MDDS Articulator Volume 17 Issue 1

ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

Winter 2012 Volume 17, Issue 2

THE AFFORDABLE CARE ACT & ITS

IMPACT ON DENTISTRY Pg. 6 Potential Effects of the Affordable Care Act 10 Can I Fix This With Invisalign? 14 Sirona’s Omnicam: A Game-Changer for the Patient Experience 15 Volunteer Dentist/Pilot Providing a Lifeline 16 Feed the Foundation Restaurant Spotlight - Lou's Food/bar 18 TeamSmile 24 Bonding Futures 24

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ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

Volume 17, Issue 2

MDDS Articulator Editor Carrie Seabury, DDS

Director of Marketing and Communications Staff Photographer Jason Mauterer Creative Manager & Managing Editor Chris Nelson Communications Committee Anil Idiculla, DMD, Chair Karen Franz, DDS Kelly Freeman, DDS Brandon Hall, DDS Kyle Klepacki, DDS Jeremy Kott, DDS Maria Juliana DiPasquale, DMD Nicholas Poulos, DDS Maureen Roach, DMD MDDS Executive Committee President D. Diane Fuller, DDS President-Elect Mitchell N. Friedman, DDS Treasurer Larry Weddle, DMD Secretary Ian Paisley, 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 3690 S. Yosemite St., Suite 200 Denver, CO 80237-1827 Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com ©2011 Metropolitan Denver Dental Society Member Publication

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Inside This Issue:

Fat Squirrels and Hibernating Bears -

Sirona’s Omnicam: A Game-Changer

Winter is Coming.............................4

for the Patient Experience...............15

The Affordable Care Act

Volunteer Dentist/Pilot

& its Impact on Dentistry...................6 Member Matters...............................8

Providing a Lifeline..........................16 Feed the Foundation - Lou's Food/Bar....18 Getting Excited for the Ski Season......21

Potential Effects of the Affordable Care Act........................ 10 MDDS Member Spotlight - Larry T

Event Calendar..............................22 TeamSmile......................................24

Weddle, Jr., DMD, MS..................... 12

Bonding Futures.............................27

Colorado Orthodontic Foundation

Health Care Reform - Some Changes

Reaches 150 Patients In Treatment....13

that May Effect You.........................29

Can I Fix This With Invisalign?........ 14

Classifieds......................................30

Get To Know Your MDDS Staff Lori Steele - Office Manager

Lori joined MDDS in May of this year as the Office Manager. She grew up in Des Moines, IA and lived in Minneapolis, MN for 27 years before moving to Colorado in 2007.

Lori went to Iowa State University and studied music and psychology. A professional musician for a good part of her life, she started playing and singing at the age of fifteen. She was trained in jazz, blues and rock music as well as being classically trained at Drake University. Heavily involved in music at school, she was lucky to have worked with jazz greats Stan Kenton's and Doc Severinsen’s bands holding jazz keyboard workshops. Her most exciting musical moment was when she met, interviewed and jammed with B.B. King while he was playing at a blues club she worked at in Minneapolis. Besides singing, Lori plays several types of keyboards, bass guitar and percussion.

Lori's past professional endeavors include working

for a non-profit scientific research firm as their Business Manager and Membership Liaison and at a non-profit animal shelter where she utilized her varied office skills as well as her creative side, writing bios and articles on the animals while capturing their personalities on film. Recently completing an HR Management course and training in the Psychology and Culture of the Work Environment, she loves to experience and learn new things.

Lori spends her free time studying ancient history as well as writing music with her significant other, Steve, also a musician. Avid scuba-divers, they love to travel to the Caribbean and also go camping, hiking and fishing in the Rockies. She is a member of two ocean preservation societies and she volunteers doing research on animal behavior for a program called Watch the Wild for the non-profit company Nature Abounds.

With several years of Office Management experience, Lori’s outstanding communication and organizational skills along with her upbeat personality contributes greatly to the energy of MDDS.

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REFLECTIONS Fat Squirrels and Hibernating Bears - Winter is Coming

By Carrie Seabury, DDS

I

don’t mean that in a Game of Thrones foreboding kind of way (and if you are with me on that obscure reference, well then you and I need to grab a beer together and catch up on the Lannister clan). Nay, the phrase “Winter is Coming” brings a thrill to my world. I would like to argue that Spring gets entirely too much hype. Blossoms are blooming, birds are chirping, painted toes are peeking through newly acquired sandals, blah blah blah. So overrated! The absolute best moment of the year is that crisp feel in the air that assures you that winter is coming yet again. My favorite aspects of the hint of winter (in no particular order) are: Boots! Sweaters!

Pumpkin Spice Lattes! Kids back in school filling their malleable little brains with things other than how to fit your little brother inside a mini-fridge (I may or may not be speaking from personal experience here.) All of these favorites are topped easily with the ultimate best part of winter. The first snow. That first snow always slows me down and makes me take a moment to enjoy my surroundings. It is such a dramatic transformation. It makes the world look a little softer, a little more muted and peaceful, and just a little more bedazzled.

In my house the first snow always brings Jack Frost to our doorstep. He wraps three presents (for each of my boys) in white paper.

I think he may make a quick run to Hobby Lobby because the presents are always coated with silver glitter and white rhinestones.

I don’t know how he does that - he must have interned with Martha Stewart for a bit.

Without a word, he rings our doorbell and

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disappears without leaving a single footprint in the snow.

The look in my kids’ eyes at the wonder of a surprise gift from a quirky mysterious benefactor is too much. Granted it only lasts 2.5 seconds and then they realize there is a new material object in front of them that is ready for play…then destruction…then abandonment. But I have to argue that 2.5 seconds is worth the $1.99 bottle of glitter.

(I don’t know how I would know how much Hobby- Lobby charges for that extravagance when it is obviously Jack Frost doing all the legwork).

“The true beauty of seeing Medicaid patients is that you can incorporate the Medicaid system into your practice in so many different ways.”

Many would argue that nothing can replace that magic of childhood. We are taught early in life that there are characters like Hannukah Harry, Santa, E.B. (Easter Bunny) the Tooth Fairy, and in our case, Jack Frost, who care so much about us that they shower us with love and gifts and expect no thanks in return.

These characters with their hearts of gold are giving for the sake of giving in the purest form of giving there can be. It’s no wonder it is such a blow when we find out this magic can’t last forever.

I recently had a realization that assures me that I will have this magic in my life for many years to come. If I can’t be the recipient of this

unconditional - no expectations magic, then I sure want to be the donor of some magic.

This feeling is shared by us all – it’s why we get those warm fuzzies when we “help” Santa and his elves. And his reindeer. And that little guy named Hermey who wants to be a dentist.

It’s why fundraisers and charities draw us in time and time again. It is what motivates the anonymous donor to give money for say…a new state-of-the-art MDDS dental educational facility guaranteed to draw in world renowned speakers bringing our Denver metropolitan collective skill set a few notches above the rest. But I digress.

I have seen the magic we thought we lost from childhood grow strong in my office. My office staff, my practice partner and I are developing a model that incorporates Medicaid into our private practice. I’m seeing smiles on their faces during our planning phase. I’m seeing a little light behind their eyes with the notion of truly serving our community. Sometimes when we have planning sessions about incorporating Medicaid into the practice a little fairy dust starts falling down. I don’t know where that stuff keeps coming from.

Our area has many kids that qualify for Medicaid but their parents cannot find a dental home that is accepting new Medicaid patients. Public dentistry is doing its best to try to serve as many Medicaid patients as they can, but our public sector needs some help from our private sector. My office knows the initial impact of our solution will be small but we have decided to dedicate one afternoon a month to seeing Medicaid patients. For years our office has been closing down the last Thursday of the month for an all day staff

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meeting. We found over time that our meetings have grown shorter and shorter. I think it is because after this many years of working with the Elite Team of Awesomeness (ETOA), we no longer need to verbally communicate. We have morphed into a hive mind. We spend half an hour staring at each other, sending telepathic signals to each other until we are assured that our Formic colony is ready for the next month. (I just read this great dental office manager book called Ender’s Game. It gave me a lot of new ideas on how to run the practice more efficiently. It turns out that telepathic communication is actually cheaper than a new Amtel paging system!).

Long story short, because we have so much extra time on our hands, and the whole team wants to feel the magic, we have decided to open our doors to Medicaid patients and fill a very small part of the dental needs of our community. We will start with our very humble Thursday afternoon and find ways to grow the program within the practice.

Yes, the reimbursements are low which means we will all be taking a pay cut or volunteering during our Medicaid blocks of time. We expect no thank you notes, no pumpkin bread, and no dental dioramas in return. Our gifts are not as cool as a new Beyblade or Skylander, but a small spark may click in our patient’s heads when they realize they haven’t had to go down to the school nurse for a toothache in a

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long time. The greatest gift we could possibly give is enough preventative dentistry and education that these kiddos never have to experience a dental injection. Compare THAT to an Ultimate Collector’s Millenium Falcon Lego Set. Step off, Jack Frost.

Dentist. For The Win. The true beauty of seeing Medicaid patients is that you can incorporate the Medicaid system into your practice in so many different ways.

You can decide to only see older kids if you are worried about the squirrely two year olds in your chair. You can block out a day or afternoon in your month to see only Medicaid patients or you can feather them into your normal schedule where there are normally holes. We certainly don’t have it all figured out yet, but my ETOA have locked down many details that we are happy to share with you if you need some guidance.

I will now close with the transitive property we all learned in geometry: IF: Magic = Giving without expectations of receiving AND: Giving without expectations of receiving = Medicaid THEN: Medicaid = Magic Hey Jay-Z - Can I get a woop woop for docs who see Medicaid patients?

Peace Out. Oh – and Happy Winter!

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Winter 2012

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THE AFFORDABLE CARE ACT & ITS IMPACT ON DENTISTRY By: Ian Paisley, DDS

S

ince it was signed into law on March 10, 2010 few topics have caused greater debate in the American political arena than the Affordable Care Act (ACA). Otherwise known as Obamacare, it sets the table for sweeping changes in the way our healthcare system operates. It will impact the insurance industry, healthcare providers and of course individuals. The question I wish to discuss today is: what will be the ACA’s impact on the dental profession?

Most people who have made an effort to learn something about the ACA are aware of its most striking provisions. One is to prevent insurance companies from excluding coverage or charging different premiums for people with a pre-existing medical condition. Another is preventing insurance companies from creating a lifetime benefit maximum. Many of the major provisions in the Act will take effect on January 1, 2014. One of note is the creation of health insurance exchanges by the states where individuals or companies will be able to shop for insurance packages from multiple competing insurers. Not as many people, though, are aware of the effects the ACA will have on dentistry.

When the provisions of the law are dissected carefully there will be some direct and obvious effects on dentistry. While a majority of the law deals with medical care, it seemed that lawmakers were also very interested in dental care for children. There will be a great expansion of Medicaid coverage for children. The same is not true for adults, this summer’s Supreme Court ruling removed provisions that would have increased adult Medicaid dental benefits. Pediatric dental care was also targeted in the provisions for insurers participating in the insurance exchanges. “Any issuer covering pediatric dental services as part of the essential health benefits must do so without annual or lifetime limits as defined under the ACA and its implementing guidance.” These provisions will also limit co-payment or cost-sharing for basic pediatric dental benefits.

At the 2011 American Dental Association House of Delegates, a resolution called for a study of the impact of the ACA and the projected marketplace exchanges on the dental profession. Pieces of this report have come out and indicate that “While the Medicaid expansion for adults did not include a requirement for dental coverage, the states that choose to expand their programs must do so by using one of several benchmark plans, which might contain some dental coverage.”

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HEALTHCARE REFORM The provisions of the ACA could also have another effect on the business of dentistry. The ACA does have language that requires businesses with more than 50 employees to contribute financially to their employees’ insurance plans. This is not the case for businesses with less than 50 employees. According to a 2007 economic census there were 363 dental “firms” with more than 50 employees, which turns out to only be 0.3% of all dental “firms.” Businesses with fewer than 50 employees who choose to provide coverage for employees will be eligible for tax credits on a sliding scale, but that provision will disappear in 2016.

The American Dental Association (ADA) has taken an active role in the political discussion of the ACA. The Association supports the repeal of ACA provisions that are not consistent with Association policy. One example is the creation of a 2.3% medical device excise tax scheduled to take effect on January 1, 2013. A bill was passed in the House of Representatives in June to remove this provision but got stalled in the Senate. This provision is projected to increase the cost of dental care by $160 million annually. The ADA has also made public other concerns about the provisions of the ACA. First, Medicaid funding for dentistry is not properly addressed. Without increases in reimbursements to dentists, the legislation will increase the number of covered children, which will increase demand for services, but will not increase the supply of dentist who can afford to treat these patients. They also expressed concern about continued Medicaid administrative barriers and a lack of data-gathering initiatives to improve Medicaid coverage.

Second, No basic adult Medicaid benefit was addressed, so adults in underserved communities will continue to have difficulty accessing dental care. Third, certain provisions of the ACA provide funding for development of a mid-level provider model in dentistry. The ADA argued against the funding for development of the mid-level practitioner model calling it, in effect, a two-tiered system, whereby dental care would be provided to the underserved by non-dentists with less training. They also expressed concern about the use of Title VII funds, formerly reserved for dental residents and partially for training dental hygienists.

The changes discussed so far and their outcomes are some of the more predictable ones. It is more difficult to see how the ACA will affect dentistry on a broad scale. There are concerns that the ACA will result in a fundamental shift in the employer-based insurance system. There are concerns that the costs associated with the enactment of the ACA will fundamentally change the insurance marketplace. Either of these changes could have an effect on the dental profession. The truth is, that nobody really knows for sure what the broad outcomes of the ACA will be. As with any massive

change in public policy it will take time to realize the outcomes of this legislation. The effect of the ACA and its provisions on the future of dental practice will depend on how the provisions are regulated and implemented. The dental profession must promote and cultivate the strong and ongoing interest of lawmakers in oral health care and must maintain active engagement in the policymaking process.

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MEMBER MATTERS New Members - Welcome!

Dr. Emilio I. Arguello Dr. Brooks Barefoot Dr. Nathan Barton Dr. Anuja Buch Dr. Semiramida Condoianis Dr. Lisa Datta-Phillips Dr. Dafne Ellis

Dr. Cyrus Fanning Dr. Sofia Fontecilla Dr. Clay Fuller Dr. Mellissa Gilman Dr. Lloyd Herman Dr. Alison W. Hoover Dr. Amanda Hudec

Dr. Jeremy Jannuzzi Dr. Matthew A. Johanson Dr. C. Marc Jones Dr. Robert Lefkowitz Dr. Tony R. Lere Dr. Kristin Lere Dr. James R. Lessig

Dr. Collin T Linn Dr. Michael Okuji Dr. Anupama A. Patel Dr. Ivo Pumpalov Dr. Boriana Pumpalova Dr. Cara Riley Dr. Alex R. Roberts

Dr. Aristo Shyn Dr. Joseph E. Taylor Dr. Karina Thompson Dr. Tera Van Houten Dr. Marcus Walker

MDDS Night with the Rockies

This year’s MDDS Night with the Rockies was another sell-out! There were seventy-five attendees including fifth, third and four year dental students who were hosted by a grant initiative from the ADA.

Dr. Mason brought his whole team from Colorado Orthodontics

Enjoying the view at Coors Field

Dental Line 9

The September Dental Line 9 featured interviews with Drs. Vogl and Hurst about the upcoming COMOM 2012.

Drs. Vogl, Seabury, Novelen, Shah and Micklin

Drs. Hurst, Kawasugi, Stamm, Lampert and Idiculla

COMOM 2012

The 6th Annual COMOM was held in Pueblo, Colorado on September 28-29, 2012. During those two days, volunteer dentists performed over 7,000 procedures on 1,500 patients. Over $1,000,000 in dental care was donated. We would like to thank all who supported this year’s COMOM.

A full house at the Colorado State Fairgrounds in Pueblo

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The pediatric area of COMOM 2012

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SAVE THE DATE & SIGN UP EARLY

2012

Nov. 16-17, 2012 8:00am - 4:00pm

Metro Denver Dental Society & Dr. Barry Glassman Present:

Comprehensive Oral Sleep Medicine Barry Glassman, DMD, is a Diplomate of the Academy of Dental Sleep Medicine. We are very fortunate, once again, to have him join us and take our dentists one step further into oral sleep medicine and appliances!

Through this course you will learn – This unique exciting two day advanced course in dental sleep medicine will review the basic concepts of sleep medicine and proceed in-depth into critical areas required to fully and confidently implement dental sleep medicine into a dental practice: 1. How to identify potential patients in your practice and increase referral base 2. Managing all potential muscle, joint, and occlusal untoward effects of oral appliance therapy 3. A Step-by-Step guide to appliance therapy and the use of home studies in guiding titration and in outcome measurement 4. Case presentations of more complex cases and an opportunity to bring your cases to present and/or discuss 5. Bruxism as a movement disorder of sleep and the relationship between pain and sleep as well as bruxism’s role in dental health

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ONLY TWO LECTURES LEFT: Next year, 2013, is set to be a banner year for us.

We will be celebrating our 10th Anniversary!

If you haven’t done so, go to www.knowledgefactoryco.com/subscribe and sign-up to receive our periodic newsletters.

October 11 Astra Tech

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Parameters for integration of aesthetics and function in implant dentistry

November 15 Zimmer Dental

}

Interdisciplinary implant dentistry: current concepts and techniques in aesthetics and immediacy

Dr. Sergio Rubinstein, Prosthodontist Chicago, Illinois

Dr. John P. Davliakos, Prosthodontist Annapolis, Maryland

Location: MDDS Building, 3690 S. Yosemite Street Denver, Colorado 80237

Time: 5:30 PM to 8:30 PM /// Complimentary light dinner at 5:30 PM. Lecture begins promptly at 6:00 PM. /// CE credits are available. Fees for 2012 are waived due to corporate sponsorship.

Please Note: Capacity is limited. If interested in attending, please call 720.488.7677 to reserve your place.

Aldo Leopardi, BDS, DDS, MS Prosthodontist /// P. 720.488.7677 /// F. 720.488.7717

SCAN THIS CODE FOR THE FULL SCHEDULE OR VISIT: www.knowledgefactoryco.com/disc-schedule-2012

6. A comprehensive literature review No prerequisite required to take this class

Register today at mddsdentist.com or call (303) 488-9700 mddsdentist.com

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POTENTIAL EFFECTS OF THE AFFORDABLE CARE ACT

By Craig Palmer, ADA News staff

A

n estimated 3 million children will gain dental benefits by 2018 through health insurance exchanges, roughly a 5 percent increase over the number of children with private benefits currently, the Association said in a report on potential effects of the Affordable Care Act on dentistry.

Beyond the exchanges, more children will benefit through employer-sponsored dental benefits with dependent coverage, “although the number is uncertain at this time,� the Association said.

The law includes pediatric dental coverage in a list of essential health benefits to be provided by small and individual group health plans.

The ACA does not address coverage for adult dental benefits. However, some states are

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looking at adult coverage as a potential optional benefit after the ACA-mandated health benefit exchanges are in place.

The report also examines other potential effects of the ACA. Medicaid The predicted expansion of coverage varies significantly depending on how states respond to the Supreme Court decision barring federal withholding of Medicaid funds from states that refuse to expand their programs.

According to various policy experts, the number of children and non-elderly adults added to Medicaid rolls could be as high as 24 million or as low as 11 million, the Association

said. Actual increases in monthly enrollment will be lower because of the frequency with which beneficiaries enter and leave Medicaid as their financial circumstances change.

Health Care Delivery and Financing Better integration and coordination of health care delivery and financing through Accountable Care Organizations is a major goal of the Affordable Care Act. To date, the emerging ACO models have focused largely on health care services for the Medicare population. Expert analysis recently completed indicates that there are very few ACO type models of care than include dental services, the Association said. Looking forward, it is uncertain when and to what degree ACOs will integrate dental care delivery and

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HEALTHCARE REFORM reimbursement as part of the core health care services they provide.

The ADA has taken the lead in developing the Dental Quality Alliance to ensure that specific concerns of dentistry are adequately addressed.

The Association is likewise engaged with federal health information technology officials to represent dentistry’s interests.

Health Insurance Exchanges Exchanges must be in place in time to begin enrolling beneficiaries by October, 2013. The effects for dentistry could be significant if, for example, the ACA-required essential pediatric dental benefit is inadequate or too expensive or if plans with inadequate dental networks dominate the exchange marketplace.

The ADA offers advocacy materials and shares best practices with constituent dental societies to encourage maximum competition in the exchanges that gives consumers a real choice of benefit plans with robust dental networks. Case studies are shared with constituents on how a state society can ensure an adequate essential dental benefit for children (California), advocate for maximum competition within the exchange that includes stand-alone plans and plans with embedded dental benefits (Washington state and Colorado), and determine whether to include adults as an add-on to the essential benefit package (Vermont).

Dentist Employers The ACA does not require small businesses with 50 or fewer employees to provide health insurance. More than 99 percent of dental practices have 50 or fewer employees.

Small business employers who pay at least 50 percent of the premium for employee coverage may qualify for a small business tax credit. To qualify, the employer must have fewer than 25 full-time equivalent employees whose average annual wage does not exceed $50,000 per employee. The tax credits, which disappear after 2016, will be available on a sliding scale to assist the purchase of health insurance.

Taxes and Limits on Tax Preferred Accounts Flexible spending accounts allow employees

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to set aside tax-free money to pay medical and dental bills. Starting in 2013, the FSA set-aside will be limited to $2,500 a year and increased annually by a cost-of-living adjustment.

The ADA continues to support repeal of ACA provisions that are inconsistent with Association policy. This includes the 2.3 percent medical device excise tax scheduled to take effect Jan. 1, 2013. The ADA and members of the Organized Dentistry Coalition have opposed implementation of the tax, and the U.S. House of Representatives has passed legislation, which is stalled in the Senate, to eliminate the tax. The coalition estimates that the tax will increase the cost of dental care by more than $160 million annually. The IRS has yet to issue final regulations.

“The ADA has taken the lead in developing the Dental Quality Alliance to ensure that specific concerns of dentistry are adequately addressed. The Association is likewise engaged with federal health information technology officials to represent dentistry’s interests.

In 2013, there is 0.9 percent payroll surtax on wage and salary income over $200,000 for single filers or $250,000 for joint filers. The 2012 Medicare Hospital Insurance (Part A) tax for the Medicare Hospital Insurance (HI) Trust Fund is 1.45 percent of all salary income, with an equal 1.45 percent paid by employers. Starting January, 2013, the tax will be 2.35 percent on all earnings above $200,000 and $250,000 respectively. For the self-employed, the rate increases from 2.9 to 3.8 percent.

There is also a 3.8 percent tax in 2013 on some investment income of taxpayers whose modified adjusted gross income exceeds $200,000 for single and $250,000 for joint filers. Investment

income includes rents, dividends, interest, royalties and capital gains on property sales (with a partial exclusion for primary residence sales).

Dentists as Health Care Coverage Consumers Plans in the individual and small group market could include prohibitions on refusal to cover pre-existing conditions, excessive waiting periods, copayments or deductibles for certain preventive services and on coverage rescissions, and comprehensive coverage, guaranteed issue and renewability, premium rating limits on rate increases based on age, gender or health condition and required coverage for dependents up to age 26.

Public Health Infrastructure ACA provisions consistent with Association policy include: increased funding for public health infrastructure, including Centers for Disease Control and Prevention oral health programs and national oral health surveillance programs; additional funding for school-based health center facilities; increased grant opportunities for general, pediatric or public health dentists; funding for National Health Service Corps loan repayment programs.

CDC initiation, in consultation with professional oral health organizations, of a five-year national public education campaign focused on oral health prevention and education.

Many of these new programs have not been funded. The ACA also authorizes federal spending to support a state alternative provider demonstration project, which is inconsistent with Association policy. Money has not been appropriated by Congress to support the demonstration.

Palmer C. Potential effects of the Affordable Care Act. Posted October 9, 2012 online at http:// www.ada.org/news/7670.aspx. Copyright © 2012 American Dental Association. All rights reserved.

Reprinted by permission.

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MEMBER MATTERS MDDS Member Spotlight Larry T Weddle, Jr., DMD, MS

Dr. Weddle has an orthodontic practice established in Westminster, CO. Q: You are currently on the pathway to the MDDS presidency. Last year you were Secretary and this year you are serving as Treasurer. What helped you prepare for these roles?

not so difficult. Now, there are a number of reasons individuals join boards but for me it is altruism. The dental profession has already given me so much it is only right that I unselfishly give some of my time and energy to help advance our local dental society.

A: Well, if I may, let me provide a little history on recent changes made to the officer ladder because my move this year from Secretary to Treasurer is very unique compared to years past.

When I joined the Board as Secretary, the position had a two year term and then succeeded to the position of Vice-President, not Treasurer.

This year our membership, upon recommendation from our Leadership Development Committee and Board, voted to eliminate the VP position.

The overall objective was to reduce the time commitment by one year, thereby encouraging future leaders to run for an officer position. I do believe this change in the officer ladder will prove valuable as every officer will now serve in each position of the Executive Committee for one year. Another benefit of this change comes from the fact that as Treasurer I am consistently evaluating the financial health of the society. With the assistance of past Treasurers and key staff members, I have learned how to perform thorough monthly audits that I review with our Executive Director, bookkeeper and accountant. The intimate knowledge gained through this evaluation helps me make financial decisions that are in the best interest of our members and will continue to benefit me when I am President-Elect and then President.

Q: How did you establish your orthodontic practice and what has been the key to your success?

Q: What were your initial thoughts when you first considered running for Secretary?

A: When then President, Dr. Michael Scheidt, approached me regarding the opening for MDDS Secretary I knew it was a great opportunity but honestly, I had some initial reservations. Was I prepared for the job? Could I take valuable time out of my already busy schedule to fulfill my role on the Executive Board? Do I want the important position of MDDS President?

These were just a few of the questions racing through my mind and I knew this decision would impact my life and MDDS for the next 4-5 years.

Q: Why is it important to you to serve organized dentistry in these roles?

A: We all lead busy lives, but I have learned that life only gives you a limited number of opportunities, with this in mind the decision to run proved to be

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A: After completing my orthodontic residency at Georgia, I made the big move to Colorado to join an existing orthodontic practice. My time as an associate proved to be a valuable experience, but I knew in my heart I wanted the challenge of having my own practice. After carefully studying the local demographics and meeting with established general dentists and orthodontists in the area, I decided to start a practice from scratch in north Westminster.

My personal philosophy on creating and maintaining a successful practice begins with always putting the needs and interests of my patients first. My staff and I try our best to exceed our patients’ expectations and strive to be the best part of their day. Furthering ones’ education with CE to improve clinical and practice management skills is also very important. I also tell myself to have fun, bring a positive upbeat attitude into the office daily and don’t forget to slow down occasionally and smell the roses. This has worked for me and I believe, if practiced, one can achieve a very fulfilling career. Lastly, let me say that I am fortunate to have a wonderful staff that cares about me and the practice, and I cannot thank my referring colleagues enough for their support these last ten years.

Q: As treasurer, you currently have a major role in planning the new MDDS educational building. Did your experience with your own practice condo purchase and tenant build-out help you prepare for this?

A: First, let me say that I am just one member of a very talented task force that is working diligently to help make our society’s vision of a state of the art CE Institute a reality. Like many of our task force members, I do bring the experience of having gone through the process of finding that ideal location, negotiating lease/purchase contracts, as well as selecting an architect and contractor who would do the best job for me and my money. In this case it is our members’ money so we are all very focused in our efforts to make this venture

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Winter 2012

a success for our society. We want to give our members something that they can really utilize and be proud of now and for many years to come.

Q: Where did the idea for a new MDDS building/CE institute come from?

A: The plan for a new MDDS building/CE Institute grew out of MDDS’ 2009 Applied Strategic Plan. Our ASP asked that we study the feasibility and need for a hands on CE center. Our study consisted of membership surveys and other marketing research.

Our conclusion is that a CE Institute centrally located in the downtown area will allow us to deliver higher quality and lower cost CE to our members and to our colleagues regionally and nationally.

Our objective now is to provide a state of the art facility with hands on capability to attract the new and existing study clubs as well as draw in CE courses which are currently being given at hotels in the metro area. We will provide additional hands on courses for our RMDC attendees before, during and after the convention as well as host nationally known CE providers such as the Dawson Academy throughout the year.

Traditionally, the local dental society has been who dental professionals look to for their CE needs. We want to regain that status and allow our MDDS members, our dental colleagues, vendors, and CE course providers to look no further than MDDS to house that need and even provide the CERP certification when needed.

Q: As an orthodontist what do you hope to gain from the new building and what type of classes or study groups would you like to see hosted in its walls?

A: For me personally, I would love to see MDDS host interdisciplinary courses where the GPs and specialists spend quality time together to improve communication and treatment planning skills. I would also welcome financial/retirement planning courses, as well as popular courses from business and community leaders who are very skilled in teaching business principles and life skills that can be utilized daily in my professional and personal life.

Q: Who is your source of inspiration?

A: This one is easy for me. Although I have had many important people and mentors in my life, it all began with my wonderful parents. They grew up fairly poor in Kentucky but knew they wanted a better life for themselves than previous generations.

They both worked multiple jobs including nights while putting themselves through school. They taught me the value of hard work, perseverance, honesty and respect for myself, family and others. I watched my Dad get up early and put on a tie five days a week for 35 years with very little to no complaining about his life, so when I am having a bad Monday morning facing another busy week I just think of him and that motivates me to quit griping and get going!

“COLORADO ORTHODONTIC FOUNDATION REACHES 150 PATIENTS IN TREATMENT”

By Alexandra Gage, Managing Director, The Colorado Orthodontic Foundation

Denver, CO—Since obtaining 501(c)3 classification in 2009, the Colorado Orthodontic Foundation (COF) has been growing and gaining momentum throughout the state of Colorado.

Now in their 3rd full year of treating patients, they currently have 150 patients in treatment. Having already completed treatment on over 25 patients, the organization—which relies on the generosity of local orthodontists to volunteer their time and skills to treat local low-income children otherwise unable to afford treatment—has made a huge impact on communities all along the Front Range of Colorado.

With 38 Colorado orthodontists currently treating COF patients in 11 counties throughout Colorado, the organization has expanded in 2012 and started treatment on over 35 patients this year alone.

With screening days coming up in September and February, it’s clear that these numbers will only go up! As more orthodontists and general dentists find out about the organization, more and more referrals have been coming to the COF’s door. “We are excited about how many families are hearing about our program and our amazing orthodontic providers—it’s special to be able to provide these services to patients who are really in need,” says COF’s Managing Director, Alexandra Gage. “I’m confident that reaching the 150 patient mark is just one of many more milestones to come.”

The Colorado Orthodontic Foundation is a non-profit, 501(c)3 organization providing orthodontic care and education to as many financially challenged families as possible. For more information, please visit our website at thecof.org; we can be reached by email at info@ thecof.org.

13

CLINICAL

CAN I FIX THIS WITH

INVISALIGN?

By Karen Franz, DDS

C

an I fix this with Invisalign?” How many times a day do we all hear this question?

In the past, Invisalign and other removable aligner systems have typically been reserved for minor crowding, spacing, or orthodontic relapse cases.

In 2010, Invisalign released the “G3” features, which included built in hooks to attach elastics for Class II and Class III correction, and new shapes of attachments to improve rotation correction. When Invisalign Teen was released, it addressed concerns of compliance and lost aligners as well as the ability to treat teeth that are not fully erupted.

Last year, Invisalign introduced its new generation “G4” aligner features. The three main clinical situations that it aims to address are control of root angulation on maxillary central incisors and canines, better control of maxillary lateral incisors in all dimensions and better treatments of open bites.

I have certainly encountered the unwanted tooth tipping when closing a space such as a large diastema with aligners in the past; solving one problem while creating another. One of the new features of the next generation Invisalign is a new double attachment with one small attachment near the incisal edge of the tooth and one near the gingiva to help upright the root, with the added benefit of improved esthetics during treatment because the attachment is near the gingiva, it is often covered by the lip. Second, for lateral incisors, a new combination of an attachment bonded to the facial surface and a pressure point on the

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lingual surface allows the tooth to be controlled on both sides so it can move in several planes at the same time to decrease treatment time.

Third, Invisalign claims that closure of anterior open bites is more predictable. In the past, extrusion of teeth has been difficult without the use of auxiliary appliances or elastics. Now, new attachments on the teeth can extrude the upper incisors at the same time and provide different force levels to the centrals and laterals. So, Invisalign can get the bite closed, but can it keep it closed? In long term studies of open bite closure with fixed appliances, relapse is found to be frequent, and tongue position is an important factor (Smithpelter and Covell, AJODO (2010) 137:605-14, Zuroff et al, AJODO (2010) 137:302-8).

Baeck (AJODO (2010) 138: 396-4) showed good long-term success with intrusion of posterior teeth with mini-implants (TADs). Studies of open bite closure with aligners is much more limited, but success may be improved by the use of TADs with aligners or myofunctional therapy in the case of a tongue habit, using the same philosophies which improve success in fixed appliance cases.

Finally, even in cases which may not be fully correctable with clear aligners, they can be used in conjunction with fixed appliances. For example, beginning treatment with a palatal expander to correct a severe crossbite, or a functional appliance to correct a Class II malocclusion, followed by aligners to straighten the teeth. While clear aligners may not be able to treat every situation, and may not be right for every patient, they are increasingly able to treat more complex cases.

Articulator

Winter 2012

SIRONA’S OMNICAM:

A GAME-CHANGER for the PATIENT EXPERIENCE

By Brandon Hall, DDS

C

ertain things come along in the dental world that make you stop and think: “Wow, this is really going to change how we treat our patients.”

Not only that but how it will positively affect patients’ experiences in our dental offices. I had the opportunity to witness the unveiling of one of these such advances recently.

First, let me say that I’m in no way getting paid or influenced whatsoever to write this article or make a recommendation. I’m simply a wideeyed, newer dentist who embraces technology and can clearly see when something is going to revolutionize dentistry. Patients want us to diagnose their oral conditions utilizing the latest technology because quite frankly, they deserve it. CAD/CAM technology has made leaps and bounds in the last ten years and now things are kicked up a notch.

I spent a weekend this past August in Las Vegas at Sirona’s 27-And-A-Half Party as a celebration of their CEREC technology’s 27.5 year birthday.

However, there was a palpable buzz in the air that Sirona was releasing something that was going to be a game-changer in the chairside CAD/CAM world. And indeed it is. It’s called the Omnicam.

Essentially Omnicam is a 3D, full color HD videocamera as an acquisition unit for Sirona’s CEREC unit. It captures a patient’s teeth and surrounding tissue in vivid, highly detailed 3D. Traditionally, with CEREC, the teeth were captured with a bulkier intra-oral camera that

mddsdentist.com

takes still images and the computer than stitches them together. While the Omnicam takes images also, it does at a much faster speed and in color.

The camera is also much slimmer. So not only can you fabricate restorations with Omnicam but you can also use the video stream and images as a patient education tool. The 3D model created by Omnicam is essentially an identical representation of the patient’s teeth and gums. Not only in the tissue detail but the actual color as well. In fact, some of the images I saw that Omnicam produced seemed to be in higher detail than the actual mouth.

Remember that annoying powder with Bluecam and previous CEREC acquisition units. It’s expensive, it gets everywhere and patients aren’t huge fans of it. No more with Omnicam. You just simply aim the camera and let it ride. You can scan upper and lower arches and the buccal bite whenever you’d like. Even with saliva, it scans seamlessly.

It’ll be exciting to see what Sirona does with Omnicam over the next several years. Not only that, but what their competitors, especially D4D’s E4D system, come up with as a response. We’ll see if “competition breeds innovation” here.

As the digital world around us changes at a frenzied pace, so too does the technology available to diagnose and treat our patients. Offices of the future will be able to utilize digital technology for all aspects of dentistry and I’m certain Omnicam will be a huge part of this for a lot of practices.

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Winter 2012

15

NON-PROFIT NEWS

Volunteer Dentist/Pilot Providing a Lifeline

By Judith Eckles

W

hat do pheasant hunting and providing dental services to poor Mexican adults and children have in common?

Boulder dentist Mitch Friedman (far left in the adjacent photo) knows the answer. Mitch learned to fly 17 years ago because he was tired of making the 12-hour drive to South Dakota to go pheasant hunting. After earning his pilot certificate, he and two partners bought a Cessna 210 Turbo that turned the hunting trip into a two and a half hour flight. The next thing you know, Mitch was enticed by a colleague to fly to Guachochi, Mexico to help poor Mexicans and Tarahumara Indians with their dental needs.

During the past ten years Mitch has also been flying missions for LifeLine Pilots, a nonprofit 501 (c)(3), one of about 100 organizations involved in what is known as “Charitable Flying.” Volunteer pilots, like Mitch, come from all walks of life. Men and women of all ages who share one common goal to donate their time, money and airplanes flying missions to help people they don't even know. These pilots pay for all flight costs from fuel to airport fees.

LifeLine volunteer pilots fly children and adults to see specialists; transport lifesaving organs to waiting transplant patients; airlift medical supplies and goods to areas that have suffered Mother Nature's wrath; make it possible for families to visit their wounded warriors in medical facilities hundreds of miles away; help save the planet by flying for environmental and conservation causes; and shuttle dogs to no-kill shelters where they can be adopted into loving homes. Or, as in the case of dentist Mitch Friedman, they fly to where their help is needed.

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One of Mitch’s most memorable missions was flying to Mexico and landing on a narrow, 4,500 feet dirt strip at 8,000 feet. “I performed dental surgery on poor adults and children who walked 30 miles and camped overnight because I was the first dentist they ever saw,” explained Mitch.

Another memorable mission for Mitch was “flying a young child home after receiving cancer treatment.”

LifeLine Pilots are “great folks to work with,” said Mitch. Apparently the American Dental Association feels the same way about Mitch. A few years ago he received their prestigious Humanitarian Award given to an Association member who has been contributing services, both internationally and nationally, for at least ten years.

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Winter 2012

17

FEED THE LOU'S FOOD/BAR

RESTAURANT SPOTLIGHT:

FOUNDATION

1851 West 38th Avenue, Denver For Reservations Call 303 458-0336

Mention MDDF when making your reservation in November and 10% of your tab goes to benefit MDDF!

By Jeremy Kott, DDS & Nicholas Poulos, DDS

C

hef Frank Bonanno (right) and his restaurants are well known around the Denver culinary community. His love of food came from food experiences at an early age, the smell of pastries and pastas from his grandmother’s kitchen, watching Julia Child with his mother and testing her recipes. This love of food led him to formal training at the Culinary Institute of America in Hyde Park, N.Y. and honed at some of the finest eateries in the world. Chef Bonanno has done stretches at The French Laundry and Gramercy Tavern. These experiences gave him an appreciation for fresh, locally grown items at the peak of their flavor.

All these experiences has led Chef Bonanno to open a series of venues in Denver: Mizuna, Luca D’Italia, Osteria Marco, Bones, Green Russell, Russell’s Smokehouse, and our featured restaurant for Feeding the Foundation, Lou’s Food/Bar. Located in Denver’s Sunnyside neighborhood, Chef Bonanno wanted to offer fresh, quality food that is accessible to all. At Lou’s Food/Bar, Chef Bonanno offers American country food with a French twist, in a family centered eatery.

A great way to start the evening off at Lou’s Food/Bar is with their wonderful assortment of charcuterie and cheese. The salami is

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house-cured and the pâté are made in-house, sourced from local farmers and change weekly.

There is also an assortment of other appetizers, including escargot, calamari and French onion soup to wet your appetite.

The salads could be a meal unto themselves, especially if you add one of the available proteins to round it out. But, why stop there when there are so many other extraordinary things to be eaten? There are several classic sandwiches on the menu, from different regions of the country, like the Shrimp Po’ Boy and Lou’s Reuben. However, what really steals the show is the assortment of burgers, especially the beef short rib burger. The lemon garlic aioli adds an unexpected zing.

If, after all that food, you still have room left, you could try one of the housemade sausages or one of the main dishes, none better than the classic fried chicken and mashed potatoes. The potatoes are silky smooth and the fried chicken manages to be wonderfully crispy on the outside while staying juicy and tender on the inside.

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Winter 2012

FEED THE FOUNDATION Calling all foodies & philanthropists We would like to introduce a new fundraising program for the Metropolitan Denver Dental Foundation you will not want to miss: “Feed the Foundation”. We will be partnering with a series of Denver culinary hot-spots to feed you some amazing meals while helping to raise money for our foundation at the same time. The program could not be simpler.

So how does it work?

Step 1: When the Articulator shows up on your desk at work, do not push it to the side. Instead, find the “Feed the Foundation” page and read all about the amazing food and people at that month’s partnering restaurant. (You’ve already made it through that step – see how easy this is?).

Step 2: Get a group of friends, family, co-workers, strangers, etc. together and make plans for a fabulous dinner. Call the featured restaurant to make a reservation (must be for dinner on Sunday through Thursday and make sure to mention that you are with MDDF and you want to “Feed the Foundation").

Step 3: Eat, drink and be merry. The restaurant will track all MDDF parties for the month and donate 10% of every food bill back to us at the end. (It probably wouldn’t hurt to remind your server when you check in just to be sure).

We are going to work very hard to try and partner with Denver area's best restaurants to give you a wonderful experience. Please help us by spreading the word and getting this program off to a great start!

W E C A R E A B O U T Y O U R S U C C E S S Dental practice transitions are about relationships.

The relationship of the doctors and between the doctors and patients. We work to build those relationships so there is trust and integrity which results in a successful, smooth transition.

CTC Associates Chatterley Transition Consulting info@ctc-associates.com

mddsdentist.com

303-795-8800

www.ctc-associates.com

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Winter 2012

19

7 130th annual scientific session

7 april 25-27

7 saint paul rivercentre

k 2013 Star of the North Meeting l

SAINT

PAUL

APOLIS

MINNE

for additional information or to request a copy of the preliminary program, visit www.starofthenorthmeeting.org or email info@mndental.org.

The 2013 Star of the North Meeting brings you the best clinicians and dental companies in the industry, providing the latest in cutting edge techniques and information. Choose from over 80 continuing education sessions presented by over 35 nationally recognized speakers—all conveniently located close to home. nationally Known...

7 We find prominent leaders in the dental industry and bring them to YOU! Don’t miss the opportunity to learn

• • •

7

registration opens January 2, 2013

from the best and get the most out of your CE dollars!

We’re providing over 20 workshops to give you valuable one-on-one time with clinicians and experience hands-on learning.

7 Attendees can earn up to 6 CE credits per day! close to home...

7 7 7 ®

Talk face-to-face with over 275 knowledgeable exhibitors and test out the latest products for your practice in person rather than through a picture on a computer screen.

Network with over 9,000 dental professionals who attend each year. Take advantage of the opportunity to learn outside the classroom by sharing ideas and experiences with your peers.

Plan some fun with your team and order tickets for one of our special events. Catch up with old friends by attending your class reunion or one of the many social events sponsored by affiliated organizations.

You’d never give your customers the same solution. Neither would we.

Diagnosis on page 21

Our Practice Finance Specialists will prescribe solutions that fit your practice, helping you with acquisition financing or practice debt refinancing. In addition, we can help with buyins or buyouts, expansions, relocations or new practice start-ups.

Call Kerrie Bunce at 303-713-6411, Lucas Harmon at 303-713-6429, or Michael Thomas at 720-566-7705

branch

usbank.com/smallbusiness

Subject to normal credit approval. Some restrictions may apply. Deposit products offered by U.S. Bank National Association. Member FDIC. © 2012 U.S. Bank MMWR19030

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Articulator

Winter 2012

GETTING EXCITED for the

SKI

SEASON

By Ryan Saunders, DDS

L

ast winter was one of the mildest in the mountains on record. My friends and I were constantly checking weather websites looking for a storm on its way to our mountain this weekend, or maybe next week, or if not our usual mountain, maybe a different ski area just a little further away. Or even a lot further away. We thought, maybe Utah’s getting the snow, or California. Maybe we should go to Canada? But the snow just never came. I was skiing on a run last winter in March, and came across a sign that said “short walk”. Short walk? During what is typically the height of the snowpack, a sign was suggesting that I finish up my turn, take off my skis, walk across the grass to where the snow started again, put my skis back on and make my next turn. For the last year in Colorado, we have been snow deprived.

Getting an early start on the season in September a few years ago

However, just one season before was the best snow I can remember.

We would have the best snow day of the year then we would go to sleep and have it again the next day.

The snow kept coming and coming. Run after run, I had snow in my beard, snow in my mouth and my nose, making my breathing difficult and muffling my shouts of excitement. We had perfect blue sky days in the trees, moguls, on the groomers, on the flats and in the steeps. Whatever your perfect conditions for skiing are, whatever your perfect day, we had it. And now, as I write this on September first, winter is on its way. It’s been 100 degrees in Denver, but where I’m sitting in the mountains right now, I have goosebumps. It’s chilly. I saw aspens changing last weekend. This feels early. We’re due for another good season, and I think it’s on its way.

mddsdentist.com

I think that the best thing you can do to motivate and have a great year is to get excited about it. Get to the mountains as much as you can. Start early in the year. Some resorts open as early as October. Get there and go easy the first few days. Even with a high level of fitness, going really hard all day the first day will make you sore and increase your chances of injury.

Most of us in Colorado have sports we like to do in the summer. Road biking, mountain biking, running and hiking are all great for cross training. It's a lot easier to motivate to do something you love, than to stick to an indoor exercise routine.

The Skier’s sit is a good way to get some of the burn over with before the season starts.

If you would like to do some specific strengthening exercises with a group, there are many ski conditioning classes offered at gyms around town. Lunges, wall sits, leg curls and bicycle crunches can be helpful. Strengthening your core is good for skiing (as well as dentistry!). Just make sure you keep exercising through October, November and December, when it starts to get cold, so you can still be in shape when the snow starts flying in January!

Ryan Saunders, DDS, was a member of the University of Colorado Freestyle Ski Team from 1998-2001, has competed in mogul skiing internationally and was ranked in the top 25 in the U.S. Dr. Saunders graduated from the University of Colorado in 2006 and maintains a private practice in Commerce City.

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21

EVENT CALENDAR NOVEMBER 2012

JANUARY 2013

April 2013

November 2

January 24-26

April 19 & 20

Metro Denver Dental Society: Ladies Night out at the Vineyard Balistreri Vineyards 1946 E. 66th Ave. Denver, CO 80229 6:00pm - 8:00pm For more info go to: mddsdentist.com

November 3

Metro Denver Dental Society: Behavior Management Strategies in Pediatric Dentistry with Special Consideration of Medical Immobilization - Dr. Ulrich Klein Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 8:00am-3:00pm (303) 488-9700 For more info go to: mddsdentist.com

November 15

D.I.S.C - Interdisciplinary Implant Dentistry: Current Concepts and Techniques in Aesthetics and Immediacy Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00pm - 9:00pm (720) 488-7677 For more info go to: knowledgefactoryco com/2012/05/disc-schedule-2012/

November 16 & 17

Metro Denver Dental Society: Comprehensive Oral Sleep Medicine - Dr. Barry Glassman Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 8:00am-4:00pm (303) 488-9700 For more info go to: mddsdentist.com

DECEMBER 2012 December 14 & 15

Metro Denver Dental Society: Nitrous Oxide/Oxygen Administration Training Dr. Jerome Greene Cody Dental Group 4301 E. Amherst Ave. Denver, CO 80222 Friday, 8:00am–5:00pm Saturday, 8:00am–12:00pm (303) 488-9700 For more info go to: mddsdentist.com

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Metro Denver Dental Society: 2013 Rocky Mountain Dental Convention Colorado Convention Center 700 14th St. Denver, CO 80202 (303) 488-9700 For more info go to: rmdconline.com

February 2013 February 20

CPR & AED Training, a Two Year Certification Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00pm-9:00pm (303) 488-9700 For more info go to: mddsdentist.com

February 22

Metro Denver Dental Society: Basic Radiation Education for Unlicensed Dental Personnel Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 8:00am-12:00pm (303) 488-9700 For more info go to: mddsdentist.com

March 2013 March 8

Metro Denver Dental Society: Endo Mini Residency -Dr. John West Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 (303) 488-9700 For more info go to: mddsdentist.com

March 21

Sinus Course Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 (303) 488-9700 Keep checking mddsdentist.com for upcoming information.

March 28

Prevention of Oral Disease (Ms. Andrea Wiseman) Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00pm-8:30pm (303) 488-9700 Check mddsdentist.com for upcoming information.

Metro Denver Dental Society: Botox and Dermal Fillers Training: Course I American Academy of Facial Esthetics Dr. Louis Malcmacher Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 8:30am-5:00pm (303) 488-9700 For more info go to: mddsdentist.com

April 25

CPR & AED Training, a Two Year Certification Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00pm-9:00pm (303) 488-9700 For more info go to: mddsdentist.com

May 2013 May 16

MDDS 116th Annual Meeting Wings Over the Rockies Air & Space Museum 7711 E Academy Blvd.

Denver, CO 80237 6:00pm - 9:00pm (303) 488-9700 For more info go to: mddsdentist.com

May 24

Hands -on Course Presented by Dr. Robert Vogel This will be a premier MDDS CE event presented by implant specialist Dr. Robert Vogel. Keep checking mddsdentist.com for upcoming information.

JUNE 2013 June 13

CDA Annual Meeting CDA House of Delegates & Annual Meeting in Steamboat Springs at the Sheraton Resort All Day Keep checking mddsdentist.com for upcoming information.

JULY 2013 July 18-20

ADA New Dentist Conference Four Seasons Hotel Denver 111 14th St. Denver, CO 80202 All Day Keep checking mddsdentist.com for upcoming information.

mddsdentist.com

Articulator

Winter 2012

23

A

t a TeamSmile program in Kansas City, a single mom approached the front desk shyly. “I have a boy that

has been complaining of a tooth ache but I lost my insurance recently due to a divorce. I am not poor just trying to get on my feet. I can’t afford to take him to the dentist, can you help me?” The boy had two cavities that were filled and he got to meet some Chiefs’ players.

At a TeamSmile program in Denver, a man arrived with his six kids. It had been a bad day. He signed all nine of his kids up for the program but his car broke down and he was only able to bring six of his kids in a taxi because that was all the money he had. The children were all in need of dental care and the father’s gratitude was felt as he continued to shake every volunteer’s hand. He expressed over and over how much he appreciated us taking care of his kids and that programs like these are what makes life a little easier for people in his situation. He was not poor, but with many mouths to feed, the extra funds needed for dental care was not in the family’s budget.

Story after story, it is evident that the need for dental care in our community’s children is growing. The American Dental Association reports that tooth decay affects more than one in four children in the United States between the ages of two to five, and one in two children between the ages of twelve to fifteen. It is a growing epidemic in United States and it has become more common then asthma and hay fever as far as chronic childhood disease.

The start…The idea behind TeamSmile originated in an airport in Chicago. A Kansas City dentist, Dr. William Busch, was 24

mddsdentist.com

Team

watching the news and a story about a child that had died from an untreated abscessed tooth played on the TV screen. After watching the story, right there Dr. Busch decided he was going to help these children in our communities receive the dental care they need and deserve in order to stay healthy.

In the fall of 2007, the first TeamSmile outreach program was hosted by the Kansas City Chiefs. The Chiefs promoted a one-day event where dental volunteers provided dental outreach services to children at Arrowhead Stadium. On this day over one hundred children from the surrounding community received over $50,000 in free care. The smiles on the children’s faces and gratitude from the parents and guardians was enough to make Dr. Busch know this event needed to be an annual thing.

But word got out about this unique concept of using the love of sports teams to entice children into a dental experience. Soon Jason Krause of Henry Schein became a partner in the fight to help these children not only in Kansas City but in other cities across the United States. Dr. Busch and Jason Krause created a non-profit organization called TeamSmile. Its mission is to create community programs that utilize the talents of local dental professions and the allure of the local sports team to create an unique experience that serves the area’s children. TeamSmile has grown and so has the program. The program now has a preventative care area where every child gets their teeth cleaned, varnish applied and are taught how the mouth and body is linked. Each child leaves with a Colgate toothbrush and tooth paste so they are given the tools to be successful at taking care of their teeth.

Articulator

Winter 2012

mSmile

By Kellie Reneau

In the past five years, TeamSmile has grown to ten programs across the United State. Jason’s passion for the program brought it to Denver and gained the support of the Denver Nuggets. The program has been repeated two times and served over 200 children with $100,000 worth of dental care. The children not only are treated to dental care but they get to meet many Nuggets players, dancers and ambassadors and each child received two tickets to a game. The Nuggets are proud of this program and it was featured in the NCAA Charity of Giving newsletter. It has now become a yearly program to serve area community organizations. Recently, the Denver Broncos teamed up to be a part of this Denver experience. TeamSmile is heading back to Denver on November 17, 2012. If you would like to volunteer at this program or donate funds to support this wonderful cause, visit the website www.teamsmile.org or send an email to kellie@teamsmile. org. All types of volunteers are needed so you do not have to have a dental background to be a part of this cause.

At a TeamSmile in Orlando, a father without dental insurance walked more than one mile with his four children so his one daughter could be seen. She had been complaining for months that her tooth hurt but he had no insurance and no means to help her. Not only did TeamSmile help his child, but also treated his other three children, two of which had cavities. The gratitude of this father could be felt when he expressed with tears in his eyes, “Thanks for helping my children when I couldn’t.”

This story is why TeamSmile continues to grow–to help our communities’ children when no one else can. But it takes the talents, time, and funding from the area communities to make this happen – to help the children - one smile at a time.

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Bonding Futures

MATERIAL MATTERS

By Sheldon Newman, DDS

A

previous column on bonding1 discussed the technique sensitivities of total etch and self-etch bonding systems. All of these systems demonstrate failure over time.

Current research is identifying the mechanisms for this failure and improvement methods. After etching the dentin and impregnating the exposed collagen with primer/bonding resin, there remains at the bottom of the hybrid layer (bonding resin interweaving with collagen), and above the inorganic imbedded collagen, a layer of exposed collagen.2-7 This layer, in both laboratory and clinical studies, has been described as penetrated by water in a phenomenon dubbed “water trees”.8 The collagen in this layer is subject to degradation.9-12 It is the location of failure in the total etch technique. In self-etch systems there are a number of different potential failure locations varying from that which has just been described as remaining smear layer, depending on many factors that vary among the commercially available self-etch systems.13 The penetration of water is only a small part of the problem. There are several proteins embedded in dentin’s collagenous structure that are dormant enzymes. The two groups of pro-enzymes are matrix metalloproteinases (MMPs) and cysteine cathepsins (CC).14 These enzymes can be activated to begin the digestion of the collagen by lowering the pH. They enzymes get turned on by the acid etching procedure. The water trees hydrate the exposed collagen unwinding the strands of the collagen. The slow unwinding of the strands of collagen allows access of the acid activated MMPs and CCs to break the collagen. That combined action slowly leads to failure of the bond at the exposed collagen layer below the hybrid layer over several years.12 There are several possible approaches to address this problem area. One is to crosslink the collagen, inhibiting the access of the collagenases. Another is to improve the penetration of the resin into the collagen. These proposed mechanisms for improvement have not been addressed. One method with published research is to remineralize the exposed dentin.15-18 This experimental procedures is not clinically available yet. Another approach is to inhibit the enzymes.

Basic research on the use of a chlorhexidine (CHX) wash, after acid etching appears to have an effect on inhibiting MMPs and CCs.1920 There may be an effect with self-etching systems, but an effective clinical application method is still questionable.21 A concentration of 0.2% to 2% does not appear to have any significant effect on initial bond strengths but may improve bond strengths long term.22-27 In the total etch technique, one can apply a CHX solution after etching.

One can dry the etched prep and then rewet it with a commercial CHX cavity cleanser for 30 seconds, followed by a quick removal of excess before applying the resin. There are commercial products

mddsdentist.com

like Consepsis (Ultradent) and Cavity Cleanser (Bisco) are 2% CHX solutions. There may be others, but check their ingredients to make sure there is not glycerol or oils in them. Other precautions include reviewing for allergy to CHX gluconate and the possibility of staining of composite resins.

There is one more method being explored for improving the longevity of the bond. That is the use of quarternary ammonium methacrylates (QAMs). These monomers incorporated in small concentrations in dentin bonding agents are being investigated in in vitro studies. They may have both antibacterial28, 29 and MMP-inhibitory effects.30, 31 These materials do not appear to have a detrimental effect on initial bond strengths. Long term effects are yet to be determined.

There are exiting changes in bonding materials and techniques coming soon. For now the additional step of using a CHX cavity wash during the total etch procedure may improve the prognosis of your bonded restorations, direct or indirect.

References: 1. Newman SM; Materials Matters: Invest in your bond. Articulator 16(1 labeled “2”):19,Sept/Oct 2011.

2. Hebling J, Pashley DH, Tjäderhane L, Tay FR; Chlorhexidine arrests subclinical degradation of dentin hybrid layers in vivo. Journal of Dental Research 84:741–6, 2005.

3. Breschi L, Mazzoni A, Ruggeri A, Cadenaro M, Di Lenarda R, De Stefano Dorigo E. Dental adhesion review: aging and stability of the bonded interface. Dental Materials 24:90–101, 2008.

4. Pashley DH, Tay FR, Breschi L, Tjäderhane L, Carvalho RM, Carrilho M, et al; State of the art etch-andrinse adhesives. Dental Materials 27(1):1–16, Jan. 2011.

5. Eliades G, Vougiouklakis G, Palaghias G; Heterogeneous distribution of single-bottle adhesive monomers in the resin-dentin interdiffusion zone. Dental Materials 17:277-83, 2001.

6. Yoshida Y, Van Meerbeek B, Snauwaert J, Hellemans L, Lambrects P, Vanherle G; A novel approach to AFM characterization of adhesive tooth-biomaterials interfaces. Journal of Biomedical Materials Research 47:85-91, 1999.

7. Sano H, Shono T, Takatsu T, Hosada H; Microporous dentin zone beneath resin-impregnated layer.

Operative Dentistry 19:59-64, 1994.

8. Tay FR, Pashley DH; Water treeing – A potential mechanism for degradation of dentin adhesives.

American Journal of Dentistry 16(1):6-12, Jan. 2003.

9. Armstrong SR, Vargas MA, Chung I, Pashley DH, Campbell JA, Laffoon JE, Qian F; Resin-dentin interfacial ultrastructure and microtensile dentin bond strength after five-year water storage. Operative Dentistry 29(6):705-712, 2004.

10. Shono Y, Terashita M, Shimada J, Kozono Y, Carvalho RM, Russell CM, et al. Durability of resin–dentin bonds. Journal of Adhesive Dentistry 1999;1:211–8.

11. Hashimoto M. A review – Micromorphological evidence of degradation in resin–dentin bonds and potential preventional solutions. Journal of Biomedical Materials Research: Part B, Applied Biomaterials 92:268–80, 2010.

12. Hashimoto M, Ohno H, Kaga M, Endo K, Sano H, Oguchi H; In vivo degradation of resin-dentin bonds in humans over 1to 3 years. Journal of Dental Research 79:1385-91, 2000.

13. Van Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J., Van Landuyt KL; State of the art of selfetch adhesives. Dental Materials 27(1):17-28, Jan. 2011.

14. Tjäderhane L, Nascimentod FD, Breschie L, Mazzonie A, Tersariol ILS, Geraldeli S, Tezvergil-Mutluayk A , Carrilhom MR, Carvalhon RM, Tay FR, Pashley DH; Optimizing dentin bond durability: Control of collagen degradation by matrix metalloproteinases and cysteine cathepsins. Dent Mater (2012), in press http://dx.doi.org/10.1016/j.dental.2012.08.004 15. Tay FR, Pashley DH. Biomimetic remineralization of resin-bonded acid-etched dentin. Journal of Dent Research 88(8):719–24, August 2009.

16. Kim YK, Mai S, Mazzoni A, Liu Y, Tezvergil-Mutluay A, Takahashi K, et al. Biomimetic remineralization as a progressive dehydration mechanism of collagen matrices—implications in the aging of resin–dentin bonds. Acta Biomaterialia 6(9):3729–39, Sept. 2010.

17. Kim J, Vaughn RM, Gu L, Rockman RA, Arola DD, Schafer TE,et al. Imperfect hybrid layers created by an aggressive one-step self-etch adhesive in primary dentin are amendable to biomimetic remineralization in vitro. Journal of Biomedical Materials Research, Part A 93(4):1225–34, 2010.

18. Gu LS, Kim J, Kim YK, Liu Y, Dickens SH, Pashley DH, et al. A chemical phosphorylation-inspired design for Type I collagen biomimetic remineralization. Dental Materials 26(11):1077–89, Nov. 2010.

19. Tay FR, Pashley DH, Loushine RJ, Weller RN, Monticelli F, Osorio R; Self-etching adhesives increase collagenolytic activity in radicular dentin. Journal of Endodontics 32:862–8, 2006.

Articulator

Winter 2012

27

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Check Out the New MDDS Online Classifieds!

The new MDDS online classifieds are up and FREE for members. Find a new home for that unused equipment, or the perfect new team-member for your practice. You can also purchase your Articulator classified online now as well!

28

HEALTHCARE REFORM Health Care Reform - Some Changes that May Effect You By: Andrea Levine

H

ealth care reform brings a number of changes for employers and health plans in 2012. As employers, you need to be aware of how these changes will affect you now and in the future. Read on for a checklist of the most immediate reforms and how they affect your organization.

Determine whether you have a grandfathered plan and whether your plan will maintain that status in 2012. If you make certain plan changes, the plan is no longer grandfathered. If you have a non-grandfathered plan, it must comply with various health care reform provisions.

For non-grandfathered plans starting on or after August 1, 2012, certain women’s preventive health services must be covered with no cost sharing.

Fully insured plans may receive rebates in August 2012 if they qualify for one under the new medical loss ratio rules. The rebates must be used for the benefit of plan members, which may include reducing enrollees’ premium payments.

WOMEN’S PREVENTIVE CARE GUIDELINES Effective for plan years starting on or after August 1, 2012, non-grandfathered plans must cover specific preventive health services for women with no cost sharing. These services include well-woman visits, STD screening and contraceptives. Exceptions to contraceptive requirements apply to religious employers.

September 23, 2012: Summary of Benefits and Coverage (SBC) – Issuers must be ready to provide the SBC to health plans beginning on September 23, 2012. Health plans must provide this document (or have the issuer provide it) to any participants who enroll or re-enroll during an open enrollment period on or after this date. Additionally, they must provide the SBC to participants who enroll in coverage through a means other than open enrollment, beginning with the first plan year that begins on or after this date.

spending accounts (FSAs) offered under a cafeteria plan will be limited to $2,500. The $2,500 limit will be adjusted for inflation for 2014 and later years.

January 31, 2013 – Additional Form W-2 Reporting Requirements – On the 2012 W-2 Forms due at the end of January, employers must provide information showing employees how much their health care coverage costs.

Employers must disclose the aggregate cost of employer-sponsored coverage provided to employees on the employees’ W-2 Forms. The purpose of the reporting requirement is to provide information to employees regarding how much their health coverage costs. The reporting does not mean that the cost of the coverage is taxable to employees.

Effective in 2014, the health care reform law imposes penalties on employers with at least 50 full-time equivalent employees if they do not offer health coverage to their employees or if they offer health coverage to their employees that is not “affordable” or does not provide “minimum value” and certain other requirements are met.

Beginning in 2014, large employers (those with at least 50 full-time equivalent employees) that do not offer health coverage will be subject to a penalty if any of their full-time employees receives a premium credit toward a health plan offered through a state-based insurance exchange. In 2014, the monthly penalty will be equal to the number of full-time employees (minus 30), multiplied by 1/12 of $2,000 for any applicable month.

SMALL BUSINESS TAX CREDIT – Small employers that qualify for the tax credit provided by the health care reform law can claim the tax credit by filing Form 8941 (Credit for Small Employer Health Insurance Premiums) with their annual tax filings.

60-DAY NOTICE OF PLAN CHANGES – Plans and issuers must provide 60 days notice of any material modifications to the plan that are not related to renewals of coverage. Notice can be provided in an updated SBC or a separate summary of material modifications.

The size of the credit depends on your average wages and the number of employees you have. For tax years beginning in 2010 through 2013, the maximum credit is 35 percent of the employer’s premium expenses that count toward the credit. The full credit is available to firms with average wages below $25,000 and less than 10 fulltime equivalent workers. It phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers.

January 1, 2013: $2,500 Health FSA Limit – Effective for plan years beginning on or after January 1, 2013, employee salary reduction contributions to health flexible

I hope you find this helpful, but for additional information, please feel free to contact Andrea Levine at Copic…(720) 858-6287.

CONNECT BENEFITING

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RMDCONLINE.COM

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CLASSIFIEDS Aurora, Colo. Professional dental office space consisting of 1003 sq. ft. available for lease. Some existing dental equipment, currently in suite, may also be available to purchase making for an affordable, smooth and quick practice start up. Suite is partitioned, plumbed, and wired for three dental operatories. Ideal location with great traffic visibility and easy access. Call Dr. Trompeter at: 303-688-3838, (C: 720-2441523) or e-mail at trompeternotes@msn.com Transition Services: For more information on how to sell your practice or bring in an associate, please contact Larry Chatterley and Susannah Hazelrigg with CTC Associates at (303)795-8800 or visit our website for practice transition information and current practice opportunities www. ctc-associates.com.

General Practices for Sale: Practice listings in Denver, Loveland, Fort Collins, Centennial, Colorado Springs, Lamar, and Eagle County. For more information on current practice opportunities, including an summary of practice details, please visit our website www.ctc-associates.com or call Larry Chatterley and Susannah Hazelrigg with CTC Associates at (303)795-8800.

Practices for Sale: Listings in Colorado: Denver, Boulder, Arvada, Parker, Colorado Springs, South-Central & Western Colorado,

SAVE THE DATE

Grand Junction and WY, KS & NE. 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 888-886-6790. Practice Sales, Practice Appraisals, Partnerships & Buy-In’s.

DENTAL OFFICE SPACE: Arvada/ Westminster, 1 story professional building complex. 1,100 sq. ft. professional office.

Fronted by busy Old Chicago restaurant and adjacent professional massage therapy practice. Modern, well-designed and attractive unit with 4 Tx rooms dental equipment installation-ready with cabinetry, gas lines, plumbing, electrical in place.

Plenty of storage & Dr. private office with private entrance. Great drive-by & walk-by exposure with ample dedicated parking.

New carpet tenant finish allowance. Contact: Jim True at 303-425-9200 Space-Sharing Opportunity! In Lakewood upscale area. New (2004) office with 4 operatories and the possibility of 2 more.

(303) 989-4444 PRACTICES FOR SALE! ASSOCIATE BUY-OUTS AND BUY-INS! New Listings Coming Soon 2012-2013! Metro Denver!

Northern Colorado! Eastern Colorado!

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24 25 26

SEE ADS at www.sastransitions.com Inventory changes fast! Susan Spear, Transition Specialist / Licensed Broker, SAS Transitions, Inc. Buyer and Seller Support Available! SAS Dental Practice Brokers Contact Us at 303.973.2147 Email: susan@sastransitions.com New connections!

Facebook: http://www.facebook.com/ SASTransitionsDentalPracticeBrokers LinkedIn: http://www.linkedin.com/pub/ susan-spear/8/2a2/633 GENERAL DENTAL PRACTICE: Denver, Colorado Downtown Location! Established patient base, Dentrix! Updated dental suite! Great Satellite Practice or positioned for Merger! Call Susan 303-973-2147 or susan@sastransitions.com SAS Dental Practice Brokers! www.sastransitions.com GENERAL DENTAL PRACTICE: Rural, Colorado 1000 active patients! Great Opportunity for New GPR/Grads and Returning Military dentists! Motivated Seller willing to help with the transition.

Excellent Satellite Practice! Susan 303-9732147 or susan@sastransitions.com SAS Dental Practice Brokers! www.sastransitions.com

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Col. Teresa Gonzales The Colorado Convention Center

Learn more at 30

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Ms. Ellen Gambardella Dr. Charles Blair ...and many more!

Banking on Your Terms

ORTHO

Dental-Banking Team

Practice Build-Out

Ops

Days Of Hyg iene

Produc t ion

When Pacific Continental bankers Scott Beard and Amanda Mombert talk to their dental-banking clients, they know the difference between a pano and an intraoral camera. Whether helping to grow a practice with a line of credit or just financing a digital x-ray, their dental knowledge makes a world of difference.

At Pacific Continental, our bankers not only speak dental, they’re experts in delivering the financial services you need, when you need them…on your terms.

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877-231-2265

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am confident the lease terms Colin negotiated on my behalf were significantly better than I could have accomplished on my own. Carr Healthcare Realty completely understands the current market conditions and leveraged them to my advantage. The new lease terms exceeded my original expectations!”

Natalie Schafer, DDS Wheat Ridge Oral Surgery

Colin Carr President

303.817.6654 colin@carrhr.com

Christian Gile Principal Denver Metro

303.960.4072 christian@carrhr.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 favorable terms and concessions.

Every transaction is unique and provides substantial opportunities on which to capitalize. The slightest difference in the terms negotiated in a lease or purchase can impact your practice by hundreds of thousands of dollars. With this much at stake, expert representation and skilled negotiating are essential to receive the most favorable terms.

Roger Hernandez Colorado Springs Southern Colorado

719.339.9007 roger@carrhr.com

Kevin Schutz

Boulder • Northern Colorado Western Slope • Wyoming 970.690.5869 kevin@carrhr.com

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.

Lease Negotiations • Office Relocations • Lease Renewals • Purchases