March 2014 TDJ by Texas Dental Association

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Remembering TDA Editor-in-Chief Stephen R. Matteson, DDS 1937 - 2014 Page 200 Also Inside: TDA 2013 Financial Report, 2015 Proposed Budget and Explanation Page 234

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GET GETHELP HELPWITH WITHYOUR YOURHEALTH HEALTH INSURANCE INSURANCETRANSITION. TRANSITION. Purchasing Purchasing insurance insurance through through Perksʼ Perksʼ TDA TDA Financial Financial Services Services Insurance Insurance Program Program means means youʼll youʼll always always have have attentive attentive customer customer service service from from a team a team dedicated dedicated to to TDA TDA members members and and staff. staff. TDA Financial Services Insurance Program TDA Financial Services Insurance Program is working with Blue Cross and Blue Shield is working with Blue Cross and Blue Shield Texas, a Division Health Care Service of of Texas, a Division of of Health Care Service Corporation, make insurance transition Corporation, to to make thethe insurance transition easier insured TDA members and staff. easier forfor insured TDA members and staff. TIME IS IS RUNNING OUT. TIME RUNNING OUT. The deadline is Jan. 3030 to to sign upup The deadline is Jan. sign forfor coverage effective Feb. 1, 1, 2014. coverage effective Feb. 2014.

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TEXAS DEn TAl Jo ur n Al Established February 1883

Vol 131, No 2

March 2014

219

210 ABOUT THE COVER

TDA Editor in Chief Dr Stephen R. Matteson died in January 2014. An accomplished dentist and beloved husband, father, and grandfather, TDA President Dr David Duncan looks back at Dr Matteson’s career.

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THE jfk AssAssinATiOn fROm A dEnTAl pERspECTiVE: An inTERViEw with an oral and maxillofacial surgeon—Jack bolton, dds, msd T. Campbell Bourland, DDS, MS An oral surgeon recounts his experience as an intern at Parkland Hospital the day President John F. Kennedy was shot and killed.

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restorative material and other tooth-specific variables AssOCiATEd wiTH THE dECisiOn TO REpAiR OR REplACE dEfECTiVE REsTORATiOns: findings fROm THE dEnTAl pBRn Valeria V. Gordan, DDS; Joseph L. Riley III, DDS; Donald C. Worley, DDS; Gordon H. Gilbert, DDS; The DPBRN Collaborative Group In this reprint from the Journal of Dentistry, dentists participating in the Dental Practice-Based Research Network (DPBRN) conduct a study that had 2 main objectives: (1) to identify and quantify the types of restorative materials in the existing failed restorations; and (2) to identify and quantify the materials used to repair or replace those failed restorations.

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TdAgOVERnAnCE Texas Dental Association 2013 Financial Report, 2015 Proposed Budget, and 2015 Budget Explanation

MONTHLYFEATURES 200 206 246 247 247 248

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President’s Message Oral and Maxillofacial Pathology Case of the Month Critically Appraised Topic of the Month In Memoriam Memorial and Honorarium Donors TEXAS Meeting Preview

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250 254 258 260 261 274

Value for Your Profession Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management Calendar of Events 2013 TDA Annual Session TEXAS Meeting Photo Contest Winner Advertising Briefs Index to Advertisers

TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.

Editorial Staff

Editorial Advisory Board

BOARD Of BOARd OF diRECTORs DIRECTORS TEXAs dEnTAl TEXAS DENTAL ASSOCIATION AssOCiATiOn

Daniel L. Jones, DDS, PhD, Interim Editor Harvey P. Kessler, DDS, MS, Associate Editor Harvey P. Kessler, DDS, MS, Associate Editor Nicole Scott, Managing Editor Nicole Scott, Managing Editor Barbara Donovan, Art Director Barbara Donovan, Art Director Paul H. Schlesinger, Consultant Paul H. Schlesinger, Consultant

Ronald C. Auvenshine, DDS, PhD Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD Patricia L. Blanton, DDS, PhD William C. Bone, DDS William C. Bone, DDS Phillip M. Campbell, DDS, MSD Phillip M. Campbell, DDS, MSD Michaell A. Huber, DDS Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Paul A. Kennedy Jr, DDS, MS Scott R. Makins, DDS Scott R. Makins, DDS Daniel Perez, DDS Daniel Perez, DDS William F. Wathen, DMD William F. Wathen, DMD Robert C. White, DDS Robert C. White, DDS Leighton A. Wier, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS Douglas B. Willingham, DDS

The Texas Dental Journal is a peer-reviewed publication. The Texas Journal is a peer-reviewed publication. Texas Dental Association Texas Dental Association 1946 S IH-35 Ste 400, Austin, TX 78704-3698 1946 S IH-35 Ste 400, Austin, TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 Phone: 512-443-3675 • FAX: 512-443-3031 E-mail: tda@tda.org • Website: tda.org E-mail: tda@tda.org • Website: tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly, one issue will be a directory issue, by the Texas Texas Dental Journal (ISSN 0040-4284) is published monthly, one issue will be a directory issue, by the Texas Dental Association, 1946 S IH-35, Austin, TX, 78704-3698, 512-443-3675. Periodicals Postage Paid at Austin, Dental Association, 1946 S IH-35, Austin, TX, 78704-3698, 512-443-3675. Periodicals Postage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35, Austin, TX 78704. Copyright 2014 Texas Dental Asociation. All rights reserved. S IH 35, Austin, TX 78704. Copyright 2014 Texas Dental Association. All rights reserved. annual Annual subscriptions: Texas Dental Association members $17. In-state ADA Affiliated $49.50 + tax, Out-ofTexas Dental Association members $17. In-state ADA Affiliated $49.50 + tax, Out-ofstate ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. state ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affiliated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 NonSingle issue price: $6 ADA Affiliated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 NonADA ADA Affiliated. For in-state orders, add 8.25% sales tax. Affiliated. For in-state orders, add 8.25% sales tax. contributions: Contributions: Manuscripts and news items of interest to the membership of the society are solicited. Electronic Manuscripts and news items of interest to the membership of the society are solicited. Electronic submissions are required. Manuscripts should be typewritten, double spaced, and the original copy should be submissions are required. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. For more information, please refer to the Instructions for Contributors statement printed in the Sepsubmitted. For more information, please refer to the Instructions for Contributors statement printed in the September Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed tember Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles. financial or other interests they may have in products or services described in their articles. Advertisements: Publication of advertisements in this journal does not constitute a guarantee advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of the quality of or endorsement by the Association of the quality of value of such product or of the claims made of it by value of such product or of the claims made of it by Texas Dental Journal is a member of the Journal is a member of the its manufacturer. American American Association of Dental Editors. Association of Dental Editors. Member Publication

PRESIDENT PRESIDENT David A. Duncan, DDS David A. Duncan, DDS 806-355-7401, davidduncandds@gmail.com 806-355-7401, davidduncandds@gmail.com PRESIDENT-ELECT David H. McCarley, DDS David H. McCarley, DDS 972-562-0767, drdavid@mccarleydental.com 972-562-0767, drdavid@mccarleydental.com IMMEDIATE PAST PRESIDENT IMMEDIATE PAST PRESIDENT Michael L. Stuart, DDS Michael L. Stuart, DDS 972-226-6655, mstuartdds@sbcglobal.net 972-226-6655, mstuartdds@sbcglobal.net VICE PRESIDENT, NORTHWEST VICE PRESIDENT, NORTHWEST David David C. Woodburn, DDS C. Woodburn, DDS 806-358-7471, 806-358-7471, olddave1@gmail.com olddave1@gmail.com VICE VICE PRESIDENT, NORTHEAST PRESIDENT, NORTHEAST Jean Jean E. Bainbridge, DDS E. Bainbridge, DDS 214-388-4453, 214-388-4453, jbainbridgedds@sbcglobal.net jbainbridgedds@sbcglobal.net VICE VICE PRESIDENT, SOUTHEAST PRESIDENT, SOUTHEAST Gregory Gregory K. Oelfke, DDS K. Oelfke, DDS 713-988-0492, 713-988-0492, greg@oelfke.com greg@oelfke.com VICE VICE PRESIDENT, SOUTHWEST PRESIDENT, SOUTHWEST Yvonne Yvonne E. Maldonado, DDS E. Maldonado, DDS 915-855-2337, yvonnedent2000@yahoo.com 915-855-2337, yvonnedent2000@yahoo.com SENIOR DIRECTOR, NORTHWEST SENIOR DIRECTOR, NORTHWEST Steven J. Hill, DDS Steven J. Hill, DDS 806-783-8837, 806-783-8837, sjhilldds@aol.com sjhilldds@aol.com SENIOR SENIOR DIRECTOR, NORTHEAST DIRECTOR, NORTHEAST Jerry J. Hopson, DDS Jerry J. Hopson, DDS 903-583-5715, dochop@verizon.net 903-583-5715, dochop@verizon.net SENIOR SENIOR DIRECTOR, SOUTHEAST DIRECTOR, SOUTHEAST William William S. Nantz, DDS S. Nantz, DDS 409-866-7498, 409-866-7498, wn3798@sbcglobal.net wn3798@sbcglobal.net SENIOR SENIOR DIRECTOR, SOUTHWEST DIRECTOR, SOUTHWEST Joshua Joshua A. Austin, DDS A. Austin, DDS 210-408-7999, 210-408-7999, jaustindds@me.com jaustindds@me.com DIRECTOR, DIRECTOR, NORTHWEST NORTHWEST Charles Charles W. Miller, DDS W. Miller, DDS 817-572-4497, cwdam@sbcglobal.net 817-572-4497, cwdam@sbcglobal.net DIRECTOR, NORTHEAST DIRECTOR, NORTHEAST William H. Gerlach, DDS William H. Gerlach, DDS 972-964-1855, drbill@gerlachdental.com 972-964-1855, drbill@gerlachdental.com DIRECTOR, SOUTHEAST DIRECTOR, SOUTHEAST Karen A. Walters, DDS Karen A. Walters, DDS 713-790-1111, kwalters@sms-houston.com 713-790-1111, kwalters@sms-houston.com DIRECTOR, SOUTHWEST DIRECTOR, SOUTHWEST John B. Mason, DDS John B. Mason, DDS 361-854-3159, jbmasondds@aol.com 361-854-3159, jbmasondds@aol.com SECRETARY-TREASURER Ron Collins, DDS Ron Collins, DDS 281-983-5677, roncollinsdds@yahoo.com 281-983-5677, roncollinsdds@yahoo.com SPEAKER OF THE HOUSE SPEAKER OF THE HOUSE John W. Baucum III, DDS John W. Baucum III, DDS 361-855-3900, jbaucum3@msn.com 361-855-3900, jbaucum3@msn.com PARLIAMENTARIAN Michael Vaclav, DDS Michael Vaclav, DDS 806-355-7463, drvaclav@suddenlinkmail.com 806-355-7463, drvaclav@suddenlinkmail.com INTERIM EXECUTIVE DIRECTOR INTERIM EXECUTIVE DIRECTOR Michael L. Stuart, DDS Michael L. Stuart, DDS 512-443-3675, mstuartdds@sbcglobal.net 512-443-3675, mstuartdds@sbcglobal.net LEGAL COUNSEL LEGAL COUNSEL Mr William H. Bingham Mr William H. Bingham 512-495-6000, bbingham@mcginnislaw.com 512-495-6000, bbingham@mcginnislaw.com

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President’s Message David Duncan, DDS, TDA President

Remembering Dr Stephen R. Matteson, TDA Editor 2009-2014

…I was especially touched by the number of lives Steve had touched in a very profound way. There was so much I didn’t know about this man whom I served with on the Board of Directors. Besides serving as a dentist, an academician, and the editor, he was a golfer, a photographer, singer, and a beloved husband and grandpa.

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ince becoming president, I have had the privilege of meeting many of my peers whom I would not otherwise had the opportunity to get to know. I may live in Amarillo, but I work daily with members all over the state, Dr Stephen R. Matteson, TDA Editor 2009-2014 forming relationships that are more than an acquaintance. One that I wish I would have had more time with is the late Dr Stephen R. Matteson, TDA’s editor from 2009 to 2014. Steve died in January, and though we were together at Board meetings, we sadly did not get to know each other on a more personal level. However, from what I know of him, he touched the lives of so many in a positive and meaningful way, including those of the TDA staff, with whom he worked with every day. TDA Managing Editor Nicole Scott relayed this story to me of Steve. “When Dr Matteson was first elected editor in May 2009, Eddy Shires (former managing editor) and I traveled to San Antonio to meet him. He wanted a face-to-face meeting. He invited us to his home to have lunch with him and meet his wife Mary Ann. When we walked in, they were so gracious, showing us around their home and the big framed pictures they had taken, which were hanging all over the house. Mary Ann is an artist, and her beautiful photos and paintings were on display. Then, we got to know each other, laughing and telling stories in their living room. It was such a nice way to meet someone, especially someone for whom I would be working. It was the preview to his sweet nature. He was the most supportive and nicest man. Over the years, we really got to know each other well, and I looked forward to a phone call from him every day at 10:30 am.”

Steve died at his home in San Antonio on Monday, January 6, 2014. I attended his funeral service at St. Mark’s Episcopal Church in San Antonio, and I was especially touched by the number of lives Steve had touched in a very profound way. There was so much I didn’t know about this man whom I served with on the Board of Directors. Besides serving as a dentist, an academician, and the editor, he was a golfer, a photographer, singer, and a beloved husband and grandpa. As the obituary we published in the January 2014 TDA Today explains: He was first elected as TDA editor in May 2009 and served in that capacity and on the Board of Directors. He was instrumental in advancing the Association’s publications to improve their recognition nationwide among the dental profession. He received multiple national and international awards, including the American Dental Association’s Golden Apple Award, the International College of Dentists (ICD) USA Section’s Golden Pen Award in 2012. Under Steve’s direction, the TDA created its newest publication Smart Mouth, which received a Special Citation journalism award in 2012 by the ICD USA Section. He received his DDS degree from the University of Pennsylvania in 1962. After 2 years as a general dentistry officer in the United

States Air Force in North Carolina, he returned to his native state of New Jersey and practiced general dentistry for 10 years. In 1973, he sold his practice and completed a residency in oral radiology at the University of Connecticut Health Center. He then joined the faculty at the University of North Carolina School of Dentistry and served as director of radiology from 1975 to 1988. He was recruited as chair of the Department of Dental Diagnostic Science at University of Texas Health Science Center at San Antonio Dental School in 1988 and served in that leadership role until 2000 when he retired and was appointed professor emeritus in 2002. He returned for a second career in academics and service to the profession in 2005. He was a key figure in establishing the Dental School’s, National Institute of Health-funded, Evidence-Based Practice CATs program, which is a current monthly feature in the Texas Dental Journal. Steve will be remembered for his many contributions to the dental profession. In the 1980s, he led the national panel that developed the original FDA-sponsored radiographic selection criteria for dentistry. He served as president of the American Academy of Oral and Maxillofacial Radiology and the national Supreme Chapter of Omicron Kappa Upsilon, the dental honor society. He was also

founding director and president of the American Board of Oral and Maxillofacial Radiology. His national leadership efforts were instrumental in obtaining specialty status for oral and maxillofacial radiology. His research focused on radiographic diagnosis. He published more than 60 articles in the scientific literature and served as radiology section editor of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. At the time of his death, Steve was an active participant in an oral and maxillofacial radiology group practice. Most importantly, Steve loved his family. He lived in San Antonio with his wife Dr Mary Ann Matteson, professor emeritus at the UTHSCSA School of Nursing. He and Mary Ann enjoyed trips to Alpine several times a year, and he adored his 3 children and 5 grandchildren. You’d often hear stories of his grandchildren — he’d pick them up from school, take them shopping. And, he was proud to show you a picture of them on his iPhone. Jackie Robinson said, “A life is not important except in the impact it has on other lives.” All who came to know Steve could feel his impact, and I’m happy to say I had the honor.

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Oral and Maxillofacial Pathology Case of the Month Clinical History A 10-year-old Hispanic female was referred to the Oral and Maxillofacial Imaging Center, TAMU-Baylor College of Dentistry, from the orthodontics department for pretreatment imaging. Panoramic, lateral cephalometric, and left hand wrist radiographs were performed in September 2010. The panoramic radiograph demonstrated that the patient was in the late mixed dentition stage (Figure 1A). The mandibular primary second molars were still present. Second molars were developing/unerupted and third molar buds were present. The patient’s parents decided to delay starting the orthodontic treatment at that time. Nineteen months later in April 2012, the patient, now 12 years old, returned for reevaluation before starting orthodontic treatment. The new panoramic radiograph demonstrated that the patient had all permanent teeth erupted except all third molars (Figure 1B). In addition, there now was a well-defined oval radiolucency in the right mandibular angle that was not noted in the prior panoramic radiograph. The patient was asymptomatic. Clinical examination revealed no evidence of bony swelling. The patient denied any history of trauma or past surgery and she was not taking any medications. Her medical history was noncontributory. No treatment was performed other than starting the orthodontic treatment and following up with the radiolucency at the right mandibular angle.

Hui Liang, DDS, MS, PhD, associate professor, Department of Diagnostic Sciences, Texas A&M University — Baylor College of Dentistry, Dallas, Texas Liang

Yi-Shing Lisa Cheng, DDS, MS, PhD, associate professor, Department of Diagnostic Sciences, Texas A&M University — Baylor College of Dentistry, Dallas, Texas

Cheng

Harvey P. Kessler, DDS, MS, professor, Department of Diagnostic Sciences, Texas A&M University — Baylor College of Dentistry, Dallas, Texas Kessler

Jay A. Crossland, DDS, private practice, Black Hills Oral & Maxillofacial Surgery, PC, Rapid City, South Dakota

Crossland

Figure 1A. Panoramic radiograph of a 10-year-old girl demonstrated normal bony trabecular pattern in mixed dentition stage.

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Figure 1B. Cropped panoramic radiograph of the same patient taken 19 months later showed a well-defined oval radiolucency at the right mandibular angle in the permanent dentition stage.

Figure 1C. Cropped panoramic radiograph of the same patient taken 15 months later from the time of Figure 1B showed no significant change in size and shape of the radiolucency at the right mandibular angle.

In July 2013 (15 months after the second visit), another panoramic radiograph was taken (Figure 1C). No significant changes were noted regarding the size and shape of the radiolucency in the right

mandibular angle. The patient was still asymptomatic and there was no bony expansion. Fixed orthodontic appliances were present in both arches.

What is your diagnosis for this radiolucent lesion? See page 254 for discussion and answer.

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Historical Account

Editor’s Note: The 50th anniversary of the assassination of President John F. Kennedy occurred in November 2013. This interesting article recounts one oral and maxillofacial surgeon’s experience on that fateful day, as the mortally wounded President was treated at Parkland Hospital in Dallas.

The JFK Assassination From a Dental An Interview With an Oral and Maxillofacial Surgeon — Jack Bolton, DDS, MSD By T. Campbell Bourland, DDS, MS

ver a year ago, I found myself in a precarious position that many associates in a group practice discover. I needed a new place to call home and find a community to establish myself in as a competent oral surgeon, eagerly waiting to serve the local patient population. As I looked around the Dallas-Fort Worth metroplex for a place to land, I heard a surgeon on my side of town might be looking to retire. He was a cornerstone of the East Dallas community and a vast contributor to the field of dentistry especially the division of oral maxillofacial surgery. I had crossed paths once with Dr Jack Bolton and mercifully it was not when he was a Texas State Board Dental Examiner. As an oral surgery resident at Baylor, I saw Dr Bolton in the audience when the former Parkland Oral Surgery Chairman Dr Robert Walker gave the dental students and residents a 45-minute synopsis of the President John F. Kennedy assassination nearly half a decade earlier as he witnessed it. Dr Bolton was in attendance because he was one of the oral surgery interns at Parkland under Dr Walker’s tutelage when JFK was rushed to the hospital. Dr Walker’s lecture was fascinating. I found myself with many more questions than answers.

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I vowed that one day I would find the time to interview Dr Walker personally with my inquiries, which I tragically missed due to his untimely passing. When I met Dr Bolton personally to discuss the possible sale of his practice, I knew I had living history in front of me. I found Dr Bolton to be one of the most agreeable gentlemen I have ever met. His demeanor was commanding and steadfast. Through our conversation, I could see his dedication to the East Dallas community and the profession of dentistry. He illustrated all the characterizations of a successful practitioner. During our conversation, we consistently wandered from discussing the practice transition and landed on the topic of Dr Walker’s lecture and the JFK assassination. He provided many details unlike any I have heard before. I knew I had an opportunity again to obtain front line answers to history that I had to put on paper to share with all generations. With 20 questions, I hope I provide a unique perspective to November 22, 1963, through the eyes of an oral surgery intern.

Perspective:

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4. Where were you at Parkland 4. when you heard the news the President was shot and headed to the Parkland ER? That morning, Don Curtis and I (Don was a year ahead of me) had operated and we finished just after 11:00 AM. We had a full clinic we had to go take care of. We usually had 45-50 patients. We were in the clinic working and we were used to hearing sirens because the ambulance dock was right behind our reception area. These sirens kept going on and on and on. Don was in one operating area and I was in another and he came by me and said, “Jack, there is something going on. I am going to go by the major surgery area. There is something happening.” Don left, and I continued to see patients. Miss Hickman, our clinic nurse told me, “Don never came back.” I told her I would go over and see what is happening. So I put a coat on and went over to the major surgery area. Back then, they just started

the trauma teams at Parkland. The emergency room was split up into minor emergency, minor medicine, major surgery, and major medicine. In the major surgery area we had a trauma room set up that was ready to go at all times. So I went into the major surgery area and I went around the corner and I saw (Dr Jim) Carrico. He was the resident that was head of the trauma team that was on call. Don Curtis was there and 2 or 3 other people at the time. I think it was Don who said, “They’ve shot the President, Jack.” The hair on the back of my neck stood out. There on this table lay the President. I walked around. I cannot remember who else was in the room but I walked around to the head of the table and it looked to me like the whole right occipital area of the President’s head was gone. There was a lot of blood. I stood there for a minute and thought to myself, “I don’t have anything I can do so I

A view through the wooden fence atop the The Eternal Flame over the grave of 212 TexasJohn Dental Journal l www.tda.org March 2014 grassy knoll in Dallas’ Dealey Plaza. President Fitzgerald Kennedy atl the Arlington National Cemetery in Virginia.

Lee Harvey Oswald holds a rifle in a photo taken in 1963.

1. Dr Bolton, what year were you in 1. training when in the fall of 1963 at Parkland? I was an intern during the fall of 1963. I graduated from Baylor College of Dentistry in the spring of 1962, and I spent a year after I graduated getting a master’s degree. 2. What percentage of facial 2. trauma was treated by oral surgery at the time compared to ENT and plastics? Oral surgery treated all of facial trauma. There was no plastic surgery residency at the time. ENT existed but they did not do much with facial trauma. 3. How many oral surgery residents 3. were at Parkland at the time? There were 6 residents total. We had 2 interns, 2 first-years, and 2 second-years. We rotated on anesthesia for 6 months, pathology for 3 months, medicine and infectious disease for our intern year.

am going to get out of here.” Just about the time I left the room they took Lyndon Johnson, Lady Bird Johnson, and Jackie Kennedy down the hallway by the trauma rooms and sequestered them so nobody could get to them. And that is when I thought to myself, “My gosh! This is really something.” 5. When you were on for facial trauma, did the oral surgery resident always take part in the trauma workup or was the patient stabilized by other services and then you consulted? Oral surgery was always around. Don Curtis did a cut down on the President, and another oral surgery resident assisted with general anesthesia on Lee Harvey Oswald when he was brought in. The way that it would work is the trauma team would do the work and they would give us a call if there were facial injuries. We had a very good rapport with trauma service. Back then, we did not have seatbelts and airbags, so we did a lot of midface trauma. Trauma was our major function at Parkland. 6. How many residents versus attending physicians did you see in Trauma Room 1 when the President was brought in? I saw no attendings in the room. 7. How about Governor Connally? Coincidentally, across the hall from President Kennedy was Governor Connally. He had a chest injury. When the feds left, the Secret Service turned things over to the Texas Rangers. Contrary to today, where you have to use a card to get in and out of doors; we had nothing like that. They had a Texas Ranger at each exit of Parkland by the next morning. You had to identify yourself and they had to look you

up to get in. They kept Connally in the recovery room. Every time you did a case and you would have to go to the recovery room, there was a bed over on the side with 2 Texas Rangers sitting there where Connally was until they could get him to a private room. It was a very emotional time for everyone. Something I will never forget. 8. Did the President have any vital signs at all? They had already stripped him down. I don’t have any knowledge of that. 9. Was any type of imaging done during the resuscitation effort like a chest x-ray or plain film of his skull? None to my knowledge. 10. How long did the resuscitation efforts continue? I am not aware how long. 11. Supposedly, one of the criticisms from the Warren Commission Report was that a “dentist” placed a central venous catheter in the President? Was this true? Don Curtis did the cut down on the President. I am sure Jim Carrico, the surgery resident, told Don that he needed a line and so Don started that cut down. I do not remember seeing anything hanging (fluids) when I went in. Don was focusing on the left leg, as I remember.

“They’ve shot the President, Jack.” The hair on the back of my neck stood out. There on this table lay the President. I walked around. I cannot remember who else was in the room but I walked around to the head of the table and it looked to me like the whole right occipital area of the president’s head was gone. 12. Can you describe the wounds you saw on the President? Supposedly the President had a neck injury too. I never did see it. All I could see was the occipital injury on the right side. 13. Here are the copies of his autopsy photos from the internet. Is this how he looked to you? That is it right there. The significant injury to the President’s head. The only injury I saw was to the occipital area. There was a lot of brain tissue hanging out of there. 14. Did the wounds indicate to you that there were multiple shooters? I could not say. 15. Did you wonder if oral surgery was going to have any part in his care if he survived or was it evident that the resuscitation efforts were futile? After I walked around the table and saw that injury, I knew he was gone. 16. Did you have any interactions with the Secret Service? I started walking out of the major surgery area. There was a door going into radiology and there was a man standing there at the door. He asked me, “Do Texas Dental Journal l www.tda.org l March 2014

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you have official duties here?” I said to him, “Yes, sir, I do.” He said, “Well, let me ask you to do this. You stand here at this door and do not let anyone in here until I get back.” I said okay. I am standing here in that door between radiology and surgery. I stood there for about 5 or 10 minutes. The next thing I see is Dr Walker comes out of the area where the trauma room is and he has got tears in his eyes. Dr Walker does not ever have tears in his eyes, and he says to me, “My God, Jack. They’ve killed the President.” That just shook me to my toe nails. Dr Walker walked off back to our clinic. I stood there for a short period of time. There were 4 Secret Service agents who had had Lyndon Johnson, Lady Bird Johnson, and Jackie Kennedy, and each one of the agents had machine guns. Back in those days, we did not see people or police walking around with machine guns. That was really an eye-opening experience for me to see that in public. They brought a car around, and I was standing on the ambulance dock where the ambulance was. Then, out comes Mr and Mrs Johnson, and the Secret Service pulled up in one of those Lincoln Town Cars. They opened the back door on one of those cars and put Mr and Mrs Johnson on the floor board, and those Secret Service agents got in on top of them as a human shield. I thought, “Boy, you better remember this, Jack. This is serious when you are in the United States, and you are worried you might be shot by a sniper driving down the street.” That is exactly what they were thinking. 17. How about the First Lady? They took the 3 of them off (Jackie Kennedy, Lyndon Johnson, and Lady Bird Johnson) to another

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part of the hospital to sequester them, and I knew that this was serious business and that we were seeing history made. I stood there for another 5 minutes, and the guy never came back. 18. Did she seem coherent or was she in total shock? They left and it was a short time later they brought President Kennedy out. They had put him in a coffin. They had an ambulance backed up to the dock. They took the casket and put in the back of the car, and Mrs Kennedy was following right behind the casket wearing that pink suit. She had blood all over her. She got in the back with them and that is when they left Parkland and went out to Love Field. Back then communications were entirely different. On the ambulance dock they had probably 20 pay telephones stretched out for the press to phone in their stories. 19. Many of the doctors who were present have written books, done interviews, and publicized the President’s treatment at Parkland. Do you think the espousing of all this information violates HIPAA regulations? You would now! I never said a whole lot about it because there were so many books. I think they interviewed Dr Jenkins. Crenshaw wrote a big book about it. I do not remember seeing Chuck there. Everybody who had anything to do with it was interviewed. 20. Does anything you saw make you think there was a conspiracy or cover up? There has been a lot of controversy over how many bullets, the angle of the bullets. I could not speak to any of that. All I saw was that he had a severe head injury. I am not a forensic pathologist, but I thought exit

wounds were pretty good size wounds as opposed to entrance wounds and that was a pretty small wound in his throat as compared to what was on the back of his head. Let us just say this … as many gunshot wounds as we saw out there during that time, those guys knew what they were talking about. I would put them (the doctors) up against anybody as far as treating and recognizing trauma. Gunshot wounds were a run-of-the-mill injury at the time out there. Another interesting part of Dr Bolton’s story is watching Dr Clark from Neurosurgery sign the President’s death certificate. As soon as Dr Clark put the pen down, it was immediately swiped since the perpetrator knew that the pen would be a valuable keepsake. Also, Dr Bolton describes the entire procession of dignitaries that followed the Presidential limo and the mortally wounded President to the hospital. Dr Bolton went out to the limo and offered Mayor Cabell’s wife a glass of water while she looked around in shock trying to digest the events. The first-hand account of the Presidential assassination yielded details unlike I have ever heard. I was gratified to know that oral surgery played such a unique role in the trauma work up and the resuscitation effort. Tom Brokaw’s book, The Greatest Generation, aptly describes the character of men like Dr Jack Bolton. As the transition takes place in his practice, I hope Dr Bolton will stay around for as long as I can convince him. The good doctor deserves a parade the last time he walks out of the door in his practice. I am sure he will lay low and go quietly, much as the oral surgery residents and staff did during those tumultuous days back in November 1963. I hope he will at least pat himself on the back and say to himself, “Job well done.”

Evidence indicates that shots were fired from the sixth floor of the Texas School Book Depository in Dallas, and its employee Lee Harvey Texas Dental Journal l www.tda.org l March 2014 215 Oswald was charged with the Presidentâ&#x20AC;&#x2122;s murder.

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PRACTICE-BASED RESEARCH

Abstract

Restorative Material and Other Tooth-specific Variables Associated with the Decision to Repair or Replace Defective Restorations: Findings from The Dental PBRN

Objectives: Using data from dentists participating in The Dental Practice-Based Research Network (DPBRN), the study had 2 main objectives: (1) to identify and quantify the types of restorative materials in the existing failed restorations; and (2) to identify and quantify the materials used to repair or replace those failed restorations.

Valeria V. Gordan, DDS Joseph L. Riley III, DDS Donald C. Worley, DDS Gordon H. Gilbert, DDS The DPBRN Collaborative Group

Methods: This cross-sectional study used a consecutive patient/restoration recruitment design. Practitioner-investigators recorded data on consecutive restorations in permanent teeth that needed repair or replacement. Data included the primary reason for repair or replacement, tooth surface(s) involved, restorative materials used, and patient demographics.

Originally printed in the May 2012 Journal of Dentistry: J Dent. 2012 May;40(5):397405. doi: 10.1016/j.jdent.2012.02.001. Epub 2012 Feb 8. Reprinted with permission from Elsevier.

Introduction Replacement of existing restorations still occupies most of general practitionersâ&#x20AC;&#x2122; treatment time (1-4). The reasons restorations are replaced may vary according to the material in the existing restoration, as well as to other tooth-specific factors (5-7). Identifying the materials and tooth-specific variables that can influence a dentistâ&#x20AC;&#x2122;s decision to repair or replace restorations can be valuable when planning new strategies for minimally invasive dentistry. Furthermore, it can provide

Dr Gordan is a professor, Department of Restorative Dental Sciences, Operative Dentistry Division, University of Florida College of Dentistry, Gainesville, Florida. Dr Riley is a professor, Department of Community Dentistry and Behavioral Sciences, University of Florida College of Dentistry, Gainesville, Florida. Dr Worley is a practitionerâ&#x20AC;&#x201C;investigator, HealthPartners Dental Group and HealthPartners Research Foundation, Minneapolis, Minnesota. Dr Gilbert is a professor and chair, Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama. Corresponding author: Dr Valeria V. Gordan, Professor, Department of Restorative Dental Sciences, University of Florida, College of Dentistry, PO Box 100415, Gainesville, FL, 32610-0415; Office: 352-273-5846, Fax: 352-273-7970; E-mail: vgordan@dental.ufl.edu. Competing interests: The authors declare that they have no competing interests. This manuscript has been peer reviewed.

Results: Data for 9,875 restorations were collected from 7,502 patients in 197 practices for which 75% of restorations were replaced and 25% repaired. Most of the restorations that were either repaired or replaced were amalgam (56%) for which most (56%) of the material used was direct tooth-colored. The restorative material was 5 times more likely to be changed when the original restoration was amalgam (OR=5.2, p<.001). The likelihood of changing an amalgam restoration differed as a function of the tooth type (OR=3.0, p<.001), arch (OR=6.6, p<.001); and number of surfaces in the original restoration (OR=12.2, p<.001). Conclusion: The probability of changing from amalgam to another restorative material differed with several characteristics of the original restoration. The change was most likely to take place when (1) the treatment was a replacement; (2) the tooth was not a molar; (3) the tooth was in the maxillary arch; and (4) the original restoration involved a single surface.

Key words: practice-based research, repair, replacement, decision, defective, restorations Tex Dent J 2014;131(3): 219-231.

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P R A C T I C E - B A S E D RESEARCH

a new insight to clinicians when considering repair versus replacement of existing restorations. Therefore, using data from dentists participating in The Dental Practice-Based Research Network (DPBRN), the study had 2 main objectives: (1) to identify and quantify the types of restorative materials in the existing failed restorations; and (2) to identify and quantify the materials used to repair or replace those failed restorations. Additionally, the study sought to identify the restorative material and other tooth-specific characteristics associated with the decision to repair or replace the existing restoration by testing the following hypotheses: (1) Dentists are more likely to change restorative materials when the material of the original restoration is amalgam; (2) Restorations that are replaced are more likely to involve a change of restorative material than restorations that are repaired; (3) The likelihood of changing from amalgam restoration differs as a function of other tooth-specific variables, such as tooth type and number of surfaces in the original restoration.

Materials and Methods Selection and recruitment process

This cross-sectional study included 197 practitioner-investigators participating in the DPBRN were enrolled in this study and recorded data on consecutive defective restorations that needed repair or replacement on permanent teeth. The DPBRN comprises outpatient dental practices mainly from 5 regions:

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AL/MS: Alabama/Mississippi; FL/ GA: Florida/Georgia; MN: dentists employed by HealthPartners and private practitioners in Minnesota; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente Center for Health Research, Portland, Oregon; and SK (Scandinavia): Denmark, Norway, and Sweden. Practice structures differed by DPBRN region. Dentists from the AL/MS and FL/GA regions were primarily in independent or small group practices, MN and PDA dentists were primarily in large group practices, and SK dentists were in public or private health care settings. This study was approved by the respective Institutional Review Boards of the participating regions. DPBRN practitioner-investigators were recruited through continuing education courses and/or mass mailings to licensed dentists within the participating regions. As part of the eligibility criteria, all dentists completed (1) a DPBRN Enrollment Questionnaire describing their demographic and practice characteristics and certain personal characteristics, (2) an Assessment of Caries Diagnosis and Caries Treatment Questionnaire, (3) training in human subjects protection, and (4) a DPBRN orientation session with the regional coordinator. Copies of the questionnaires and summary data for dentistsâ&#x20AC;&#x2122; demographic and practice characteristics are available at dpbrn. org/users/publications/Default.aspx. Results from previous studies confirm that dentists in practice-based research networks have much in common with dentists at large (8,9).

This study used a consecutive patient/ restoration recruitment design and every patient who received a repair or replacement of a restoration on a permanent tooth was asked to participate. Patients who returned for additional appointments while data collection was still ongoing were not eligible for further data collection. Only restorations eligible during the first appointment were enrolled. The practitioner could enroll up to 4 restorations per patient and continued to collect data until information on 50 restorations had been collected. The number of lesions/patient was restricted in order to limit the size of clustering at the patient-level, thus increasing the precision and generalizability of the study. Patient recruitment varied from practice to practice, and on average the recruitment took about 5 months. A consecutive patient/restoration log form was used to record information on eligible restorations whether or not the patient participated in the study. All the data collection forms used for this study are available at DentalPBRN.org/users/publications/ Supplement.aspx.

Variable selection

Restoration replacement was characterized as the entire removal of the existing defective/failed restoration and any adjacent pathologically altered or discolored tooth tissue that was esthetically or functionally unacceptable. Repair was characterized as the removal of part of the existing restoration and any adjacent pathologically altered as well as discolored tooth tissue that was esthetically unacceptable followed by

P R A C T I C E - B A S E D RESEARCH

placement of restorative material in the prepared site. Repair also included light grinding and polishing, removal of overhangs, polishing discolored tooth-colored restorations, or sealing margins. Practitioner-investigators collected data for each enrolled restoration that needed repair or replacement on permanent tooth surfaces. Data collected included: (1) the main reason for repair or replacement of the restoration (previously reported)10; (2) tooth type and tooth surfaces being restored; and (3) the restorative materials used for the old and the new restoration. Dentists diagnosed the need to repair or replace the existing restoration based on the diagnostic methods they typically use in their practice, which consist mainly of visual-tactile in association with radiographic examinations. Restorative materials were classified as amalgam, direct or indirect resinbased composite (RBC or IRBC), conventional or resin-modified glass-ionomer (GI/RMGI), ceramic or porcelain, cast gold or other metallicbased material, combined metalceramic material, and temporary restorative materials. When multiple materials were reported, the material most likely to fail was used for classification. Information about gender, age, race, ethnicity, and insurance coverage of enrolled patients was also recorded. The Data Collection Form was pretested by 16 DPBRN practitionerinvestigators. Pre-testing consisted of assessing the feasibility of the

form in the flow of a busy practice environment, as well as the comprehension and intuitiveness of the classification criteria. The pretesting phase for each of these groups met a test-retest reliability of kappa > 0.70 or ICC > 0.70.

Statistical analysis

A binary logistic model, with Generalized Estimating Equations to adjust for clustering within dental practices and restorations within patients, was used to examine dentist, patient, and restoration variables as predictors of the decision to repair or replace the restoration. The GENLIN procedure within SPSS 19 was used with an exchangeable correlation matrix structure. Hypothesis 1: Dentists are more likely to change restorative materials when the material of the original restoration is amalgam. Hypothesis 2: Restorations that are replaced are more likely to involve a change of restorative material than restorations that are repaired. Hypotheses 3: The likelihood of changing from an amalgam restoration differs as a function of other tooth-specific variables, such as tooth type (molar, premolar, anterior), and the number of surfaces in the original restoration. For data analysis, the original and treatment materials were combined into 3 major categories: 1) amalgam; 2) direct tooth-colored restorations (resin-based composite [RBC], compomer, and glass ionomer); and 3) indirect restorations (indirect

RBC, ceramic, gold or metallic, and porcelain fused to metal). The dependent variable for this study was “material change” coded as the same material used in treatment as in the original restoration (no change) = 0, a different material was used in treatment (change) = 1. For example, if the original material was amalgam and an indirect restoration material was used in the treatment visit, it was classified as a change and coded 1; whereas, if an indirect restoration material was used for both the original restoration and during the treatment visit, it was classified as no change and coded 0. The independent variables were coded as follows: Material: amalgam =1, direct tooth-colored restorations and indirect restorations=0; Treatment: repair=1, replacement=0; Tooth: molar=1, pre-molar and anterior=0; Arch: maxillary=1, mandibular=0; Surfaces: 1=1, 2=2, 3+=3. The first step in the analysis consisted of testing hypothesis 1, which involved the main effect of amalgam as the original restoration material (model = “amalgam”). The second step involved testing hypothesis 2, which was tested by the material × treatment interaction term (model = “amalgam” + “treatment” + “amalgam × treatment”), where treatment meant repair or replacement. The third hypothesis was tested one variable at a time and was supported when the interaction term involving that variable and amalgam was statistically significant. Certain variables — namely, patient variables (age, gender, race, insurance status), Texas Dental Journal l www.tda.org l March 2014

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dentist variables (SK region, gender, years since dental school graduation) and restoration variables (treatment, tooth site, arch, number of surfaces on the original restoration, secondary caries, the dentist placed the original restoration) were included as control variables if that variable was not being specifically tested in that particular model as part of the hypothesis test. Each hypothesized significant interaction term was interpreted by testing the amalgam variable at each level of the tested variable.

Results

Table 1. Dentists’, practices’, and patients’ characteristics Variable Dentists’and practices’ characteristics (n=197) Gender (male)

70% (138)

Years since dental school graduation

21.7 (SD=10.5)

Full-time (32+ hours per week in patient care)

86% (162)

Dental chairs per office

4.0 (SD=2.3)

Practice type Solo or small group private practice Large group practice Public health service

58% (114) 37% (72) 6% (11)

Percent of revenue derived from dental insurance

58% (SD=32)

Percent of time spent on non-implant restorative care

56% (SD=20)

Patients’characteristics (n=6,744) Gender (female)

57% (3,862)

The 197 participating dentists returned data on a total of 9,875 restorations collected from 7,502 patients. Three hundred ninetyone of the restorations resulted in a temporary restoration or the dentist did not specify the treatment. Complete data were not available for an additional 563 restorations; therefore, all subsequent analyses involved 8,921 restorations with complete data from 6,759 patients. Seventy-five percent (n=6,657) of restorations were replaced and 25% (n=2,264) repaired. Practice and patient characteristics are presented in Table 1. Patients were treated in 197 practices distributed across the DPBRN regions as AL/MS=39, FL/GA=44, PDA=40, MN=36, SK=38. One hundred thirtyeight (70%) providers were male and 59 (30%) were female. Mean number of years since dental school graduation was 21.6 (SD=10.5). The average percent of time spent performing non-implant restorations

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Mean (SD) or % (n)

Age 51.4 (SD=16.0) Hispanic ethnicity (missing=109)

12% (762)

Race (missing=97) White Black or African American Asian or Pacific Islander American Indian or Alaskan native Other

90% (6,003) 6% (412) 1% (86) <1% (60) 1% (101)

Number of restorations done during the visit Single restoration 2 restorations 3 restorations 4 restorations

76% (5,105) 18% (1,228) 5% (311) 2% (115)

Dental insurance or any third-party coverage

21% (1,438)

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Figure 1. Restoration material (%) used by original material 100%

84%

80% 60%

44%

40%

53% 41% 15%

20%

22%

26%

Original Amalgam

Original Direct

Replacement Amalgam was 55.8 (SD=19.9). Regarding patient characteristics, 57% were female and 43% were males, and 21% had dental insurance. Patient race was White, 89%; Black or African American, 6%; American Indian or Alaskan native, 1%; Asian, 2%; Native Hawaiian or other Pacific Islander, < 1%; and Other, 1%.

Replacement Direct

The overall percent distribution of the restorative material for the restorations that were repaired or replaced was: 56% (4,999) were amalgam restorations, 37% (3,296) were direct tooth-colored restorations, and 7% (626) were indirect restorations. The distribution of the restorative materials used to repair or replace the failed

Original Indirect Replacement Indirect restorations was 29% (2,559) amalgam, 56% (5,000) direct toothcolored, and 15% (1,362) indirect restorations. Figure 1 presents the percentages for the replacement material used for each of the original materials. The frequencies for the original restoration material crosstabulated with the treatment material are presented in Table 2.

Table 2. Percent distribution of the restorative material used in the new treatment according to the material in the original restoration Treatment material

Amalgam % (n)

Direct tooth-colored % (n)

Indirect % (n)

Total

Replacement Original Amalgam 39% (1,545) 43% (1,730) 18% (724) 3,999 Original Direct tooth-colored 8% (192) 79% (1,823) 12% (282) 2,297 Original Indirect 2% (6) 8% (28) 91% (327) 361 Total 1,743 3,581 1,333 6,657 Repair Original Amalgam 64% (643) 34% (336) 2% (21) 1,000 Original Direct tooth-colored 4% (44) 95% (950) <1% (5) 999 Original Indirect 49% (129) 50% (133) 1% (3) 265 Total 816 1,419 29 2,264

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Table 3 shows the percent distribution of the restorative material used in the repair and replacement of restorations in the USA regions and SK regions according to the material in the original restoration. For the SK region, with the exception of the indirect restorative material, the majority of the restorations were

either repaired or replaced with direct tooth-colored restorations. The number of indirect restorations had a 3-fold increase after the treatment. The SK variable was statistically significant in testing for a difference in the probability of changing the restoration material (OR = 1.98, p .001 in the test of hypothesis 1) suggesting

that SK dentists were more likely than US dentists to change an amalgam material. Exploratory analyses were performed removing SK data from our models with no change found in the interpretation of any of the findings reported below.

Table 3. Percent distribution of the restorative material used in the repair and replacement of restorations in the USA regions and SK regions according to the material in the original restoration Treatment material

Amalgam % (n)

Direct tooth-colored % (n)

Indirect % (n)

Total

USA Original Amalgam 52% (2,180) 32% (1,322) 16% (694) 4,196 Original Direct tooth-colored 9% (234) 81% (2,039) 10% (236) 2,509 Original Indirect 24% (135) 23% (132) 53% (296) 563 Total 2,549 3,493 1,226 7,268 SK Original Amalgam 1% (8) 93% (744) 6% (51) 803 Original Direct tooth-colored < 1% (2) 93% (734) 7% (51) 787 Original Indirect 0% (0) 46% (29) 54% (34) 63 Total 10 1,507 136 1,653

Testing Study Hypotheses

Regression coefficients tested in hypotheses 1-3 are shown in Table 4. Hypothesis 1: Original material For repair or replacement of the restorations, the restoration material was 5 times more likely to be changed when the original material was amalgam (OR=5.2, p<.001) than when the original material was a direct tooth-colored or indirect material.

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Hypothesis 2: Treatment The likelihood of changing an amalgam restoration differed as a function of whether the treatment was repair or replacement, as indicated by the significant amalgam Ă&#x2014; treatment interaction effect (p<.001). When the restoration was repaired, the material was nearly 2 times more likely to be changed when the original material was amalgam (OR=1.9, p<.001) than when the original material was a direct tooth-colored or

indirect material; whereas when the restoration was replaced, the material was nearly 8 times more likely to be changed when the original material was amalgam (OR=7.8, p<.001) compared to the other materials. Hypothesis 3: Tooth-specific variables The likelihood of changing an amalgam restoration differed as a function of the tooth type, as indicated by the significant amalgam Ă&#x2014; tooth type interaction effect (p <.001).

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Table 4. Regression coefficients tested in hypotheses 1, 2, and 3.

(b)

(c)

OR (95% CI) (a)

p value

Amalgam(b)

1.7 (.1)

5.2 (4.6-5.9)

.<001

Amalgam × treatment Repair Replacement

1.4 (.1) .6 (.1) 2.3 (.1)

4.1 (3.2-5.3) 1.8 (1.4-2.3) 7.8 (6.7-9.2)

<.001 <.001 <.001

Amalgam × tooth type

2.3 (.2) 1.1 (.1) 1.5 (.1) 5.0 (.4)

9.7 (8.1-11.2) 3.0 (2.5-3.5) 4.5 (3.6-5.7) 137.2 (62.4-301.9)

<.001 < .001 <.001 <.001

Amalgam × arch Maxillary Mandibular

.4 (.1) 1.9 (.2) 1.4 (.1)

1.6 (1.2-1.9) 6.6 (5.5-8.0) 4.1 (3.4-4.8)

<.001 <.001 <.001

Amalgam × surfaces Single surface 2 surfaces 3+ surfaces

-.7 (.1) 2.5 (.2) 1.9 (.1) 1.2 (.1)

0.5 (0.4-0.6) 12.2 (8.5-17.7) 7.0 (5.4-9.0) 3.4 (2.9-4.0)

<.001 <.001 <.001 <.001

(a)

B (SE)

Molar Premolar Anterior

The dependent variable was “material change” and was coded as material not changed=0 and material changed=1. All non-amalgam original restoration materials (direct tooth-colored or indirect material) were the reference group. All models included certain patient characteristics (age, gender, race, insurance status), dentist characteristics (region, gender, years since dental school graduation) and restoration characteristics (treatment, tooth site, arch, number of surfaces on the original restoration, secondary caries, the dentist placed the original restoration) as control variables if not a tested variable in that model.

For restorations that were either repaired or replaced, if the restoration was in a molar tooth, the material was 3 times more likely to be changed when the original material was amalgam (OR=3.0, p<.001) than when the original material was a direct tooth-colored or indirect material; whereas when the restoration was in

a premolar tooth, the material was more than 4 times more likely to be changed when the original material was amalgam (OR=4.5, p<.001) compared to the other materials. Furthermore, when the restoration was in an anterior tooth, the material was more than 137 times more likely to be changed when the original

material was amalgam (OR=137.2, p<.001). See Table 5. The likelihood of changing an amalgam restoration also differed as a function of the arch, as indicated by the significant amalgam × arch interaction effect (p<.001). When the restoration was in the maxillary arch, the material was more than 6 times more likely to be changed when the original material was amalgam (OR=6.6, p<.001) than when the original material had been a direct tooth-colored or indirect material; whereas when the restoration was in the mandibular arch, the material was 4 times more likely to be changed when the original material was amalgam (OR=4.1, p<.001) compared to the other materials. See Table 6. Finally, the likelihood of changing an amalgam restoration differed as a function of the number of surfaces in the original restoration, as indicated by the significant amalgam × tooth interaction effect (p<.001). When the restoration involved a single surface, the material was 12 times more likely to be changed when the original material was amalgam (OR=12.2, p<.001) than if the original material was a direct tooth-colored or indirect material. When the restoration involved two surfaces, the material was 7 times more likely to be changed when the original material was amalgam (OR=7.0, p<.001) compared to the other materials, whereas, when the restoration involved 3 or more surfaces, the material was more than 3 times more likely to be changed when the original material was amalgam (OR=3.4, p<.001). See Table 7.

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Table 5. Percent distribution of the restorative material used in the new treatment according to the material in the original restoration and tooth type Treatment material

Amalgam % (n)

Direct tooth-colored % (n) Indirect % (n) Total

Molar Original Amalgam 46% (1,567) 40% (1,363) 14% (488) 3,418 Original Direct tooth-colored 14% (153) 75% (813) 11% (121) 1,087 Original Indirect 27% (6) 24% (81) 49% (162) 334 Total 1,811 2,257 771 4,839 Premolar Original Amalgam Original Direct tooth-colored Original Indirect Total

41% (606) 11% (74) 19% (29) 709

42% (619) 79% (527) 28% (42) 1,188

17% (249) 10% (65) 53% (65) 395

1,474 666 152 2,292

Anterior Original Amalgam 14% (15) 79% (84) 8% (8) 107 Original Direct tooth-colored <1% (9) 93% (1,433) 7% (101) 1,543 Original Indirect 11% (15) 27% (38) 62% (87) 140 Total 39 1,555 196 1,790

Table 6. Percent distribution of the restorative material used in the new treatment according to the material in the original restoration and arch Treatment material

Amalgam % (n)

Direct tooth-colored % (n)

Indirect % (n) Total

Maxillary arch Original Amalgam 45% (1,777) 40% (1,064) 15% (402) 2,643 Original Direct tooth-colored 6% (118) 86% (1,751) 8% (171) 2,040 Original Indirect 14% (45) 24% (74) 62% (193) 312 Total 1,340 1,002 766 4,995 Mandibular arch Original Amalgam 43% (1,011) 43% (1,002) 15% (343) 2,356 Original Direct tooth-colored 9% (118) 81% (1,022) 9% (116) 1,256 Original Indirect 29% (90) 28% (87) 44% (137) 314 Total 1,219 2,111 596 3,926

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Table 7. Percent distribution of the restorative material used in the new treatment according to the material in the original restoration and number of surfaces involved Treatment material

Amalgam % (n)

Direct tooth-colored % (n)

Indirect % (n)

Total

One surface Original Amalgam 44% (466) 55% (582) 2% (18) 1,066 Original Direct tooth-colored 6% (63) 93% (905) 1% (10) 978 Original Indirect 31% (10 50% (16) 19% (6) 32 Total 539 1,503 34 2,076 Two surfaces Original Amalgam Original Direct tooth-colored Original Indirect Total

48% (951) 10% (120) 20% (4) 1,075

44% (874) 85% (991) 65% (13) 1,878

8% (162) 1,987 5% (54) 1,165 15% (3) 20 219 3,172

Three or more surfaces Original Amalgam 40% (771) 31% (610) 29% (565) 1,946 Original Direct tooth-colored 5% (53) 76% (877) 19% (223) 1,153 Original Indirect 21% (121) 23% (132) 56% (321) 574 Total 945 1,619 119 3,673

Discussion The longevity of dental restorations is dependent on many factors, including those related to materials, the dentist who placed the restoration, and the patient. The longevity of amalgam restorations has been the main proof of the success of this restorative material, as evidenced by numerous studies (3,11-15). However, despite the fact that studies have discussed its safety as a restorative materialamalgam restorations are being replaced, and most likely it is because of its inferior esthetic appearance, alleged adverse health effects, and environmental concerns (16-19,20-23). Consistent with the

fact that the use of amalgam as a restorative material is decreasing in general dental practice, amalgam was not the main restorative material used when repair or replacement of restorations took place in the current study (11,24,25). In fact, when repairing and replacing existing restorations, clinicians were significantly more likely to change the restorative material when the material in the original restoration was amalgam. Amalgam has actually been banned from certain countries in Europe, in particular in the Scandinavia region. Indeed, the current study showed that for participants from the Scandinavian region, almost all of the restorations

that were either repaired or replaced used direct tooth-colored restorative materials. Restorations that were replaced were more likely to involve a change of restorative material than restorations that were repaired. When the original material was amalgam and the restoration was repaired, it was then acceptable to some dentists in the U.S. regions to repair existing amalgam restorations using amalgam as the restorative material. Previous studies have shown that repair is an effective treatment alternative to amalgam restorations that were originally considered defective (26-28). Laboratory studies Texas Dental Journal l www.tda.org l March 2014

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have also attested to the success of the amalgam repair (29-31). The replacement of defective restorations will lead to loss of healthy tooth structure and weakening of the tooth, creating an increased risk of cusp fracture (32-34 ). Additionally, it may increase significantly the number of surfaces involved in the restoration. In fact, the results of the current study showed that when the replacement of an existing restoration took place and it had an increase in the number of surfaces involved, dentists opted for an indirect restoration, as evidenced by the 3-fold increase of the number of indirect restorations after treatment. Direct tooth-colored material was the main choice of material to repair or replace failed restorations by practicing dentists. Resin-based composite (RBC) materials rely on mechanical bonding and they can be placed in small surface areas; therefore, they were probably an appealing option for the repair treatment of defective or failed restorations. Additionally, numerous in vitro studies have reported acceptable bonding strength forces for the repair of RBC materials (35-41). Clinical studies have also confirmed the long-term success of restorations that have been repaired with RBC materials (42-44). Direct tooth-colored material was also the main choice for the replacement of failed restorations. Previous studies have confirmed that the use of RBC restorations has increased in the last several years (45-49). It is possible that patients’ expectations for a moreesthetic appearance than that of the existing amalgam material may have

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influenced the clinician’s decision to replace the existing restoration with a tooth-colored material. Studies have confirmed the decline of amalgam as a restorative material in recent years (11,50,51). The likelihood of changing from amalgam when repair or replacement was done differed significantly as a function of tooth-specific variables, such as tooth type, arch location, and the number of surfaces in the original restoration. Premolar and anterior teeth were most likely to receive a change in restorative material when the original restoration was amalgam. Anterior teeth are located in an esthetic zone and premolar teeth are also positioned in a more-esthetic zone when compared to molar teeth; therefore, it would be expected that those teeth would receive a toothcolored restoration if the restoration had to be replaced. Because molar teeth receive most of the biting forces and amalgam materials have performed well in this area, dentists may not have been as likely to change the restorative material when the restoration was in a molar tooth (52). Also related to the same line of thought, when the number of surfaces in the original restoration was smaller, particularly if the tooth involved one surface and had an amalgam, the restoration was more likely to be changed with a direct tooth-colored material. Occlusal forces may not have been as critical to the decision if the tooth had involved two or less surfaces. Indeed, the study showed a gradual decrease in the tendency to change the restorative material from amalgam to direct tooth-colored materials as the number of surfaces

in the original restoration increased. Regarding the arch location, it is unclear why dentists were more likely to change the restorative material when the original restoration was an amalgam and the tooth was located in the maxillary arch. Even though some studies discussed that tooth type and arch location had significant differences in bond strength — with lower bond strength forces on maxillary molar teeth than on mandibular molar teeth — there have been no clinical studies to substantiate those findings (53,54). In summary, the results of the study showed that amalgam material was not being frequently used in the repair or replacement of defective or failed restorations. Practitioners clearly were more likely to use direct tooth-colored materials to repair or replace existing restorations.

Conclusion The probability of changing from amalgam to another restorative material differed for most characteristics of the original restoration in which the repair or replacement took place. The change was most likely to take place when (1) the treatment was a replacement; (2) the tooth was not a molar; (3) the tooth was in the maxillary arch; and (4) the original restoration involved a single surface. Acknowledgments This work was supported by National Institutes of Health grants U01DE-16746 and U01-DE-16747. Opinions and assertions contained herein are those of the authors

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and are not to be construed as necessarily representing the views of the respective organizations or the National Institutes of Health. The informed consent of all human subjects who participated in this investigation was obtained after the nature of the procedures had been explained fully. References 1. Roumanas ED. The frequency of replacement of dental restorations may vary based on a number of variables, including type of material, size of the restoration, and caries risk of the patient. Journal of Evidence-Based Dental Practice. 2010;10:23–24. [PubMed] 2. Simecek JW, Diefenderfer KE, Cohen ME. An evaluation of replacement rates for posterior resin-based composite and amalgam restorations in U.S.Navy and Marine Corps recruits. Journal of the American Dental Association. 2009;140:200–209. [PubMed] 3. Soncini JA, Maserejian NN, Trachtenberg F, Tavares M, Hayes C. The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth: findings From the New England Children’s Amalgam Trial. Journal of the American Dental Association. 2007;138:763–772. [PubMed] 4. Mjör IA, Moorhead JE, Dahl JE. Reasons for replacement of restorations in permanent teeth in general dental practice. International Dental Journal. 2000;50:361–366. [PubMed]

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37. Bonstein T, Garlapo D, Donarrummo J, Jr, Bush PJ. Evaluation of varied repair protocols applied to aged composite resin. Journal of Adhesive Dentistry. 2005;7:41– 49. [PubMed] 38. Loomans BA, Cardoso MV, Roeters FJ, Opdam NJ, De Munck J, Huysmans MC, Van Meerbeek B. Is there one optimal repair technique for all composites? Dental Materials. 2011;27:701– 709. [PubMed] 39. Ozcan M, Koolman C, Aladag A, Dündar M. Effects of different surface conditioning methods on the bond strength of composite resin to amalgam. Operative Dentistry. 2011;36:318–325. [PubMed] 40. Hamano N, Chiang YC, Nyamaa I, Yamaguchi H, Ino S, Hickel R, Kunzelmann KH. Effect of different surface treatments on the repair strength of a nanofilled resin-based composite. Dental Materials J. 2011;30:537–545. [PubMed] 41. Loomans BA, Cardoso MV, Opdam NJ, Roeters FJ, De Munck J, Huysmans MC, Van Meerbeek B. Surface roughness of etched composite resin in light of composite repair. Journal of Dentistry. 2011;39:499–505. [PubMed] 42. Gordan VV, Shen C, Riley IIIJL, Mjör IA. Two-year clinical evaluation of alternative treatments to replacement of defective composite restorations. Journal of Esthetic and Restorative Dentistry. 2006;18:144–154. [PubMed]

43. Gordan VV, Garvan CW, Blaser PK, Mondragon E, Mjor IA. A long-term evaluation of alternative treatments to replacement of resin-based composite restorations: Results of a seven-year study. Journal of the American Dental Association. 2009;140:1476–1484. [PubMed] 44. Moncada G, Martin J, Fernandez E, Hempel MC, Mjor IA, Gordan VV. Sealing, repair and refurbishment of class I and class II defective restorations: a three-year clinical trial. Journal of the American Dental Association. 2009;140:425–432. [PubMed] 45. Rosenstiel SF, Land MF, Rashid RG. Dentists’ molar restoration choices and longevity: a web-based survey. Journal of Prosthetic Dentistry. 2004;91:363–367. [PubMed] 46. Haj-Ali R, Walker MP, Williams K. Survey of general dentists regarding posterior restorations, selection criteria, and associated clinical problems. General Dentistry. 2005;53:369–375. [PubMed] 47. Magne P. Composite resins and bonded porcelain: the postamalgam era? Journal of the California Dental Association. 2006;34:135–147. [PubMed] 48. Opdam NJ, Bronkhorst EM, Roeters JM, Loomans BA. A retrospective clinical study on longevity of posterior composite and amalgam restorations. Dental Materials. 2007;23:2–8. [PubMed] 49. Makhija S, Gordan VV, Gilbert GH, Litaker MS, Rindal DB, Pihlstrom DJ, Qvist V. for The

DPBRN Collaborative Group. Practitioner, patient, and caries lesion characteristics associated with type of restorative material: Findings from The Dental PBRN. Journal of the American Dental Association. 2011;142:622–632. [PMC free article] [PubMed] 50. Christensen GJ. Amalgam vs composite resin. Journal of the American Dental Association. 1998;129(12):1757–1759. [PubMed] 51. Ottenga ME, Mjor I. Amalgam and composite posterior restorations: curriculum versus practice in operative dentistry at a US dental school. Operative Dentistry. 2007;32(5):524–528. [PubMed] 52. Kikuchi M, Korioth TWP, Hannam AG. The association among occlusal contacts, clenching effort, and bite force distribution in man. Journal of Dental Research. 1997;76:1316–1325. [PubMed] 53. Hobson RS, McCabe JF, Hogg SD. Bond strength to surface enamel for different tooth types. Dental Materials. 2001;17:184–189. [PubMed] 54. Oztürk B, Malkoç S, Koyutürk AE, Catalbas B, Ozer F. Influence of different tooth types on the bond strength of two orthodontic adhesive systems. European Journal of Orthodontics. 2008;30:407–412.

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2013/2014 Financial Report Texas Dental Association Prepared by Ron Collins, DDS, TDA Secretary-Treasurer

he year 2013 proved to be as brisk a recovery in the financial markets as 2012. As I write this article the DOW has reached an all time high, and the economy in Texas appears to be very healthy. Our membership numbers have increased over last year, but our percentage of membership relative to market share has slightly decreased.

Collins

The year 2013 showed good returns on our investments as the economy improved. The TDA has changed their money manager to Bland Garvey Wealth Advisors out of Richardson, Texas. They now manage our Relief Fund, The Reserve Division accounts of the General Fund, The Building Account, and as of March the Legislative account. The Relief Fund showed a gain of $33,302 up 6%. Together the reserve Division accounts showed a gain of $321,905 an increase of 14%. The building account was transferred to Bland Garvey in late fall and the Legislative account was transferred in March 2014 and have no real track record to report. The budget for 2015 is predicated on a $10 dues increase. The board approved this increase after diligently trying to decrease expenses where possible. Notably, savings were achieved in promoting virtual video conferencing in place of face-to-face meetings that saves money on travel and hotel expenses. The national ADA meeting in 2015 will not have a Texas Party saving the Association about $30,000. A second ADA delegation caucus was eliminated realizing additional significant savings. The building account, legislative account and the Reserve Division balances were within the minimum prescribed balances and did not need replenishment in the 2015 budget. As we all know the cost of doing business increases on a yearly basis and the TDA is no exception with increases in salaries, supplies, printing, hotel and travel expenses, convention expenses, insurance and a myriad of other costs of doing the business of the TDA. Beginning with the 2014 calendar year there is no longer a surplus from previous years. This means there will be no â&#x20AC;&#x153;carry overâ&#x20AC;? of funds to help

234

Texas Dental Journal l www.tda.org l March 2014

balance the 2015 budget. The proposed budget includes a $100,000 commitment to the TDA Smiles Foundation that supports our outreach to the state’s communities to help provide needed dental services to the underserved. This remains our most positive public relations effort for organized dentistry. Additionally the board voted to continue Directors and Officers insurance for all component societies in the state. There are several primary areas of financial concern facing the TDA in the next few years. In order to mitigate the conference center’s yearly negative cash flow of approximately $70,000, the Board has voted to lease or sell it. Also the uncertainty of the resolution of the employee’s pension plan and the hiring of a new executive director continues to pose a challenge to the TDA. The Perks Program that provides significant revenue to the TDA is constantly looking for programs that are beneficial to the TDA membership and it is important that each member use this program to help save on members’ equipment and materials costs and give the TDA needed revenue. As your secretary/treasurer I continue to look for ways to improve the finances of the TDA and to accurately and clearly report them to the membership. It is my pleasure to serve in this capacity.

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Texas Dental Journal l www.tda.org l March 2014

235

2015 Proposed Budget Texas Dental Association

Revenues

2013 Actual

2013 Budget

2014 Budget

2015 Proposed

1,807,609

1,928,600

1,851,515

1,802,600

AnnuAl SeSSion

Annual Session

PuBliCATionS/ WeBSiTe

2. 3. 4.

Journal TDA Today TDA Website

421,757 43,865 14,729

459,512 41,280 20,900

494,653 46,145 20,000

450,139 44,165 12,500

Total Publications/Website

480,351

521,692

560,798

506,804

Building a. Building Leases b. Building Conference Center Leases

187,892 4,050

197,675 11,000

203,605 12,000

256,424 72,500

Total Buildings

191,942

208,675

215,605

328,924

2,679,650 0 23,738

2,820,041 125 9,500

3,011,628 125 6,500

2,975,340 0 9,500

BuilDinG

oPeRATionS

PuBliCATionS/ WeBSiTe

BuilDinG

20,250 3,241 92,124 302,739 501,204

0 6,058 92,119 385,126 501,204

0 0 114,415 390,126 0

0 0 113,466 395,126 0

Total Operating

3,622,946

3,814,173

3,522,794

3,493,432

TOTAL REVENUES

6,102,848

6,473,140

6,150,712

6,131,760

Annual Session

1,314,869

1,436,550

1,328,770

1,356,750

8. 9. 10.

Journal TDA Today TDA Website

347,265 49,750 13,236

327,100 50,100 19,070

353,600 49,100 7,945

380,100 55,100 6,495

Total Publications/Website

410,251

396,270

410,645

441,695

11a. Building Leases 11b. Building Conference Center Leases

245,377 68,743

250,984 69,070

243,200 74,075

251,700 72,500

314,120

320,055

317,275

324,200

expenses AnnuAl SeSSion

Operating a. Dues* b. Investment Earnings c. Miscellaneous d. Contributions — Grants — ADA Membership e. Dental Assistant Training f. Affiliates Administration g. MBL Partnership h. Cash Carry Over

Total Buildings CAPiTAl iMPRoVeMenTS

12.

Capital Improvements

26,363

30,000

55,000

30,000

ConTinGenCY

13.

Non Budgeted Contingency

43,369

125,000

30,000

14.

Central Office Departments

BoARD oF DiReCToRS

15.

Board of Directors

CoMMiTTeeS

16.

Committees

CounCilS

17.

ADA/nATionAl oRGAniZATionS

CenTRAl oFFiCe

3,047,387

3,260,256

3,145,835

3,094,324

173,836

206,192

203,696

185,954

51,545

62,394

96,345

73,758

Councils

272,191

325,147

243,370

266,098

18.

ADA /National Organizations

224,852

205,765

190,445

199,450

HouSe oF DeleGATeS

19.

House of Delegates

63,601

60,510

59,330

64,530

FeDeRAl inCoMe TAX

20.

Federal Income Tax

75,500

45,000

70,000

65,000

TOTAL EXPENSES

6,017,884

6,473,140

6,150,712

6,131,760

84,964

REVENUE OVER EXPENSE

* The dues income amount is based on a $10 dues increase.

236

Texas Dental Journal l www.tda.org l March 2014

2015 Proposed Budget Texas Dental Association

Central Office Departments PeRSonnel

14.

eXeCuTiVe DiReCToR

oFFiCe oPeRATionS

SeRViCeS

oTHeR eXPenSeS

2013 Actual

2013 Budget

Central Office Departments Personnel a. Regular Salaries b. Salaries — Temporary c. Payroll Taxes d. Dental Reimbursement-Employee e. Health Insurance f. Retirement

1,466,480 36,641 118,045 10,480 144,349 145,119

1,675,485 1,000 146,540 14,285 172,103 160,540

1,552,995 1,000 138,016 0 125,571 171,799

1,554,513 1,000 133,578 0 128,240 164,611

Total Personnel

1,921,114

2,169,953

1,989,381

1,981,942

Executive Director: g. Salary h. Auto Allowance i. Health Insurance

151,775 4,500 11,328

161,984 7,200 9,499

165,000 7,200 9,784

191,600 0 5,860

Total Executive Director

167,603

178,683

181,984

197,460

Office Operations: j. Insurance — Directors/Officers k. Maintenance l. Postage and Couriers m. Printing n. Supplies — Office o. Taxes — State and Local p. Telephone

43,911 36,292 30,151 12,018 16,644 3,206 19,715

47,500 34,100 32,600 16,300 17,400 3,288 30,000

2014 Budget

2015 Proposed

63,000 29,500 29,902 14,900 18,800 3,000 22,900

47,244 31,900 30,900 13,700 18,500 3,300 23,400

Total Office Operations

161,936

181,188

182,002

168,944

Services: q. Accounting Services-Payroll r. Accounting & Auditing Services s. Bank Charges t. Consultants u. Human Resources v. Legal Services w. Lobbying x. Gifts and Memorials

4,355 30,410 21,363 41,280 0 231,290 264,500 1,735

4,780 32,000 16,800 0 0 135,000 306,000 2,000

4,780 32,000 24,000 105,000 0 135,000 273,000 2,000

4,850 33,000 24,000 23,000 24,000 147,000 279,500 2,000

Total Services

594,934

496,580

575,780

537,350

Other Expenses: y. Contributions z. Dues Processing aa. Education & Organizational Development bb. Meetings cc. Professional Dues and Memberships dd. Subscriptions ee. Recruiting ff. Travel

100,000 50,281 8,244 3,536 5,254 5,436 800 28,248

100,000 72,000 10,800 10,700 5,600 4,252 500 30,000

100,000 65,000 11,800 3,750 5,600 6,600 500 23,438

100,000 60,000 11,500 3,940 5,300 5,300 500 22,088

Total Other Expenses

201,800

233,852

216,688

208,628

3,047,387

3,260,256

3,145,835

3,094,324

Total Central Office

Texas Dental Journal l www.tda.org l March 2014

237

2015 Proposed Budget Texas Dental Association

Board of Directors, Councils, Committees, ADA, HoD BoARD oF DiReCToRS

2013 Actual

15.

Board of Directors: a. President b. President — Stipend c. President-elect d. President-elect — Stipend e. Past President f. Secretary Treasurer g. Secretary Treasurer — Stipend h. Editor i. Editor — Stipend j. Vice Presidents k. Senior Directors l. Directors m. Other Officers n. Board Meetings Total Board of Directors

CoMMiTTeeS

CounCilS

ADA/nATionAl oRGAniZATionS

HouSe oF DeleGATeS

FeDeRAl inCoMe TAX

238

16.

17.

18.

19.

20.

16,338 30,000 11,480 8,400 8,678 4,059 0 4,098 8,400 22,130 19,049 17,753 9,924 13,527

2013 Budget

26,862 30,000 12,382 8,400 7,393 5,743 8,400 6,375 8,400 23,042 18,620 18,520 11,084 20,971

2014 Budget

24,887 36,000 13,185 8,400 6,948 4,600 8,400 5,425 8,400 21,662 17,720 17,620 10,459 19,990

2015 Proposed 20,500 36,000 12,305 8,400 6,863 4,000 8,400 3,705 8,400 20,422 16,520 16,420 10,334 13,685

173,836

206,192

203,696

185,954

Committees: a. Access to Care b. Assets Management c. Awards d. Budget e. Building f. Communications g. Finance and Audit h. New Dentist i. Personnel and Professional Affairs j. Future Focus Committee

16,747 0 19,053 4,722 559 0 2,181 8,283 0 0

10,879 1,011 19,485 2,755 467 2,725 1,751 8,078 200 15,043

15,965 100 14,945 4,870 467 3,075 3,015 14,380 200 39,328

15,565 100 28,775 710 390 3,030 6,210 9,720 0 9,258

Total Committees

51,545

62,394

96,345

73,758

Councils: a. Annual Session b. Legislative and Regulatory Affairs c. Constitution and Bylaws d. DENPAC e. Dental Economics f. Dental Education, Trade and Ancillaries g. Ethics and Judicial Affairs h. Membership i. Peer Review

19,317 125,156 5,386 62,185 8,046 14,193 4,856 26,148 6,905

24,155 159,084 6,223 57,187 9,911 18,520 9,511 29,370 11,186

21,470 99,836 5,818 50,000 9,426 11,625 5,500 30,695 9,000

18,280 139,995 3,637 50,000 6,266 10,570 2,100 26,945 8,305

Total Councils

272,191

325,147

243,370

266,098

ADA /National Organizations: a. ADA Delegates b. ADA 15th Trustee Headquarters c. ADA Texas Reception

178,163 12,796 33,893

161,715 10,400 33,650

138,395 15,400 36,650

182,000 15,800 1,650

Total ADA /National

224,852

205,765

190,445

199,450

House of Delegates: a. HOD 50 Year and Life Luncheon b. HOD Headquarters c. HOD Past President’s Breakfast

3,900 57,595 2,106

4,700 53,610 2,200

5,300 51,830 2,200

5,300 57,030 2,200

Total House of Delegates

63,601

60,510

59,330

64,530

Federal Income Tax

75,500

45,000

70,000

65,000

Total Miscellaneous

75,500

45,000

70,000

65,000

Texas Dental Journal l www.tda.org l March 2014

2015 Proposed Budget Texas Dental Association 2013 Actual

2013 Budget

2014 Budget

2015 Proposed

Annual Session AnnuAl SeSSion ReVenue

Annual Session Revenue a. Advertising b. Clinics for Continuing Education c. Classes/Tours d. Contests — Photo e. Exhibits f. Miscellaneous g. Other Groups h. Registration i. Sponsorships Total Annual Session Revenue

AnnuAl SeSSion eXPenSe

Annual Session Expense a. Audio-Visual b. Bank Charges c. Classes d. Clinician Handouts e. Clinician Honorariums f. Clinician Support g. Council /Board Dinner h. Exhibits i. Hospitality Suite j. Insurance k. Miscellaneous l. Onsite Program m. Other Groups n. Photo Contest o. Postage p. President’s Reception q. Promotion r. Red Coats’ Breakfast s. Registration t. Shuttle Services u. Stipends v. Supplies — Office w. Texas Party x. Travel y. VIP Reception Total Annual Session Expense Annual Session Net Revenue

3,550 881,285 0 600 721,183 960 73,368 64,215 62,450

7,500 961,200 2,500 400 714,000 0 100,000 55,000 88,000

9,000 901,200 0 600 714,000 715 75,000 61,000 90,000

9,000 892,000 0 600 674,000 1,000 80,000 61,000 85,000

1,807,609

1,928,600

1,851,515

1,802,600

135,947 38,686 270 0 270,600 168,271 4,681 223,004 40,618 4,337 3,040 30,147 45,787 3,452 14,170 1,067 49,780 429 111,727 10,811 23,000 1,356 58,756 43,981 30,949

200,000 40,000 2,500 100 310,000 200,000 4,500 170,000 38,000 5,000 2,500 30,000 70,000 4,000 12,000 1,800 48,000 400 128,000 11,000 22,750 4,000 50,000 50,000 32,000

130,000 40,000 0 0 300,000 180,000 4,000 200,000 38,000 4,500 2,500 30,000 50,000 4,400 12,000 1,500 48,000 0 120,000 11,000 23,000 4,000 50,000 43,870 32,000

150,000 40,000 0 0 300,000 180,000 4,000 216,500 38,000 4,500 2,500 30,000 40,000 4,000 12,000 1,500 48,000 400 115,000 11,000 23,000 2,000 55,000 47,350 32,000

1,314,869

1,436,550

1,328,770

1,356,750

492,741

492,050

522,745

445,850

Texas Dental Journal l www.tda.org l March 2014

239

2015 Proposed Budget Texas Dental Association Publications/ Website JouRnAl ReVenue

JouRnAl eXPenSe

TDA ToDAY ReVenue

TDA ToDAY eXPenSe

WeBSiTe ReVenue

WeBSiTe eXPenSe

10.

2013 Actual

2013 Budget

TDA Journal Revenue a. Advertising b. Single Issue Purchases c. Subscriptions

298,728 444 122,585

331,000 500 128,012

367,000 500 127,153

325,078 500 124,561

Total TDA Journal Revenue

421,757

459,512

494,653

450,139

TDA Journal Expense a. Meetings b. Postage and Couriers c. Printing and Production d. Supplies — Office e. Travel

92 55,547 291,586 39 0

200 50,000 276,500 200 200

200 57,000 296,000 200 200

200 60,000 319,500 200 200

Total TDA Journal Expense

347,265

327,100

353,600

380,100

TDA Today Revenue a. Advertising b. Subscriptions — Membership Dues

8,850 35,015

5,100 36,180

11,100 35,045

9,000 35,165

Total TDA Today Revenue

43,865

41,280

46,145

44,165

TDA Today Expense a. Postage b. Printing and Production c. Supplies — Office

22,985 26,764 1

22,000 28,000 100

25,000 24,000 100

26,000 29,000 100

Total TDA Today Expense

49,750

50,100

49,100

55,100

TDA Website Revenue a. Advertising and Merchandise Sales b. TDA Affiliates Support

13,229 1,500

19,400 1,500

18,500 1,500

11,000 1,500

Total TDA Website Revenue

14,729

20,900

20,000

12,500

TDA Website Expense a. Education and Organization Development b. Postage c. Promotion d. Software and Software Support e. Subscriptions — Publications f. Supplies — Office g. Travel h. Website Engineering i. Website Hosting j. Website Services — TDA Express

2015 Proposed

600 25 300 400 25 150 970 100 5,500 11,000

300 0 100 400 0 50 895 0 6,200 0

300 0 0 300 1,000 0 895 3,000 1,000 0

Total TDA Website Expense

13,236

19,070

7,945

6,495

2-4 Total Public/Web Revenues 8-10 Total Public/Web Expense

480,351 410,251

521,692 396,270

560,798 410,645

506,804 441,695

70,099

125,422

150,153

65,109

Communications Net Revenue

240

0 0 0 0 0 0 185 3,189 5,576 4,286

2014 Budget

Texas Dental Journal l www.tda.org l March 2014

2015 Proposed Budget Texas Dental Association 2013 Actual

Buildings BuilDinG ReVenue

BuilDinG eXPenSe

11.

ConFeRenCe CenTeR eXPenSe

BuilDinG MAinTenAnCe FunD

11.

2014 Budget

2015 Proposed

TDA Building Revenue a. Lease Income

187,892

197,675

203,605

256,424

Total TDA Building Revenue

187,892

197,675

203,605

256,424

TDA Building Expense a. Building Tenants b. Building Lease Broker Fees c. Gifts and Memorials d. Insurance — Operating e. Postage f. Repairs and Maintenance — Equipment g. Service Contracts h. Supplies — Office i. Taxes — State and Local j. Utilities Total TDA Building Expense

ConFeRenCe CenTeR ReVenue

2013 Budget

1,479 1,632 0 21,526 23 16,736 77,556 4,108 65,434 56,883

1,500 0 200 19,000 0 18,000 83,000 5,500 60,784 63,000

1,500 0 200 19,500 0 16,500 83,000 4,500 61,000 57,000

1,500 0 200 22,000 0 16,500 83,000 4,500 67,000 57,000

245,377

250,984

243,200

251,700

TDA Conference Center b. Lease Income

4,050

11,000

12,000

72,500

Total TDA Conference Center Revenue

4,050

11,000

12,000

72,500

TDA Conference Center Expense k. Repairs and Maintenance — Equipment l. Service Contracts m. Supplies n. Taxes — State and Local o. Telephone p. Utilities

142 20,312 87 25,073 10,461 12,668

6,000 12,000 0 29,270 7,800 14,000

2,000 18,000 3,000 25,575 10,000 15,500

2,000 15,000 3,000 27,000 10,000 15,500

Total TDA Conference Center Expense

68,743

69,070

74,075

72,500

117,723

TDA Building Maintenance Fund Building Maintenance and Repair Building Maintenance and Repair — Conference Center

3,826

Texas Dental Journal l www.tda.org l March 2014

241

Texas Dental Association 2015 Budget Explanation 1a.

Income from vendor advertising in the annual session program brochures. 1b. Income from ticketed clinician classes and events. 1c. Income from classes such as cooking and painting. 1d. Fees from Photo Contest. 1e. Income from exhibit booth spaces. 1f. Other income associated with the TDA annual session. 1g. Fees from alumni lunches and other professional groups’ events. 1h. Pre-registration and on-site registration fees. 1i. Income from corporate sponsorships. 2a. Income from sale of classified and display advertising in Texas Dental Journal. 2b. Sale of single issues. 2c. Income from sale of Journal subscriptions, including allocations of dues of $17 per dues-paying member. 3a. Income from advertising in TDA Today. 3b. Member subscriptions allocated from dues at $5 per dues-paying member. 4a. Income from advertising on the TDA website. 4b. Payment from affiliates for portion of website development and maintenance costs. 5a. Income from leased space in the TDA building. 5b. Income from leased space in the TDA Conference Center. 6a. Dues income available for operations after allocation of $22 per member for Texas

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6b.

6c.

6d. 6e. 6f.

6g.

6h. 7a. 7b.

7c. 7d. 7e. 7f.

7g. 7h.

Dental Journal and TDA Today. Money earned from various short-term investments of dues collected and any interest income from current revenue. Legislative Day and other income associated with the operating fund. Grant awarded by the ADA to promote membership growth. Income from dental assistant training program. Payment from the forprofit affiliate, FSI, for administrative support of staff and equipment provided by the TDA. Distribution of 90 percent of the partnership income from TDA Member Benefits, Ltd, in which TDA is the limited partner. Surplus carried over from 2013. Audio-visual for clinicians. Charges in connection with the annual session bank accounts and credit card charges. Costs of classes, such as cooking and painting. Printing of clinicians’ handouts. Cost of honoraria, hotel, and travel. Course supplies, electrical, and gifts for clinicians; convention center meeting rooms; and signs. Other costs associated with clinics. Costs of council/Board dinner.

7i.

Exhibit hall costs, printing of exhibitors’ prospectus, refreshments, electric/ decorating for exhibitors and security. 7j. Cost of catering for speakers, staff and Council on Annual Session during annual session. 7k. Insurance premiums paid to cover meeting cancellation. 7l. Charges for other costs associated with the annual session. 7m. Cost of printing on-site program. 7n. Alumni luncheons and CPR classes. 7o. Costs associated with the Photo Contest. 7p. Postage used for annual session. 7q. Costs associated with the President’s Reception. 7r. Mass mailings, promotional items, and advertising. 7s. Cost of Council on Annual Session and Department on Annual Session staff breakfast during meeting. 7t. Cost for registration firm for the annual session, as well as on-site setup cost, electrical, and staffing. 7u. Cost of shuttle transportation around downtown for attendees. 7v. Stipends paid to the San Antonio District Dental Society, Alliance of the TDA, and the Texas Dental Assistants Association. 7w. Supplies purchased for use at the annual session.

7x. 7y.

7z. 8a.

8b.

8c.

8d. 8e.

9a. 9b.

9c. 10a. 10b. 10c.

10d.

10e. 10f. 10g.

10h.

Catering, music and space rental for The Texas Party. Department of Annual Session staff travel and Council on Annual Session travel to scout other dental meetings. Catering, music and space rental for the VIP Reception. Cost of meetings held in connection with Texas Dental Journal business. Cost of mailing the Texas Dental Journal to all members. Cost of printing, typesetting and artwork for the Texas Dental Journal. Supplies used for the Texas Dental Journal. Staff travel in connection with Texas Dental Journal business. Cost of mailing newsletter, TDA Today. Cost of printing, typesetting, and artwork for the newsletter, TDA Today. Supply costs associated with TDA Today. Educational programs for website staff. Cost of postage for mailing to potential website advertisers. Costs on site at the annual session to promote the website. Costs associated with software and support for the website. Professional publications related to the website. Supply costs for the website. Travel costs for staff to promote the website to the membership at the annual session. Costs for maintaining updates and enhancements to the website.

10i. 10j. 11a. 11b. 11c.

11d.

11e. 11f. 11g.

11h. 11i. 11j. 11k. 11l.

11m.

11n. 11o. 11p. 11q.

Costs to design, implement and host website. Software service costs to maintain TDA Express. Expenses allotted to maintain the tenant relations. Broker fees associated with leasing property. Gifts of appreciation for service vendors and memorials for building display. Premiums paid for insurance associated with the TDA building. Postage used for mailing building information. Cost of equipment maintenance for the building. Service contracts associated with building such as the elevator service, security, HVAC, landscaping, etc. Supplies used to maintain the building. Property taxes paid on building. Telephone expense allocated to the building. Gas, water and electricity expenses. Repairs and maintenance required above and beyond the service contracts. Service contracts associated with building such as the janitorial service, security, HVAC, landscaping, etc. Supplies used to maintain the building. Property taxes paid on the building. Telephone expense allocation to the building. Gas, water and electricity expenses. Building Maintenance Fund uses interest earnings for remodeling and major repair costs. The budgeted expense amount is based on the

12.

13.

14a.

14b. 14c.

14d. 14e. 14f. 14g. 14h. 14i. 14j. 14k.

14l.

14m.

interest earnings for the year ended 2 years prior to the budget year. Capital improvement needs are reviewed and prioritized, and estimated costs are projected. Contingency for approved expenditures by the Board of Directors. Full- and part-time salaries and year-end bonus (1 weekâ&#x20AC;&#x2122;s salary). The amount for 2015 reflects maintaining current staffing levels with annual salary adjustments. Temporary help for the TDA Central Office. Employerâ&#x20AC;&#x2122;s portion of FICA and Medicare based on 7.65% plus state and federal unemployment tax. Direct Reimbursement Dental Plan for employees. Medical insurance for employees. Payments to retirement plan for all eligible employees. Salary for the executive director. Car allowance for the executive director. Health insurance for the executive director. Liability coverage for TDA Officers and Component Society Officers, and personal property coverage. Maintenance contracts for office and computer equipment and general office operations. Postage, metering equipment, and maintenance, and UPS and Federal Express charges. All printing jobs done outside office such as stationery, business forms, office forms, and dues statements.

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14n. General office, printing and copy machine supplies. 14o. Personal property taxes of the Central Office furniture and equipment. 14p. Telephone service for Central Office using Grande Communications and facsimile charges. 14q. Cost of payroll service used by TDA. 14r. Accountant fees for annual audit, consulting services, and tax return preparation. 14s. Charges for transaction fees and returned checks. 14t. Expenses associated with outside consulting firms. 14u. Expenses associated with outside HR consulting services. 14v. Retainer for legal counsel and related legal expenses. 14w. Expenses associated with consulting firms engaged for legislative lobbying services. 14x. Flowers for funerals, special gifts to VIPs, members, and their families. 14y. Funding for the operating costs of the Texas Dental Association Smiles Foundation. 14z. Credit card processing fees and other bank charges for processing dues payments. 14aa. Continuing education and organizational development costs for TDA staff members. 14bb. Meals and supplies not directly related to a specific council, committee, or Board meeting that occurs at the TDA Central Office. 14cc. Memberships to the Austin Club, TSAE, ASAE, and other licensing requirements for TDA staff.

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14dd. Press clippings and other subscriptions used in the Central Office. 14ee. Advertising cost for open staff positions. 14ff. Travel expenses for executive director and TDA staff not related to a council or committee. 15a. Travel reimbursement for the president while on TDA business. 15b. Stipend paid to the president. 15c. Travel and per diem reimbursement for the president-elect while on TDA business. 15d. Stipend paid to the presidentelect. 15e. Travel and per diem reimbursement for the past president, previously included in the Other Officers line. 15f. Travel and per diem reimbursement for the secretary-treasurer while on TDA business. 15g. Stipend paid to the secretarytreasurer. 15h. Travel expenses for the editor. 15i. Stipend paid to the editor. 15j. Travel and per diem reimbursement for the 4 vice presidents while on TDA business. 15k. Travel and per diem reimbursement for the 4 senior directors while on TDA business. 15l. Travel and per diem reimbursement for the 4 directors while on TDA business. 15m. Travel and per diem reimbursement for the speaker of the house and parliamentarian while on TDA business.

15n. Costs associated with conducting Board meetings such as coffee, soft drinks, lunches, Board dinners (the cost of the Board lunch and dinner is deducted from Board per diem), mailing and printing of Board-approved communications and conference calls. 16a. Meeting and travel costs for the Committee on Access to Care, Medicaid, and CHIP, which monitors access to care and state funding issues. 16b. Meeting costs and travel reimbursement for committee that oversees the investments of the Reserve Fund and the TDA Relief Fund. 16c. Cost of awards presented by the TDA, including meeting and travel reimbursement costs for committee. 16d. Meeting costs and travel reimbursement for committee that formulates initial budget recommendations for the Board of Directors. 16e. Meeting costs and travel reimbursement for committee that administers Building Account and is responsible for oversight of the building. 16f. Meeting costs, travel reimbursement, and projects of the Communications Committee. 16g. Meeting costs and travel reimbursement for committee that monitors the TDA financial functions. 16h. Meeting costs, travel reimbursement, G.O.L.D. Reception, and projects of the Committee on the New Dentist.

16i.

16j. 17a.

17b.

17c.

17d. 17e.

17f.

17g.

17h. 17i.

18a.

18b.

18c. 19a. 19b.

19c. 20.

Meeting costs to discuss personnel issues. Minimal costs are budgeted as this committee meets in conjunction with Board meetings or by telephone conference. Oversight of the strategic plan is accomplished through the Future Focus Committee. Reimbursement for travel, meeting costs, and council projects for the Council on Annual Session. Reimbursement for travel, meeting costs, and council projects for the Council on Legislative and Regulatory Affairs. Reimbursement for travel, meeting costs, and council projects for the Council on Constitution and Bylaws. Administrative support for DENPAC. Reimbursement for travel, meeting costs, and council projects for the Council on Dental Economics. Reimbursement for travel, meeting costs, and council projects for the Council on Dental Education, Trade, and Ancillaries. Reimbursement for travel, meeting costs, and council projects for the Council on Ethics and Judicial Affairs. Reimbursement for travel, meeting costs, and council projects for the Council on Membership. Reimbursement for travel, meeting costs, and council projects for the Council on Peer Review plus training sessions for component officers. Reimbursement for travel and hotel for 47 Delegates and Alternates to attend the ADA annual session and pre-caucus, and meeting costs of printing, postage, and supplies. Printing, supplies, meeting rooms, and general expenses associated with the 15th Trustee District Headquarters at the ADA annual session. Reception given by the TDA at the ADA Annual Session. Costs of luncheon for 50 Year and Life Members at the TDA Annual Session. Costs associated with meetings of the TDA House of Delegates, including reference committees. Costs for breakfast for past presidents and past vice presidents at annual session. Estimated costs for federal income taxes for non-related business income.

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CAT OF THE MONTH Critically Appraised Topics

Electrical Pulp Testing has not been Shown to be Superior to Cold Test in Diagnosing Pulp Vitality (UT CAT #2533)

Clinical Question: In adult patients with unknown pulpal status, Is the Electrical Pulp Test (EPT) a more reliable predictor of pulp vitality in comparison to cold test when determining pulpal diagnosis? Clinical Bottom Line: Electrical pulp test has less validity and reliability in diagnosing pulpal vitality in comparison to cold test, but the difference was not clinically significant. The most accurate vitality test is the cold test. Best Evidence: Villa-Chávez CE, Patiño-Marín N, et al. Predictive values of thermal and electrical dental pulp tests: a clinical study. Journal of Endodontics. 2013 Aug; 39(8):965-9. PMID: 23880259. Key Results: 60 vital and 50 non-vital teeth were studied. The accuracy and reproducibility of the electrical pulp test was less than cold testing. Sensitivity of EPT (76%) was less than cold test (88%). Specificity of both was 1.00. Positive predictive value (PPV) for both was 100% and negative predictive value (NPV) was 83% for EPT vs. 90% for cold test. Prevalence of non-vitality was 45%. Comments on Evidence: The in-vivo study was done on human teeth requiring root canal therapy and the results were determined by blind comparison with the clinical gold standard: visual inspection of the pulp (no bleeding=necrosis; bleeding=vital). The use of EPT and the cold test in a randomized controlled study would provide more validity. Applicability or Significance: The cold test provided the best reproducibility (0.88) and highest accuracy (0.94). EPT and the cold test are applicable in determining pulp vitality, however confirmation of EPT findings with cold test is suggested.

Authors:

Dr. Sara Fayazi is currently an Endodontic Resident at UTHSCSA.

Dr Shelrethia Battle-‐ Siatita is currently a Periodontic Resident at UTHSCSA.

Dr. Fabricio B. Texeira is currently a Director of Advanced Education in Endodontics at UTHSCSA.

CATs Student Technical Editor: Judy Philip. For more information on the UTHSCSA Evidence Based Practice Program, contact Mabel Hernandez at 210-567-3516 or visit: http://ebp.uthscsa.edu/. The UT/CATs library can be searched at: http://cats.uthscsa.edu. The CATs program is supported by NIH R25DE018663 and the HHS/HRSA Grant 1D86HP24480-01.

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Memorial and Honorarium Donors to the Texas Dental Association Smiles Foundation

In Memory of: Jimmy Baresh

Donald R. Blake Richardson, Texas July 19, 1941 – January 12, 2014 Good Fellow, 1992 • Life, 2007

Don K Bulloch, DDS Dr & Mrs H.S. Bailey

Joyce Hopkins

B. Philip Boswell Jr El Paso, Texas February 15, 1942 – January 8, 2014 Good Fellow, 1997 • Life, 2008

Robertson Orchard Dental Associates

Kay Smith Robertson Orchard Dental Associates Your memorial contribution supports:

•

Those in the dental community who have recently passed Seymour Ash El Paso, Texas September 27, 1923 – January 26, 2014 Good Fellow, 1980 • Life, 1988 • Fifty Year, 2000

Robertson Orchard Dental Associates

•

In Memoriam

educating the public and profession about oral health; and improving access to dental care for the people of Texas.

Please make your check payable to:

TDA Smiles Foundation, 1946 S IH 35, Austin, TX 78704

PLACE YOUR NEXT DISPLAY AD HERE! Circulation 9,000 readershipexceeds exceeds Circulationisismore overthan 9,000 andand readership 50,000.Our Our Journal is the statewide 50,000. Journal is the onlyonly statewide publication publication of its kind to reach the majority of its kind to reach the majority of Texas dentists.of

Texas Dentists.

For more information, please visit our website at tda. For more information, please visit our website at org or contact TDA Managing Editor Nicole Scott at tda.org or contact TDA Managing Editor, Nicole nicole@tda.org or 512-443-3675 ext 124. Scott at nicole@tda.org or 512-443-3675 ext 124.

Billy B. Bridgford Maryneal, Texas November 23, 1937 – December 27, 2013 Good Fellow, 1988 • Life, 2003 • Fifty Year, 2012 Don K. Bulloch Lampasas, Texas December 8, 1931 – February 6, 2014 Good Fellow, 1986 • Life, 1997 • Fifty Year, 2011 Don K. Henckel Houston, Texas September 3, 1940 – January 18, 2014 Life, 2012 Elwood M. Hood Jr Austin, Texas September 11, 1921 – January 11, 2014 Good Fellow, 1977 • Life, 1986 • Fifty Year, 2002 Billy T. Johnson Victoria, Texas December 12, 1926 – January 3, 2014 Good Fellow, 1979 • Life, 1991 • Fifty Year, 2003 Robert C. Meador Sugar Land, Texas April 14, 1942 – December 28, 2013 Good Fellow, 1998 • Life, 2008 R. Donald Smith Jr Fort Worth, Texas August 1, 1927 – January 25, 2014 Good Fellow, 1975 • Life, 1992 • Fifty Year, 2001 Grace D. Snuggs Dallas, Texas August 23, 1973 – February 3, 2014 Dana L. Walker New Braunfels, Texas December 19, 1950 – January 8, 2014 Texas Dental Journal l www.tda.org l March 2014

Display_qtr page for TDJ.indd 1

12/16/2013 6:03:10 PM

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PREVIEW Social Media: Why Your Practice Needs to Pay Attention to Digital Moms Rita Zamora

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Moms have become power social media users. That’s right, moms—the power behind the health care pocketbook—have become forces in social media. In a survey of 1,400 respondents, BabyCenter’s Social Mom Report found moms are 11% more active on Facebook than the general internet population 18 and over. Moms also lead usage across other major platforms including: YouTube, Instagram, Twitter, Pinterest, and Google Plus.

So, what are moms doing on social media? Much more than you might think. While many digital moms engage in the typical sharing of photos, liking, commenting, and following, they are also stumbling upon new information or asking for advice. Moms have found social tools help them discover new products and services—and more and more businesses are meeting moms where they are already spending their time. In addition, digital moms don’t hesitate to ask their social network their opinion. Pew Research Center’s Internet & American Life Project 2010 survey showed people valued friends and family’s online advice about day-to-day health situations equally as important as from professional sources such as doctors and nurses. In addition to paying attention to digital moms, of greater concern is ensuring your practice is not an online mystery. While a good website benefits you, the true validator of your practice has become social media. In a study commissioned by Google (ZeroMomentOfTruth.com), research showed a website is just one point of discovery. Once consumers find a website, their journey continues to online review sites, social networks, and even video. Needless to say if your online presence ends with a website, your practice is missing out on critical exposure. Imagine a mom looking for a new dentist for her family. Put yourself in mom’s shoes for a moment. In between her career, or homemaking, grocery shopping, chauffeuring the kids to daycare, soccer or gymnastics, etc., she doesn’t have time to visit multiple potential new dentists. Moms today want to be sure your practice is the best decision she can make for her family—in the most convenient manner possible. Increasingly moms are relying on their smart phones and social media for advice and guidance, while in

line at the grocery store, or waiting in front of the school to pick up their kids... Moms have become voracious researchers. Is your practice accommodating digital mom’s needs? Ask yourself the following questions to find out:

Is it easy for mom to get to know you? A valuable benefit of social media is the ability to establish and grow trust with patients and referring doctors. Doctors who are willing to share a bit of their human side will find this can help attract like-minded patients and referral partners. Even practices with mature social media communities can benefit from the expression of personality and shared values via content.

Is it easy for Mom to find you? A website is one thing; however, with Google positions becoming increasingly determined by the placement of Google AdWords, social media is a cost effective way to leave virtual bread crumbs to be discovered by digital moms.

Is it easy for mom to communicate and stay in touch with you? Whether it be email, social media, or text, ensure you offer digital mom several convenient options to suit her preferences and support her busy life.

Is it easy for Mom to see what others think of your practice? While reviews on your website are one option, a more powerful testimonial is that attached to a real person. For example, a review attached to a personal profile on Facebook, complete with a believable profile photo.

If you are new to social media, I hope you are beginning to see how your practice could benefit from catering to mom’s needs through an expanded online presence. On the other hand, if your practice is already active on social media, I hope you gained new perspective to boost your existing efforts. Social media is extremely dynamic—one more reason continuing education in this area is vital to practice marketing and communication. Please join me for my social media courses: “Social Media 101,” “Keys to Social Media Marketing Success”, and “Harnessing Word Of Mouth in the Digital Age.” See you soon in San Antonio!

Is it easy for Mom to see what your office looks like? If a photo is worth a thousand words, then video should be worth millions. Digital moms want to know exactly what your office looks like. Is it clean and modern or sadly outdated? Remember Mom’s too busy to schedule an appointment and gamble that your practice will suit her preferences.

Ms Zamora’s Class Schedule at the Texas Meeting: Social Media 101

Friday, May 2 • 8:30 am – 11:30 am

Keys to Social Media Marketing Success 1:30 pm – 4:30 pm

Harnessing Word of Mouth in the Digital Age Saturday, May 3 • 8:30 am – 11:30 am

Ms Zamora is an authority in social media marketing and training for dental professionals. She and her team specialize in training clients for independence so they can manage social media themselves. Most importantly she brings more than 18 years of experience working hands-on in the dental business world to the table.

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value for your

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The Challenges of Complian ce: Dentists In the Eye of the Storm Jim Moore, CHP; Smart Training LLC

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2013 was a watershed year with respect to regulatory requirements for dental practices: •

• •

•

The Omnibus Rule stepped HIPAA toward broader enforcement. (The Omnibus Final Rule strengthens and re-affirms HIPAA Privacy, HIPAA Security, and HITECH Breach Notification requirements.) House Bill 300 imposed amended training mandates. OSHA adopted the Globally Harmonized System of Classification and Labelling of Chemicals (GHS)—an internationally agreed upon system created by the United Nations. OSHA required GHS training for most offices by December 1.

Most compliance consultants consigned their crystal balls to the dustbin years ago; compliance pathways are no longer predictable. The compliance landmark events of 2013; however, paint a rather telling picture of OSHA and U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) compliance expectations for the next 24 to 36 months.

HIPAA Updates There’s no way to know whether the OCR will expand, extend, or renew the $9.2 million HIPAA-compliance audit contract with KPMG—one of the nation’s “big 4” auditors. However, it’s fair to assume that some entity will step into the breach and perform that function during 2014. Noncompliance on the part of hospitals and other large-practice targets is too obvious, and the anticipated civilmoney-penalty revenue stream is too large to ignore.

KPMG’s efforts effectively paved the way for a widespread “steamroller” approach to compliance audits. The company developed an accountancydriven approach to assessing HIPAA compliance. As a result, KPMG’s findings from 150 HIPAA-compliance audits were especially revealing: more than 30% of the practices audited claimed to be “unaware” of HIPAA and HITECH Act requirements. According to the OCR, audited covered entities (which according to HIPAA rules, includes dentists that transmit any information in an electronic form in connection with a transaction for which the U.S. Department of Health and Human Services has adopted a standard) typically displayed: • Consistent lack of application of sufficient resources • Incomplete implementation of processes and specifications • “Complete disregard” for patient privacy issues We can say with some degree of certainty that patient-privacy regulation will not go away. If anything, privacy requirements and associated regulatory burdens will continue to increase. The inescapable consequence: HIPAA audits will continue and become far more widespread. If KPMG-style HIPAA audits continue through 2014 and beyond, willful disregard of patient privacy issues may see some practices fined out of existence. Business Associate and Business Associate Agreements Perhaps as important are the Business Associates (BA) “ticking time bombs” uncovered by KPMG. In essence, auditors identified Business Associates as the Achilles’ heel of patient-privacy security. To date, few dental practices have given the issue adequate attention. Thanks to the Omnibus

Rule, Business Associate Agreements (BAA) are now required. In short, any vendor with access to a practice’s Protected Health Information (PHI) should enter into a BAA; doing so pledges the vendor to train its employees to safeguard PHI in the same manner required of the dental practice. I deal with this subject on a daily basis. Many vendors are understandably anxious to avoid the training requirements and other legal entanglements presented by a BAA. Some vendors claim that since they’re also covered entities, they’re exempt from the BAA requirement altogether. Nothing could be further from the truth. If a business associate sustains the theft of an unencrypted laptop containing patient PHI, for example, the business associate is at risk for the disclosure. If a BAA does not exist between the vendor and dental practice, then both are on the hook. Interestingly, this dual responsibility is effectively created by the lack of a BAA. Assuming most dental practices have fulfilled their statutory obligations with respect to training employees and safeguarding patient health information, we can point to the business associate issue as a real and present danger. Unfortunately, much of the BAA scrutiny must be performed by a practice manager or by the dentist; most staff members lack the requisite experience to determine which business associates pose a genuine liability for the practice. Of the practices audited by KPMG, 89% demonstrated substantive HIPAA and HITECH patient-data security problems. KPMG audits pointed time and again to the need for a risk analysis or assessment. Indeed, KPMG’s national HIPAA services leader Michael Ebert said that the lack of Texas Dental Journal l www.tda.org l March 2014

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value for your

profession

risk assessment was consistently “the biggest weakness” auditors found. A detailed HIPAA risk assessment and deficiency remediation process emerges as an effective “get out of jail free” card for many dental practices. A risk analysis—and the associated effort required to remediate any vulnerabilities found—is increasingly seen as evidence of a “good faith effort,” and may do much to dissuade auditors from levying substantial fines or taking other enforcement action.

OSHA Updates While patient privacy issues are vexing enough, occupational safety and health challenges will likely take center stage during 2014 and 2015. As the GHS continues to gain traction across the country, OSHA will be working to ensure that employees exposed to hazardous chemicals receive proper GHS training. Based on our consulting experience, hazard communication has never been a particularly easy compliance requirement for dental practices to meet. The OSHA Hazard Communication standard—also referred to as the “employee right-to-know” standard— requires: • •

•

Office-specific lists of hazardous chemicals used or stored A copy of the manufacturer’s Material Safety Data Sheet (MSDS) or Safety Data Sheet (SDS) for each chemical Employee training on the Globally Harmonized System

GHS requires new safety data sheets replace the MSDS maintained by dental offices for so many years. The timing of manufacturer development and distribution of SDS, however, may cause compliance delays that are beyond a dentist’s or administrator’s control.

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…we’re fairly certain that OSHA will continue its preoccupation with emergency exits and exit route identification. Complying with OSHA’s emergency exit specifications—for example, having unblocked emergency exits equipped with working, lighted signage—could be problematic; especially in rural settings or in dated buildings.

Emergency Readiness and Safety Guards Additionally, we’re fairly certain that OSHA will continue its preoccupation with emergency exits and exit route identification. Complying with OSHA’s emergency exit specifications— for example, having unblocked emergency exits equipped with working, lighted signage—could be problematic; especially in rural settings or in dated buildings. Other specifications, such as conducting fire drills and developing and maintaining an emergency action plan, are relatively easy to comply with. Another continuing OSHA issue is that of machine guarding. Any sort of grinder or abrasive wheel machine— like the machines commonly found in dental office labs—must incorporate a safety guard that’s in place and functional. Unfortunately, because of the unremitting pace of laboratory work, the temptation to remove guards is strong. But an OSHA inspector needs only to walk into a lab area while the guard is off the machine for that practice to be liable for a fine. The only way to avoid this unpleasant scenario is to keep the guard in place on the machine.

Required Written Safety Programs OSHA’s new Regional Emphasis Programs aim to identify and cure specific deficiencies on a region-byregion basis. While the exact targets of local emphasis programs are difficult to predict, we have no doubt that written safety programs will continue to be an area of focus. Written safety programs must be sitespecific; in other words, they must be crafted especially for the individual practice. Merely buying one from a

vendor and putting it into a binder is not sufficient. The content must be altered to fit the specific demands of the unique practice setting. Additionally, the content must be updated annually. Most dental offices require these written programs: • • • •

Emergency Action Plan Electrical Safety Bloodborne Pathogens Standard Hazard Communication

In other facilities equipped with x-ray equipment, an Ionizing Radiation written program is required as well. The Emergency Action Plan written program includes details about exit signage and evacuation plans. OSHA has long required a diagram of evacuation routes be posted in a conspicuous location within the office. The written program merely translates this diagram into verbiage office workers can reference. OSHA’s electrical safety standards address requirements to safeguard employees from electrical hazards— specifically electrical equipment and wiring in (or in close proximity to) hazardous locations. Our experience has shown that many practices ignore the need for this written program altogether. The written Bloodborne Pathogens exposure control plan must also be updated annually, and typically covers the use of universal precautions, as well as office-specific engineering and work practice controls. Recent events in other states have shown that this information is still relevant; important safeguards are still lacking in too many dental practices.

for the next several years. Meanwhile, many dental offices will continue to operate without them. This is likely the sort of violation that OSHA will focus on with increasing frequency. Whether the time spent to create the required written programs can be weighed against potential fines involved is a decision for dentists and practice stakeholders to make.

Conclusion For 2014 and 2015 in particular, dental office regulatory requirements and the associated burden of compliance will only increase. The signposts presented during 2013 are powerful indicators of the direction those requirements are taking. The real challenge of compliance—particularly from the standpoint of Texas dentists—is to use 2014 to get ahead of the regulatory curve. If anything, this year will likely be seen as the eye of the storm—the whirlwind of compliance requirements is sure to gain speed again in years to come, and this brief lull should be a time for preparation. Jim Moore is a bestselling author and certified HIPAA professional. He develops OSHA and HIPAA-compliant training for Smart Training LLC, a TDA Perks Program partner. Texas-based Smart Training worked with TDA Perks to provide an online training module for HB-300 compliance. Smart Training also offers its Learning Management System (LMS) and Regulatory Compliance Services to the Texas dental industry, and offers exclusive discounts to TDA members. For more information about Smart Training, please call 469-342-8300. For more information regarding TDA Perks Program, please visit tdaperks. com, or call 512-443-3675.

The requirements for these written programs will likely remain unchanged

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Oral and Maxillofacial Pathology Diagnosis and Management

Stafne Defect (Lingual Mandibular Bone Depression) Oral and Maxillofacial Pathology Case of the Month (from page 206)

Discussion The lingual mandibular bone depression was first reported by Stafne in 1942 and described as a usually unilateral well-defined radiolucent lingual bony defect located at the posterior region of the mandible below the inferior alveolar canal (1). Since this initial publication, many additional names have been used, including Stafne defect, Stafne bone cyst, static bone cavity, latent bone cyst, idiopathic bone cavity, lingual mandibular bone depression, developmental salivary gland defect, and lingual salivary gland depression. In addition, several variants are recognized based on their location adjacent to major salivary glands. The lingual posterior (LP) variant is associated with the submandibular gland; which was originally described by Stafne and most commonly reported in the literature. The lingual anterior (LA) variant is associated with the sublingual gland and a medial ramus (MR) variant is associated with the parotid gland; both variants are extremely rare (2,3). Philipsen et al suggested that lingual/buccal mandibular bone depression is the term that most appropriately covers all three variants of this particular entity (3). However, the name Stafne defect might be easily communicated by the general dentists.

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The lingual/buccal mandibular bone depression is a relatively rare incidental finding on a routinely used panoramic radiograph. The incidence of the LP variant is about 0.10%-0.48%; the incidence of the LA variant is even less at 0.009%; and less than a dozen cases of the MR variant are reported in the literature (3-6). Despite its developmental etiology, it is not congenital and most cases are reported in middle-aged or older adults. Childhood cases, like the presenting case, are occasionally seen. The age of occurrence ranges from 11 to 87 years with a peak incidence in the fifth and sixth decades. It affects males more often than females, with a male to female ratio 6.1:1.3 The LP variant of Stafne defect typically presents as a corticated unilateral round or ovoid radiolucency below the inferior alveolar canal. It may involve the lower mandibular cortical border, in the submandibular fossa area between the mandibular angle and the first permanent molar. The size may vary from 1 to 3 cm in diameter (2). Patients rarely have any clinical signs or symptoms. The diagnosis of Stafne defect is based on clinical and the characteristic radiographic findings. Biopsy is not necessary. Therefore, it is important for the dentists and oral surgeons to recognize this entity and be able to make the diagnosis. Some variations

in the radiographic appearance have been reported, such as noncorticated borders, bilateral locations, or multilocular appearance. If there is any doubt, the diagnosis can be confirmed by CT, CBCT scan, MRI or sialography (7,8). Those advanced imaging modalities will provide â&#x20AC;&#x153;definitiveâ&#x20AC;? diagnosis and preclude a biopsy or surgical treatment (7,8). Most cases of Stafne defect are caused by the adjacent submandibular gland. However, rare cases caused by sublingual or parotid glands also have been reported as variants of this entity. The LA variant is typically located in the apical region between the mandibular incisors and premolars, and above the mylohyoid muscle. Radiographically, it appears as a well-defined radiolucency with corticated borders (2). An example is presented in Figure 2A with demarcation of the cortex demonstrated in the axial and sagittal images of cone beam computed tomography in Figures 2B and 2C. Due to its location, this variant can mimic other lesions and create the most diagnostic challenge. The differential diagnosis typically includes common inflammatory lesions secondary to a devitalized tooth, and odontogenic and non-odontogenic cysts and tumors. Advanced imaging modalities (CT, CBCT, MRI and ultrasound) have been found to be

very useful in several recent literature cases to confirm the final diagnosis of this rare LA variant and to avoid surgical intervention (9-11). The MR variant is associated with the ascending ramus and can be found on either the lingual or buccal surfaces. Radiographically, it appears as a well-defined radiolucency with corticated borders in the posterior ramus and close to the neck of the condyle. An example is presented in Figure 3. So far, all cases of the MR variant occurred in males, with only one case occurred on the buccal side (4,5,6,12). Although there are several hypotheses regarding the etiology of the lingual/buccal mandibular bone depression, the most widely accepted hypothesis is that a hyperplastic/ hypertrophic lobe of the major salivary gland leads to focal bone atrophy or resorption as a response to longstanding pressure on the bone cortex (3). This is why the cross-sectional images will demonstrate the indentation of the cortex with clear demarcation. However, the contents of the depression may also include salivary gland tissue, muscle, lymphatic tissue, adipose tissue, and blood vessels (13). Stafne defect is considered a normal anatomical variant rather than a pathological condition. Therefore, once the diagnosis is made, follow

Figure 3. Cropped panoramic radiograph of a MR variant showed a well-defined oval radiolucency with corticated borders in the posterior ramus and close to the neck of the left condyle.

Figure 2A. Panoramic radiograph of a LA variant showed a well-defined oval radiolucency at the apices of teeth #26-28 with corticated borders.

Figure 2B. Cropped axial image of cone beam computed tomography of the same patient shown in Figure 2A demonstrated an indentation of lingual cortical plate of right mandibular canine area.

Figure 2C. Cropped sagittal image of cone beam computed tomography of the same patient shown in Figure 2A demonstrated the depth of the bony defect.

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Oral and Maxillofacial Pathology Diagnosis and Management up with clinical examination and radiographs to monitor the condition are sufficient. Stafne defect usually remains the same in size with time, like the case presented here. In some cases, it may increase in size with time. However, it should remain asymptomatic and no clinical expansion should be noted (14). In conclusion, we presented an interesting childhood case of a Stafne defect and discussed variants of this entity to increase awareness of variations in its radiographic presentation. Recognition of this developmental anomaly is critical to avoid unnecessary surgical exploration, treatment or the need for advanced imaging such as CT. However, the use of the advanced imaging modalities may prove especially valuable in atypical cases to help establish a definitive diagnosis.

References 1. Stafne E. Bone cavities situated near the angle of the mandible. J Am Dent Assoc 1942;29:1969-72.

based on 583 cases from a world-wide literature survey, including 69 new cases from Japan. Dentomaxillofac Radiol 2002;31(5):281-90. 4. Barker GR. A radiolucency of the ascending ramus of the mandible associated with invested parotid salivary gland material and analogous with a Stafne bone cavity. Br J Oral Maxillofac Surg 1988;26(1):81-4. 5. Shields ED. Technical note: Stafne static mandibular bone defectfurther expression on the buccal aspect of the ramus. Am J Phys Anthropol 2000;111(3):425-7. 6. Wolf J. Bone defects in mandibular ramus resembling developmental bone cavity (Stafne). Proc Finn Dent Soc 1985;81(4):215-21. 7. Branstetter BF, Weissman JL, Kaplan SB. Imaging of a Stafne bone cavity: what MR adds and why a new name is needed. AJNR Am J Neuroradiol 1999;20(4):5879.

2. White SC, Pharoah MJ. Lingual salivary gland depression. Oral Radiology : Principles and Interpretation. St. Louis, Mo.: Mosby/Elsevier; 2009. p. 574-76.

8. Kim JS. Multilocular developmental salivary gland defect. Imaging Sci Dent 2012;42(4):261-3.

3. Philipsen HP, Takata T, Reichart PA, Sato S, Suei Y. Lingual and buccal mandibular bone depressions: a review

9. Solomon LW, Pantera EA, Jr., Monaco E, White SC, Suresh L. A diagnostic challenge: anterior variant of mandibular lingual bone depression. Gen Dent 2006;54(5):336-40.

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10. Sisman Y, Etoz OA, Mavili E, Sahman H, Tarim Ertas E. Anterior Stafne bone defect mimicking a residual cyst: a case report. Dentomaxillofac Radiol 2010;39(2):124-6. 11. Friedrich RE, Scheuer HA, Grobe A. Anterior lingual mandibular bone depression in an 11-year-old child. In Vivo 2012;26(6):1103-7. 12. Mann RW, Keenleyside A. Developmental lingual defects on the mandibular ramus. Oral Surg Oral Med Oral Pathol 1992;74(1):124-6. 13. Shimizu M, Osa N, Okamura K, Yoshiura K. CT analysis of the Stafneâ&#x20AC;&#x2122;s bone defects of the mandible. Dentomaxillofac Radiol 2006;35(2):95-102. 14. Neville BW, Damm DD, Allen CM, Bouquot JE. Developmental defects of the oral and maxillofaical region. Oral and Maxillofacial Pathology. St. Louis, Mo.: Saunders/Elsevier; 2009. p. 24-25.

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CALENDAR OF EVENTS MARCH2014 27-29

The Greater Houston Dental Society will host its annual Star of the South dental meeting in Houston. For more information, please contact Ms Charlotte Bolls, meeting planner, GHDS, One Greenway Plz Ste 110, Houston, TX, 77046. Phone: 713-961-4337; FAX: 713-961-3617; E-mail: cbolls@ ghds.org; Website: starofthesouth.org.

Ms Normalee Ward, LDA, 2121 N Causeway Blvd Ste 153, Metairie, LA 70001; Phone: 504-834-6449; FAX: 504-838-6909; E-mail: norma@ nodc.org; Website: nodc.org.

11-12

The Arkansas State Dental Association will host its scientific annual session at Statehouse Convention Center in Little Rock, AR. For more information, please contact Ms Angela Rogers, ASDA, 7480 Hwy 107, Sherwood, AR 72120; Phone: 501-834-7650; FAX: 501-834-7657; Email: angela@angelarogersgroup. com; Website: arkansasdentistry.org.

26-28

The Oklahoma Dental Association will host its annual meeting at the Cox Convention Center in Oklahoma City, OK. For more information,

APRIL2014 3-5

258

The Louisiana Dental Association will host its annual session and New Orleans Dental Conference at New Orleans Morial Convention Center in New Orleans, LA. For more information please contact

Texas Dental Journal l www.tda.org l March 2014

please contact Ms Lynn Means, ODA, 317 NE 13th St, Oklahoma City, OK 73104; Phone: 405-848-8873; FAX: 405-848-8875; E-mail: lmeans@okda. org; Website: okda.org.

JUNE2014 6-7

The Texas Academy of General Dentistry will host its annual New Dentist Conference at the Omni Southpark Hotel in Austin, Texas. For more information, please contact Lindsey Robbins, education director, TAGD, 409 W Main St, Round Rock, TX, 78664; Phone: 512-244-0577; FAX: 512-244-0476; E-mail: lindsey@ tagd.org; Website: tagd.org.

The TDA Smiles Foundation will hold a 14-chair Texas Mission of Mercy in Mineral Wells. For more information, please contact Foundation Manager Judith Gonzalez at TDASF, 1946 S IH35 Ste 300, Austin, TX 78704; Phone: 512-448-2441; E-mail: judith@tda. Email: judith@tda. org; Website: tdasmiles.org.

MAY2014 1-4

19-21 2

19-21

The Texas Dental Association will host its annual Texas Meeting at the Henry B. Gonzalez Convention Center in San Antonio, Texas. For more information, please contact Sandy Blum, annual session director, TDA, 1946 S IH 35 Ste 400, Austin, TX 78704; Phone: 512-443-3675; FAX: 512-443-3031; E-mail: sblum@ tda.org; Website: texasmeeting.com. The Greater American Dental Association The San Antonio Hispanic will host its annual Washington Dental Society will host its gala, Leadership Conference in Pearl A Night at the Pearl, at the Washington, DC. For more Stable, 303 Pearl Pkwy, San Antonio, information, please contact Brian TX 78215. For more information, Sodergren, ADA, 1111 14th St, NW contact GSAHDA: E-mail: gsahda@ Ste 1100, Washington, DC 20005; hotmail.com; Website: gsahda.org. Phone: 202-789-5168; FAX: 202-7892258; E-mail: sodergrenb@ada.org; The American Dental Association Website: ada.org. will host its annual Washington Leadership Conference in Washington, DC. For more information, please contact Brian Sodergren, ADA, 1111 14th St, NW Ste 1100, Washington, DC 20005; Phone: 202-789-5168; FAX: 202-7892258; E-mail: sodergrenb@ada.org; Website: ada.org.

THE Texas DenTal Journalâ&#x20AC;&#x2122;s CALENDAR will include only meetings, symposia, etc., of statewide, national, and international interest to Texas dentists. Because of space limitations, individual continuing education courses will not be listed. Readers are directed to the monthly advertisements of courses that appear elsewhere in the Journal.

The Texas Dental Journalâ&#x20AC;&#x2122;s Calendar will include only meetings, symposia, etc., of statewide, national, and international interest to Texas dentists. Because of space limitations, individual continuing education courses will not be listed. Readers are directed to the monthly advertisements of courses that appear elsewhere in the Journal.

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Texas Dental Association 143rd Annual Session 2013 TEXAS Meeting Photo Contest Photographer: Rajat M. Diwan, DDS, Buda Title: “Lady in Red” Category: BW/Abstract/Artistic Award: First Place Information on the 2014 TEXAS Meeting Photo Contest is available on texasmeeting.com.

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ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ABBEVILLE DENTISTRY: We are seeking an honest, hard-working, patient focused dentist who want to contribute to a culture of caring, nurturing and skilled professionals. If you have the desire to be a part of a team where you can focus on patients and not worry about the headaches that come with the business side of dentistry, please call us. If you are seeking an environment that provides stability, growth and continuing education, we’d like to share with you how you can fit into that plan. Twenty years ago, I started my practice simply dedicated to serving my patients and community. Now, I’m privileged to guide over 10 practices and 80 wonderful staff. I’ve turned the administrative, operations and marketing efforts over to people who enjoy doing those sorts of things so our doctors and staff can focus on their patients. I’ve also been able to provide young doctors with an environment where they can grow and practice what they love doing without the worry of costly overhead or administrative headaches. At the same time, offering the potential for significant income and a great life balance. You’ll enjoy a great environment with no egos and no political barriers. We’re growing and need a few quality individuals to join us in creating something truly special. We’re forming

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MONTHLY RATES: First 30 words = $40; each additional word = 10¢ Ads must be submitted via e-mail, fax, or web through tda.org and are not accepted by phone. Journal editors reserve the right to edit copy of classified advertisements. Any dentist advertising in the Texas Dental Journal must be a member of the American Dental Association. Advertisements must be not quote revenues or gross or net incomes; only generic language referencing income will be accepted.

AMARILLO: Pediatric dentist for a locally owned practice looking to provide care for our patients as well as build their own patient base. Ownership opportunity available. Please contact Dr Britt Bostick, DDS, bbost35821@aol. com or call 806-438-5745. Texas Dental Journal l www.tda.org l March 2014

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ADVERTISING BRIEFS practice. Capable caring staff. We are looking for a bright

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3 offices with state-of-the art technology and a highly

The practice revenue was on pace to be around mid 6

trained support staff. We are looking for the right fit

figures in 2013 with only 1 doctor producing. Serious

for our practice. Ideally, someone who is looking for a

inquiries only as this is a unique opportunity not

long-term opportunity. New grads are welcome to apply.

suited for most solo practitioners looking to acquire a

Please email resume to tal@austinchildrensdentistry.

practice. CENTRAL AUSTIN (ID #T225): Located in a very

com.

desirable area of north central Austin, this established fee for service general family practice offers a lot for an

AWESOME PRACTICE IN EAST TEXAS FOR SALE: SLH is

incoming dentist. The practice is located in a 1,500 sq ft,

looking for a qualified associate or new graduate, with

4-operatory facility within a small 2-story professional

an option to buy, that would like the opportunity to

condominium building. The practice boasts a committed

immediately transition into a general dentistry practice

and well-trained staff, strong hygiene program, solid

in this growing town of East Texas. The owner is willing

active patient base and gross annual revenues averaging

to stay for a negotiated amount of time if necessary to

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ADVERTISING BRIEFS ensure a smooth transition. The location of the practice

DDR DENTAL — HOUSTON (WEST SIDE): General

is near the hospital in a beautiful scenic area surrounded

practice. Excellent gross with very high net income.

by many professional buildings. The staff is excited and

Fronts Westheimer near Beltway 8 in established

ready for a new member and future owner that will

strip center. Dentist earns high income on 4 day work

allow their current dentist to pursue other opportunities.

week. Three fully equipped operatories, 2 dentists

The office space is 1,500 square feet with 4 treatment

and 1 hygiene. Established patient-base with growth

rooms equipped, 2 private offices, and 6 highly

opportunity. Contact Chrissy Dunn at 800-930-8017 or

experienced employees. The new practitioner will lease

www.DDRDental.com (Dental Trust tm Member).

space from the group dental practice. The group practice occupies a portion of the building complex and is

ddR dENTAL — houSToN (WoodLANdS /

looking to transfer ownership of the patient base and/or

CoNRoE): Periodontal practice. Two offices in growing

equipment within six months. Listing #3050 CB. Pictures

Woodlands and Conroe. Exceptional combined gross

can be made available. For more information contact our

with very, very high net income. Established patient-base

office at 972-562-1072 or email sherri@slhdentalsales.

with growth opportunity. Well cared for facilities with

com or visit our website at www.slhdentalsales.com.

4 operatories in Woodlands office and 4 operatories in Conroe office. Contact Chrissy Dunn at 800-930-8017 or

DALLAS / FORT WORTH: Area clinics seeking associates.

www.DDRDental.com (Dental Trust™ Member).

Earn significantly above industry average income with paid health and malpractice insurance while working

ddR dENTAL- PANhANdLE TEXAS: Oral surgery

in a great environment. Fax 312-944-9499 or e-mail

practice. Extremely high gross with exceptionally high

cjpatterson@kosservices.com.

net income. Four fully-equipped operatories with surgical suite. Option to purchase building also available.

DALLAS AREA: New and beautiful general dentistry

Well-established referral and patient base. Contact

practice on I-30 near Rockwall. Over 5 years of clinical

Chrissy Dunn at 800-930-8017 or www.DDRDental.com.

experience required. Perfect for dentists who refer endo! Pay based on collections. PPO and Medicaid accepted.

DENTISTS ARE NEEDED full and part-time to provide care

Hours are M-F 2:00 PM - 8:00 PM and Saturdays

in various Texas Tech University Health Science Center’s

available. Visit www.mockingbirddentalgroup.com.

(TTUHSC) Correctional Health Clinics. The positions are on the TTUHSC staff and with all applicable benefits:

ddR dENTAL — houSToN (ChIMNEy RoCk):

malpractice insurance, life insurance, retirement plan,

General practice — Terrific growth opportunity with

vacation, holiday time, and a competitive salary. Contact

newly renovated facilities. Fronts high traffic Chimney

806-381-7081, ext. 8324.

Rock Road. Four operatories in use and plumbed for 4 more. Free standing building with 7,000 total sq ft also

DENTISTS: A practice of 1 year looking for a BC/BE

available for sale. Contact Chrissy Dunn at 800-930-8017

pediatric dentist to come on board as employee with

or www.DDRDental.com.

possible buy-in. This is an all pediatric dentists’ office. You would be working next to a BC pediatric dentist.

Texas Dental Journal l www.tda.org l March 2014

265

ADVERTISING BRIEFS Good terms with great pay and work hours. Must be able

an accurate contact number and email address to the

to get Board Certified within 1 year. OR cases done at El

following: drdarj@gmail.com.

Paso’s Children’s Hospital. Excellent opportunity. Contact 719-671-5617 or tparco@dentalquestions.com.

EL PASO: We are hiring a skilled and compassionate dentist to join our stable and successful practice. We

DFW AREA: Seeking general dentists and specialists.

are seeking a highly professional dentist with a knack

Our offices are located in the Dallas / Fort Worth area.

for general dentistry. Prospective candidates must

We are looking for caring, energetic associates. New

be dynamic, fun loving, and looking for a long term

graduate and experienced dentists welcome. We

commitment. Our practice is highly productive affording

offer benefits, a helpful working environment and an

our providers an opportunity to attain competitive

opportunity to grow. We accept most insurance and

compensation. If interested, please forward your CV to

Medicaid. Please submit your resume via email to

annette@vistahillsfamilydental.com.

jennifer@smileworkshop.com or call our office at 214757-4500.

EL PASO: Well-established general practice of over 30 years seeking full-time general dentist associate.

EAST TEXAS: Well-established dental practice seeks

Associate would be sole dentist at one of 2 office

caring, proficient, and motivated dentist for associate

locations with full staff including hygienist. Income

employment. Our office is located in a mid-sized town

opportunity well above average. Professional

with abundant outdoor activities including hunting and

opportunity even greater. Send resume to

fishing and a “small town” atmosphere. We offer all

drartbejarano@gmail.com.

phases of dentistry. Interested candidates should email correspondence and resume to mloon242@aol.com.

ENDODONTIST -- FULL TIME, KILLEEN: Carus Dental, established in 1983 in Austin, has always been

EDINBURG: Falcon Dentistry PA dba Falcon Dental Center

committed to the traditional doctor-patient relationship

seeks dentist in Edinburg. Doctor of Dental Surgery

and to the highest quality in dental care and service.

degree required. Texas dental license required. Qualified

We currently have approximately 48 doctors on staff

applications may submit resume directly to Atlantis

across our 21 practices in Austin, Houston and Central

Gloria Moya, office manager, via fax at 956-287-4926 or

Texas. We offer dental services in general dentistry, oral

via email at falcondentistry@gmail.com.

surgery, orthodontics, pediatric dentistry, endodontics, periododontics and prosthodontics in some or all of

EL PASO: Full-time position for a general dentist. Do not

our practices. Carus Dental has been accredited by the

waste your best years at dead end jobs. Great earning

Accreditation Association of Ambulatory Health Care

potential and future partnership option. Affordable El

since 2000. We offer a competitive salary and excellent

Paso Dental is looking for a Texas-licensed dentist to

benefit package including a 401k, health insurance and

work full-time in our office in El Paso. Applicant must

a professional work environment. To learn more about

be licensed in the state of Texas and have 1 year of

American Dental Partners and Carus Dental please

experience. If interested please submit a resume with

visit us at www.amdpi.com and www.carusdental.

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ADVERTISING BRIEFS com. If interested, please send CV and cover letter to

HOUSTON AND SAN ANTONIO: Care For Kids, a pediatric

kateanderson@amdpi.com.

focused practice, is opening new practices in the San Antonio and Houston area. We are looking for energetic

GALVESTON: Well-established, successful practice

full-time general dentists and pediatric dentists to join

of 35 years needs FT associate dentist for FFS/PPO

our team. We offer a comprehensive compensation

practice. Experienced staff, new equipment, Galveston.

and benefits package including medical, life, long- and

Senior owner loves to teach sedation, implants, and

short-term disability insurance, flexible spending, and

other surgical procedures. No Medicaid, No DHMO

401(K) with employer contribution. New graduates

practice in 6 ops, 2 surgical suites, all operatories

and dentists with experience are welcome. Be a part of

computerized with digital X-ray and intra-oral cameras;

our outstanding team, providing care for kids of Texas.

digital panoramic X-ray; paperless charts for easy

Please contact Anna Robinson at 913-322-1447; e-mail

documentation. Visit www.todaysdentistrytexas.com.

arobinson@amdpi.com; FAX: 913-322-1459.

The Galveston area is just south of Clear Lake 25 minutes which has planned communities with superior schools,

HOUSTON/CLEAR LAKE â&#x20AC;&#x201D; DENTAL OFFICE: In high

multiple educational, recreational and cultural venues

visibility smaller professional building at highest traffic

as well as access to all of the Houston cultural and sport

corner location in adjacent family oriented, high income

venues, shopping and restaurants. We are minutes away

master planned community. Adjacent CVS, nearby

from all types of water sports including several large

schools, retail and office centers, NASA and other long

marinas. Possibility of buy-in and partnership possible

term tenants (UTMB orthopedic and urgent childcare

after an interim term. Interview today! E-mail CV to

center, podiatrist and chiropractor) drive patient traffic.

kkcarroll10yahoo.com or call 832-385-8875.

Nice finishes and all plumbing and electrical in place for 6 or more operatories, offices and consult rooms.

GOLIAD: Associate/buy-in partnership opportunity

Lease incentives, negotiable terms. Dwight Donaldson,

available in high producing and high collection practice.

Monument Real Estate, 281-240-0077, ddonaldson@

100% fee-for-service practice. If you have excellent

terramarktx.com.

communication skills, a light touch and above average skills, we should meet. Our practice uses Cerec

LAREDO / MCALLEN: If you are looking for a great

technology, places and restores implants, is 100% digital

opportunity to join an amazing team with ownership

and has a high emphasis on cosmetic dentistry. Great

potential and minimal administrative responsibility, this

emphasis on patient comfort with oral sedation used

is it! We are looking for a motivated and personable

extensively. Our town has an excellent school district

individual with a positive attitude who is passionate

and our patients have a great appreciation for quality

about working with children. Our 3 locations offer

dentistry. Visit our website at www.goliaddentalcare.

a modern environment with all digital records and

com. Call Dr Dan Garza at 361-645-2381 or email

X-rays. We offer in-office oral conscious sedation and

dmolar@sbcglobal.net.

general anesthesia at local hospitals. Our emphasis is on exceptional patient service, team member development and having a lot of fun. Our compensation

Texas Dental Journal l www.tda.org l March 2014

267

ADVERTISING BRIEFS package includes a percentage of collections with a

economy, consistently low unemployment rate. Well-

daily guarantee, plus 401k, medical, vacation, and

established practice (over 30 years) with Dexis, digital

holidays. Our mission is to positively impact the lives

pano, 4 total operatories, fee for service, no PPOâ&#x20AC;&#x2122;s or

of our patients, their families and our team members. If

capitation plans, little external marketing. Excellent net

you would like to be a part of this amazing team please

on 3.5 days per week. Loyal, long-term staff. Beautiful,

call Dr Guzman at 956-607-0732 or email drguzman@

free-standing, custom designed and built office also for

littleheroesdentistry.com.

sale or lease. Four operatories, lab, sterilization area, private office, consultation room, staff lounge, business

LAREDO: We are looking for a pediatric dentist for

office, reception area and covered parking. Located on

a rapidly growing practice. Strong referral sources.

major artery near downtown. Doctor desires career

Hospital cases performed twice a week at local hospital.

transition. Call 432-638-2583.

State-of-the-art practice with digital X-rays and charts. If part-time, then dentist can fly in to see patients and

MIDLAND: One of the fastest growing cities in Texas

still maintain living at their current city. Partnership in

needs a dynamic, caring, patient-focused dentist

future is an option if candidate interested. Please email

to join our growing practice. Associate and/ buy-in

t2tpdlaredo@gmail.com.

opportunities are available. Please contact Dr Britt Bostick, DDS, at bbost35821@aol.com or call 806-438-

LONGVIEW PEDIATRIC PRACTICE SEEKING FULL-TIME

5745.

ASSOCIATE: Sherri L. Henderson & Associates, LLC is looking for a qualified associate to transition into an

NORTH TEXAS: Pediatric dentist needed for busy north

active pediatric dental practice. The associate will be

Texas practice. Enjoy life in Sherman, Texas, a family-

working with a knowledgeable staff and a great new

oriented city with the convenience just 1 hour north

patient flow. This practice is dedicated to performing

of Dallas, but without the hustle and bustle of the big

high quality dental care to the children and adolescents

city! Excellent practice opportunity for motivated and

of the surrounding communities. The dentist/owner

nurturing pediatric dentist seeking full-time associate

established the practice 14 years ago, and offers a future

with potential for partnership. Practice has a great

opportunity to buy-in. This beautiful pediatric practice

reputation and is committed to providing quality

is 5,000 sq ft, with 4 doctor chairs and 4 hygiene chairs,

comprehensive care for our patients and families in a

plus a quiet room and a new patient room. A full-time

fun and relaxed atmosphere. State-of-the-art facility

schedule of 4.5 days per week is offered, with salary

with highly trained and dedicated staff. Competitive

based on 40% of production. Health insurance and

compensation and benefits. Fee-for-service, limited

benefit plans are negotiable. Listing #3435. Photos

Medicaid. Must possess high personal standards, strong

available. For more information, please contact our

work ethic, excellent technical and communication skills,

office at 972-562-1072, email sherri@slhdentalsales.

and be willing to treat the full range of pediatric dental

com, or visit our website at www.slhdentalsales.com.

patients. Opportunities for in office conscious sedation, IV sedation and hospital dentistry. Please email resume/

MIDLAND FANTASTIC OPPORTUNITY: General dental practice for sale. Nationâ&#x20AC;&#x2122;s #1 per capita income, booming

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Texas Dental Journal l www.tda.org l March 2014

CV to bth1@cableone.net.

ADVERTISING BRIEFS OPPORTUNITY TO TRANSITION into a busy oral surgery

PRACTICE FOR SALE SOUTHWEST OF FORT WORTH

practice within a multi-disciplined practice. Present oral

in fast growing area. Average Gross; 6 operatories;

surgeon is retiring. Practice is private fee for service. New

Excellent Lease. Seller is relocating. Need to move

i-CAT (3D) in office. For information contact Paul Kennedy,

quickly on this one. DFW 214-503-9696. WATS 800-583-

DDS at pkennedy@gte.net or 361-960-6484.

7765.

oRAL SuRGEoN NEEdEd. Oral surgeon will be busy

READY TO SELL â&#x20AC;&#x201D; CORPUS CHRISTI AREA: Sherri

for a full day or two with implant and bone grafts.

L. Henderson & Associates. The DDS is relocating to

Competitive pay. Flexible in scheduling. Please call 361-

another city. This cosmetic and general dentistry practice

387-3442.

was established in 1982 in a professional office complex with 1,400 sq ft and 3 existing treatment rooms. This

PEDIATRIC DENTIST, PART TIME: Carus Dental,

location would make a great place for a start-up or

established in 1983 in Austin has always been committed

satellite practice and it has plenty of space next door for

to the traditional doctor-patient relationship and to

expansion. The location is on one of the busiest streets

the highest quality in dental care and service. We

with access to Padre Island Drive. This is a cash basis

currently have approximately 48 doctors on staff across

practice with a dedicated loyal staff and great revenue

our 21 practices in Austin, Houston and Central Texas.

potential. The current owner has extensive experience

We offer dental services in general dentistry, oral

with TMJ and sleep apnea and would be willing to

surgery, orthodontics, pediatric dentistry, endodontics,

return to the practice periodically if the new owner was

periododontics and prosthodontics in some or all of

interested. Listing #3070. Pictures available. Contact

our practices. Carus Dental has been accredited by the

972-562-1072 or email sherri@slhdentalsales.com. Visit

Accreditation Association of Ambulatory Health Care

www.slhdentalsales.com.

since 2000. We offer a competitive salary and excellent benefit package including a 401k, health insurance and

SAN ANTONIO NORTH WEST: Associate needed.

a professional work environment. To learn more about

Established general dental practice seeking quality

American Dental Partners and Carus Dental please

oriented associate. New graduate and experienced

visit us at www.amdpi.com and www.carusdental.

dentists welcome. GPR, AEGD preferred. Please contact

com. If interested, please send CV and cover letter to

Dr Henry Chu at 210-684-8033 or versed0101@yahoo.

kateanderson@amdpi.com.

com.

PEDIATRIC PRACTICE FOR SALE: Very large private

SAN ANTONIO: Pediatric dentist. Well-established

pediatric practice in large metropolitan area in Texas, mix

and growing pediatric practice is seeking a caring and

of PPO and Medicaid in a beautiful, free-standing 5,000

energetic associate for a full-time and part-time position.

sq ft building with 10 chairs. Highly profitable private

We offer excellent production with incredible earning

practice established 30 years. Texas Practice Transitions,

potential, vacation and other benefits. New graduates

Inc. Rich Nicely has been serving Texas dentists since

are welcome. Please submit your resume to velezluke@

1990. Visit www.tx-pt.com or call at 214-460-4468;

yahoo.com.

Rich@tx-pt.com. Texas Dental Journal l www.tda.org l March 2014

269

ADVERTISING BRIEFS SLh dENTAL SALES (ShERRI L. hENdERSoN

PEDIATRIC: Very large private pediatric practice in large

& ASSoCIATES): Consulting and staging for your

metropolitan area in Texas, mix of PPO and Medicaid

transition! Let us help you make a transition plan. We

in a beautiful, free standing 5,000 sq. ft. building with

can analyze the market, review your current patient

10 chairs. Highly profitable private practice established

base, secure the staff, spruce up the office space,

30 years. HUNTSVILLE: Medium sized full fee patient

and much more. We specialize in practice transition

base; Digital x-rays; Free standing building; long term

consulting and can assist you in a plan to help you create

staff; 4 days of hygiene per week. ARLINGTON: Highly

all the right conditions to begin that step from retiring

visible large sized practice and building on major road;

to starting up a new practice. Our team has decades

6 equipped treatment rooms; digital x-rays; 100%

of hands-on experience in the dental market place as

paperless; Mix of PPO and DHMO patients. EAST TEXAS:

practice owners, employees, and management advisors.

Small full fee patient base. Great building with water

ASSOCIATES, PARTNERS AND BUYERS AVAILABLE. Are

views from each of the 4 treatment rooms. VICTORIA:

you seeking an associate, partner, or buyer? SLH has

Medium sized practice; PPO patient base; free standing

qualified candidates ready in all parts of Texas looking for

building, long term staff; doctor refers out lots of

your specific practice profile. There are many graduates

dentistry. MIDLAND: Large sized practice; full fee patient

as well as very experienced dentists looking for the

base; Digital x-rays; Modern free standing building; long

opportunity to transition into your already established

term staff; EL PASO: East side; Large practice; full fee

practice. These dentists have great people skills, case

patient base. EL PASO: West side; medium sized practice;

presentation experience and can be a very valuable and

mostly PPO patient base. OKLAHOMA: 1 hour outside

reliable addition to your bottom line. CONTACT US. If

OKC; Large full fee office, 5 treatment rooms, fantastic

you are unsure about the right timing or simply would

building; urgent sale situation.

like to talk about the opportunities, call us today for a complimentary consultation in person or by telephone.

ThE hINdLEy GRouP, LLC â&#x20AC;&#x201D; dENTAL PRACTICE

All contact with you is strictly confidential. Call on our

SALES: NEW LISTING! NORTH HOUSTON, ENDO

experience to assist you in making that transition dream

PRACTICE: Highly regarded Endodontist selling well

become a reality. Call 972-562-1072 or email sherri@

established practice due to family relocation. $1 Million

slhdentalsales.com, website slhdentalsales.com.

plus in revenues on 3 days per week with very strong profit margin. Friendly, knowledgeable staff. NEW

SUGAR LAND, CYPRESS, PEARLAND AND THE

LISTING! THE WOODLANDS, TEXAS, GENERAL PRACTICE:

WOODLANDS: Full- and part-time positions available.

This 44 year old practice has been located in a wonderful

Well established and rapidly growing practices that offer

Woodlands location for the past 9 years! This general

great financial opportunity. High income potential and

dental practice is open 4 Â˝ days per week, operating

future equity position. E-mail CV to Dr Mike Kesner,

from 2,395 sq ft with 3 fully equipped fully digitized

drkesner@madeyasmile.com.

operatories. Upper-Middle class patient demographic, FFS with mostly insurance and some cash revenues.

TEXAS PRACTICE TRANSITIoNS, INC. Rich Nicely has

Lower revenues due to lack of marketing and declining

been serving Texas dentists since 1990. Visit www.

health of owner. Substantial upside opportunity! Must

tx-pt.com or call at (214) 460-4468; Rich@tx-pt.com.

Sell! NEW LISTING! SOUTH HOUSTON, ORTHO PRACTICE:

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Texas Dental Journal l www.tda.org l March 2014

ADVERTISING BRIEFS Retiring orthodontist desires to sell remaining patients,

equipped operatories and 3 additional plumbed. Loyal,

equipment and centrally located office condominium

experienced staff. Doctor is retiring. Call 800-856-1955 or

of 1,160 sq ft. Optimum purchaser candidates would

email kate@thehindleygroup.com.

include: an orthodontist wanting a larger location, an orthodontist desiring a satellite location, or an

WACO: Great associate opportunity. Waco practice

orthodontist wanting to grow a practice in this affluent

looking for motivated associate with a desire to join

Houston area. Perfect for a new resident graduate

a PPO/fee-for-service practice. Great pay, great work

wanting to be in the strong Houston economic

environment with two other dentists and top notch staff.

environment! WEST HOUSTON GENERAL DENTAL

Please contact Dr Johnson at 435-237-2339 or email at

PRACTICE FOR SALE: Small general dental practice

johnson.2978@gmail.com.

with high percentage restorative revenues. Average 8 new patients per month. 2 fully equipped operatories

OFFICE SPACE

with 1 additional hygiene room and another room plumbed for expansion. Digital Pano. Same location

BEAUMONT: New beautiful orthodontic office for lease,

for 13 years. Cash and Insurance revenues. Motivated

completely furnished and equipped on the best location

seller! Excellent opportunity for start up at low cost.

in Beaumont -- 6 chair bay, 2 business offices; 2,300 sq

SOUTH OF HOUSTON, TEXAS COASTAL PLAINS GENERAL

ft with lots of supplies. For more information, please call

DENTAL PRACTICE FOR SALE: Well-established for 28

409-861-2851 or email drtsyler@gmail.com.

years and in same location for last 17. Strong revenues and healthy profit margin on 4 days per week! 2500 sq ft

DALLAS AND ROCKWALL: Orthodontic or other specialty

building with 4 fully equipped operatories also for sale.

office for lease to share with owner. Furnished and

Experienced, dependable staff. Great opportunity!

equipped. Dallas office is 4,000 sq ft in Lake Highlands

WEST CENTRAL TEXAS GENERAL DENTAL PRACTICE:

area with 2,500 sq ft leasable residence above. Rockwall

25-year-old well-established family dental practice

office is 1,800 sq ft in antique building and furnishings.

for sale. Open 4.5 days per week. 2400 sq ft building

E-mail rcppc@sbcglobal.net.

with 4 fully equipped operatories. 3 direct digital X-Ray units in operatories plus numerous other upgrades

HOUSTON / LEAGUE CITY: Medical/office space

to equipment and building, which is also for sale.

available for lease in a stellar location, right outside the

Steady new patient growth and outstanding staff.

largest school in Texas with 4,200 students on campus. In

NORTHWEST HOUSTON GENERAL DENTAL PRACTICE:

a fast growing area with a lot of young families, located

Well established, very traditional practice with moderate

close to the waterfront, boardwalk, Gulf Coast beaches,

fee for service revenues and healthy profit margin.

Houston downtown, NASA and Hobby Airport. Home to

Open 4 days a week. 1,200 square foot facility with

one of the stateâ&#x20AC;&#x2122;s top rated Independent school districts,

3 fully equipped operatories. Doctor retiring. NORTH

stunning yet affordable waterfront neighborhood

OF HOUSTON GENERAL DENTAL PRACTICE: Very well

developments, NASA, BOEING, UTMB. Contact Vijay

established practice in the same location for 31 years.

Bhagia 832-618-0652 or eduvillageland@gmail.com.

Moderate cash revenues with some PPO insurance. Practice open 4 days per week. 2,200 sq ft with 2 fully Texas Dental Journal l www.tda.org l March 2014

271

ADVERTISING BRIEFS ABBEVILLE DENTISTRY: are seeking an honest, hardNORTH TEXAS DENTAL We PRACTICE OPPORTUNITIES:

operatory. One employee with 36-years experience

working, patient focused Services dentist who to contribute Lewis Health Profession has want multiple career

in this office. Located in Muenster TX, a quaint small

opportunities in the greater Dallas/Fort to a culture of available caring, nurturing and skilled professionals. If

town, at 204 N. Main #C. About 70 miles north of Dallas

area. forasale, Worth you have the Practices desire to be partassociate of a teamopportunities, where you can finished dental offices, and specialty focus on out patients and not worry about thepractice headaches that

near the Red River. Two outstanding school systems

opportunities. Lewis Health Profession hasus. 30 If come with the business side of dentistry,Services please call

football and basketball teams. Very good hospital. Home

yearsare experience dental practice with over you seeking aninenvironment thattransitions, provides stability, 1,000 successful transitions completed. Dentistry our growth and continuing education, we’d like to shareis with

of “German Fest” a widely-known yearly celebration held

onlyhow business. Wefitconfidentially withyears all clients. you you can into that plan.deal Twenty ago, Health Profession offers seller representation, ILewis started my practice simply dedicated to serving my

(H) 817-488-1207 Contact email: brnrd.luke@gmail.com.

buyer representation, opportunity assessments, associate patients and community. Now, I’m privileged to guide placement and strategic Please check over 10 practices and 80 planning wonderfulservices. staff. I’ve turned the

EQUIPMENT FOR SALE: New handheld portable X-ray

out our web siteoperations at www.lewishealth.com for current administrative, and marketing efforts over opportunities. additional information, contact to people who For enjoy doing those sorts of things so Dan our

on wheels. New chairs/units operatory packages, new

Lewis atand Lewis Health Profession Services 972-437-1180 doctors staff can focus on their patients. I’ve also or dan@lewishealth.com. been able to provide young doctors with an environment

Contact nycfreed@aol.com.

where they can grow and practice what they love doing SAN ANTONIO 4-OPERATORY PRACTICE FOR SALE: without the worry of costly overhead or administrative

We have outgrown the space, looking the to relocate. headaches. At the same time, offering potentialSpace for is perfect for a specialist. Transition available. The space significant income and a great life balance. You’ll enjoy a is located right off the Country Club golf great environment withDominion no egos and no political barriers. course in San Antonio. Very modern, tranquil, pleasant We’re growing and need a few quality individuals to join

location, granite countertops, plumbed for nitrous, us in creating something truly special. We’re forming second floor with balcony. Please contact Dr Stratton a new, interactive, fun environment that kids and their at

both K-12. One private and one exemplary public. Two

each April in the New Heritage Park. (O) 940-759-2889

unit. New intraoral wall X-ray unit, new mobile X-ray implant motors. Everything is brand new, with warranty.

INTERIM SERVICES HAVE MIRROR AND EXPLORER, WILL TRAVEL: Sick leave, maternity leave, deployment, vacation or death, I will cover your office. Call Robert Zoch, DDS, MAGD at 512263-0510 or drzoch@yahoo.com. OFFICE COVERAGE for vacations, maternity leave, illness.

210-687-1150 e-mail tiffini@dominiondentalspa.com. parents will findorrefreshing and exciting. If you’d like to talk

Protect your practice and income. Forest Irons and

about this opportunity, please give me a call. I’d be happy SEGUIN: Orthodontic space in. Officewe to share the vision, theoffice success andfor thelease expectations

800-433-2603 (EST). Visit www.forestirons.com.

was phased down when orthodontist retired. Office have while answering your questions candidly and openly. is equipped and functional. Great for a start up or a I hope you’ll consider this position and give me a call. Britt satellite location. Email inquiries to lmassadds@gmail. Bostick, DDS. 806-438-5745 or email bbost35821@aol. com. com.

FOR SALE

ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS DENTAL PRACTICE FOR SALE Retiring dentist offering AREA: 5 general dentistry practices available (East Dallas, 36 year-old one-chair practice with original equipment.

Associates. “Dentists Helping Dentists Since 1983.” Call

MISCELLANEOUS DENTIST/CONSULTANT: PT (min 4 hrs/day) for national claim review company. Work from your home or office.

Must have active Texas dental license. Fax resume to 212686-4703. EXTRACTION/ORTHODONTIC CE: September 26-27 in

Great potential for younger dentist who wants to work

Minneapolis 18 hours CE. Dr DePaul will teach PowerProx

full-time. Approx 900 sq ft with adequate space for 2nd

Six-Month Braces. Drs Fletcher and Murph will teach

272

Texas Dental Journal l www.tda.org l March 2014

extractions using pig jaws. Dr McCall will teach immediate dentures. Cost is $1894 if signed up by May 1; $2,294

PLACE A CLASSIFIED AD IN THE

after May 1. Contact sixmonthbraces@hotmail.com or

TEXAS DENTAL JOURNAL

drtommymurph@yahoo.com.

EXTRACTION/ORTHODONTIC CE: September 2627 in Minneapolis 18 hours CE. Dr DePaul will teach PowerProx Six-Month Braces. Drs Fletcher and Murph will teach extractions using pig jaws. Dr McCall will teach immediate dentures. Cost is $1,894 if signed up by May 1; $2,294 after May 1. Contact sixmonthbraces@hotmail. com or drtommymurph@yahoo.com.

COST PRINT: $40 for the first 30 words, 10 cents per word after that.

LOOKING TO HIRE A TRAINED DENTAL ASSISTANT?

ONLINE: $10 a month (no word limit). $60 one-time additional fee to post online immediately.

We have dental assistants graduating every 3 months in Dallas and Houston. To hire or to host a 32-hour externship, please call the National School of Dental Assisting at 800-383-3408; Web: schoolofdentalassistingnorthdallas.com.

It’s a member benefit! Reach more then 9,000 of your dental colleagues.

CONTACT For more information, please visit tda.org or contact Nicole Scott, Managing Editor at 512-443-3675 ext 124 or by e-mail nicole@tda.org.

DDR Dental Trust Classified_qtr page for TDJ.indd 1

12/16/2013 5:55:46 PM

Serving Texas Dentists for more than 40 Years

• Practice Appraisals • Practice Sales • Associate Agreements

800-930-8017

James L. Dunn, Trustee Texas Dental Journal l www.tda.org l March 2014

273

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