replace the qualified plan contributions. The proceeds can be invested in various mutual funds for potential growth and are then distributed in a lump sum at age 65. 4) Residual or “Partial” Disability Protection with “Recovery” Benefits: If you suffer a “Partial” disability, you could still be practicing, but suffering a big earnings loss. Make sure your policy has a low earnings loss threshold (15% is the best available) and pays a dollar for dollar benefit based on the earnings loss up to the total disability monthly benefit during the first 12 months of a partial claim. Do also carefully study the “recovery” provision to make sure benefits continue with a minimum 15% earnings loss upon full recovery and your full-time return to work – all the way to age 65 if the loss continues. Many policies severely limit recovery benefits. 5) “Mental/Nervous Disorder” Benefit Limitations: Avoid policies with strict limitations on payment of claims for such disorders (24-month aggregate benefit limits are common today). Look for coverage that treats such disorders as any other illness. A properly structured IDI policy is considered by many Financial Advisors to be the cornerstone of your financial plan because it protects your most valuable asset – your ability to practice Dentistry or your specialty. Dig deeper into your policy to make sure all you’ve worked so hard for is properly protected. David Richards is a Financial Advisor and Disability Income Specialist for Wealth Strategies Group, LLC in Denver, CO. He has 21 years of experience working with Dental professionals. He can be reached for comment or more information at (303) 714-5875, via email at david. richards@wealthsg.com and on the web at www.ddsdi.com Registered Representative and Financial Advisor of Park Avenue Securities LLC (PAS). Securities & Services and Advisory Services offered through PAS, member FINRA, SIPC. Wealth Strategies Group is not an affiliate or subsidiary of PAS. GEAR #2013-9993 (exp. 07/16). * Source: 2009 State of the Individual Disability Income Industry – Fall 2009 – Disability Management Services. ** Source: Source: 2013 ADEA Dean’s briefing book *** Optional riders are available for an additional premium. A person’s eligibility for benefits is determined on a case by case basis taking into consideration the factual circumstances presented as well as the terms and conditions of his/ her policy(s).

Articulator

Fall 2014

WE NEED YOUR

SUPPORT

THANKS TO OUR MWDI SPONSORS!

Go to mwdi.org

to donate

Includes cash donations and sponsorships; this does not include donated service and equipment.

Mile High Founding Members (Contributions of $5,280+)

JARCHITECT OE

1st Impressions Orthodontics Dr. Terry L. Brewick - Governor's Park Dental Group Brighton Smiles - Dr. Jaci Spencer Burnham Oral Surgery - Dr. Michael Burnham Dr. David E. Chavez Denver Metro OMS The Doctors at Mountain Range Dentistry, Dr. Nicholas Chiovitti & Dr. Paul K. Mizoue Dr. Mark S. Ehrhardt Dr. Louisa I. Gallegos Larry Gayeski, CPA Dr. Alan Gurman Dr. Roger D. Nishimura Ohmart Orthodontics Dr. Ian Paisley Dr. Shon Peterson Rocky Mtn. Dental Partners - Aspen/Aurora/Cherry Creek Dr. Robert T. Rudman Dr. Michael Scheidt & Kathryn Scheidt, MSN Sedona Periodontics - Dr. Chris Sakkaris Stamm Dental, Drs. Heather Stamm & Kai Kawasugi Tennyson Pediatric Dentistry Dr. Larry T. Weddle, Jr. Dr. Cassady B. Wiggins Young Dentistry for Children

Benefactors (Contributions of $2,000+) 2013 MDDS Delegates to the CDA Dr. Kimberly Danzer The Dental Center Dr. Mitchell Friedman, Dr. Anil Idiculla Dr. Sheldon Newman & Linda Newman Dr. Sean W. Shaw, Periodontics Dental Implants Dr. Joseph K. Will

Patrons (Contributions of $500+) Alpha Omega Dental Fraternity Bank of America Dr. Jack W. Choi Colorado Society of Oral & Maxillofacial Surgeons, Inc. Dr. Charles S. Danna Dr. Karen D. Foster Dr. George G. Gatseos GHP Investment Advisors Dr. Paul L. Glick HJ Bosworth Company Dr. Michael B. McKee Dr. James C. Nock Dr. Alexander H. Park Ridgeview Pediatric Dentistry Dr. Michael N. Poulos Dr. Edward F. Rosenfield Dr. Christopher J. Sakkaris Dr. Eric W. VanZytveld Dr. Gregg Lewis Jacob Williams Dr. Herbert T. & Lenore Williams Young Dentistry for Children

DENTAL INSTRUMENTATION

Board Room Founders (Contributions of $3,000 each)

Dr. Michael A. Burnham Dr. Nicholas Chiovitti Dr. Charles S Danna Dr. Mitchell Friedman Dr. Troy A. Fox Dr. Sheldon Newman Dr. Ian Paisley Dr. Michael J. Scheidt Dr. Larry T. Weddle Jr

The MWDI is owned and operated by the Metro Denver Dental Society

CLINICAL DIAGNOISIS CHALLENGE: VERRUCOUS CARCINOMA CASE By John McDowell, DDS

64-year-old man presents for evaluation of his chief complaint, “I have this bump growing on the outside of my lower gums. It has been growing slowly over the last few weeks. Even though it doesn’t hurt, I am concerned that it might be cancer.” His medical history is positive for hypertension (Lisinopril 40 mg/day; Coreg 6.25 mg b.i.d.) and Type 2 diabetes (Glyburide 2.5 mg/day). He has had periodic dental treatment with his most recent dental prophylaxis occurring four months prior to the present visit. He quit smoking 24 years ago but smoked approximately one pack of cigarettes per day for approximately 20 years (he states he began smoking in college). He states he consumes about one or two glasses of wine per week. His family history is non-contributory. He denies a history of any lung, liver or kidney disease. He denies a history of hepatitis, neurologic disease/condition, immune compromise/suppression, autoimmune disease or drug allergies.

the exception of bilateral detectable lymph nodes in the submandibular and submental chains. All detectable nodes are freely-movable, firm (but not bony hard) and not tender to palpation. No other lymph node chains or groups demonstrate any lymphadenopathy. His intraoral exam demonstrates generalized gingival inflammation with scant amounts of plaque found on all dental surfaces. No mandibular right probing depths exceed 4 mm. The gingival tissues around the lesion bleed slightly upon probing. There is no significant mobility noted on any of the teeth on the mandibular right. The lesion shown (and related to his chief complaint) is a single ovoid nodule located on the facial surface of the attached mandibular right gingiva. The nodule is very firm but not bony hard. The nodule appears to have a broad base. From the clinical examination, the depth of the lesion cannot be determined definitively but the lesion does not appear to invade the deeper structures or the lingual gingival tissues. What is your differential diagnosis, your working diagnosis and your plan for this patient? Answers on pg. 29

His vital signs are all within normal limits. His extraoral examination is non-contributory with

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TEDxMileHigh

DENVER SPOTLIGHT

By Brandon Hall, DDS

re you looking for some inspiration? Do you like getting together with fellow talented Coloradoans? How about pushing the boundaries of the status quo?

All of this came together at the TEDxMileHigh event on June 14th here in Denver. It was held at the Ellie Caulkins Opera House, which served as the perfect venue for this special day. I attended this year as well as two years ago. As a business owner and someone who strives to be philanthropic, it’s the perfect opportunity to immerse myself among colleagues and learn about the people pushing the norm in the fields of healthcare, business, art and entrepreneurship. It’s truly an inspirational day. TED began in 1984 “as a conference where Technology, Entertainment and Design converged, and today covers almost all topics — from science to business to global issues — in more than 100 languages. Meanwhile, independently run TEDx events help share ideas in communities around the world.” I think most of us are familiar with “TED Talks.” In fact, you can cruise over to the website (www.ted.com) and watch a plethora of videos on a variety of topics, among them social media, human sexuality and entrepreneurship. Since TED’s inception, the popularity of it has soared and with the advent of streaming video content on the internet and Youtube, many of their “talks”

have become viral. They even have weekly hour long podcasts. As far as the TEDx event here, the speaker portion was held from 1:00pm to 5:00pm with exhibits before and after. In between sessions people had the ability to connect and share ideas. The roster of speakers was quite diverse but awe-inspiring. Among them were three high school prodigies talking about their research in the field of science and medicine, a master penman and a business coach. You discover that people have a multitude of talents and those talents span all horizons. But what emanates throughout each person’s story is the passion they hold for what they do. I believe that is important to us as dentists. It’s crucial to keep the passion for the dental treatment we provide. If you have lost that passion or struggle to find it, an event like this has the ability for you to reinvigorate yourself. Like the speakers and attendees at the TEDxMileHigh event, we all have a gift. That gift is the ability to provide dental care to people from all walks of life. Everyone chooses what type of practice they want to have. It’s important that we work hard with insurance companies, the government, the public and, most importantly, ourselves to protect our livelihoods and professions. Let’s not let outside influences dictate how we practice. That way, like each speaker at the TED, we have an inspiring story to tell, no matter how big or how small.

Take a Closer Look All malpractice policies are not created the same

There are a lot of diﬀerences between being a Member of the Trust and just another policy number at a large, commercial carrier. Both give you a policy the Practice Law requires, but that’s where the similarity ends. Consider… Who do I talk to when I have a patient event, claim or question? The Trust: Local dentists who understand your practice, your business and your needs. Them: Claims call center (likely in another state).

Do I have personal input and access to the company? The Trust: Yes. You are represented by your CDA Component Society giving you direct, personal access to the Board of Directors. Them: No.

How much surplus has been returned to dentists in Colorado? The Trust: Over $1.2M has been distributed back to Colorado dentists as a “return of surplus” (after all, it’s your Trust, your money). Them: $0

Besides a policy, what do I get when I buy coverage? The Trust: Risk mitigation training, educational programs and an on-call team that “speak dentist.” Them: That’s it; just a policy.

Do I have to give my “Consent to Settle” a case? The Trust: All settlements are based on the best interests of the dentist, patient and Trust Members. Them: Read the ﬁne print; ask about their “Hammer Clause.”

How many years has the company been serving Colorado dentists? The Trust: 27 years. Established by dentists in 1987. Them: It’s hard to say... they tend to come and go.

Protect your practice. Call the Trust today. Dr. Nathan Reynolds Dr. Randy Kluender 303-357-2604 303-357-2602 www.tdplt.com

??? FINANCIAL

THE DENTIST’S BUSINESS PLAN AND PERSONAL FINANCIAL PLAN MUST COINCIDE By Edward Leone Jr., CFP, RFC, DMD, MBA

r. Jones has just purchased Dr. Smith’s dental practice. This practice has operated for 35 years and met all of the criteria which Dr. Jones and his advisors desired. Financing through a local bank was accomplished and after a short period of introduction and familiarity with the staff and patient population, Dr. Jones was in charge of his new dental practice. Along with this very important acquisition comes tremendous responsibility.

In order to manage this practice efficiently and to impose his personal desires and direction for the practice, Dr. Jones needs to develop a business plan. This business plan must include the following: 1. A statement of practice philosophy 2. Establishment of ownership form (Sole Proprietor, C Corporation, S Corporation, LLC) which lends the best benefit to the doctor regarding tax issues, fringe benefits, staff and employee status, retirement savings strategies along with other business issues 3. Set performance standards which can be communicated to staff, quantified and monitored with periodic adjustment for improvement (examples—technology needs, compliance standards, continuing education, administrative efficiency, scheduling, collections, billing practices, insurance protocols, receivables, overhead control, patient relations) 4. Establish effective benchmarks and examine return on investment before engaging a product or service 5. Establish understandable staff policies (office manual, performance evaluation system, fringe benefit policy, bonus incentive system) 6. Develop internal and external marketing strategies 7. Establish a succession plan The business plan requires much dedicated thought and execution, but must be engaged in order for the dentist to have a successful and implementable personal financial plan. Most dental practices employ the expert help of a certified public accountant and an attorney. Expanding the team of advisors to include the spouse, a certified financial planner and one or more experts on a variety of insurance needs is essential to making the business plan workable and coincident with a personal financial plan. This collection of advisors will help the dentist avoid being influenced by human characteristics which we all possess (emotion, fear and group think) which can divert or alter what can be a successful plan. Dentists need to address the following in the conduct of business and personal wealth planning:

C. Income requirements D. Risk factors E. Time horizons F. Special needs G. An inflation factor along with expected rate of return on investments. As you should realize, these are very essential but complex issues which the dentist cannot dedicate adequate time to address and monitor with his or her limited skill sets in many of these areas. It is also important to review all of these business and personal plan elements periodically to consider adjustment and improvement. We urge our patients to do a dental checkup. I urge you to do a wealth checkup with the purpose of dedicated detail to each issue listed above and the focus on savings, debt, taxes, lifestyle costs and major capital investments. Timing, dedication and discipline are essential to business and personal success. Dr. Jones should not be an exception to the rule, but rather, a part of the successful membership of our great profession. Dr. Leone is a past President of MDDS and CDA. Along with service as an ADA Trustee, he has also held the office of Treasurer of the American Dental Association. Dr. Leone continues to practice clinical dentistry and is also an Associate at GHP Investment Advisors Inc. in Denver.

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Fall 2014

PRACTICE MANAGEMENT BUILDING A GREAT PRACTICE MEANS BUILDING A GREAT TEAM By Derek Rawnsley and Scott Beard

ne of the key characteristics of a good dentist is fierce independence – having a solid sense of how you are going to practice your craft, your way.

Derek Rawnsley

Scott Beard

And while such a trait is key to becoming a successful practitioner, understanding the critical benefit of teamwork is just as important. After all, running a successful practice is a lot like running a successful sports franchise - you have to assemble the right team. For a dentist to be successful, one must quickly understand that no one can do it alone, and a key part of the profession is to develop partnerships with the right teammates. Just as a quarterback concentrates on his skill set (running an offense and passing) he needs the blocking and running and receiving of quality teammates. For many new dentists however, the thought of building a solid team might take a backseat to getting the practice up and running and building a patient base. But try to imagine if a quarterback took the field without competent teammates. He could call the ideal play against the defense, line up the players in the correct position, take the snap and throw a beautiful spiral downfield…and get sacked if his line doesn’t block, or have his pass intercepted because a receiver ran the wrong route. What follows is a list of teammates a dentist might consider when assembling their winning team: • Teammate - Certified Public Accountant: CPAs can assist with a lot more than tax preparation. A CPA who is proficient in working with dental clients can help with expense efficiencies and identify areas in which you can improve cash flow. They have access to dental financial statistics that allow you compare your practice with its peers. A well-skilled dental CPA understands the nuances of the various specialties, whether you are a general dentist or an endondontist. • Teammate - Attorney: Using an attorney is wise for matters such as lease negotiations, employment contracts and buy/sell agreements. Finding an attorney who works with dentists can speed up the process and also identify

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potential problems or concerns that are specific to the industry. It can also make a practice purchase or sale run more smoothly as these attorneys know the specific issues to address. Attorneys can help with HR compliance and guidelines in order to avoid issues in these areas. • Teammate – Insurance Agent: An insurance agent can help identify and offer suggestions that best fit the needs of a dentist both personally and for their practice(s). Insurance needs can be complex and finding an agent who can provide insight in all areas is beneficial. • Teammate – Banker: A good banker can offer financing solutions to buy or expand a practice. In addition, they may have programs to assist with purchasing the real estate that houses your business. Additionally, a banker with key understanding of the dental industry should offer insight on how financial decisions you make today will impact your practice in the future. What is key in developing any relationship with these teammates is a very simple test dentists should apply to every member of the team: Is this business relationship an investment or just an expense? In other words, do you have a consultative relationship with the members of your outside team? Are they providing you sound advice and ways to improve your practice and maximize revenue? A quality teammate is an investment. If it is an expense, you should strongly consider making a change. The good news is that more often than not, a relationship with one core teammate can lead to others. If you already have a good CPA, ask them about attorneys, insurance agents and bankers they might recommend. Have a good attorney? Ask about insurance agents. Also, take advantage of referrals and networking opportunities from dental trade associations and professional groups. The key is to realize that no matter how large or small your practice is, there is always a need for quality teammates to help propel you toward your goals. Derek Rawnsley is Vice president and Business Development Officer for Pacific Continental Bank, based in Denver. Scott Beard is Executive Vice President and Director for Healthcare Lending for Pacific Continental Bank. They can be reached at Derek.Rawnsley@therightbank.com and Scott.Beard@therightbank.com

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Fall 2014

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Fall 2014

CLINICAL

SCREW-ACCESS MARKING: A TECHNIQUE TO SIMPLIFY RETRIEVAL OF CEMENTRETAINED IMPLANT PROSTHESES Todd R. Schoenbaum, DDS; Yi-Yuan Chang, BS, MDC; and Perry R. Klokkevold, DDS, MS Abstract: One of the commonly cited disadvantages of cement-retained implant prostheses is their inability to be retrieved. The screw-access marking technique discussed in this article allows for any clinician, at any time, to simply and predictably retrieve the cemented implant prosthesis. By applying a discrete, but easily recognizable, marking on the occlusal surface of the restoration, the entry point into the screw-access chamber can be precisely and safely created. The screw-access marking technique is efficient, effective and widely applicable.

There has been much debate about screw-retained versus cement-retained implant prostheses with regards to longevity, ease of use, costs, complexity and esthetics. 1-5 The primary advantages commonly cited in favor of screwretained prostheses are that they are easier to retrieve and do not carry the risk of retaining cement subgingivally. 6 In spite of this, cement-retained prostheses continue to be a popular choice for implant restorations due to their ability to compensate for some implant angulation issues, relative ease of fabrication, predictable costs—which are generally unaffected by fluctuations in the costs of alloys—occlusal esthetics,7 decreased bacterial leakage,8 increased mean porcelain fracture loads,9 and familiar restorative cementation protocols.

Current Removal Methods

The existing technique for the removal of cement implant restorations is to measure the distance between landmarks and the screw-access chambers based on periapical radiographs and to make rough estimates of the screw access line of draw on the occlusal/palatal surface of the restoration.15 If available, photographs from, or immediately after, the surgical phase can be valuable in determining the access as well. Although this is a viable technique, it can be difficult to perform accurately and does not account for buccal-lingual angulation of the implant. Cone beam computed tomography (CBCT) scans may help to resolve this issue, but are generally avoided due to increased costs and radiation exposure compared to periapical radiographs. When single-unit prostheses (and larger fixed partial dentures) are removed this way, it often results in destruction of the existing restoration. The resulting access opening is often too large or irregular to allow the restoration to be used again if desired.16 The inaccuracy of this method can lead to significant damage to the abutment as well, compromising Figure 1 its ability to be reused if desired (Figure 1). Although it is often the only choice for removal, Fig 1. The removal of cement-retained implant restorations can be difficult this “measure and estimate” technique is stressful and unpredictable, often requiring the destruction of the crown and/or and time-consuming for the clinician.

Inevitably, some cemented implant restorations will need to be removed at a future date. Common prosthetic reasons for removal include: fractured porcelain; fractured or loose abutment screws; hypoocclusion; open interproximal contacts; excessive contours; retained cement leading to peri-implantitis; failed esthetics; and unacceptable recession of the periimplant gingiva.4,10-14 In the authors’ the abutment. experience, the removal of a cemented implant prosthesis is often performed by a clinician who was not part of the original treatment team and is, therefore, unaware of the precise location of the screw access. As such, removing the cemented implant prosthesis is highly unpredictable due to the lack of standardization of techniques and materials used in implant prosthetics and the inability to identify the materials used radiographically. This ultimately leads to difficulty and unpredictability in removal, increased treatment time, and added costs for the patient.

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An alternative technique using a silicone occlusal index was developed in 2007 to mark screw-access holes on cemented implant prostheses.17 In this technique, the estimated location of the screw-access holes on the occlusal surface is marked with wax, and a silicone putty matrix is formed over the top. The limitations of this technique are that the screw-access hole indication is only an estimation based on gold calipers, and that the clinician performing the removal must be in possession of the matrix.

Articulator

Fall 2014

Figure 3

Figure 2

Fig 2. The cast with the definitive implant abutment is mounted on thesurveyor to accurately record the path of the screw-access chamber. Fig 3. Surveyor pin Figure 2 the screw-access chamber on the cast. aligned with

Figure 1 b

Figure 4

Figure 4 Figure 5

Figure 9

Figure 6

Figure 7

Figure 8

Fig 4. Once aligned, the surveyor pin is raised without changing the position of the cast. Fig 5. A fine-point sable brush is fitted to the surveyor in place of the pin. Fig 6. The prosthesis is placed on the abutment, then the brush is loaded with an opaque brown or white stain and lowered to the crown. Note the small concavity created on the occlusal surface to receive the stain; this ensures that the screw-access marking will not wear away under load. Fig 7. In situations where a more discrete marking is desired, a white opaque stain is used. Fig 8. The screw-access marking clearly indicates the precise location of the screw access through the occlusal surface of the restoration. If the prosthesis needs to be removed at any future date, the screw can be easily and predictably accessed by creating a hole at that location. Fig 9. The white-colored screw-access marking is subtler, but it is equally effective at indicating the location of the screw-access chamber.

The Authorsâ&#x20AC;&#x2122; Technique The purpose of the technique detailed in this articleâ&#x20AC;&#x201D;a modification of a technique first described by Schwedhelm in 200618â&#x20AC;&#x201D;is to resolve one of the major concerns and make the retrieval of cemented implant restorations easier and more predictable. With this minor modification, the retrieval of the cement-retained implant prostheses is no more difficult than that of screw-retained units, even when the clinician creating the access was not involved in the initial treatment. During the fabrication of the restoration, the laboratory can perform a simple modification to the prosthesis to ensure that, if needed, the future retrieval will be nearly as simple as removing a screw-retained prosthesis. By making a small indentation on the occlusal surface of a cemented restoration and clearly marking it with an opaque white (or brown) tint, the access

point into the screw chamber can be easily identified. The great advantage of this technique is that the screw-access marking is easily identified by any astute clinician at a future date, even one with no involvement with the initial treatment, ensuring simplified access and removal.

Screw-Access Marking Technique Step-By-Step The technique is carried out as follows: 1. Place the definitive abutment on the implant analog on the laboratory cast. 2. Mount the cast in a surveyor (Figure 2). This is done to accurately record the path of the screw-access chamber and will allow the occlusal surface to be precisely marked, indicating the location for the screw access. The surveyor pin (Figure 3) is aligned with the screw-access chamber on the cast, ensuring that it is correctly aligned in both mesial-distal and buccal(continued on .page 18)

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Articulator

Fall 2014

CLINICAL

(cont. from pg. 17)

Figure 10

Figure 11

Figure 9 Figure 12

marking technique is best indicated for cemented posterior implant restorations, particularly when implant angulation is outside of the expected range. The screw-access marking method will also work on anterior units, as long as the angulation places the screw access palatal to the incisal edge. Due to esthetic concerns, this technique is not indicated for anterior cemented restorations with a line of draw that would result in the indicator marking being placed on the facial surfaces. Removal of cemented implant restorations—with or without the screw-access marking—does still have a risk for porcelain fracture during the creation of the access. The risk of porcelain fracture can be minimized by using appropriate burs for the material being cut (ie, fine grit diamond burs), with light intermittent pressure and water coolant. When appropriate, the prosthesis–abutment complex can be reused and the access closed as would be done for any other screw-retained restoration. This technique is not applicable for solid abutments or “one-piece” implant designs.

Summary

Fig 10. The definitive prosthesis and abutment ready for delivery. Fig 11. The definitive abutment is delivered and torqued to the specified level. Fig 12. The definitive restoration is cemented with a resin-modified glassionomer cement. This cement provides good retention but remains slightly soluble should any cement be retained subgingivally. Postoperative evaluation reveals healthy peri-implant gingiva. Fig 13. Should the prosthesis need to be retrieved at a future date, the white-colored screw-access marking clearly indicates where to create the hole.

lingual angulation. 3. Align the cast so that the surveyor pin passes directly down the screw access of the abutment (Figure 4). 4. Replace the surveyor pin with a fine-tip sable brush (Figure 5). 5. Place the definitive restoration on the abutment. Create a small concavity with a fine diamond bur at the point of contact to ensure that the opaque stain does not wear away under function (Figure 6). 6. Lower the brush (pre-loaded with the opaquing porcelain) onto the surface of the restoration (Figure 7), allowing the opaque stain (white or brown) to flow into the concavity created by the bur. The brown stain (Figure 8) is more obvious than the white stain (Figure 9), although it may be esthetically objectionable under some circumstances. 7. Fire the restoration according to the manufacturer’s instructions. 8. Deliver the definitive abutment, and torque to manufacturer specifications (Figure 10 and Figure 11). Note in Figure 10 that the subgingival

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emergence of the abutment has been stained to better match the gingival shade of the restoration, thus guarding against esthetic complications secondary to future changes in the gingiva. In Figure 11, the screw-access chamber is cleaned with 2% chlorhexidine solution, dried and obturated with polyvinyl siloxane (PVS). Note that the custom abutment in Figure 11 has been designed with the margins at approximately 0.5 mm subgingivally to ensure that removal of the excess cement is easily performed with minimal chance of retaining cement subgingivally.

Discussion: Technique Advantages and Applications This technique is a simple and convenient way to increase the ease with which cemented implant restorations can be removed if needed. The screw-access marking is subtle enough to be esthetically and functionally unobtrusive (Figure 12 and Figure 13). The additional time required to perform the technique is minimal and requires no special training for the ceramist. If widely implemented, this technique will remove one of the major difficulties with cementretained restorations by making their retrieval significantly more predictable and efficient. The screw-access

By creating and staining a small marking on the occlusal surface of cement-retained implant restorations, the access point to the abutment screw can be clearly identified, ensuring that any future retrieval of the prosthesis is simple and predictable, thus resolving one of the primary difficulties with cement-retained implant restorations. REFERENCES

1. Misch CE. Screw-retained versus cement-retained implant-supported prostheses. Pract Periodontics Aesthet Dent. 1995;7(9):15-18. 2. Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent. 1997;77(1):28-35. 3. Chee W, Felton DA , Johnson PF, Sullivan DY. Cemented vs. screwretained implant prostheses: which is better? Int J Oral Maxillofac Implants. 1999;14(1):137-141. 4. Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol. 2002;29 suppl 3:197-212; discussion 232-233. 5. Drago C, Lazzara RJ. Guidelines for implant abutment selection for partially edentulous patients. Compend Contin Educ Dent. 2010;31(1):14-28. 6. Sadan A, Blatz MB, Bellerino M, Block M. Prosthetic design considerations for anterior singleimplant restorations. J Esthet Restor Dent. 2004;16(3):165-175. 7. Weininger B, McGlumphy E, Beck M. Esthetic evaluation of materials used to fill access holes of screw-retained implant crowns. J Oral Implantol. 2008;34(3):145-149. 8. Piattelli A, Scarano A, Paolantonio M, et al. Fluids and microbial penetration in the internal part of cement-retained versus screw-retained implant-abutment connections. J Periodontol. 2001;72(9):1146-1150. 9. Al-Omari WM, Shadid R, Abu-Naba’a L, El Masoud B. Porcelain fracture resistance of screw-retained, cement-retained, and screwcement- retained implant-supported metal ceramic posterior crowns. J Prosthodont. 2010;19(4):263-273. 10. Schwarz MS. Mechanical complications of dental implants. Clin Oral Implant Res. 2000;11 suppl 1:156-158. 11. Jemt T, Lekholm U, Gröndahl K. 3-year followup study of early single implant restorations ad modum Brånemark. Int J Periodontics Restorative Dent. 1990;10(5):340-349. 12. Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported by Brånemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup. Int J Oral Maxillofac Implants. 1991;6(3):270-276. 13. Jemt T, Lindén B, Lekholm U. Failures and complications in 127 consecutively placed fixed partial prostheses supported by Brånemark implants: from prosthetic treatment to first annual checkup. Int J Oral Maxillofac Implants. 1992;7(1):40-44. 14. Becker W, Becker BE. Replacement of maxillary and mandibular molars with single endosseous implant restorations: a retrospective study. J Prosthet Dent. 1995;74(1):51-55. 15. Patil PG. A technique for repairing a loosening abutment screw for a cement-retained implant prosthesis. J Prosthodont. 2011;20(8):652-655. 16. Chee W, Jivraj S. Screw versus cemented implant supported restorations. Br Dent J. 2006;201(8):501-507. 17. Hill EE. A simple, permanent index for abutment screw access for cemented implantsupported crowns. J Prosthet Dent. 2007;97(5):313-314. 18. Schwedhelm ER, Raigrodski AJ. A technique for locating implant abutment screws of posterior cement-retained metal-ceramic restorations with ceramic occlusal surfaces. J Prosthet Dent. 2006;95(2):165-167.

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DISC_MDDS_artad_Summer2014v3.qxp_Layout 1 9/2/14 1:11 PM Page 1

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Overdentures: A New Look on Classic Prosthodontics Dr. Xavier Saab, Prosthodontist Houston, Texas

November 20, 2014 Diagnosing and Managing Patients to Avoid Complications Straumann Dr. Dean Morton, Prosthodontist, Professor and Chairman of the Department of Oral Health and Rehabilitation at the University of Louisville School of Dentistry. Director of the Advanced Education Program in Prosthodontics. Louisville, Kentucky

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Fall 2014

NON PROFIT NEWS

SALUD FAMILY HEALTH CENTER A VALUABLE RESOURCE FOR UNDERSERVED PATIENTS By Lisa Bennett, DDS

hen I tell people I work in a public health clinic I am often asked one of the following questions: Are you employed by the government? Do you get loan repayment? When are you planning to move to private practice? Do you see a lot of meth mouth? I end up responding in my educator tone of voice that I adopt when teaching dental students: No, I am not employed by the government; I am eligible for loan repayment; I am not planning to move to private practice; No, I don’t see a lot of “meth mouth,” but I do occasionally see “Mountain Dew mouth.” I have been working at the Salud Family Health Center in Brighton for six years. Salud is a non-profit Federally Qualified Health Center (FQHC) meaning it is eligible for federal funding as well as reimbursement for Medicaid. Dentists working for FQHC’s may apply for loan repayment. The most common programs are the National Health Service Corps (NHSC.hrsa.gov) and the Colorado Health Service Corps (coloradohealthservicecorps.org). Much like private practice, Salud dental clinics provide a wide range of dental services with the option to refer to cooperating specialists when necessary. Salud differs from private practice in its mission to increase access and offer medical, dental and behavioral health care at each site. Salud dentists are employees so we benefit from paid vacation time and holidays; IRA contributions; health, disability, life, and malpractice insurance; reimbursement for continuing education and organized dentistry memberships; and payment of dental and DEA license renewal. We have autonomy in patient treatment and enjoy the ability to work in collaboration with a large group of dentists. We also serve as preceptors for fourth-year dental students. They gain an appreciation for public health dentistry and some, like me, go on to pursue a career in this field. I chose a career in public health dentistry because I enjoyed my experience as a dental student rotating through community health centers, and I found a way to apply my college major of Spanish. I am grateful for the opportunity to provide high quality oral health care to a population with limited resources. I plan to continue working for Salud because I am passionate about my role as a community leader, educator and public health dentist.

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Salud patients consist of the members of the communities in which Salud clinics are located. Patients that receive high priority are medically underserved, low income or are migrant and seasonal farmworkers. Salud accepts insurance, Medicaid or uses a sliding fee scale based on income. The population we see is at higher risk for dental disease. As a reflection of today’s culture, “Mountain Dew mouth” is prevalent as well as “baby bottle tooth decay,” and we focus heavily on education and prevention. We see everyone from infants with neonatal teeth to patients over 100 years old. All members of a family come to see us and most patients view Salud as their lifelong dental and medical home. Public health clinics, like Salud, are valuable resources for underserved patients. They also provide an exciting and challenging environment in which to practice dentistry. It is rewarding to serve the mission of Salud, “to improve access and reduce barriers to care including: ability to pay, transportation,and language… without regard to age, sex or disease process.” A prospective patient may call our Contact Center at (303) 655-4955. For more information, visit our website at www.saludclinic.org. To advocate for Salud Family Health Centers and to ensure we continue to provide access to our patients and communities, please consider joining our National Advocacy Network at www.saveourchcs.org.

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Fall 2014

MDDF’S SMILE AGAIN PROGRAM® PARTNERS WITH WARREN VILLAGE TO CHANGE SMILES AND CHANGE LIVES By Elyse Montgomery, Director of Family Services, Warren Village

id you know that families with children are the fastest growing segment of the homeless population? Celebrating 40 years of serving the Denver community, Warren Village is committed to helping move families from poverty and homelessness to stability and prosperity. We recognize that a holistic approach to help clients address their economic, physical, psychological and social wellbeing is essential to help families thrive, experience success in the workforce and reduce dependence on public assistance. Located in the Capitol Hill neighborhood, Warren Village is a two-year transformational program, nationally recognized for its programs to help motivated low-income, single parent families move from public assistance to self-sufficiency. Combining subsidized housing, on site nationally accredited child care, intensive case management and career development, residents begin the process of rebuilding their lives and achieving their dreams. Warren Village has had the privilege of partnering with the Smile Again Program since 2002. The Smile Again Program helps connect survivors of domestic abuse with dental care professionals who provide cost-free dental care. Our experience with the Smile Again Program has been overwhelmingly positive and life-changing for our clients. Many of the families at Warren Village have been previously homeless. The relationship between homelessness and domestic violence is extremely strong; the majority of our families have experienced domestic violence. When people think of domestic abuse, often certain images come to mind – usually of a battered or bruised woman. What people may not realize is that domestic abuse may also include isolation from family and friends and

a partner controlling many aspects of an individual’s life, including financial control. Many of our clients come to us with huge unmet or emergency dental needs. We find that our clients have neglected their teeth and their dental health due to high cost of care, poverty, lack of insurance or refusal from partners to allow medical services. Over the years we have referred many clients to the Smile Again Program. One success story is that of a young woman named Barbara. Raised primarily by her grandmother and an extended network of relatives, Barbara and her high school sweetheart became young parents at age 17. They tried to live together as a couple while moving from place to place and staying with relatives who would take them in. Sadly, the nature of their relationship changed once their son was born. The verbal abuse escalated to physical abuse. Her boyfriend spent more and more time running with the wrong crowd, leaving her with all of the financial and parenting responsibilities. Barbara dropped out of high school in her senior year and worked at a fast food restaurant to support the family and eventually went to a shelter to escape the abuse. Once moving to Warren Village and establishing her own home for the first time, Barbara had a hard time finding work. In conversation with staff we learned that she was very self-conscious of her teeth and smile and suffered from chronic pain due to dental decay and gum disease. She had not seen a dentist in over five years. We referred Barbara to Smile Again and the results were amazing! Not only did her volunteer dentist help her with all of her dental issues, the entire office staff made her feel welcomed, appreciated and important. After some time focusing on her health, Barbara’s life improved. She was able to get a job working full-time as a customer service representative at a call center and now has plans to attend college.

CAN YOUR DENTAL TEAM HELP DEFEND YOU IN A MALPRACTICE LAWSUIT? Friday, Oct. 31st, 2014 Presented by Dr. Mitchell Gardiner The MWDI is owned and operated by the Metro Denver Dental Society

EDUCATION SILVER BULLETS: CU-SDM COMMENCEMENT 2014 By Rick Collette, First Year Dental Student

ill you carry on? Or be carried away?” asked Dr. Robert Greer, who gave the 2014 commencement address at the University of Colorado School of Dental Medicine. The true measure of a person, he said, is not their successes, but how they handle their failures. The Class of 2014 has many challenges yet before them, and there are no magic solutions—or silver bullets, according to Dr. Greer. He spoke to the major points in dentistry from doing no harm to providing compassionate care. “Believe in something” and “pursue your passions” are certainly good advice. But it was his poignant story of his own meteoric rise followed by the sudden death of his beloved wife that struck home. Calling up Napoleon Bonaparte, Dr. Greer insisted that the measure of a person is how they handle their “personal Waterloo.” Though he gave no easy answers,

the questions themselves spoke volumes. For the CU School of Dental Medicine class of 2014, their challenges will come in a variety of settings. Fourty percent of the graduates are entering general practice, with a further thirty percent doing an AEGD or GPR program. Four are attending specialty programs, two in

periodontics, one in pedodontics, and one in prosthodontics. Interestingly, only 11 of the graduates plan to stay in the greater Denver area. The rest are scattering throughout the country as far east as Washington, DC and as far west as Hilo, HI. No matter where they end up, we who remain at the CU School of Dental Medicine wish them luck in their upcoming adventures.

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EVENT CALENDAR OCTOBER 2014 October 3-4 Colorado Mission of Mercy â&#x20AC;&#x201C;CMOM Prairie View High School 12909 East 120th Avenue Henderson, CO 80640 All Day (303) 710-6548 October 9-14 ADA Annual Session San Antonio, TX Henry B. Gonzalez Convention Center October 14 CPR & AED Training Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:00pm - 9:00pm (303) 488-9700 October 16 How to Build Your Dream Practice! Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:00pm - 9:00pm (303) 488-9700 October 23 MDDS New Member Welcome Event Three Dogs Tavern 3390 W. 32nd Avenue, Denver, CO 80211 6:00pm - 8:00pm

October 24-25 Botulinum Toxin & Dermal Fillers & Frontline TMJ & Orofacial Pain Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 Oct. 24 8:00am - 5:00pm Oct. 25 8:00am - 1:00pm (303) 488-9700

November 13-15 Oral Surgery for the General Dentist A Practical Approach 3 Day Hands On Seminar Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:30am - 4:00pm (all three days) (303) 488-9700

October 31 Can Your Dental Team Defend You in a Malpractice Lawsuit? Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:30am - 3:30pm (303) 488-9700

November 21 All on Four: Live Implant Surgery and Immediate Provisionalization Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am - 4:00pm (303) 488-9700

NOVEMBER 2014

DECEMBER 2014

November 1 MDDS Event Behavior Management Strategies in Pediatric Dentistry with Special Consideration of Medical Immobilization Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am - 3:30pm (303) 488-9700

December 5-6 Nitrous Oxide/Oxygen Adminstration Training Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 Dec. 5 8:30am - 5:00pm Dec. 6 8:00am - 12:00pm (303) 488-9700

November 6 MWDI Donor Appreciation Event Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:30am - 9:00pm (303) 488-9700

JANUARY 2015

You can find more details on all of these events at

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January 22-24 2015 Rocky Mountain Dental Convention Colorado Convention Center, 700 14th St, Denver, CO 80202 & The Mountain West Dental Institute, 925 Lincoln St. Unit B Denver, CO 80203 All Day (303) 488-9700

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Take 5 and Make Colorado Healthier! Itâ&#x20AC;&#x2122;s our professionâ&#x20AC;&#x2122;s time to shine! Enroll as a Medicaid provider and Take 5 new patients or families today. For the first time, adults are now covered by Medicaid in Colorado. This means that an estimated 300,000 Colorado adults will be seeking dental treatment. They need you â&#x20AC;&#x201C; and in fact their well being depends on it. Make a pledge to Take 5. Join your colleagues and make a commitment to address the needs of those served by Medicaid. On July 1, the full benefit for the Colorado Medicaid Dental Program will be available to patients and includes a $1,000 annual benefit, in addition to a full denture benefit. DentaQuest will administer the Colorado Medicaid Dental Program, and will provide regional field representatives to personally assist dentists, help with Medicaid enrollment, and educate your staff on best practices for efficient billing and patient management. DentaQuest administers dental benefits in 28 states. Visit cdaonline.org/Take5 and join the list of CDA members committed to caring for the new population of patients in Colorado. Questions? Call the CDA at 303-740-6900 or 800-343-3010. 26

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Fall 2014

PROFESSIONAL MARKETING AND APPRAISAL “specializing in professional practice sales and appraisal"

Help Serve Colorado’s Underserved You can help serve our underserved population by signing up for the new Colorado Medical Dental Program for Medicaid members, administered by DentaQuest, the nation’s most experienced dental benefits manager. Our mission is to improve the oral health of all. With DentaQuest, you’ll experience: • Online EOBs • Easy claims filing • Online eligibility • Timely payment • Online utilization management And you’ll be helping our residents who are most in need. Sign up today! Just call Provider Support at 855-225-1731 or visit www.DentaQuest.com.

Buying or Selling a Dental Practice 25 Years Colorado Dental Transition Experience

The demand for successful dental practices is at an all time high, and We at PROFESSIONAL MARKETING & APPRAISAL are working daily with qualified buyers! If you are thinking of retiring, moving, or a career change we will counsel you as to the fair market value of your practice at NO COST TO YOU. We will discuss our TIME TESTED strategies for a seamless transition. We will explore your options and take into consideration your personal and professional needs in a private and confidential manner.

Jerry Weston, MBA Tyler Weston, Broker (303) 526-0448 dentaltrans.com pma0448@yahoo.com

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Founded by a team of industry professionals who have been providing waste management services to Colorado for over 18 years, HCMWS proudly serves hospitals, clinics, laboratories, blood banks, dentists and funeral homes, as well as any facility that is looking for a safe and cost-effective way to dispose of their medical waste.

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6 N Tejon, Suite 501 Colorado Springs, CO 80903 info@hcmws.com 719-445-5044 720-319-9419 www.hcmws.com Articulator

Fall 2014

MWDI SPEAKER CANNIBIS: LEGALIZED, NOW WHAT? By Bart Johnson, DDS, MS

ow that recreational use of marijuana has been legalized in Colorado and Washington, there is even more reason for the dental team to know about the drug, its effects and how best to counsel patients who use it for either medicinal or recreational uses.

Historically, the oldest known written record of cannibis use was from the Chinese Emperor Shen Nung in 2727 BC. Greeks and Romans knew of it, and it spread throughout the Middle East in the Islamic empire to North Africa. There is debate if it was a principle ingredient of the holy anointing oils using “Kaneh-Bosm,” which some historical botanists identify as cannabis, but whom also recognize three or four other plants that may have been the actual constituent. It was brought to South America (Chile) in 1545 and was a plantation product for the production of hemp for clothing, paper and rope (the stalk of the plant is very fibrous and woody; it is where the raw hemp material is derived). In North America during the colonial times, it was one of several plantation products; again more for the hemp than for the psychoactive drug.

rolled cigarettes (joints) provide the oils across the capillary network of our very large lung field for a quick and effective rise in blood levels. Ingestion of the leaves in food forms (classically brownies or cookies) results in a slower but still effective uptake of the drug. Smoking marijuana has a much higher combustion temperature compared to tobacco, and because the goal is to hold it in the lungs as long as possible, it is capable of inflicting much more heat damage to the oral and fine pulmonary alveolar tissues. Some of this effect can be reduced by using a bong or hookah; pulling the lipid-soluble –9THC through the water not only cools it, but filters out the water-soluble impurities for a better high. Recently, vaporizers have entered the market that also provide the drug in a vapor form that can be inhaled across the pulmonary mucosa. There is a pharmaceutical version of –9THC called dronabinol (brand name Marinol) that is available in 2.5, 5 and 10 mg tablets. While effective, most users find the natural leaves to be more enjoyable. It may be because of the minor psychoactive substances found in the leaf, or the subtle tastes and smells that various strains provide.

As dentists, we have a responsibility to educate our patients. We can inform them about the oral effects of the hightemperature combustion and encourage them to limit their exposure or at least mitigate it with water pipes.

The main psychoactive drug in marijuana is delta-9 tetrahydrocannibinol, or –9THC. However, research into the composition of the smoke has found over 400 different chemicals, 23 of which have been identified as having some psychoactive effect. It should be noted that marijuana also has unusually high levels of benzo(a)pyrene, the most wellresearched carcinogen found in tobacco smoke. The plant has two main species, Cannibis sativa, which has no –9THC, and Cannibis indica, which has the psychoactive –9THC. As with many farmed products, there are different strains which experts can point to subtle differences in taste, smoothness, activity and appeal.

The most concentrated version of –9THC is in hashish. The tops of the plants are cultivated and the sap that flows out is 3x more concentrated with –9THC. It is milked, dried and concentrated into slabs where it can be ingested via eating, smoking or made into a tea.

With that concept in mind, the actions of marijuana make sense: we see the patient get “stoned” where their learning, movement, memory and other cognitive functions become impaired. They become apathetic and unmotivated, which for some (particularly adolescents) is a desired goal, and often interpreted as a sense of peacefulness and dreamy relaxation. They experience distortion of time and space, emotional disinhibition, and motor impairment. In the medical applications of the drugs, many patients find pain pathways are blunted and marijuana can function well to help reduce chronic pain syndromes. In the chronic user, unfortunately these “shutting down” processes can go on to lead to permanent memory loss and irrevocable diminution of cognitive ability. In the short-term users who stop using the drug, many often remark how they have “come out of the fog” and their thinking is much clearer once use ceases. All of these effects are magnified in the adolescent brain because it is still developing.

The most common way marijuana is ingested is via smoking. Hand-

The drug has many side effects. Perhaps the most beneficial in the

How the plant is grown and processed will yield various products. Only the female plants have the –9THC, and so the males are eliminated from the production strains. The females that have not yet been fertilized and gone to seed (Sensimilla or “without seeds”) are better for drug levels in the leaves; once a plant has gone to seed, the seeds reduce the concentration of psychoactive substances elsewhere in the plant. Note that marijuana seeds are technically not illegal to possess as they have no –9THC.

What do we know about –9THC? It mimics a class of endogenous neurochemicals known as the endocannabinoids. Research has yet to definitively identify the roles of these chemicals in our brain biochemistry, but they appear to be involved in brain neuromodulation by blunting the release of neurotransmitters. Just like we need to control our brains by activating certain portions when the time is right, we also need to shut down competing or unnecessary portions at other times. These chemicals appear to function globally in our “shutting down” process.

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Fall 2014

medical setting is hypothalamic stimulation of appetite, which is helpful for emaciated cancer and HIV+ patients. In the recreational user, this is simply known as the â&#x20AC;&#x153;munchiesâ&#x20AC;? where they want to eat a lot. Other side effects include red eyes, sometimes very dilated pupils and disoriented behavior/ paranoia. Some people get suppression of the immune system and the heat damage to the pulmonary tissues. The most dangerous threat of marijuana to society is the impaired driver. Because of distortion of time and space (objects appear farther away than they really are), motor impairment and diminution of reaction time, drivers using this drug become very dangerous to others, including themselves. Traffic accidents, many fatal, have occurred by driving under the influence of marijuana. Many states have passed medical marijuana laws that allow a physician to prescribe regulated amounts of the drug for their patients who will gain benefit. Two states, Colorado and Washington, passed laws that now allow for recreational use of the drug under very regulated conditions. Both states only allow this use in adults over the age of 21, and in private areas only. DUI laws are strict in both states. In Colorado, people can grow up to six plants for personal use only and possess 1 oz of the drug while driving; In Washington, they also can possess 1 oz but cannot grow their own (i.e., must buy it from licensed establishments) unless authorized for medicinal purposes. In Colorado, tourists can use it while in-state, but cannot transport it across state lines. Both states sell the drug via dispensaries which cannot be pharmacies since pharmacies are federally controlled. The fiscal numbers are impressive: Colorado started six months earlier than Washington and has already tallied $115 million in revenue and $20 million in taxes; Washington just started in July 2014 but has already generated $3.8 million in revenue. It remains to be seen if these new laws will have overall positive fiscal effects (increased revenue, no significant uptick in accidents and medical problems) or if they will end up costing each state a lot of money in unforeseen ways. As dentists, we have a responsibility to educate our patients. We can inform them about the oral effects of the high-temperature combustion and encourage them to limit their exposure or at least mitigate it with water pipes. We can teach them about responsible use of the drug just like we would do with alcohol. We can encourage our children not to use this drug because it is well-known as a gateway drug for other substance abuses, as well as the known damaging effects on the adolescent brain. We can be compassionate for our medical users as this drug may be one of a few that can restore a form of quality of life, even if it means they function in a chronic foggy state. Oral hygiene for people in this situation may be challenging, and we have to do our best to find ways to be sure it happens, even if that means recruiting family members to help. If our patients or colleagues get to dangerous places with their use of the drug, we can refer them to rehabilitation centers for help. In the end, I am personally against the use of any chemical that interferes with the natural exquisiteness of our brain biochemistry, but recognize that certain limited situations may warrant exceptions.

mddsdentist.com

DIAGNOISIS CHALLENGE: VERRUCOUS CARCINOMA CASE - ANSWERS (from pg. 10) Suggested answers: The differential diagnosis is 1. Squamous cell carcinoma; 2. Verrucous carcinoma; 3. Squamous papilloma; 4. Verruca vulgaris. The diagnostic imperative (the disease or condition that must be ruled out) is exophytic squamous cell carcinoma. The plan with the highest utility is to perform (or refer for the surgical procedure) an excisional biopsy. An excisional biopsy was performed excising tissue from the distal of the mandibular first molar to the pre distal of the mandibular first molar also taking the associated dental papillae and periosteum. In this case, the biopsy diagnosis was verrucous carcinoma with evidence of mild dysplasia extending to the margins of the submitted tissue. A second surgical procedure with wider excision revealed clear margins. Verrucous carcinoma (VC) of gingival tissues is uncommon but not rare. VC most often is diagnosed in older men. Although it is well known that there is no safe form of tobacco, most chronic users of smokeless tobacco do not develop oral malignancies. In fact, many well-designed studies have shown no strong correlation between smokeless tobacco use and oral malignancies. The typical appearance of VC is a well-demarcated exophytic nodule with a verruciform or papillary surface. Slow, painless growth is a common patient history given. VC is considered by many authors to be a low-grade variant of squamous cell carcinoma. Metastasis of VC is rare with lymph node involvement being so uncommon that radical neck dissection is not indicated in most cases. Although VC does not typically demonstrate the course of oral squamous cell carcinoma. Following receipt of the pathologistâ&#x20AC;&#x2122;s report indicating a diagnosis of VC, close follow-up is indicated. Potential recurrence must be discussed with the patient. Discontinuance of risky behaviors (including the use of tobacco products and alcohol consumption) must also be discussed with the patient.

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Fall 2014

ROCKY MOUNTAIN DENTAL CONVENTION IN BEAUTIFUL DENVER, CO

JAN

22 23 24

Hosted by

Rocky Mountain Dental Convention

20 CONNECT 15 RMDC ▶ DENVER,CO The Colorado Convention Center Photo by: Scott Dressler-Martin and VISIT DENVER Photo by: Scott Dressler-Martin and VISIT DENVER

Learn more at

RMDCONLINE.COM

DON’T MISS OUR EXCITING LINE-UP! Dr. Steven Buchanan Ms. Teresa Duncan Dr. Mic Falkel Dr. Greg Gillespie Dr. Sam Low

Dr. Henry Salama Dr. Maurice Salama Dr. John Svirsky Ms. Rebecca Wilder ...and many more!

CONNECT RMDCFRIDAY NIGHTPARTY (across from the Convention Center)

Friday, January 23 - 5:30pm-8:30pm

Featuring DJ Bedz, official DJ for the Denver Broncos & Nuggets!

SPONSORS:

Capitol Ballroom at the Hyatt Regency Rocky Mountain Dental Convention

20 CONNECT 15 RMDC ▶ DENVER,CO HOSTED BY

BENEFITING

FRIDAY NIGHT AFTER-PARTY at Chlóe 1445 Market Street 30

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“WHY IS SO MUCH ATTENTION GIVEN TO RATE OF RETURN?”

FINANCIAL

By Daniel Flanscha, CFP®, CLU, ChFC

am always amazed, how much emphasis is placed on investment Rate of Return in America. In this article, we are going to explore the difference between Average Rate of Return(s) (ROR) and Actual ROR and discuss how any financial plan based on ROR assumptions can lead to a false sense of security and potentially to financial disappointment and insecurity.

We begin with a simple example and grossly exaggerated ROR to make a point. For this example, assume you invested $100,000 and the first year you doubled your money (+100% ROR). At the end of the first year you had $200,000 in your account. The second year you lost 50% (‐50%) so you ended up with $100,000. The third year you doubled your money again (+100% ROR) and end the year with $200,000. The fourth year you again lose 50% (‐50%) finishing the year back with an account valued at $100,000. What was your actual rate of return? It is easy to see that it is zero. Now let us look what your average ROR was: 100 + 100 [two positive years] – 50 – 50 [two negative years] = 100 / 4 years = 25% Average ROR. One is prompted to ask: "Why are financial institutions allowed to market on the basis of average ROR?" Are you upset yet? Let’s take a look at a real time period and compare “average” versus “actual” ROR. If you had invested a consistent amount of money at the beginning of each year for 10 years starting in 1995 in large company stocks (based on the S&P 500), at the end of the ninth year your average ROR would have been 14.00%, but your actual ROR would have only been 7.52%. To be fair, the actual ROR is not always lower than the average ROR. To further demonstrate, I will share with you another example. If you had made the same investments in the previous example but started in the year 2000, by the end of the ninth year (end of 2009) your average ROR would have been 1.21% and your actual ROR would have been 1.33%. Obviously, the actual ROR can turn out to be higher than the average. What happens when you apply this in a method that traditional financial planning uses – linear math? Suppose you visit with a financial planner/ banker/investment sales person and they tell you: if you invest $10,000 per

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year and receive an average of 14.00% at the end of 20 years you would have $910,000. You may feel satisfied, secure and at peace knowing you will have close to a million dollars in net worth. But what if in reality you only receive an actual ROR of 7.52%? If this were so, the reality is your account would be worth just under $467,000. There is a BIG difference between $910k and $467k! So what are you basing your financial decisions on? In the second example, if your actual ROR had been 1.33% your account would have been worth $227,000. So I repeat – Why are we paying so much attention to ROR and why are we basing retirement aspirations and serious financial decisions on them? I believe there are several reasons. First it is easy to apply mathematical assumptions to money to arrive at conclusions. Secondly, I believe deep down human nature tends to be a little greedy. We often think we will be the one who actually earns the 14% ROR It is no wonder so many are disappointed and become disenchanted with what they have been doing financially over the past couple of decades. So what is the solution? First I believe it is important to use ROR assumptions, in our planning, that are more realistic. Secondly, I believe the past decade has taught us that saving may be as important as investing. This is a truth that was known in the past but often ignored, when we thought the stock market would promise us double digit ROR Unfortunately, as a general rule, I don’t think we understand anymore the difference between saving and investing. Many people think they are saving when the reality is they are investing and there is BIG difference between these too. Finally, I believe it is important for each of us to spend more time and energy studying planning options. From a macro economic perspective other issues such as: lost opportunity costs, the velocity of money, long term tax efficiencies and the coordination and integration of financial moves must be considered. Those things go beyond the scope of this article but it is through the consideration of these things that we can begin to potentially achieve better results with even less risk than we would if we were depending on ROR. The next time you hear someone begin to share with you an example regarding money using some sort of ROR assumption, you will at least be able to take note and begin to evaluate the scenario from a different perspective. Based on personal experience it will not take long for you to observe a situation in which ROR is utilized to justify some future number. Just turn on the television or radio or pick up some sort of publication. My guess is you won’t make it through the day without seeing or hearing something.

Articulator

Fall 2014

Metro Denver Dental Society’s Awards Gala and President’s Dinner Ellie Caulkins Opera House Lobby

Thursday, January 22, 2015 (Night of the RMDC) 6:30pm – 10:00pm

oin MDDS President, Dr. Larry Weddle, at this premier RMDC social event. Attendees will be dressed to impress for live music, reception, dinner and society awards ceremony.

Enjoy this unique and fun event for only $72/pp.

You are invited to the~

Thursday. November 6th, 2014 6:30pm - 9:00pm

Donor AppreciationEvent Members and Vendors are invited to an evening of food and drinks at the Mountain West Dental Institute in honor of all our supporters, without whom the MWDI would not exist. Look for the invitation in the mail. Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 Please reply by Monday, November 3, 2014. mddsdentist.com (303) 488 â&#x20AC;&#x201C; 9700

Casino Night

Casino Night Friday, March 20th, 2015

Benefiting the Metro Denver Dental Foundation Register Online at MDDSDENTIST.COM

CLASSIFIEDS Sleep Apnea Diagnostic Equipment for Sale Pharyngometer, Rhinometer, 2 Embletta home sleep study units, $500 and other sleep apnea aids. SGS retail cost $26,000 but will sell for $14,000 OBO. Reply to danceattack73@hotmail.com Real Estate Dental Space for lease near Southglenn Mall Dental office space for lease near Southglenn Mall. Approx. 1500 SF in professional dental building. Space is fully built out including cabinetry, gas lines, plumbing and electrical for 4 ops. Landlord offering free rent and generous TI allowance. No NNNs. Responsive and caring property manager. Please call Sharon Sheppaard 303726-2093 Dental Office Space Highlands Ranch/Littleton Share space with specialty practice in high profile dental/medical building 2 days a week. Highlands Ranch/ Littleton. Reply to danceattack73@ hotmail.com General Practices for Sale with CTC Associates: Practice listings along the Front Range in Denver, Arvada, Lakewood, Littleton, Castle Rock, Colorado Springs, and Fort Collins. Additional opportunities available in Montrose and throughout the eastern mountains. We also have opportunities in New Mexico, Utah, Idaho, Wyoming and Hawaii. For a summary of each current practice opportunity, go to www.ctc-associates.com or call Larry Chatterley and Susannah Hazelrigg at (303)795-8800.

Ortho Practice for Sale with CTC Associates: New, beautiful, high tech, spacious Orthodontic practice for sale in Colorado Springs. This practice offers private consultation room, large imaging room, 5 operatories, digital imaging and paperless charts, with plenty of room to expand. Contact Marie Chatterley with CTC Associates at (303)249-0611 or marie@ctc-associates.com. Practices for Sale: Listings in Colorado: Denver, Centennial, Boulder, Arvada, Parker, Colorado Springs, South I-25 corridor, Central & Western Colorado, Grand Junction and WY & KS. For more information and listing description(s), please visit our website: www.adsprecise.com; new listings added frequently; Peter Mirabito, D.D.S., Jed Esposito, M.B.A., ADS Precise Consultants 855-461-0101. Practice Sales, Practice Appraisals, Partnerships & Buy-In’s. Announcements & Services Transition Services with CTC Associates: For more information on how to sell your practice or bring in an associate, or for information on buying a practice or associating before a buyin or buy-out please contact Larry Chatterley and Susannah Hazelrigg at (303)795-8800 or visit our website for practice transition information and current practice opportunities www. ctc-associates.com.

Visit mddsdentist.com/classifieds to place an ad.

We believe Dental Practice Transitions are more than TRANSACTIONAL, they are

TRANSFORMATIONAL

Appraisals Practice Sales Buy-Ins or Buy-Outs Buyer Representation Post-Transition Coaching Start-Up Coaching Associateships Candidate Matching Negotiations/Mediation Practice Management

“

The practice brokerage business is essentially transactional. Our company’s mission is to go further, to be TRANSFORMATIONAL for our clients and in the industry. Beyond adding value to our services, we understand that success isn’t just about what you accomplish in your life, it’s about what you inspire others to do with their lives. Larry Chatterley (Founding Broker)

CTC Associates Practice Transition Specialists

info@ctc-associates.com

303-795-8800

”

www.ctc-associates.com

At Carr Healthcare Realty… We provide experienced representation and skilled negotiating for dentists’ office space needs. Whether you are purchasing, relocating, opening a new office, or renewing your existing lease, we can help you receive some of the most favorable terms and concessions available. Every lease or purchase is unique and provides substantial opportunities on which to capitalize. The slightest difference in the terms negotiated can impact your practice by hundreds of thousands of dollars. With this much at stake, expert representation and skilled negotiating are essential to level the playing field and help you receive the most favorable terms. If your lease is expiring in the next 12 – 18 months, allow us to show you how we can help you capitalize on your next lease or purchase.

Colin Carr President Denver Metro

303.817.6654 colin@carrhr.com

Roger Hernandez Colorado Springs Southern Colorado

719.339.9007 roger@carrhr.com

Our Services • Identification and evaluation of desirable properties • Negotiation of lease rate or purchase price • Negotiation of concessions including tenant finish and free rent • Negotiation of business terms such as: purchase, renewal and expansion options; parking and signage rights; exclusivity; assignability and more • Guidance on lease vs. purchase scenarios • Demographic information • Assistance with the organization of ground-up construction

Kevin Schutz Boulder Northern Colorado

970.690.5869 kevin@carrhr.com

Lease Negotiations • Office Relocations • Lease Renewals • Purchases