UDA Action by Mills Publishing Inc.

In-personhours

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

In-personhoursand broadcast live on YouTube

Featuring: Gary Lowder, DDS 2 credit

In-personhoursand broadcast live on YouTube

6:30 pm – 9:00 pm at The University

Dentistry Periodontics: Updates in Periodontics

Restorative Dentistry; The real beauty of anterior composite resin restorations. Easy, beautiful, profitable

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

8:00 am – 12:30 pm at The University of Utah, School of Dentistry

The 4th Annual G. Lynn Powell Lecture Series: Digital planning and execution: from simple to complex

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

Utah, School

2022-2023 University of Utah, School of Dentistry Continuing Education Lectures

9 2022

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

In-personhoursand

In-personhoursand broadcast live on YouTube

In-personhoursand broadcast live on YouTube APR

Featuring: Richard Bauman, DMD, MS 2 credit

Featuring: Robert Timothy, DDS 2 credit

FRI

OCT 20 2022

WHATSSEENEW

14 2023

Endodontics: Endodontics Complications: Prevention and Management

Featuring: Mark Ludlow, DMD, MS 6 credit

Dental Sleep Medicine: The role of dentistry in the treatment of sleep-related breathing disorders

Featuring: Hans C. Reinemer, DMD, MS 2 credit broadcast live on YouTube of of

THUR JAN 19 2023

Oral Radiology: Seeing is believing, but sometimes we are not seeing as well as we should.

FRI SEPT

THUR MAR 16 2023

THUR FEB 16 2023

Featuring: Jaimee Morgan, DDS 4 credit

Pediatric dentistry: Pediatric Dental Emergencies: What every provider and parent needs to know

THUR

8:30 am - 4:00 pm at The University of Utah, Alumni House

MS 2 credit In-personhoursand broadcast live on YouTube THUR NOV 17 2022 The University of Utah School of Dentistry Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. 3/1/2020 to 2/28/2024 Provider ID# 363354 University of Utah School of Dentistry is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. To Register for Dental CE Register by going to our website at dentistrycde/orhttps://umarket.utah.edu/um2/byusingthisQRcode→ CONTACT Dr. Jerald Boseman at 801-587-2246 Jerald.boseman@hsc.utah.eduor Karin Mishler at 801-587-2023 Karin.mishler@hsc.utah.eduor

Featuring: George Bailey, DDS,

Dental News Jodi

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The Utah Dental Association holds itself wholly free from responsibility for the opinions, theories or criticisms herein expressed, except as otherwise declared by formal resolution adopted by the association. The UDA reserves the right to decline, withdraw or edit copy at its discretion.

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UDA Action is published bi-monthly. Annual subscriptions rates are complimentary to all UDA members as a direct benefit of membership. Non-members $30. Utah Dental Association, 801-261-5315 1568 500 W Ste. 102, Woods Cross, Utah 84010 uda@uda.org.

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Dr Len Aste, UDA

UDA Action is published by Mills Publishing, Inc. 801-467-9419; 772 East 3300 South, Suite 200, Salt Lake City, Utah 84106.

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Dr Kay Christensen, UDA President

Dr Mohammed Qaisi – Illinois Schafer Christopher Smiley Mark R. Taylor,

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– Michigan Dental Association Dr

UDA President Elect U.S.TDICNews Kate Zabriske – Northwest Dentistry PRESIDENT'S MESSAGE 4 Enjoy the Joy ASSOCIATION6 Change, the One Constant 8 The Measure of Success 15 Influence of Free-Sugar Intake on Dental Caries 16 Are We There Yet? 21 HPI Poll: Insurance Reimbursement Not Keeping Up With Increased Practice Operating Costs CONVENTION5 An Awesome Anatomy Flashback at the 2023 UDA Convention 14 Convention Presenters NEWS ARTICLE 22 U.S. News Reveals the 2020 Best Jobs PRACTICE7 Oral Pathology Puzzler: Do You See What I See? 9 Utilize the Contract Analysis Service Before Signing an Insurance Contract 10 The Role of Dentists in Oral Cancer Detection 11 The Value and Benefits of Patient Financing 12 What to Set Your Sites on When Staging and Grading 13 Ethics in Dentistry 14 More Tips For Hiring and Developing a Great Staff 17 The Teacher, Yoga and the Third Eye 18 The Power of Potential: Planting Seeds for Success One Person at a Time 20 Where's the Line? Define, Apply and Maintain Professional Boundaries

News

Dr Roger P. Lewis – Compendium

If we can make and keep goals in these four areas, I think it will do much in helping to maintain a healthy balance in life. We may enjoy our profession more. We may find more joy in our personal lives as well. My son once shared with us the phrase, “Enjoy the joy”. He would include this at the end of each letter that he wrote home to us each week. We asked him what he meant when he said this, if it was just a catchy phrase, or if it had a deeper meaning to him. Here’s a part of his response:

I hope we will all set goals to help us achieve a better balance in life, professionally and personally. And, hopefully, we can all follow the counsel of a twenty-year-old young man to “Enjoy the joy!”

Physical Needs - it’s important to keep healthy and fit to avoid the fatigues and ailments that can come from repetitive daily work. I think everyone recognizes the clarity of mind and spirit, and the renewed energy that comes from regular physical exercise. Plus, it’s one of the best remedies to fight against depression and mental stresses. Set a goal to keep physically healthy.

As I see summer nearing its close, and fall waiting just around the corner, I’m thinking of the past few months and how quickly they have flown by! I’m sure most of you may have similar feelings about time flying by and how busy our lives have been. In addition to the regular schedules of running a dental practice, many other activities and events need to be filtered in and given their just attention. Graduations, weddings, funerals, games, family vacations, and more demand a lot of our time and attention, especially if we want to stay in everyone’s good graces. And it’s not just the summertime that brings the busy schedules. People seem to have the tendency to constantly pack their lives as full as they can with numerous activities and responsibilities. Much of the busyness of life comes from a responsibility to others, much comes from choice. Some of it may even come from perceived expectations, from trying to “keep up with the Jones’”, or from “fear of missing out”. No matter the reason, or reasons, for our busy lives, it is essential that we do our best to find a good life balance in order to fully enjoy the life we have chosen.

Some have suggested four areas of needs in life in which various goals can be made to aid in achieving a good balance in life. Please consider with me these areas, or needs, and ways that one might relate their profession or other life activities to each one.

ENJOY THE JOY

Intellectual Needs - dental professionals are constant learners, participating in all kinds of ongoing continuing education, essential to keep up with the demands of an ever changing and progressing profession. But consider making time to pursue other non-dental related education or interests. Set a goal to become more wellrounded in an intellectual sense.

PRESIDENT'S MESSAGE

4 September / October 2022

Social Needs - the dental association provides many opportunities to socialize with one another and share needs, findings, frustrations, and fun. I don’t necessarily consider myself as one who loves social gatherings and such, but as I have met with other colleagues from around our state, and other states, I have always enjoyed a common kindness and camaraderie. I have come to learn that people need

Spiritual Needs - regular time taken each day to ponder, meditate, pray, reflect on blessings, and express gratitude does wonders to help keep life in proper perspective. When we can recognize a higher power than ourselves, and allow its influence in our lives, we can become more teachable and more at peace with the world around us. Set a goal to make a specific time for reflection.

“Well, it is just a catchy phrase . . .ha-ha. Jokes. So, our Branch President here in Hamtic is President Jose Nabong. He is a painter. He lives in one of the further areas from the church, in a small cement/kawayou house, in some trees on the opposite side of a field, and across a bamboo bridge crossing the river. He is a poor man. But, he is always at church and activities. One thing President Nabong always exemplifies is being happy. He’s a nice, happy guy. He told a story one day. As a child one day at school his teacher asked everyone what they wanted to be when they grew up. Some farmers; some doctors, nurses. Some businessmen. But when it was his turn, he simply told his teacher, “I want to be happy.” He was laughed at by some, and the teacher re-explained the assignment thinking he didn’t understand. But that’s what he meant to say. . . he wanted to grow up and be happy. I want to be happy, too. When you are happy, you are happy. It’s a good feeling. I enjoy feeling good! I use this phrase often, “Enjoy the joy,” cause I have so many imperfections and need to remind myself as well to accept that joy. So, I looked up one time online and found a list, “12 things happy people do differently.” Number 9 on that list is to “Savor Life’s joys – Deep happiness cannot exist without slowing down to ‘enjoy the joy.’ It’s easy in a world of wild stimuli and omnipresent movement to forget to embrace life’s enjoyable experiences. When we neglect to appreciate, we rob the moment of its magic. It’s the simple things in life that can be the most rewarding if we remember to fully experience them.” To enjoy the joy does not mean to laugh, joke, and party all the time. It means that when good is around us, soak it in. When bad is around us let the good we’ve soaked in, out. And when everyone finds the negative in something, you find the positive. The things you love in life, make sure you love them. And most especially the PEOPLE you love in your life, make sure you love them! Love them, meaning a verb. Show your love by the things you say, think, and do.”

Dr Kay Christensen UDA President

people. It’s ok to do things alone at times, but there is a strength and a good motivating power that comes from being united with others in a common quest for goodness. Set a goal to reach out and associate with others.

AN AWESOME ANATOMY FLASHBACK AT THE 2023 UDA CONVENTION

SO DO WE.

UDA Action 5

• A review of the relevant anatomy related to anesthetic injections

Dr Wayne Cottam will be presenting “What you NOW Realize you Really Needed to Know!”

Your patients rely on your expertise to evaluate and make recommendations for good oral health. Your local independent insurance agent can do the same for you when it comes to suggesting the right combination of coverage to protect the practice you’ve worked hard to build.

CONVENTION

The goal is to learn a LOT, apply it IMMEDIATELY upon returning home and having so much fun doing so that we will NEVER forget it again!

anatomy that we need to be safe, confident, and effective clinicians and begin to see how we can apply it to our everyday practice. Being more confident in the anatomy of the Infratemporal Fossa can make us more confident and effective in our injections. A better understanding of the muscles of mastication and how they relate to the TMJ can help us understand our patient’s symptoms better. Not to mention that confident knowledge in the anatomy of the floor of the mouth and the pathways of the Inferior Alveolar and Lingual Nerves will help us perform safer surgeries.

This will be a hands-on workshop, held on March 30, 2023 at the UDA Convention. Anatomy – whether we loved or hated it in Dental School, we all went through it. And for most of us, it was during the first year and once we started cutting, poking, injecting and manipulating the anatomy, we had forgotten most of it. Add to that, the fact that much of what we learned was not actually applicable in a clinical setting but more to help us get past those National Boards. Let’s face it, how many times have you stopped during a surgery and really needed to know all of the branches of VI or the number of functions that the Facial Nerve has or how in the heck the Vagus nerve actually gets to the Palatoglossus muscle and why is that the only muscle of the tongue NOT innervated by the Hypoglossal Nerve? Not many. On the other hand, how often have we wished that we were more conversant and confident in the location and attachments of the Medial and Lateral Pterygoid muscles and how they influence TMJ problems? Perhaps with a better understanding of the location of the Pterygopalatine Fossa – from which ALL Maxillary Nerves emerge – we might be able to administer more effective injections. And EVERY day I am giving an IA but not REALLY sure what structures my needle is going through and how that might contribute to the percentage that I miss.

• A review of innervation and blood supply to the oral cavity

• Attachments, actions and innervation of the muscles of mastication

Find an independent agent representing The Cincinnati Insurance Company by visiting cinfin.com or by calling Mike Terrell, 800-769-0548.

• Basic TMJ anatomy

• Relevant anatomy of the floor of the mouth, tongue, palate and paranasal sinuses

This course will review the relevant anatomy for a general community-based dentist and apply that knowledge to common procedures and therapies completed in that setting. We work in pairs, with high quality plastic skulls, with active learning techniques to reinforce the anatomy we are reviewing. Topics will include:

YOU BELIEVE IN PROVIDING SERVICE AND EXPERTISE.

This course is an effort to solidify the clinically relevant

By the 1950s and early 1960s petroleum-based products, plastics and rubber materials, were emerging as an alternative to cork. But, the company refused to consider the benefits of these new materials, as the story goes... They were confident that nothing would ever replace cork in creating that important airtight seal for some containers. Consequently, their market share began to dwindle, and they eventually went out of business. At least, that is how the story went…

There are many real world examples of well-established and successful businesses that were unable to weather the changing landscape of their niche market. They began with a wildly successful business model, grew complacent in their success, but then stagnated, and eventually fizzled and expired. Try searching: “50 Brands that Failed to Innovate.” You will find Kodak at the top of the list. Kodak dominated the photographic film market for most of the 20th Century. By the time Kodak realized that the world was going digital, it was too late.

6 September / October 2022

CHANGE, THE ONE CONSTANT

The microchip has transformed much of our world, especially dentistry. It has improved our accuracy with many things, and made us more efficient and deliberate. And remarkably, I believe it can make good dentists even better. I marvel at the precision with which we can scan, design, and manufacture so many things that used to require multiple, painstaking steps, and much time to produce. What a marvelous and exciting time to be a dentist!

There is only one problem with this story: Apparently, my mother did indeed work for the Crown Cork and Seal Company. But, the part about them going out of business is all a fabrication, which I did not learn about until just recently However, this fabled analogy is still instructive, for two reasons, 1) because many businesses that have faced similar challenges did not survive, and 2) because they actually did innovate and have now been in business for over 130 years. The Crown Cork and Seal Company was not afraid to try new materials and venture into other areas of the packaging world. They eventually dropped from their name the very material that gave them their start, cork. They are now known simply as Crown Holdings, Inc. They have 192 packaging plants in 39 countries and employ over 33,000 people. Of all Fortune 500 companies, they are number one in the packaging and container industry, and make 1 out of every 5 beverage containers worldwide. But, it all started with cork, a material they no longer even use.

There was a story that circulated in my family while I was growing up. I believe this story was told and re-told to emphasize a point and was repeated so many times that it became a legend in our home. It illustrated an important lesson in life and in business: Be willing to innovate and change. Do not ever allow yourself to stagnate. The story went like this: My mother was secretary to one of the vice-presidents of the Crown Cork and Seal Company. As the name implied, they were a manufacturer of cork products used to seal bottles and other containers. Cork is harvested from the bark of Cork Trees that only grow in certain parts of the world. Cork has the unique ability to be soft and flexible, yet quite durable, an ideal material with which to create an airtight seal. This company was founded in 1892 and thrived throughout the early part of the 20th Century. They had a great business model, their products were in demand, and they were growing. However, as the story went, they made one fatal mistake, they did not innovate. They became complacent and stagnated. They had market share and name recognition, but they did not change and adapt with the world around them, and according to the legend, eventually it led to their demise.

I distinctly remember our first office computer. By today’s standards, this machine was a stand-alone monstrosity. The only thing it connected to was an electrical outlet. Forget the internet. It was clunky and cumbersome. But, it was a big decision and a major investment at the time. To put things in perspective, this one computer set us back financially on a par with what a scanner or chairside mill might cost today, and all it did was help keep track of production and billing. That was it. It was long before the advent of Windows based computing. At the time, we spoke in kilobytes and megabytes. The first time I heard the work gigabyte was when my CPA was bragging about how much storage he had, with just two of them. My how times have changed!

While I must admit that some aspects of the pegboard era are appealing to me, trying to practice dentistry now without all of the other benefits that have accompanied the advent of the microchip seem absurd. Ponder briefly how the microchip is currently being utilized in dentistry: Accounts payable, accounts receivable, charting, scheduling, inventory, videography, photography, radiography, scanning, designing, milling, printing, and marketing, to name just a few.

ASSOCIATION

When I started into dentistry in the early 80s, computers were not in widespread use anywhere, let alone in dental offices. For accounting purposes, we relied upon the trusty pegboard system. It was a bit cumbersome, but worked well. We could have desperately clung to the pegboard, and resisted the advent of computers, but it would not have benefited us, nor our patients. It would have been like Kodak failing to acknowledge the digital inroads that eventually took over the photographic world, or as if the Crown Cork and Seal Company had resisted the advent of rubber and plastics, which, fortunately for them, they did not.

Mark R. Taylor, DDS UDA President Elect PATHOLOGY PUZZLER: YOU SEE WHAT I SEE? the the on page

PRACTICE a) Odontogenic cyst b) Ameloblastoma c) Odontogenic keratocyst d) Dentigerous cyst Which of

UDA Action 7

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following represents

I do not know what changes in our profession lie just beyond the horizon. But, one thing I can say for certain, there will be changes. And, while change can be difficult, resisting change can be stifling, even suicidal, just as it was for Kodak, and a host of other companies. Change will happen with us or without us. Embrace it, and make the best of it. Doing so will help us, not just to survive, but to thrive, in our changing world. We can either choose the path of Kodak or the actual path of the Crown Cork and Seal Company. By the way, some day, I hope to get a little more of the real Crown Cork and Seal back-story from my parents. Even though their version to me and my siblings was a bit of a fib, it certainly helped drive home the concept of how important it is to be willing to innovate and change. Thanks Mom and Dad!

best diagnosis for the radioraphic finding of a unilocular radiolucency surrounding the crown of impacted tooth #17: (continued

I didn’t take from dentistry more than I gave. I served in organized dentistry on the district, state and national levels. I’ve worked in dental education and licensing and donated my time and talents to serving the dispossessed and needy.

THE MEASURE OF SUCCESS

I never had to fire an employee or had one file a complaint against me. Over the years I was fortunate to have some wonderful people work for me. Not everyone worked out, but most stayed around for many years and then continued on as Ipatients.neverlost

I didn’t keep all my talents within my practice. I always said yes when asked to coach a little league ball team or serve on a community council or committee. I gave many hours of community service which brought me much joy and Isatisfaction.wasnever audited by the IRS or failed an audit by the state. That’s not to say they weren’t stressful experiences, but I tried to be as honest as I could with my finical obligations.

I never defaulted on my loans, refused to pay a lab bill or pay a dental supplier. I was always able to make payroll on time and never filed for bankruptcy. I always gave the patient the benefit of the doubt and never tried to over or unnecessarily charge them.

I never did any advertising for my practice on the radio, in the news paper or anywhere else. I always let my work and how we treated our patients speak for itself.

I never refused treatment to a patient who was in pain, even though they owed me money for previous work that I did on them.

8 September / October 2022

Success has come to me in the form of many patients that have thanked me for taking care of them, their children and grandchildren for all these years. Finally, success was choosing a profession that gave back to me as much or more than I put into it.

ASSOCIATION

I didn’t keep all the money I made from my practice for myself. I donated generously to local community and civic activities and sponsored many scholastic and educational events.

I never had a serious medical incident in my office where a patient had to be transported for medical treatment. I did have patients get ill and have complications from procedures I performed, but nothing that required hospitalization.

Dr Len Aste UDA Treasurer

I was never charged with Medicaid or insurance fraud, even though I often felt I deserved much more than I was getting paid.

an instrument or item down a patient’s trachea. That’s not to say that they didn’t swallow parts of an old filling or occasionally gag or throw up.

I never got a divorce or failed to support my children in their many school and sporting activities. I have to credit most of my success to my wife for all her support and love over the years.

What is the measure of success for a dental practice? That’s the question I have been asking myself since I recently sold my practice after 26 years in Manti. I think it is natural to wonder if you were successful in your profession, but how do you accurately measure your success.? When I began in private practice my goals were 1) to provide good dentistry to my patients, 2) gain their trust and respect, 3) Let the quality of my work be my advertising. 4) Be fairly compensated for my services and 5) Be a contributing member of the community. For the most part, I believe I accomplished these goals. But, as I have thought more about it, I have come to realize that it wasn’t so much what I did that measured my success but rather, what I didn’t do, that really mattered.

I never got rich and made a lot of money, but I was able to live a comfortable lifestyle and plan for a secure retirement. I learned that money isn’t everything, in fact, it had very little to do with the measure of my success.

I never had a malpractice claim filed against me or brought before the State Dental Board for disciplinary action against my license. Not every procedure I did was ideal or went according to my plan, but I always tried to do my best and was honest with my patients when things went bad.

The ADA Contract Analysis Service will provide you with information concerning a proposed contract so you can better understand and analyze its terms. The service analyzes dental provider contracts with PPOs, insurance companies or other third-party payers.

Provo District October 6, 2022 @ 6:30 PM

Rusty’s Ranch House 2275 E Highway 14 Cedar City

The Contract Analysis Service is intended as a tool to aid you in understanding and analyzing your proposed contract and is not intended to constitute legal advice.

The service identifies potentially problematic contract provisions and their possible impact on the dental practice. This information can help the dentist either negotiate more favorable contract terms or at least have a fuller understanding of what to expect as a result of entering into the agreement.

Neville, Damm, Allen, Chi (2016). Oral and Maxillofacial Pathology, 4th Ed. St. Louis: Elsevier.

(continued from page 7) Correct answer: (d) dentigerous cyst.

Dixie Hygiene Auditorium 1526 S Medical Center Drive St. George

Dixie District September 22, 2022 @ 6:30 PM

If you are a dentist who is already under contract with an insurance provider and are planning to add a new associate dentist, it is a good idea to have the contract analyzed before enrolling them in the network in case any changes have been made.

Wasatch Back District October 4, 2022 @ 6:30 PM

The Contract Analysis Service is available free to UDA members as a benefit of your membership. Utilize this service at no charge by submitting the following documents through the UDA prior to signing the proposed contract:

Odontogenic cysts are cysts that are lined by odontogenic epithelium and are subclassified as developmental or inflammatory in origin. An ameloblastoma is a slow growing, locally invasive odontogenic tumor that usually presents as a multilocular radiolucency involving the posterior mandible, most often in the molar-ascending ramus area (Neville, 2016). A painless swelling or expansion or the jaw the usual clinical presentation. An odontogenic keratocyst is a distinctive form of developmental odontogenic cyst. These lesions are significant for three reasons: a greater growth potential than most other odontogenic cysts, a higher recurrence rate (approximately 30%), and has a possible association with the nevoid basal cell carcinoma syndrome (Neville, 2016). The non-odontogenic pathology that completes the differential diagnosis for this radiographic presentation is a central giant cell granuloma or giant cell lesion. The central giant cell granuloma is an intraosseous lesion of unknown etiology. They are divided into two categories based on clinical and radiographic findings: nonaggressive and aggressive. They are usually treated by thorough curettage or sometimes an en bloc resection with some of the more aggressive lesions. Reported overall recurrence rates range from 11% to 49%.

Salt Lake North District, Salt Lake South District & Tooele District October 27, 2022 @ 6:30

• An analysis request.

The Contract Analysis Service assists member dentists in understanding contractual terms and contractual terms and contractual obligations before the dentist is legally bound by them. It takes contract legalese and translates it into easy-tounderstand language that enables dentists to make informed contracting decisions.

Jordanelle State Park Hailstone Events Center 515 HeberSR-319City

UTILIZE THE CONTRACT ANALYSIS SERVICE BEFORE SIGNING AN INSURANCE CONTRACT PRACTICE

Works Cited

Canyonlands District October 20, 2022 @ 6:30 PM

2022 CQI Seminars

Receiving a clear, concise explanation of the terms of a provider contract may help you decide if participating with such a plan is best of you and your patients, as well as helping you avoid unpleasant surprises under the contract in the future.

Carbon Country Club 3055 N Hwy 50-6 Helper

UDA Action 9

North Davis District September 27, 2022 @ 6:30 PM

Cedar Breaks District September 22, 2022 @ Noon

ORAL PATHOLOGY PUZZLER: DO YOU SEE WHAT I SEE?

A dentigerous (also known as a follicular cyst) and is defined as a cyst that originates by the separation of the follicle from around the crown of an unerupted tooth. It represents the most common developmental odontogenic cyst, accounting for approximately 20% of all epithlium-lined cysts of the jaws (Neville, 2016). It usually attaches to the tooth at the cementoenamel junction and is thought to be the result of fluid accumulation between the crown and reduced enamel epithelium. Although dentigerous cysts may occur in association with any unerupted (impacted) tooth, they most frequently involve mandibular third molars.

Thanksgiving Point Grand Ballroom 3003 N Thanksgiving Way Lehi

Utah State Fair Grounds Pioneer Building 155 N 1000 W Salt Lake City

Annie’s Diner 286 N 400 W Kaysville

• A copy of the unsigned contract and any accompanying documents.

THE ROLE OF DENTISTS IN ORAL CANCER DETECTION

PRACTICE

Photo: Image licensed by Ingram Image

Despite the prevalence of the disease and relative lack of improved survival compared with other cancers, awareness of

oral cancers remains problematic. By comparison, cervical cancer, which is associated with a significantly lower incidence and mortality rates, has a greater awareness among health care providers and the public. Primary care providers routinely instruct their patients on the role of screening the PAP smears and HPV testing. Oral cavity cancers do not enjoy the same level of awareness partly because the dental profession, considered the expert body on this anatomic subsite, has not taken ownership of this disease entity.

The major risk factors for oral cancer are smoking, which increases one’s risk threefold; exposure to second hand smoke; the use of smokeless tobacco; alcohol misuse; and human papillomavirus for cancers of the oropharynx. Quitting smoking helps decrease the risk; smokers who quit 20 years ago have the same risk as nonsmokers.

In addition to detection, dental providers should be aware that this disease entity is treated by members of the dental profession. There are numerous fellowship-trained oral and maxillofacial surgeons that treat head and neck cancers providing superb patient care and unparalleled reconstructive techniques taking occlusion and dental rehabilitation into consideration. This is where oral and maxillofacial/head and neck surgeons shine, thanks to their dental background.

Oral health care providers can take a role in increasing awareness of these types of cancers by educating their patients on the disease and helping promote the dental profession as the first line of defense against oral cancer. Dentists should not assume that physicians will pick up on signs of oral cancer. When other health care providers do identify problems in the mouth, for example in an emergency department setting, they are often caught at a much more advanced stage significantly affecting survival.

10 September / October 2022

Early detection remains the best tool for improving patient outcomes, and this where the critical role of oral health care providers comes into play. Dentists are experts in the early detection of oral cancer, putting them at the forefront of recognizing this disease and initiating treatment. Stage I 5 year survival rates are 80-90%. The survival rate drops to 30% at Stage IV. Therefore, simply put, early detection equals cure. The role of the general dentist in detecting oral cancer cannot be over-emphasized. If dentists don’t look for the signs, nobody else will until the cancers are more obvious and

profession needs to take ownership of this disease entity and feel empowered to do so. Dentists should emphasize to patients the effects of oral health on the overall health of the patient. Head, neck, and oral cavity exams done by dentists save lives. Getting the word out to the public and specific messaging from the dental profession regarding their expertise in oral cancer detection is paramount.

Mohammed Qaisi, DMD, MD FACS Illinois Dental News

Theadvanced.dental

Worldwide there are approximately 369,000 new cases of oral cancer each year that account for 145,000 deaths. In the US in the year 2021, there are over 54,000 expected new cases of cancers of the oral cavity and pharynx leading to nearly 11,000 deaths according to the National Cancer Institute. This makes oral cancer the sixth most common cancer worldwide accounting for 1.8% of all cancer deaths. It is important to note that death rates for oral cancer are higher than for cervical cancer, laryngeal cancer, skin cancer, cancer of the testes, and endocrine system cancers such as thyroid cancer. The 5-year survival rate is between 50% and 60%. Unfortunately, there has not been much improvement in these rates for many decades, with current survival rates are only slightly better than during the 1970s despite all the advances in surgical techniques, diagnostic techniques, and adjuvant treatments such as radiation and chemotherapy. There also remains a race gap in oral cancer survival, with black men having a lower 5-year survival rate.

3. Emphasize the availability of patient financing for all elective dental cases. Patients are more prone to accept treatment if they don’t have to pay the full fee all at once and can make payments over time.

Aside from its immediate impact on case acceptance and production, offering financing options also represents excellent customer service. Even patients who have no desire to purse financing options will nevertheless appreciate the practice’s commitment to making fee payment as easy as possible.

There is no question that patient financing is a highly beneficial aspect for dental practices. It can help practices perform at a high level regarding production, profitability and case acceptance. Even more important than that is the fact that it helps patients take advantage of the excellent care your practice provides, which is what dentistry is all about.

Dr Roger P. CompendiumLewis

Patient financing has benefited both patients and practices for many years. It has helped countless patients to proceed with necessary or desired treatment, which has provided higher case acceptance rates for many dentists. This is a significant practice-building dynamic. In my estimation, most dental practices have a 30% to 50% growth potential over 3 years, and providing patients with direct access to attractive and appealing financing options is one of the top strategies for being able to access that additional growth. Patient financing is a “winwin” as it allows patients to have optimal care at the right time while simultaneously enabling practices to continually increase production. But to make it work well it needs to become a fully implemented standard component of practice systems.

According to Dr. Flora, patient financing has benefited his patients for treatment, as well as the practice from a business and financial standpoint. Here are three ways to communicate the availability of patient financing to patients:

2. Include patient financing as one of the clear financial options offered to patients when presenting cases. We recommend that all options be explained to patients so that they can make an informed choice.

THE VALUE AND BENEFITS OF PATIENT FINANCING PRACTICE Utah’s leader in in-ofﬁce Dental Anesthesia HOSPITAL QUALITY ANESTHESIA IN THE COMFORT OF YOUR OFFICE Able to induce anesthesia for complex treatment plans or procedures. To schedule an appointment, or for additional information call 801-631-1312 IngramImagebylicensedImage

Many practices today have the CareCredit cred card as a patient financing source, so the question isn’t, “Is financing available?” but, “Are financing options being communicated properly in the practice?” Proper communication means that every single patient in the practice is fully aware that financing, in some form, is available to them. One way to ensure that patients and practices receive the benefits of available financing is to mention it to all new patients in their first phone call or email exchange. This creates a sense of confidence for patients regarding treatment affordability before they even walk in the

UDA Action 11

Onceoffice.they

do come in for treatment, financing availability should be part of each case presentation conversation to maximize production for the practice and create an ideal experience and outcome for the patient. Dr. Bill Flora, well-respected general dentist in Elkhart, Ind., with a highly successful practice, has utilized patient financing for many years as a strategy to increase practice production. “CareCredit is a routine and regular part of case presentation to patients in our practice,” Flora says. “We use it on a consistent basis, and it allows patients to have necessary comprehensive care now versus putting off treatment that could result in more complex and expensive care down the road.”

1. Let every patient know in phone calls and practice communications that patient financing is available. This will give them the confidence to keep their appointment and a feeling that they will be able to afford any necessary treatment.

Clinicians who have a clear understanding of which patients and which sites need treatment can better allocate treatment resources, get better outcomes for their patients. And have their practices operate more efficiently. While potentially useful, staging and grading, is only a small step forward in our effort to operate more efficiently. Fortunately, there is an alternative: evidence-based protocols that allow clinicians to consistently determine which patients and which sites need treatment. . . and which treatments maximize the change for the desired result. It is time to take a leap forward in our management of CIPD.

WHAT TO SET YOUR SITES ON WHEN STAGING AND GRADING PRACTICE

It is already challenging to collect the necessary diagnostic information within the confines of the typical maintenance/ recall visit. What clinicians need when they are chairside is a clear decision pathway for determining which sites need therapy and which treatment options are reasonable at that site.

A small step in the right direction is always a good thing. A large leap is even better. The recent “staging and grading,” certainly moves the needle a bit further toward being able to define and discuss periodontal disease with a patient in a way that motivates them to accept care. However, for dentistry to claim its rightful place on the health care stage, dentistry needs to make a larger leap.

Tim Donley, DDS

12 September / October 2022

Staging and grading was designed as a matric that can be utilized to describe periodontitis in an individual patient. Collecting staging and grading data certainly has potential merit when performing large-scale delivery-of-care analyses. Staging and grading can also aid in discussing the urgency and severity of disease with any individual patient. However, staging and grading does not render a diagnosis, nor does it provide a clinician insight into which specific sites need treatment.

To accomplish the new goal of dentistry, providers must be able to efficiently and effectively identity which sites in which patients need treatment. The old approach of giving everything a few good scrapes (in case there may be calculus present) has been relaced with a more focused efforted aimed at eliminating any clinical detectable etiology and interrupting any potential microscopic etiology at sites where inflammation is noted to create a root source that can support healthy adjacent soft tissue. Converting diseased sites to sites that are maintainable by the patient is similarly important.

An accepted definition of what constitutes a healthy site exists. Accordingly, sites not meeting the definition of health must be considered as sites that need attention. There is a way to reproducibly collect the basic data necessary to make appropriate diagnostic and therapeutic decisions. Every site should be assessed in consistent evidence-supported fashion rather than being subject to one’s personal opinion. The desired endpoint must be clear. Treatment decision should be based on scientific evidence and maximize the chance that the desired endpoint is reached.

There are still too many patients and even some practitioners who struggle to define periodontal disease. The profession of periodontology has not made it any easier. All of the past classifications of the disease, (including the latest iteration, which includes staging and grading), have focused on collecting data that is not readily interpreted by the public and the profession. As the economic screws of health care continue to tighten, patients need more education and motivation before deciding to follow through with recommended treatment. Dental practitioners wanting to improve periodontal disease awareness and case acceptance among their patients need to be able to better communicate when a problem is present and in need of a solution.

Chronic inflammatory periodontal disease (CIPD) is a systemic disease with side-specific presentations. There is now overwhelming evidence that CIPD, in addition to resulting in periodontal bone loss, contributes to the systemic burden of inflammation. It is the systemic burden of inflammation that drives the progression of many of the chronic diseases of aging. Thus, rather than the traditional goal of simply cleaning teeth and/or helping patients save teeth, the new goal of dentistry should be to help patients achieve a functional and esthetic dentition that is inflammation-free and maintainable as such by the patient. Life-long professional monitoring and therapy aimed at minimizing oral inflammation over the life of a patient is an important component of overall wellness. For certain patients who already have risk factors for the systemic conditions that can be adversely affected by oral inflammation, aggressive therapy aimed at eliminating periodontal disease and then keeping it at bay has taken on added significance.

Currently, there are seemingly as many diagnostic and treatment decision pathways as there are clinicians. Many practitioners struggle to even describe the decision pathway that they follow to determine which patients and which sites to treat. Too many dentists and hygienists continue to ignore critical evaluation of the scientific literature and treat patients with personal experience as its equal. Practitioners collect varied amount of data and then often make wildly different treatment decisions. In this era of evidence-based medicine, not having an efficient, standardized approach makes no sense.

current, knowing one’s own limitations and when to refer to a specialist or other professional, and knowing when and under what circumstances delegation of patient care to auxiliaries is Thirdappropriate.”istheprinciple

of beneficence (“do good”). “This principle expresses the concept that professionals have a duty to act for the benefit of others. Under this principle, the dentist’s primary obligation is service to the patient and public at large. The most important aspect of this obligation is service to the patient and public at large. The most important aspect of this obligation is the competent and timely delivery of dental care within the bounds of the clinical circumstances presented by the patient, with due consideration being given to the needs, desires, and values of the patient. The same ethical considerations apply whether the dentist engages in fee-for-service, managed care, or some other practice arrangement. Dentists may choose to enter into contracts governing the provision of care to a group of pa tients; however, contract obligations do not excuse dentists from their ethical duty to put patients’ welfare first.”

ASSOCIATION

Fifth is the principle of veracity (“truthfulness”). “This princi ple expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist’s primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintain intellectual integrity.”

There are five ethical principles of the code, excerpted from the American Dental Association Principles of Ethics and Code of Professional Conduct, which can be accessed tist’sprotectprincipleSecondinggivendecisionstist’sprotectpatient’sTheFirsthttp://www.ada.org/about/principes/code-of-ethicsat:ittheprincipleofapatientautonomy(“self-governance”).dentisthas“adutytotreatthepatientaccordingtothedesires,withintheboundsofacceptedtreatment,andtothepatient’sconfidentiality.Underthisprinciple,thedenprimaryobligationsincludeinvolvingpatientsintreatmentinameaningfulway,withdueconsiderationbeingtothepatient’sneeds,desiresandabilities,andsafeguardthepatient’sprivacy.”istheprincipleofnonmaleficence(“donoharm”).“Thisexpressestheconceptthatprofessionalshaveadutytothepatientfromharm.Underthisprinciple,thedenprimaryobligationincludeskeepingknowledgeandskills

These qualities are the hallmarks of both professionalism and, in acting ethically, dentists will strive to do what is right and good. “The ADA Code is an instrument to help the dentist in this quest.”

Why is the platinum rule better than the golden rule?

Fourth is the principles of justice (“fairness”). “This principle expresses the concept that professionals have a duty to be fair in their dealing with patients, colleagues and society. Under this principle the dentist’s primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense, this principle expresses the concept that the den tal profession should actively seek allies throughout society on specific activities that will help improve access to care for all.”

ETHICS IN DENTISTRY

As you face the many challenges of providing healthcare to your patients, using the Principles of Ethics and Code of Professional Conduct of the ADA will help you apply the platinum rule. The ADA Council on Ethics, Bylaws and Judicial Affairs (CEBJA) has over the last 20 years, published articles in the Journal of the American Dental Association entitled Ethical Moments. Ethical Moments articles take ethical dilemmas that dentists face and apply the code to offer suggestions of ideas on how to approach such dilemmas. Also, CEBJA just launched a podcast named “Tooth Be Told” that will tackle ethical dilemmas in an audio format. So, keep your eye out for it, or I should say your ears. There are a lot of gray areas in ethics, and it is healthy to see how others have approached what you are trying to do your best with. Keep finding joy in what you do to improve the lives of others.

The American Dental Association has a way to help dentists stay true to their North Star by having its members voluntarily agree to abide by the ADA Principles of Ethics and Code of Profes sional Conduct (the ADA code). It is important for the dental profession because of its special position of trust within society. It is this social contract that is embodied in the ADA Code. Ac cording to the preamble, “The ADA Code is, in effect, a written expression of the obligation arising from the implied contract between the dental profession and society.” In fulfilling their role in the contract, the ADA believes that the dentists:

The golden rule tells us to treat people as we would like to be treated. Those words echo in my mind, hearing my mother reminding me of this whenever she felt I was demonstrating a double standard toward others. The platinum rule says treat people the way they want to be treated. An example of the differ ence between these two rules: Just because I am comfortable being called by my first name, I would assume according to the golden rule I could call my patient by their first name. However, the platinum rule would tell me to ask the patient how they like to be addressed and then honor that.

Should possess not only knowledge, skill and technical compe tence but also those traits of character that foster adherence to ethical principles. Qualities of honesty, compassion, kindness, integrity, fairness and charity are part of the ethical education of a dentist and the practice of dentistry and help to define the true professional. As such, each dentist should share in providing ad vocacy to and care of the underserved. It is urged that the dentist meet this goal, subject to individual circumstances.

UDA Action 13

Bruce Burton, DMD CEBJA Vice Chair

MORE TIPS FOR HIRING AND DEVELOPING A GREAT STAFF

Question: We are having a hard time hiring staff for our practice. Not only are we struggling to find employees who are the right “fit” for our culture, but we are really struggling to find an office/practice manager. It seems we’ve tried everything as far as recruiting goes. Do you have any other ideas to help us?

Likewise, what are your processes for communication, organizing the work and conflict resolution? Do you have policies and procedures in your employee handbook and/ or additional training protocols for each position? Who is responsible for administering this training, and how is comprehension and proficiency measured?

PRACTICE

14 September / October 2022

Answer: You are not alone in this struggle. Employers everywhere are having a hard time finding employees to fill positions, at all levels. Since the pandemic began, many people have retired or left the workforce for a variety of reasons. And, the challenge of having enough employees to fill positions is not going away any time soon. So, practices must be more creative in recruitment, including developing partnerships with high schools, community colleges and training programs. They also need to pay attention to their work culture to ensure that they don’t lose the people they have. Opportunities for continuous learning are key for retaining employees, so let’s take a deeper look at how you can create those opportunities within your practice.

Think about the key skills you need each role to have to be successful in your practice. Ideally, you have these key skills included in the job descriptions for each position. Things like communication, organization, conflict resolution, and working on teams are all skill areas that practices need. You may have others. What do these look like when they are happening effectively? What resources do you have in place to help build and enhance these skills? If you don’t have clear expectations of employees, this would be a great place to start.

Creating an internal training process for these critical areas of interpersonal and team building skills goes a long way toward

building a talent pipeline, you’ll need to be heavily involved in the Thisprocess.isgoing

to be the way of the future when it comes to talent acquisition. While we may long for the days of “post and pick,” the truth is that this new path forward – while more timeand cost- intensive - is also more flexible, more predictable, and more likely pay off in the long run.

The study was presented by Australian researchers at the recent 100th General Session and Exhibition of the IADR, held in conjunction with the 5th Meeting of the IADR Asia Pacific Region.

Photo: Image licensed by Ingram Image

Regardless of the training you use, make sure that the learning objectives align with your goals and that it is delivered in a way that is engaging for you staff.

Training is one step in building new skills, but it is not sufficient by itself. Training plus ongoing coaching and mentoring at the practice level is what creates real changes; helping employees refine their skills as they build new habits. This requires synchronization and ongoing effort on your part to ensure that your investments in training and development bear fruit. Whether you’re focused on growing leaders or

Of the original birth cohort, dietary data and dental caries data were available. Of the participants studied, 70.4% and 36.7% consumed less than 5% TEI from free sugars at ages 18 months and 4 years, respectively. Dental caries affected 46.7% of children. In fully adjusted models, free sugar at age 18 months increased dental caries risk at ages 4-6 years.

UDA Action 15

A study investigating the relationship between free-sugar intake in early childhood and dental caries found that between ages 18 months and 4 years, free-sugar consumption increased markedly in two-thirds of the children studied, increasing the risk of dental caries at ages 4-6 years. Free sugar is any sugar added to a food or drink or the sugar that is already in honey, syrup and fruit juice. These are free because they’re not inside the cells of the food we consume.

INFLUENCE OF FREE-SUGAR INTAKE ON DENTAL CARIES ASSOCIATION

For the study, free-sugar consumption was measured in children enrolled in the Barwon Infant Study at ages 18 months and 4 years. The exposure, free-sugar intake, was quantified as continuous and binary variables indicating less than 5% of total energy intake (TEI) at ages 18 months and 4 years. The prevalence of dental caries was obtained from dental records, and multiple logistic regression estimated the effect of the exposure variables on the presence of dental caries at ages 4 to 6 years, adjusting for potential confounders.

In addition to clarifying your internal systems, policies and procedures, you should also begin building your training and professional development offerings. Now more than ever, practices need to look within to see if there are employees who can “grow into” new positions, as well as potentially be promoted into leadership roles. You may have someone in the practice who has some natural leadership abilities but needs additional support to take on an office or practice manager role. There are many trainings out there on supervision, communication, conflict resolution, etc. . . . .

cda

building shared awareness and understanding for what is expected. Without these structures, employees guess at what they should do, actions are inconsistent, and sometimes their habits do not fit well with your team and practice, creating conflict.

Jodi MichiganSchaferDental Association

16 September / October 2022

ARE WE THERE YET?

It really doesn’t matter the age. As adults and grown, seasoned professionals, we still ask the same question: Are we there yet? Do we really expect a straight answer? Our profession and our country face many problems and issues, and many of us expect truthful adult answers. Unfortunately, today’s culture does not always reward honesty. Television, social media “influencers,” apparently everyone in Washington, even top brass in our military. We all sense how brazen the lying has become.

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Is dishonesty beginning to creep into our profession? Is there more temptation to oversell treatment plans? Heaven knows financial pressures have ramped up considerably in the past 15 years with servicing loans for skyrocketing tuition as well as static or even decreasing reimbursement from even more intrusive insurance companies. Add to that the rapid of ramping up of inflation effects to supplies and labor costs as a inevitable result of wildly out of control congressional spending, there is no doubt that dentists – and our physician colleagues – are certainly feeling a financial squeeze more than ever.

“Mommy, Daddy, are we there yet?” Those of you who are parents recognize this question all too well. We also know the quick standard responses, rotated as needed: “Five more minutes!” “Almost there!” “Just around the corner!” “You’ll have to hold it!” It is amazing how easily we lie to our kids.

Nevertheless, it is our professional duty to fiercely defend this conflict to all who challenge us. No one, especially an insurance company or a government entity, is as able to guard our patients health as the doctors bound by this oath, just as no one – not insurance companies, government entities, practice owners, or even patients demanding health care as a right – must be allowed to control doctors by manipulating the fiscal means by which patients are properly treated.

But wait! There’s more! In the continuing Washington siren song that everything should be free, Congress was recently on the brink of imposing Medicare on dentistry. Since 1965 when Medicare was first born, there is a reason why physician are so envious that dentistry managed to stay out of the Medicare quagmire. Our forefather dental leaders were very prescient and clearly understood how any federal program expands and exerts even more control as costs rise. Sometimes even our dental leadership does not see that as clearly as they should. History is ignored, and the future is short sighted. “Aw, but it will not affect me,” you say? “I just don’t have to participate in Medicare?” Perhaps. But ask your physician friends what happens. In medicine, Medicare takes over and private insurance disappears at age 65. The fees are fixed and there is no balance billing. Private insurance for earlier ages set their fee schedules using Medicare schedules as a strong guide and vice versa. Guess who comes out short in that little

Dentistry and medicine may be businesses, and it is true that we are not exempted from the laws of economics, but we are special kinds of businesses. The Hippocratic Oath, while allowing to “thrive and prosper in my fortune and profession,” also admonishes that “my visit shall be for the convenience and advantage of the patient,” requiring to first and foremost to take care of our sick patients. As doctors, we feel this economic and ethical push and pull by which most competitive commercial businesses are not as tightly bound, and sometimes that can place us in an agonizing position.

on this, folks. We barely won this time. Trust me, this is not over. The political temptation is far too powerful. Nothing is for free. Proponents sell it as a benefit. But the dishonesty by omission is that it will be you who pays the bill and you will not have a choice. Once in place, it will be like any other government program: far more costly and fraught with fraud than predicted, impossible to eliminate and nearly impossible to modify, all by design. You and your American Dental Association called out the deceit this time, but another push could be “just around the corner.”

Dr David Boden Today’s FDA

As parents, it is our obligation to be truthful to our children and set the example for when they are adults. As doctors and professionals, our patients trust us to be truthful in every way. Dentists are vested with high trust and respect in a sea of frank dishonesty. This is why our predecessors, and now you, are the great leaders our society, our patients and our children seek more than ever. Speak up, defend and practice your integrity. And don’t lie to your kids.

ASSOCIATION

Often, all we can do is place the options on the table to inform the patient’s decision. A patient-centered approach presents the findings, recommendations, options and supporting evidence to inform care choices. Patient satisfaction and desired outcome are achieved by partnering with the patient in an evidence-based approach. Don’t rely on intuition and a third eye to develop a treatment plan.

It is equally frustrating to overcome the misinterpretations of personal experiences that seemingly confirm a patient’s

Promotingdisappeared.the

Presenting the nuances of evidence supporting health care choices can be fraught with challenges, particularly in this instance where the teacher, a trusted, authoritative individual promotes the dubious claims to the students. The reality is that patients of all ages regularly present with challenging beliefs that shape their care choices with “alternative facts,” often amplified by social media, and they have difficulty recognizing pseudo-science.

Heather, a dental assistant on my team, asked for advice. Parents at her son’s elementary school were concerned that a teacher had told the students that fluoride is harmful because it “clogs their third eye.” Children were now refusing to drink fluoridated water or use products containing fluoride.

Dr Christopher Smiley Michigan Dental

Heather wanted to know if there was an evidence-based approach she could take to resolve the alarm the teacher had created for her son and his classmates. Before I considered her question, I needed to know if her son’s concern was about the safety of fluoride or the suggestion that he has a third eye!

I discussed with Heather my critical appraisal of the “yoga article” the bias it showed, and identified its unsupported claims, adding that I wasn’t confident how a study could show that individuals from a fluoridated community have decreased psychic awareness. I then referenced literature on the safe and effective use of fluoride that I found on health care database search engines, including PubMed and Epistemonikos.

wrong conclusions. For example, when Grand Rapids became the first city to adjust fluoride levels in the community water supply the city water department received calls from anxious citizens complaining that their teeth were falling out because of community water fluoridation. Callers claimed that they had gum sores and that the enamel was peeling off their teeth. These citizens demanded the city quit treating their water with fluoride, convinced that whatever they were experiencing real or imagined was related to fluoridation. This happened in 1945 before searchable databases with reliable evidence. Fortunately, city officials quickly assured callers voicing concerns, letting them know that the fluoridation initiative had not yet begun! Local newspapers reported the delay in the fluoridation initiative and related the premature calls the water department had received. Callers and their reported conditions immediately

THE TEACHER, YOGA AND THE THIRD EYE

PRACTICE

best evidence isn’t always this clearcut. An evidence-based approach is needed to inform our patients by blending the best scientific evidence with the clinician’s expertise and the patient’s needs and preferences. Evidence presented must be valid and reliable and include a discussion of aspects of critical appraisal to explain why one study is more valid or reliable than another. It is best to present this information in plain language to allow our patients to make the best choices informed by the best evidence. We are obligated to provide care supported by the evidence, and the courts are looking for the best evidence to guide the standard of care.

UDA Action 17

What was meant by a third eye and where did the teacher get her information? A quick Google search produced a document from a Australian yoga festival asserting that our brain’s pineal gland functions as a third eye that governs extrasensory abilities, intuition, discernment, psychic awareness and expanded mind capacity. It went on to contend that community water fluoridation clogs these abilities and alters sleep cycles!

Step Two: Look in Less Obvious Areas

Introduction:

Once you have identified the visible strengths, start looking in less obvious places. You may uncover a hidden talent. An average performer may become exceptional with a little help from the power of suggestion.

It is one thing to recognize potential before you see it spark to life. It’s another to tell people they are good at something when there is evidence to the contrary. Most people can spot insincerity from a mile away, so it is important to remain sincere not only with the object of your encouragement, but in the context of those who are observing what you are doing as well.

Step Four: Identify Opportunities

Pay attention to what’s special. Everyone has talents and great potential spotters zero in on those gifts. In someone organized, great with people, quick to pick up on new activities, or mechanically inclined?

18 September / October 2022

THE POWER OF POTENTIAL: PLANTING THE SEEDS FOR ONE PERSON AT A TIME

Step Three: Stick with Sincerity

In addition to recognizing possibility, great potential spotters are on the lookout for the places where others can shine. They know opportunities come in all shapes and sizes. There are times the opportunities come in all shapes and sizes. There are times the opportunity is task or a project; other times it is a position or some other responsibility.

Like gardeners planting seeds, people who spot potential can help others produce results they may never have imagined for themselves. By following a few steps, anyone can learn to see the future success in others.

PRACTICE

Thank You to Our 2023 Convention Sponsors

SUCCESS

Step One: Start with Strengths

Matt Hamblin brings his 25 years of dental industry experience to DDSmatch. As a past General Manager and Territory Representative with Patterson Dental, he understands the details of dental practices and values his relationships with the dentists he serves.

Conclusion

Step Eight: Set the Stage for Success

Potential spotters follow a formula. They recognize a person’s strength, how it fits with the opportunity, and why the match makes sense.

Step Six: Connect What and Why

Kate

UDA Action 19

NorthwestZabriskeDentistry

Sometimes people with great potential fail because of factors that have nothing to do with the person or the opportunity. Exceptional potential spotters keep this in mind. And to the extent they can, they pave the way for success with training, exposure to information, time to practice new skills, and other appropriate resources.

Step Ten: Make Time for Spotting

Imagine if everyone in your workplace realized even half of his or her potential. What could people achieve alone and together? Probably more than they do now.

Step Nine: Embrace All Results

People react to potential spotters in a range of ways. Some embrace what they are told and look forward to tackling whatever opportunity the spotter highlights. Others get bogged down in self-doubt and require additional reassurance. And from time to time, the spotter may meet with rejection when the person with the potential does not immediately or, for that matter, ever embrace the opportunity. A good potential spotter is ready for anything.

When people meet with success, potential spotters acknowledge it, and they are well on their way toward finding additional opportunities to build on what has been achieved. On the other hand, when people and opportunities do not come together well, a good potential spotter takes the situation in stride and finds other avenues for people to thrive.

Step Five: Bring the Person and the Opportunity Together in the Right Place

Step Seven: Prepare for a Range of Reactions

Great potential spotters understand not only who and what to pair, but how to introduce the opportunity. At times these conversations are casual; at others they are formal meetings. Which type to hold depends upon the person and the task. Because every circumstance is different, it is important to be deliberate. If the task is part of routine work, a short conversation held in public may be appropriate. Conversely, when presenting a large project or new position, a formal meeting may be a better option.

Potential spotting can happen organically, but it can happen more often when you set aside time to think about it. Scheduling spotting time can yield great results. Great potential can be found in anyone, and when it is set in motion, it compounds. Success builds success.

Whose potential do you need to spot today?

PRACTICE

Understand Your Liability and Responsibility - Often, employers and employees mistakenly believe events and activities that take place outside of the place of employment absolve them of the rules that exist in the workplace. This is not the case. Once an employer invites most or all employees to a hosted social event or party, that event is considered an employment function. The same standard applies to off-site training or conferences that an employer pays for employees to attend.

Whilebehavior.aprofessional

It is also appropriate to provide staff members with friendly reminders of company policies for appropriate professional behavior before off-site events or in-office celebrations

While employees should be held accountable for their actions at employer sponsored functions, establishing and maintaining boundaries creates a structure for employees to follow and know what is expected of them, regardless of the setting.

Two of the members of this practice team were seen overindulging in alcohol during the evening events, and their attendance at daytime lectures was sporadic. The practice leader was frustrated and embarrassed by the behavior of these employees, feeling it reflected poorly on the practice and showed a disregard for the educational opportunities. However, the practice leader was uncomfortable addressing the employees’ behavior since it occurred outside of their place of employment.

Communication Is Key - The best action practice owners can take to communicate and document expectations of employee behavior is to include an office policy in their employee manual. CDA member benefits include access to an employee manual generator and customizable sample manual templates. TDIC Risk Management analysts provide the following direction for including behavioral expectations in an employee manual:

Risk Management analysts remind practice owners that standard harassment, antidiscrimination and workers’ compensation policies apply at company sponsored events. Employers can and have been held liable for their employees’ behavior regardless of when or where it occurred. Celebrating off-site or after hours does not negate the responsibilities of an employer and poses risks. For example, if an employee drives under the influence and causes an accident, the employer can also be held liable.

In this situation, the Advice Line recommended having an honest, transparent conversation with the employees right away. The practice leader should clearly identify what behavior is expected of staff members when attending professional meetings and events.

■ Maintaining an employee handbook is a critical point of documentation. Be sure to require staff to sign an acknowledgment for every employee manual or policy change and keep these acknowledgments in employee records.

At a Professional Conference - A practice leader invited and covered the expenses for several members of their team to attend a weekend dental conference. During the day, the conference offered educational workshops, lectures and panel discussions, along with opportunities to explore new products and technology. In the evening, there were events for staff to attend that encouraged socializing and networking.

(continued on page 21)

demeanor seems like a straightforward expectation for practice leaders and employees during the workday, guidelines for behavior can become blurred when practice team members interact with one another outside of the office. Without external signals like scrubs and an office setting, both practice leaders and staff may feel some confusion about their rights and responsibilities. - The Dentists Insurance Company’s Risk Management Advice Line fields calls regarding how to handle practice challenges. Here are just a few of those calls that illustrate the risks of poorly defined professional boundaries.

■ Never assume that everyone has the same definition of “professional behavior.” Cite specific examples of unprofessional and unacceptable behavior as well as examples of respectful behavior and professional conduct.

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■ Specify the circumstances in which professional conduct is expected. If there is a reasonable expectation that employees will be included in employer-sponsored gatherings or represent the employer at professional events, make sure to outline the expected rules of professional conduct outside of the office.

Drinking may hinder employees from using their best judgment. Because alcohol reduces inhibitions, remarks and behaviors can easily turn inappropriate. Allowing an event to become too casual and unprofessional can set the stage for a harassment claim.

WHERE’S THE LINE? DEFINE, APPLY AND MAINTAIN PROFESSIONAL BOUNDARIES

Putting on scrubs and entering the dental office are both physical and mental signals to dental professionals that the workday has begun. With that workday, a certain standard of professional conduct toward patients and colleagues informs

Plan Events Without Alcohol - Risk Management analysts also note that many of the calls they receive concerning professional boundaries involve alcohol. Hosting parties at which alcohol is provided or meeting staff for drinks after work are not recommended. Employers risk potential liability claims when professional behavior is not maintained.

who responded to the poll Aug. 16-20 reported increased prices across the board by expense category, including supplies and materials, staff wages and lab fees. Nearly one-third of dentists (31%) indicated that personal protective equipment prices have increased by more than 20 percent. Roughly 1 in 4 dentists (26%) indicated that supplies and materials prices went up by at least 20% in the past year.

To join the panel, read the full monthly reports or view the new interactive state dashboard, visit ADA.org/HPIpoll ADA SeptemberNews 2022

• Dentists’ confidence in U.S. economic recovery improved slightly in August. For the first time since April, more than a quarter of dentists indicated they were “very” or “somewhat” confident in the U.S. economic recovery, up from a low of 16% in the month of June.

Model Professional Behavior - Practice owners must be mindful that their individual style and personality dictate the office environment in which they and their staff work. They should model the same behaviors they expect from their staff members, abiding by the rules for conduct outlined in the employee manual. Always maintaining a professional

demeanor with staff members can prevent addressing any future performance issues from feeling like personal attacks.

UDA Action 21

dental hygienists remain as the most in-demand members of the dental team, with about 4 out of 10 dentists currently or recently recruiting for these positions, while recruiting dental hygienists continues to present the most difficulty for dentists.

• Dental practice schedules have been very steady for the

• Dental team recruitment needs remain steady in August. Dental assistants and

Professional Boundries (continued)

past six in86%Schedulesmonths.werefullonaverageAugust.Patient no-shows and late cancellations are largely to blame for unfulfilled appointment slots, followed by low patient demand.

provides a comprehensive Contract Negotiation Guide to help dentists engage with third-party payers on contract negotiations,” said Krishna Aravamudhan B.D.S., vice president of the ADA Practice Institute. “The ADA will continue to bring the issue of rising operational costs to the attention of the dental carriers.”

Most U.S. dental practices have experienced increased operating costs, but reimbursementinsurance has not todentistsaccordingly,increasedsayrespondingthelatestwave of the ADA Health Policy

TDIC

ASSOCIATION

“Theyear.ADA

HPI POLL: INSURANCE REIMBURSEMENT NOT KEEPING UP WITH INCREASED PRACTICE OPERATING COSTS

According to the August poll results, the insurance industry is yet to respond to increased operating costs for dentists. Nearly 60% of dentists responded that rates have remained stagnant, 25% indicate their rates have decreased and only 7% of dentists reported getting an increase in insurance reimbursement in the past

Other results from the poll included:

1,200MostinandEconomicInstitute’sOutlookEmergingIssuesDentistrypoll.oftheroughlypracticingdentists

The HPI’s Economic Outlook and Emerging Issues in Dentistry monthly poll began in January to measure the economic impact of the COVID-19 pandemic and to gather dentists’ opinions on other current and emerging issues impacting their practices. The revamped panel is a continuation and expansion of the previous poll that HPI conducted between the onset of the pandemic and December 2021.

With acceptable and unacceptable actions clearly defined, everyone in the office will be less likely to cross the line.

NEWS ARTICLE

5. Financial Manager

*See the full list of the Best Jobs here

Best Business Jobs

Health care occupations also take a majority of the Best-Paying Jobs. With an average salary of $267,020, anesthesiologist tops the list, followed by surgeon at No. 2 and oral and maxillofacial surgeon at No. 3.

22 September / October 2022

News also compiles the Best STEM Jobs

100 Best Jobs

Best Health Care Jobs

2. Surgeon

3. Oral and Maxillofacial Surgeon

1. Anesthesiologist

The 2020 Best Jobs rankings offer job seekers detailed information on training and education requirements, median salary, and job satisfaction across diverse sectors, including social services, education, construction, and creative and media For individuals interested in pursuing science, technology, engineering and math, also known as the STEM fields, U.S.

5. Nurse Practitioner

4. Obstetrician and Gynecologist

1. Dentist Physician Assistant Orthodontist

For leaders in education, policy and workforce development, U.S. News will also host its “Workforce of Tomorrow” summit Sept. 30, 2020 in Washington, D.C. The conference is committed to examining and advancing solutions for a STEM skilled workforce. To learn more, visit USNewsSTEMsolutions. com and sign up for updates from U.S. News here

3. Physician Assistant Orthodontist

To calculate Best Jobs, U.S. News draws data from the U.S. Bureau of Labor Statistics to identify jobs with the greatest hiring demand. Jobs are then scored using seven component measures: 10-year growth volume, 10-year growth percentage, median salary, employment rate, future job prospects, stress level and work-life balance. For further details on how the rankings were calculated, see the methodology.

4. Nurse Practitioner

U.S. News & World Report is the global leader in quality rankings that empower people to make better, more informed decisions about important issues affecting their lives. A digital news and information company focused on Education, Health, Money, Travel, Cars and Civic, USNews.com provides consumer advice, rankings and analysis to serve people making complex decisions throughout all stages of life. More than 40 million people visit USNews.com each month for research and guidance. Founded in 1933, U.S. News is headquartered in Washington, D.C.

3. Mathematician

2. Medical and Health Services Manager

4. Operations Research Analyst

Software developer takes No. 1 for third year, while health care and business jobs continue to dominate the list.

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2020 U.S. News Best Jobs Rankings

5. Orthodontist

U.S. News Reveals the 2020 Best Jobs

Best-Paying Jobs

1. Software Developer 2. Dentist

Media Contact: Jessica L. Lewis, jllewis@usnews.com, 202-955-2203

Washington, D.C. – U.S. News & World Report, the global authority in rankings and consumer advice, today unveiled the 2020 Best Jobs. The rankings offer a look at the best jobs across 17 lists – from best-paying jobs and best jobs without a college degree to sectors such as business and technology – to help job seekers at every level achieve their career goals. The rankings take into account the most important aspects of a job, including growth potential, work-life balance and salary.

For individuals who want to dive into the workforce after high school, U.S. News also calculated the best jobs without a college degree. Home health aid ranks No. 1, followed by medical assistant at No. 2 and medical records technician at No. 3. A majority of the jobs in this list’s top 10 are health care support positions.

1. Statistician

5. Physician

“The world has evolved significantly over the last 10 years with how we use and depend on technology. So for students who love math and science, we have good news: Our 2020 U.S. News Best Jobs rankings is packed with health care, business and technology occupations,” says Whitney Blair Wyckoff, senior editor, advice products at U.S. News. “Though you may need a lot of schooling before you get your first job, many of these roles come with high salaries.”

About U.S. News & World Report

For the third year in a row, software developer tops the list as the Best Job overall. Dentist – which peaked at No. 1 in 2017 –moves up from the No. 4 position last year to No. 2. Physician assistant comes in at No. 3, followed by orthodontist at No. 4. Occupations in health care continue to show promise due to a combination of high salaries and low unemployment rates, taking 46 of the 100 Best Jobs New to the list this year, pilot debuts at No. 39.

Jan. 7, 2020, at 12:01 a.m. U.S. News Reveals the 2020 Best Jobs

For more information, visit Best Jobs and share the rankings on Facebook and Twitter using #BestJobs.

SEMINARSPRING2023 February 10, 2023 8:00 - 3:00 (6 CE Hours) Hilton Garden Inn St. George, Utah Lunch Included WILLREGISTRATIONOPENSOON PRESENTERS Call+1-801-261-5315orText uda@uda.orgbecky@uda.org www.uda.org DR KEVIN MANGELSON DR BRENT LARSON DR NICHOLAS EGBERT TMJ MADE EASY: SIMPLE TREATMENTS FOR COMMON PROBLEMS GAYLE MASTERS, RDH ETHICS: THE WIN/WIN OF DENTISTRY OPTIMIZIING OUTCOMES AND PROFITABILITY WITH ACCELERATED DENTAL IMPLANT TOTHERAPYERGONOMICS AND BEYOND!

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Articles inside

U.S. News Reveals the 2020 Best Jobs

Where's the Line? Define, Apply and Maintain Professional Boundaries

HPI Poll: Insurance Reimbursement Not Keeping Up With Increased Practice Operating Costs

Are We There Yet?

The Power of Potential: Planting Seeds for Success One Person at a Time

Influence of Free-Sugar Intake on Dental Caries

The Teacher, Yoga and the Third Eye

Ethics in Dentistry

The Role of Dentists in Oral Cancer Detection

The Measure of Success

Change, the One Constant

Enjoy the Joy

Oral Pathology Puzzler: Do You See What I See?

The Value and Benefits of Patient Financing

An Awesome Anatomy Flashback at the 2023 UDA Convention

What to Set Your Sites on When Staging and Grading