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TEXAS DENTAL JOURNAL Established February 1883
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ABOUT THE COVER
Bruce L. Vetters, DDS, of San Antonio submitted the cover photograph, “Sundown,” in the 2014 TEXAS Meeting Photo Contest. He shot the photograph at a swamp at Lake Bigeaux between Lafayette and Baton Rouge, Louisiana, in December 2013.
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CASE REPORT: IMMEDIATE DENTURES IN AN HIV POSITIVE PATIENT Puneeta H. Singh and John D. Jones, DDS The authors quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and examine whether certain dentist, practice, and patient characteristics are associated with their use.
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DIFFERENCES BETWEEN REPORTED AND ACTUAL RESTORED CARIES LESION DEPTHS: RESULTS FROM THE DENTAL PBRN D.B. Rindal, V.V. Gordan, J.L. Fellows, N.L. Spurlock, M.R. Bauer, M.S. Litaker, G.H. Gilbert The authors present a case report of a 35-year-old patient with a previous history of recreational drug use who wished for the immediate placement of dentures to avoid being edentulous for the healing period.
MONTHLYFEATURES 496
President’s Message
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Memorial and Honorarium Donors
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Oral and Maxillofacial Pathology Case of
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Value for Your Profession
the Month
536
Oral and Maxillofacial Pathology Case
508
Critically Appraised Topic of the Month
of the Month Diagnosis and Management
529
2014 TDA Annual Session TEXAS
538
Calendar of Events
Meeting Photo Contest
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Advertising Briefs
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In Memoriam
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Index to Advertisers
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TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.
Editorial Staff
Editorial Advisory Board
BOARD OF DIRECTORS
Daniel L. Jones, DDS, PhD, Editor Harvey P. Kessler, DDS, MS, Associate Editor Nicole Scott, Managing Editor Billy Callis, Publications Coordinator Barbara Donovan, Art Director Paul H. Schlesinger, Consultant
Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD William C. Bone, DDS Phillip M. Campbell, DDS, MSD Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Scott R. Makins, DDS Daniel Perez, DDS William F. Wathen, DMD Robert C. White, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS
The Texas Dental Journal is a peer-reviewed publication. Texas Dental Association 1946 S IH-35 Ste 400, Austin, TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 Email: tda@tda.org • Website: www.tda.org 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, 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 Association. All rights reserved. Annual subscriptions: Texas 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. Single issue price: $6 ADA Affiliated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 NonADA Affiliated. For in-state orders, add 8.25% sales tax. Contributions: 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 submitted. 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 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 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. Advertisements: Publication of advertisements in this journal does Association of not constitute a guarantee or endorsement by the Association of Dental Editors and the quality of value of such product or of the claims made of it by Journalists. its manufacturer.
PRESIDENT David H. McCarley, DDS 972-562-0767, drdavid@mccarleydental.com PRESIDENT-ELECT Craig S. Armstrong, DDS 832-251-1234, drarmstrong01@gmail.com IMMEDIATE PAST PRESIDENT David A. Duncan, DDS 806-355-7401, davidduncandds@gmail.com VICE PRESIDENT, NORTHEAST Jerry J. Hopson, DDS 903-583-5715, dochop@verizon.net VICE PRESIDENT, SOUTHEAST William S. Nantz, DDS 409-866-7498, wn3798@sbcglobal.net VICE PRESIDENT, SOUTHWEST Joshua A. Austin, DDS 210-408-7999, jaustindds@me.com VICE PRESIDENT, NORTHWEST Steven J. Hill, DDS 806-783-8837, sjhilldds@aol.com SENIOR DIRECTOR, NORTHEAST William H. Gerlach, DDS 972-964-1855, drbill@gerlachdental.com SENIOR DIRECTOR, SOUTHEAST Karen A. Walters, DDS 713-790-1111, kwalters@sms-houston.com SENIOR DIRECTOR, SOUTHWEST John B. Mason, DDS 361-854-3159, jbmasondds@aol.com SENIOR DIRECTOR, NORTHWEST Charles W. Miller, DDS 817-572-4497, cwdam@sbcglobal.net DIRECTOR, NORTHEAST Dennis E. Stansbury, DDS 903-561-1122, drstansbury@gmail.com DIRECTOR, SOUTHEAST Duc “Duke” M. Ho, 281-395-2112, ducmho@sbcglobal.net DIRECTOR, SOUTHWEST James R. Foster, DDS 956-969-2727, fosterdds@gmail.com DIRECTOR, NORTHWEST W. Kurt Loveless, DDS 806-797-0341, wklovedds@gmail.com SECRETARY-TREASURER* Ron Collins, DDS 281-983-5677, roncollinsdds@yahoo.com SPEAKER OF THE HOUSE* John W. Baucum III, DDS 361-855-3900, jbaucum3@gmail.com PARLIAMENTARIAN** Arthur C. Morchat, DDS 903-983-1919, amorchat@suddenlink.net EDITOR** Daniel L. Jones, DDS, PhD 214-828-8350, djones@bcd.tamhsc.edu *Non-voting member **Non-member attendee
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President’s Message David McCarley, DDS, TDA President I had the honor of attending the graduation ceremony of the University of Texas School of Dentistry at Houston (UTSD) in May 2014. The excitement and pride of those involved were truly uplifting and inspirational.
We need to better educate our students on the choices they make when entering into debt while in school and out. They need to be aware of, and have realistic expectations of, the dental market in which they are entering. This needs to be a joint effort between our schools and the profession.
It does not seem that long ago that I strolled across the stage. But, my, how things have changed! Back then, we were taught amalgam preparations, used 90-second self-curing composites like Concise, had gold foil requirements, and our office computerization was a pegboard, appointment book, and a phone. I would like to thank UTSD Dean John Valenza for the tour of the new facility. The school was breathtaking and truly an accomplishment of which to be very proud. It almost made me want to go back to school! One of the distinct differences, though — between my generation and today’s — is the school debt that is being accumulated by today’s students. Student debt has now surpassed credit card debt in this country. The amount of debt our young dentists are laden with affects the choices they make when selecting the type of dentistry they will practice. It can also affect young dentists’ ability to join organized dentistry. The debt accumulation is far more than just the tuition, books, and student fees. In fact all 3 Texas dental schools are among the least expensive schools in the nation to attend. We need to better educate our students on the choices they make when entering into debt while in school and out. They need to be aware of, and have realistic expectations of, the dental market in which they are entering. This needs to be a joint effort between our schools and the profession. Programs like “Great Expectations” are a very good start and should become an essential component of the educational process both for the students and the recent graduates. Presently because of indebtedness, there seems to be an increasing trend for our young dentists to become employees rather than practice owners, which certainly increases post-graduate options. However, we do not want our profession to be limited, as the pharmacy and optometry professions have become, to only find work practice within non-dentist-owned entities. Even in these settings, there may be a limited number of positions. Dentistry is a wonderful profession and filled with exciting opportunities, many of which require time to build one’s expertise and the trust of the public. Hopefully the future will bring a better understanding of debt control while not allowing this to alter the course of our profession.
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Texas TexasDental DentalJournal Journal l l www.tda.org www.tda.org l l April July 2014 279 499 Mariner Dental Laboratory • 281.440.9222 • www.marinerdental-lab.com
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Member of The Institue of Business Appraisers, Inc. CALL 1-800-583-7765 OR DFW AREA 214-503-9696 Dental Journal l www.tda.org l June 2011 Texas Dental Journal l www.tda.org l July 2014509 501 TexasTexas Dental Journal l www.tda.org l October 2011 1103
Oral and Maxillofacial Pathology Case of the Month Clinical History In January 2014, a 6-year-old female child was evaluated for a “lump� in her left buccal mucosa. The mother claims that she noticed the mass in September 2013 and it had slowly enlarged over time. There was no pain associated with the mass until her daughter started to bite on the lesion with her molar teeth. It was more a bother to her than acutely painful. She denied having any areas of numbness in her mouth. The mass did not bleed, even after the child bit on it.
Physical Examination An oral examination was negative with the exception of a 2 cm mass arising from the left posterior buccal mucosa at the junction of the pterygomandibular raphe (Figure 1). The overlying mucosa had a granulomatous appearance, presumably secondary to biting trauma. The lesion was firm and was attached to the soft tissues of the region in a pedunculated fashion. It was readily moveable and it did not feel attached
Figure 1. Mass lesion of left buccal mucosa.
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McGuff
Jones
Ellis
Nicolas
H. Stan McGuff, DDS, professor, Department of Pathology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas Anne Cale Jones, DDS, professor, Department of Pathology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas Edward Ellis III, DDS, MS, professor and chair, Department of Oral and Maxillofacial Surgery, Dental School, The University of Texas Health Science Center at San Antonio, San Antonio, Texas Marlo M. Nicolas, MD, assistant professor, Department of Pathology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
Figure 2. Excisional biopsy of lesion.
any deeper than the sub-mucosa. The mass extended over the occlusal surfaces of the molar teeth. Palpation did not elicit tenderness nor could any fluid be expressed. Her neck nodes were not palpable.
Past Medical History Her past medical history was unremarkable. She had reached all developmental milestones and appeared to be a healthy individual. She had no other masses anywhere else on her body.
Biopsy
Figure 4. Hematoxylin and eosin stained histologic section showing a loose to cellular spindle cell neoplasm (Original magnification: 10X).
The mass was removed on February 2014 under general anesthesia. The lesion appeared to be attached superficially to the submucosa and did not appear to invade into the deep soft tissue (Figure 2). The specimen was submitted for pathologic examination (Figure 3).
Gross Pathology The specimen was received in a container of formalin labeled as “left buccal mucosal lesion, biopsy.� The specimen consisted of a lobulated nodular pink-tan soft tissue mass measuring 2.0 x 1.5 x 1.0 cm. The mass was serially sectioned
Figure 3. Surgical specimen showing lobulated pinktan mass.
Figure 5. Spindled myofibroblasts and fibroblasts with loose stroma and admixed inflammatory cells (Original magnification: 60X).
Figure 6. Cellular area of tumor with fascicular growth pattern (Original magnification: 20X). Texas Dental Journal l www.tda.org l July 2014
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revealing a firm solid variegated graywhite cut surface. The excisional biopsy margins were inked. The specimen was entirely submitted for histopathologic examination.
Histopathology Hematoxylin and eosin stained histologic sections revealed an unencapsulated spindle cell neoplasm exhibiting variably loose myxoid to compact cellular areas exhibiting a fascicular growth pattern (Figures 4-6). An associated patchy acute and chronic inflammatory infiltrate consisting of neutrophils, eosinophils, lymphocytes, plasma cells, and histiocytes was present. The spindled to stellate stromal cells displayed a mild degree of cytologic atypia with round to elongated ovoid nuclei, finely dispersed chromatin, small nucleoli, and pink cytoplasm. Scattered typical mitotic figures were seen (Figure 7). There were interspersed small caliber to ectatic vascular channels. An immunohistochemical stain for anaplastic lymphoma kinase (ALK) was positive within the cytoplasm of the tumor cells (Figure 8). There was also focal staining for smooth muscle actin indicating myofibroblastic differentiation (Figure 9). The tumor extended to focally involve the inked deep margin of the biopsy specimen.
Figure 7. The tumor cells display mild cytologic atypia and focal mitotic activity (Original magnification: 60X).
Figure 8. Immunohistochemical stain demonstrating cytoplasmic positivity for ALK (Original magnification: 60X).
What is the most likely diagnosis? See page 536 for the answer and discussion.
Figure 9. Immunohistochemical stain showing expression of smooth muscle actin in myofibroblastic cells (Original magnification: 60X).
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AGD Codes for all programs: 132 Anesthesia & Pain Control; 163 Conscious Sedation; 164 Oral Sedation The above continuing education programs fulfill the TSBDE Rule 110 practitioner requirement in the process to obtain selected Sedation permits. This is only a partial listing of sedation courses. Please consult our website for updates and new programs. Find us on the web at www.sedationce.com. Call us at 214-384-0796 to register for any program.
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Case Report: Immediate dentures in an HIV positive patient Puneeta H. Singh, fourth year dental student; and John D. Jones, DDS, Professor, Comprehensive Dentistry, University of Texas Health Science Center
About the Authors Puneeta H. Singh, fourth year dental student;
John D. Jones, DDS, professor, Comprehensive Dentistry, University of Texas Health Science Center
The authors have no declared potential conflicts of financial interest, relationships, and/or affiliations relevant to the subject matter or materials discussed in the manuscript.
This manuscript has been peer reviewed.
INTRODUCTION
R
eplacement of severely decayed teeth with artificial prostheses has an exceptional role in changing the quality of life in a patient. With a good impression technique and carefully executed lab work, a well designed prosthesis can be fabricated, which is tailored to the needs of the patient, with minor adjustments and corrections over time.
CASE REPORT The patient in discussion was a 35-year-old HIV positive Hispanic male. There was no definite timeline of contracting the virus in his case, and he had a history of recreational drug use, mainly methamphetamine and cocaine. There have been several documented cases of HIV from intravenous drug use, which in his case was not defined. Also, there are numerous reports on oral signs and symptoms in
Abstract A 35-year-old patient with a previous history of recreational drug use, mainly cocaine, presented to the UTHSCSA Dental School with grossly carious remaining dentition. The pattern of the wear and caries on the teeth also indicated other recreational drug such as methamphetamine over a long period of time. He was planned for extractions of the remaining teeth and placement of immediate dentures considering the patient’s wish for not being edentulous for the healing period.
Key Words Immediate dentures, methamphetamine, cocaine, HIV, impressions
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HIV positive patients — which broadly cover lesions associated with Kaposi’s sarcoma, oral hairy leukoplakia, candidiasis, HIV-associated mucositis and generalized severe periodontitis (1). Long-term effects of methamphetamine and cocaine abuse in HIV positive patients have been reported to be resulting in progressive decline of neuropsychological functions, despite retroviral therapy (2). The patient exhibited none of these signs and symptoms. His CD4 counts recorded in June 2013 were 86 cells/ cubic microliter. Typically, counts below 200 cells/cubic microliter tend to show signs and symptoms of opportunistic infections; the most common being pneumocystis pneumonia and Mycobacterium avium complex (3).
Figure 1. Oral mucosa on the anterior labial surface showing white gauze-like appearance attributable to “snuff” intake. Location of lesion corresponds to pouch keratosis.
There were no signs or symptoms of HIV positive association intraorally. On the mandibular labial mucosa, a white cobblestone appearance was attributable to regular “snuff” intake, as admitted by the patient. The location of the white discolored mucosa confirmed the site of placement of “snuff” (Figure 1). There were some concerns about extracting 14 teeth in this patient, and placing dentures the same day, mainly because of the amount of discomfort that was anticipated. His history of methamphetamine and cocaine abuse resulted in gross rampant dental caries of all his teeth to the point of non-restorability with endodontics as well. The decision was made to extract the posterior teeth so that the posterior maxillary and mandibular ridges heal well enough for a good impression for the fabrication of a
Figure 2. Gross caries noted on all remaining anterior teeth. Non restorability with endodontics resulted in treatment planning for extractions, and subsequent placement of dentures. Caries of this pattern and nature was contributed due to methamphetamine use, xerostomia, and extremely poor oral hygiene.
definitive immediate complete denture prosthesis (Figure 2).
DISCUSSIONS AND OPTIONS OFFERED Considering the medical history of the patient, the CD4 count that was
recorded in June 2013 to be 86 cells/ microliter, he was given the option of complete dentures after extraction of the remaining teeth and a healing period of 6 to 8 weeks before impressions were made. He was also given the option of immediate dentures and natural tooth or implant supported overdentures. Benefits Texas Dental Journal l www.tda.org l July 2014
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and disadvantages of all options were discussed and the patient agreed to immediate dentures, considering the post-placement esthetics and documented healing advantages of placing dentures immediately after extractions. Also, in his case finances played a major role, with the cost of implant-supported dentures or overdentures after endodontic therapy on 4 canines being greater overall, as compared to conventional dentures or immediate dentures. The patient was concerned about being edentulous for a moderate period of time while he was healing, prior to making impressions for conventional complete dentures. All these factors contributed to the decision to fabricate immediate dentures for this patient. Extraoral observations were normal with negative lymphadenopathy, swelling, asymmetry or bruising. (Figures 3a and 3b).
Figures 3a and 3b. Extraoral view of patient’s lower third of the face showed no abnormal signs.
THE TECHNIQUE The immediate denture impression was made using a special 2-stage technique. The first stage involved using molding compound for border molding followed by a rubber base final impression. For the second stage polyvinylsiloxane putty recorded the labial surfaces of the teeth and the labial vestibule. The 2 sections were removed from the mouth separately and then put back together prior to boxing. The following paragraphs provide a more detailed description of the technique.
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Figures 4a and 4b. Border molding with a low fusing compound (green stick wax) to record the borders prior to making the master impression. Anterior part of the trays have been left uncovered as the putty matrix will be flow into the space between the tray and the natural teeth.
After initial impressions were made with an irreversible hydrocolloid impression material — alginate (Jeltrate) — custom impression trays were fabricated. The design of the custom tray involved covering the lingual surfaces of the remaining maxillary teeth and extending labially about 2 mm so that a “ledge” is
formed to support putty impression material to capture the labial surface of the remaining teeth. Care was taken to adjust the custom trays to cover the primary stress bearing areas posteriorly and border molding was done with a low fusing compound to obtain a reasonably
silicone putty impression material — molded and placed to adapt to the labial surfaces. Lip movements were done to establish the labial frenum and borders. Some of the putty material went onto the lingual surfaces of the remaining teeth and locked with the rubber base material to get mechanical retention, helping it stay together for boxing later on (Figures 6a and 6b).
Figures 5a and 5b. Rubber base impression material (Polysulphide) used to make the master impression.
The 2 materials do not bond well to one other, therefore the mechanical interlocking on the lingual surfaces helped. Following this step, the master casts were fabricated with Type II dental stone, and wax rims were fabricated for the purpose of maxillomandibular jaw relations. The wax rims were limited to the posterior areas where the healed ridge was present (Figures 7a and 7b). During the clinical procedure, a platform of wax was added to cover the incisal surfaces of the maxillary anterior teeth so that a baseline incisal plane parallel to the pupillary line could be established, considering the excessive wear on his natural teeth (Figures 8a,b,c).
Figures 6a and 6b. Putty impression made for the anterior part. It interlocks with the polysulphide impression material and can be boxed for pouring the dental stone casts.
good seal and minimize the adjustments that might be required prior to making the master impression (Figures 4a and 4b). Impression of this part was made with polysulfide rubber base impression material – known to record undercuts very well (4) (Figures 5a and 5b).
The tray with the impression material was removed and excess material trimmed prior to placing the tray back into the patient’s mouth for the second part of the impression. The trimmed anterior part of the custom tray formed a butt joint for better adhesion of putty to the tray. The anterior portion was recorded with
Maxillomandibular jaw relations were recorded as for complete dentures. The incisal plane was parallel to the interpupillary line and the plane of occlusion was parallel to the ala-tragus line. Facebow and centric relation records were made and mounted on a semi-adjustable (Whipmix) articulator. Extractions were done at 2 different times. The posterior
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teeth were removed 8 weeks prior to construction of the immediate dentures, and the anterior teeth were removed at the time of placement of the immediate dentures. A surgical stent was used for maxillary and mandibular extractions to aid in the alveoloplasty. The maxillary and mandibular extractions were done, followed by the alveoloplasty in both arches and suturing with resorbable 3-0 gut sutures. The maxillary and mandibular dentures were placed and the patient returned for a 24-hour recall to monitor the tissue response to extractions and new dentures and
provide minor adjustments (Figures 9a and 9b).
act as a splint for the bone to heal undisturbed (Figures 10a,b,c,d).
Heavy bony exostoses were removed, as guided by the surgical stent, to relieve undercuts which would have otherwise caused post-placement soreness.
There was significantly good healing noted on the ridges postoperatively and the patient looked and felt a lot healthier. According to his laboratory reports of the CD4 counts, there was a rise from the initial count of 86 to 104. This could be attributable to his ability to eat well and heal quickly. He was next seen in March for a 3-month follow up, and to monitor requirements for a soft reline if needed.
POST PLACEMENT PICTURES The patient showed remarkable healing after denture placement — one of the biggest advantages of placing immediate dentures, which help to
Figures 7a and 7b. Maxillary and mandibular wax rims made for maxillomandibular relations.
Figures 8a, 8b and 8c. A platform of wax was made to establish a definite incisal plane, to establish it parallel to the interpupillary line.
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Figures 9a and 9b. Follow up after 3 days post-extractions and denture delivery. Patient shows good healing of the tissues.
References 1. Ryder MI, Nittayananta W, Coogan M, Grrenspan D, Greenspan JS. Periodontal disease in HIV/AIDS. Periodontol 2000; 60(1): 78-97. 2. Avindra Nath, Maragos William F, Avison Malcolm J, Fredrick Schmitt A, Berger Joseph R. Acceleration of HIV dementia with methamphetamine and cocaine. J Neurovirology 2001; 7:66-71. 3. Bartlett and Gallant 2007, The 2007 Medical Management of HIV Infection, Johns Hopkins University School of Medicine: http://www.hopkins-hivguide. org/management/laboratory_ testing/cd4_cell_count.html?cont entInstanceId=8279&siteId=7151 4. Anusavice KJ, Shen C, Rawls HR 2013 Phillips’ Science of Dental Materials, 12th Edition, St Louis, Elsevier.
Figure 10a. Initial post operative picture, patient shows swelling on the maxillary anterior region. Esthetics are acceptable. Clinically the retention and stability of the dentures was noted to be acceptable as well.
Figure 10b. Day 2 follow up. Reduced swelling and post-operative edema observed. Patient was more comfortable clinically as well.
Figure 10c. Day 4 follow up. Patient reported good stability and retention of the dentures. Extraction sites showed uneventful healing. Esthetics are acceptable.
Figure 10d. Week 3 follow up. Significantly reduced swelling and edema. Patient was very comfortable.
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Differences between reported and actual restored caries lesion depths: Results from The Dental PBRN D.B. Rindal, V.V. Gordan, J.L. Fellows, N.L. Spurlock, M.R. Bauer, M.S. Litaker, G.H. Gilbert Reprinted from Journal of Dentistry, 40/3, D.B. Rindal, et al. Differences between reported and actual restored caries lesion depths: Results from The Dental PBRN, 248-254. Copyright 2012, with permission from Elsevier.
About the Authors D.B. Rindal, HealthPartners Research Foundation, Minneapolis, MN, HealthPartners Dental Group, Minneapolis, Minnesota. D.B. Rindal is corresponding author at: HealthPartners Research Foundation, 8170 33rd Avenue South, MS 21111R, Bloomington, MN 55425. Tel.: +1 952 967 5026; fax: +1 952 967 5022. E-mail: donald.b.rindal@healthpartners.com. V.V. Gordan, Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida. J.L. Fellows, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. N.L. Spurlock, Private Practitioner, Milton, Florida. M.R. Bauer, HealthPartners Dental Group, Minneapolis, Minnesota. M.S. Litaker, Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama. G.H. Gilbert, Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama. For The DPBRN Collaborative Group
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INTRODUCTION
D
ental caries is a prevalent infectious disease with a significant impact on dental health services (1-4). Restorative treatments represent the bulk of general dentists’ workload and they are expected to increase dramatically due to high caries prevalence in the aging population (4). Despite major advancements in caries prevention, placement of restorations and extraction of teeth remain widespread and may even be the norm (57). Many ways to decrease the number of restorations have been suggested. Accurate preoperative diagnosis of caries depth, clear treatment guidelines, and provider feedback on their caries management performance are just a few (8). Many dentists routinely perform operative procedures on caries lesions that still have a chance to remineralise. In 2002, the Hamilton study found that ‘‘watching’’ an incipient caries lesion and intervening operatively after 2 years if deemed necessary did not result in a larger restoration (9). Early stages of caries lesions may be arrested or “healed” (10,11). At present, the American Dental Association Council on Scientific Affairs recommendations for caries restorative threshold is against surgically restoring caries confined to enamel due to their potential to arrest and remineralise (12,13). Despite this recommendation, many dentists continue to intervene when caries are still in enamel. Moreover, marked variations exist amongst clinicians and teachers of restorative dentistry in caries management and prevention (13–15). Of particular importance for long-term caries management is the decision to place the first restoration on a tooth surface (16). This moment often is the beginning of an unfortunate cycle of restoration replacement over subsequent decades. Each succeeding restoration is progressively larger, ultimately leading to a large restoration that places the tooth at substantially increased risk for endodontic treatment or extraction (17–21). The decision to place the first restoration influences not only the tooth prognosis, but also the cost of treatment over lifetime (22,23). Restorative decisions affect future assessments of patient caries risk because they are based in part on the number of existing restorations and may influence future restorative treatment
Abstract Objective The objectives of this research were to: (1) quantify the discordance between the caries lesion depth at which dentists restored initial lesions during a clinical study (“actual depth”) and the lesion depth that they reported during a hypothetical clinical scenario (“reported depth”); (2) test the hypothesis that certain practitioner, practice, patient, and caries lesion characteristics are significantly associated with this discordance. Methods Practitioner-investigators who perform restorative dentistry in their practices completed an enrollment questionnaire and participated in 2 consecutive studies on caries diagnosis and treatment. The first study was a survey asking about caries treatment. The second study collected data on restorations placed in routine clinical practice due to caries in patients over 19 years of age on occlusal surfaces only or proximal surfaces only. We report results on 2,691 restorations placed by 205 dentists in 1,930 patients with complete data. Results Discordance between actual depth and reported depth occurred in only about 2% of the restorations done due to proximal caries, but about 49% of the restorations done due to occlusal caries. Practice type, restorative material used and the diagnostic methods used were significantly associated with discordance. Conclusion Dentists frequently restored occlusal caries at a shallower depth as compared to their reported depth, but the discordance was very small for proximal lesions. Discordance for occlusal caries was more common when radiographs were not taken or if a resin restoration was placed.
Key Words
decisions for the patient (24–27). Reducing overtreatment of early caries will postpone the beginning of the restoration replacement cycle, decrease the restoration burden in dental practice, improve oral health and reduce the overall cost of care (28). Most studies to date have evaluated dentists’ caries restorative thresholds through questionnaires (8,29–31). There is only limited information on the discordance between dentists’ reported and actual intervention depths (32,33). The ability of dentists to adequately assess the treatment they provide will be a necessary first step in improving quality of care. The objectives of this research were to: (1) quantify the discordance between the caries lesion depth at which dentists restored initial lesions during a clinical study (“actual depth”) and the lesion depth that they reported restoring caries for a hypothetical clinical scenario (“reported depth”); (2) test the hypothesis that certain practitioner, practice, patient, and caries lesion characteristics are significantly associated with this discordance. The research setting is The Dental Practice-Based Research Network (DPBRN) based in the United States of America with a Scandinavian region. This network is a consortium of dental practices with a broad representation of practice types, dentists, and treatment philosophies conducting research with the ultimate goal of improving quality of care in dental practices (34–36).
Caries, threshold, restoration, remineralisation, decision making
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Materials and methods Selection and recruitment process We recruited 229 DPBRN enrolled dentists, commonly referred to as practitioner investigators (PIs), who performed restorative dentistry in their practices, completed a 101item enrollment questionnaire that collected data on provider and practice characteristics, and participated in 2 consecutive studies on caries diagnosis and treatment. The first study was a survey asking the dentist about how they diagnose and treat caries. The aims of this study were to: (a) quantify the percentages of DPBRN dentists who report using selected methods for caries diagnosis; (b) quantify the percentage of DPBRN dentists who report using a caries-risk assessment protocol of any variety; (c) quantify the percentages of DPBRN dentists who report intervening surgically at various caries depths. The second study was an observational clinical study collecting data during routine clinical practice on restorations placed due to caries on previously unrestored surfaces. The aims for this study were to: (a) quantify DPBRN PI preoperative and post-operative assessments of the depth of the caries lesion being treated; and (b) quantify the prevalence of dental material types used to restore the first restoration in a permanent tooth surface. The study recorded the main reason that the restoration was placed, the preoperative and postoperative depth of the caries lesion on the previously unrestored surface, and the type of dental restorative material that was used. PIs and their staff were trained
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by research coordinators regarding the protocol and data collection forms. The PIs recorded information about an average of 50 consecutive restorations that they placed on unrestored permanent tooth surfaces. The study collected data on 8,351 consecutive restorations inserted due to primary caries in 5,810 patients. We included only restorations placed due to caries lesions that were limited to the occlusal surface or the proximal surface. This resulted in a sample consisting of 3,001 restorations placed by 216 practitioners. Of these, 2,691 restorations placed by 205 dentists in 1,930 patients had complete data for both reported and actual depths, and were included in the current report. An adequate representation of PIs from all 5 main DPBRN regions was obtained: Alabama/Mississippi (AL/MS), Florida/ Georgia (FL/GA), HealthPartners and private practice dentists in Minnesota (MN), Permanente Dental Associates dentists (PDA) in Oregon/Washington, and Denmark, Norway, and Sweden (SK). These studies were approved by the respective Institutional Review Board (IRB) of all participating regions. Data collection process Data from the DPBRN enrollment questionnaire and 2 sequential crosssectional studies were used. The DPBRN enrollment questionnaire and the data collection forms for DPBRN Studies 3 (survey questions 30–34) and Study 4 (clinical data collection form) are provided as supplements to the publications section of the DPBRN website (http://www. dentalpbrn.org/users/publications/ Supplement.aspx). The first study had
PIs complete a survey on practice patterns in which photos of occlusal caries and radiographs of proximal caries in successive caries depth levels were presented. They were asked to indicate the caries threshold at which they would intervene surgically in 2 scenarios: high- and low-risk patients (Figure 1). The survey also asked about patient-level characteristics considered in making clinical decisions (active caries lesion, recent caries, several large restorations, current oral hygiene, presence of dental appliances, access to fluoride, diet, decreased salivary function, your subjective assessment of the patient, patient knowledge of caries progression, patient commitment to follow-up, age and socio-economic status). This question provided the patient-level variables described below. In a subsequent clinical study, PIs reported the pretreatment caries depth on 50 consecutive first restorations at which they restored a previously unrestored surface. Only proximal and occlusal caries were included in the current report. For the clinical study DPBRN clinicians were asked to estimate the caries lesion depth pre-operatively ([E1 (outer of enamel), E2 (inner of enamel), D1 (outer 1/3 of dentine), D2 (middle 1/3 of dentine), D3 (inner 1/3 of dentine]) by using whatever diagnostic methods (clinical assessments including probing, radiographs, transillumination or optical techniquesuch as Diagnodent were the options on the data collection form) they used. The surveys and data collection forms were pilot-tested to assess the feasibility and comprehension of each questionnaire item.
Figure 1. Relevant questions from the dentist survey.
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Figure 1. Continued
Variable selection Several variables were considered as possibly associated with discordance between reported and actual depths. Dentist demographics and practice characteristics (obtained from the
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enrollment questionnaire) included in the analysis were: gender, race, ethnicity, years since graduation, practice type (large group practice, public health clinic and small private practice), workload and use of caries risk assessment (yes/no response). Patient-level factors which could influence PIs’ treatment decisions
were also analysed. They included: patient’s age, gender, ethnicity, and dental insurance. Lesion characteristics considered were tooth type (molar, premolar, etc.) and the practitioner’s preoperative estimates of lesion depth. Restorative material (amalgam, composite resin, indirect composite resin, glass ionomer,
ceramic, cast metal, combined ceramic/metal or temporary restoration) and diagnostic methods were also tested for significant association with discordance.
of categorical predictor variables. Statistical significance of associations between underestimation (actual < reported) was evaluated using restoration-level analyses based on generalised estimating equation modelling to account for clustering due to multiple observations within practitioner and patient. Separate analyses were conducted for occlusal and for proximal lesions.
Statistical analysis Statistical analysis was conducted using SAS software version 9.2 (Cary, NC). Because only occlusal and proximal caries scenarios were included in the survey and only those resulted in reported caries threshold data, caries with other surface involvement were excluded from this analysis. To ensure an unbiased data set, caries on more than one tooth surface such as occlusal-proximal caries, were excluded from the analysis as well.
Results A total of 2,691 restorations placed by 205 dentists in 1,930 patients had complete data for both actual depths (clinical data) and paired reported responses (dentist’s response to the hypothetical scenario on the survey), and were included in these results. Most restorations were placed to treat lesions that had extended to a D1 (57.6%) depth, followed by D2 (24.2%), E2 (8.9%), D3 (6.7%), and E1 (2.6%). Of all the restorations with complete data on tooth type and surfaces with caries involvement, journal of dentistry 40 (2012) 248–254 39% were Class II, 32% were Class I,
Restored lesions were categorised as either ‘‘actual is less than reported’’ or ‘‘actual is greater than or equal to reported.’’ Unadjusted counts and percentages of actual depths that were less than the reported 252 depths were calculated for each level
16% Class III, and 2% were Class V restorations. Of these, 1,122 occlusal caries restorations and 1,569 proximal caries restorations were included in the current report. Table 1 summarises the relationship between actual and reported caries threshold by caries location. There is agreement or concordance between the reported and actual treatment for about 29% of occlusal and 36% of proximal caries. As previously stated, we were most interested in the discordance where dentists intervened with a restoration at actual caries depths less than reported depths. We found that this occurred for only about 2% of the restorations done to treat proximal caries, but for about 49% of the restorations done to treat occlusal caries. We examined several dentist and patient characteristics that were associated with discordance as shown in Table 2. Most of the variables were not significant in the multivariate model. We found a significant
Table 1 – Comparison between actual caries lesion depth at which a restoration was done compared to the depth reported during a hypothetical clinical scenario. Actual
Occlusal E1 E2 D1 D2 D3 Total Proximal E1 E2 D1 D2 D3 Total
Actual < Reported
Actual = Reported
Actual > Reported
N
%
N
%
N
%
52 139 352 5 0 548
96.3 81.3 55.4 2.3 0.0 48.8
2 29 199 90 2 322
3.7 20.0 31.3 40.7 4.9 28.7
0 3 84 126 39 252
0.0 1.8 13.2 57.0 95.1 22.5
54 171 635 221 41 1122
16 11 10 0 0 37
100.0 15.5 1.1 0.0 0.0 2.4
0 56 494 10 0 560
0.0 78.9 54.0 2.3 0.0 35.7
0 4 411 419 138 972
0.0 5.6 44.9 97.7 100.0 62.0
16 71 915 429 138 1569
discordance where dentists intervened with a restoration at actual caries depths less than reported depths. We found that this occurred for only about 2% of the restorations done to
Total
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Patient race was found to be marginally significant. Next we examined the choice of materials to restore the occlusal surface. We found that amalgam (vs. not using amalgam) was associated with actual not less than reported depth for occlusal surfaces ( p = 0.0007). Amalgam was used on 35% of lesions with actual less than reported, versus 44% of lesions for which actual was not less than reported. Direct resin was also associated with actual being less than reported ( p = 0.0005), being used on 62% of lesions with actual less than reported and 52% of lesions with actual not less than reported.
( p < 0.0001). Optical techniques were used infrequently and not found to be significant ( p = 0.0957).
4.
Discussion
The difference between providers’ perception of the treatment rendered and actual treatment is a well recognised and worthy problem in medicine and dentistry.32,37–39 Our findings are in line with current literature.
Table 2 – Dentist and patient characteristics ( p-values) as predictors of discordance between actual and reported depths. Proximal Univariate Dentist characteristics Gender Race Hispanic Years since graduated Type of practice Workload Caries risk assessment Patient characteristics Gender Race Ethnicity Dental Insurance Age * **
Block
Occlusal Final multivariate
Univariate
0.7382
0.1757 0.3780 0.2558 0.8743 0.0020 0.1233 0.0680
0.5467 *
0.5132 0.0677 0.5038 0.7940 0.7152
0.0677
0.3074 *
0.8825 0.0171 0.5362
0.0171
0.179
0.2987 0.0268 0.9576 0.4492 0.4865
Block
Final multivariate
0.0077
<0.0001**
0.3052
0.0268
0.0716
Estimation algorithm failed due to small cell frequencies. Large group practice vs. small private practice is significant.
association of practice type, with large group practice having a higher rate of discordance. Patient race was found to be marginally significant. Next we examined the choice of materials to restore the occlusal surface. We found that amalgam (vs. not using amalgam) was associated with actual not less than reported depth for occlusal surfaces (p = 0.0007). Amalgam was used on 35% of lesions with actual less than reported, versus 44% of lesions for which actual was not less than reported. Direct resin was also associated with actual being less than reported (p = 0.0005), being used on 62% of lesions with actual less than reported and 52% of lesions with actual not less than reported. In other words, direct resin is used more frequently in occlusal lesions that are restored at a lesser actual depth than reported. When we examined the diagnostic methods associated with discordance,
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we found that clinical assessments were not associated, being used in 92% of actual reported lesions and 93% of those not less than reported (p = 0.2036). Radiographs were associated with less discordance, being used in 42% of the restorations in which the actual depth was less than the reported depth, 54% of those not less than reported (p < 0.0001). Optical techniques were used infrequently and not found to be significant (p = 0.0957).
Discussion The difference between providers’ perception of the treatment rendered and actual treatment is a well recognised and worthy problem in medicine and dentistry (32,37-39). Our findings are in line with current literature. Our questionnaire included photographs for occlusal caries and
radiographs for proximal caries. Thus, part of the variation may be explained by the difference in the clinical estimation of caries depth through photographs provided in a survey and actual clinical examination. Radiographs are more readily duplicated with a high quality photograph. This is consistent with observing a larger concordance between reported and actual treatments for proximal caries. Most dentists use radiographs to diagnose proximal caries. The presence of radiographs for proximal caries in our survey coincides with the way PIs diagnose proximal caries in their daily practice and explains why a smaller percentage of dentists were discordant for these lesions. When dentists used radiographs to diagnose occlusal caries, the concordance was higher compared to when they relied on clinical examination only. These findings suggest that different diagnostic methods impact actual treatment decisions.
Material used to restore an occlusal surface was associated with the dentist’s decision to restore the surface earlier than predicted (21). Possibly the dentist sees a resin restoration as less damaging to the tooth surface and will be more comfortable making the decision to restore the occlusal surface when unsure of the actual depth of the caries lesion. An alternative explanation is that when the dentist removes the caries and the lesion is shallow, resin is more commonly selected to restore the tooth. Practice type was associated with the level of discordance for occlusal surfaces. When examining the reported data, dentists in large group practices report intervening on caries at later stages. This higher rate of discordance suggests that often is not the case. We also need to consider the possibility that large group practices see more new patients or patients who had been seen by another dentist. This may result in a different practice pattern because of uncertainty about current caries status. Ideally treatment decisions should reflect the oral and general health of the patient. Most literature in dentistry describes tooth, patient, dentist, and practice characteristics as important factors in treatment decisions (40-43). However, treatment pattern variations have been linked to many other factors, such as type of visit (emergency vs. non-emergency), dentist specialty status, patient preference, patient– dentist relation, and uncertainty of diagnosis or treatment outcomes
(40,44,45-48). It is possible that some of these factors also played a role in the difference between the reported caries treatment threshold and the clinical treatment provided but we were not able to measure them. The dentist and patient level factors included in our study were not statistically significant predictors of the underestimation of restorative caries threshold. These results also support the need for better diagnostic criteria that improve our ability to discriminate the caries depth and avoid unnecessary invasive treatment. This need is most apparent for occlusal caries.
References 1.
2.
3.
4.
5.
6.
Conclusion The decision regarding which caries lesion depth to intervene surgically is an important event in the life of a tooth. The substantial discordance between actual and reported depths for occlusal surfaces suggests the need for definitive diagnostic methods to improve consistency of clinical decisionmaking for these surfaces. Use of radiographs and other factors may explain this discordance. Acknowledgements This work was supported by NIH grants U01-DE-16746 and U01DE-16747. Persons who comprise the DPBRN Collaborative Group are listed at http://www.DPBRN.org/users/ publications. Opinions and assertions contained herein are those of the authors and are not to be construed as necessarily representing the views of the respective organisations or the National Institutes of Health.
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13. Bader JD, Shugars DA, Bonito AJ. A systematic review of selected caries prevention and management methods. Community Dentistry and Oral Epidemiology 2001;29:399–411. 14. Kidd EAM, Fejerskov O. Caries control for the individual patient. In: Fejerskov OK, editor. Dental caries. The disease and its clinical management. Oxford, UK: Blackwell Munksgaard; 2003. p. 303–12. 15. Yorty JS, Brown KB. Caries risk assessment/ treatment programs in U.S. dental schools. Journal of Dental Education 1999;63:745– 7. 16. Elderton R. Clinical studies concerning re-restoration of teeth. Advances in Dental Research 1990;4:4–9. 17. Anusavice KJ. Present and future approaches for the control of caries. Journal of Dental Education 2005;69:538–54. 18. Brantley CF, Bader JD, Shugars DA, Nesbit SP. Does the cycle of rerestoration lead to larger restorations? Journal of the American Dental Association 1995;126:1407–13. 19. Hayashi M, Fujitani M, Yamaki C, Momoi Y. Ways of enhancing pulp preservation by stepwise excavation – a systematic review. Journal of Dentistry 2011;39:95–107. 20. Neves Ade A, Coutinho E, De Munck J, Van Meerbeek B. Caries-removal effectiveness and minimal-invasiveness potential of caries-excavation techniques: a microCT investigation. Journal of Dentistry 2011;39:154–62. 21. Lubisich EB, Hilton TJ, Ferracane JL, Pashova HI, Burton B. Association between caries location and restorative material treatment provided. Journal of Dentistry 2011;39:302–8. 22. Dennison JB, Hamilton JC. Treatment decisions and conservation of tooth structure. Dental Clinics of North America 2005;49:825–45. 23. Shugars DA, Bader JD. Cost implications of differences in dentists’ restorative treatment decisions. Journal of Public Health Dentistry 1996;56:219–22. 24. Anusavice K. Clinical decision-making for coronal caries management in the permanent dentition. Journal of Dental Education 2001;65:1143–6. 25. Featherstone J, Domejean-Orliaguet S, Jenson L, Wolff M, Young D. Caries risk assessment in practice for age 6 through adult. Journal of the California Dental Association 2007;35:703–7. 26. The Swedish Council on Technology Assessment in Health Care: Caries – diagnosis, risk assessment and noninvasive treatment – a systematic review. http://www.sbu.se/upload/Publikationer/
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27.
28.
29. 30.
31.
32.
33.
34.
35.
36.
37.
38.
Content1/1/Caries_summary_2008. pdf;2008. Ito A, Hayashi M, Hamasaki T, Ebisu S. Risk assessment of dental caries by using classification and regression trees. Journal of Dentistry 2011;39:457–63. Neves AA, Coutinho E, De Munck J, Lambrechts P, Van Meerbeek B. Does DIAGNOdent provide a reliable cariesremoval endpoint? Journal of Dentistry 2011;39:351–60. Tan PL, Evans RW, Morgan MV. Caries, bitewings, and treatment decisions. Australian Dental Journal 2002; 47:138–41. Zadik Y, Levin L. Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription. Journal of Dental Education 2008;72:81–6. Domejean-Orliaguet S, Tubert-Jeannin S, Riordan PJ, Espelid I, Tveit AB. French dentists’ restorative treatment decisions. Oral Health and Preventive Dentistry 2004;2:125–31. Helminen SE, Vehkalahti M, Murtomaa H. Dentists’ perception of their treatment practices versus documented evidence. International Dental Journal 2002;52:71–4. Lewis DW, Kay EJ, Main PA, Pharoah MG, Csima A. Dentists’ stated restorative treatment thresholds and their restorative and caries depth decisions. Journal of Public Health Dentistry 1996;56:176–81. Gilbert GH, Williams OD, Rindal DB, Pihlstrom DJ, Benjamin PL, Wallace MC. The creation and development of the dental practice-based research network. Journal of the American Dental Association 2008;139:74–81. Makhija SK, Gilbert GH, Rindal DB, Benjamin P, Richman JS, Pihlstrom DJ, et al. Practices participating in a dental PBRN have substantial and advantageous diversity even though as a group they have much in common with dentists at large. BioMed Central Oral Health 2009;9:26. Makhija S. Dentists in practice-based research networks have much in common with dentists at large: evidence from The Dental PBRN. General Dentistry 2009;57:270–5. Palonen KP, Allison JJ, Heudebert GR, Willett LL, Kiefe CI, Wall TC, et al. Measuring resident physicians’ performance of preventive care. Comparing chart review with patient survey. Journal of General Internal Medicine 2006;21:226–30. Montano DE, Phillips WR. Cancer screening by primary care physicians: a comparison of rates obtained from physician selfreport, patient survey, and chart audit. American Journal of Public Health
1995;85:795–800. 39. Gilchrist VJ, Stange KC, Flocke SA, McCord G, Bourguet CC. A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits. Medical Care 2004;42:276–80. 40. Kay EJ, Nuttall NM. Relationship between dentists’ treatment attitudes and restorative decisions made on the basis of simulated bitewing radiographs. Community Dentistry and Oral Epidemiology 1994;22:71–4. 41. Grembowski D, Fiset L, Milgrom P, Forrester K, Spadafora A. Factors influencing the appropriateness of restorative dental treatment: an epidemiologic perspective. Journal of Public Health Dentistry 1997;57:19–30. 42. Brennan DS, Spencer AJ. The role of dentist, practice and patient factors in the provision of dental services. Community Dentistry and Oral Epidemiology 2005;33:181–95. 43. Gilbert GH, Bader JD, Litaker MS, Shelton BJ, Duncan RP. Patient-level and practicelevel characteristics associated with receipt of preventive dental services: 48-month incidence. Journal of Public Health Dentistry 2008;68:209–17. 44. Gordan VV, Bader JD, Garvan CW, Richman JS, Qvist V, Fellows JL, et al. Restorative treatment thresholds for occlusal primary caries among dentists in the dental practice-based research network. Journal of the American Dental Association 2010;141:171–84. 45. Bigras BR, Johnson BR, BeGole EA, Wenckus CS. Differences in clinical decision making: a comparison between specialists and general dentists. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology 2008;106:139–44. 46. Boykin MJ, Gilbert GH, Tilashalski KR, Litaker MS. Racial differences in baseline treatment preference as predictors of receiving a dental extraction versus root canal therapy during 48 months of followup. Journal of Public Health Dentistry 2009;69:41–7. 47. Brennan DS, Spencer AJ. Dentist preferences for patients: dimensions and associations with provider, practice, and service characteristics. International Journal of Behavioral Medicine 2006;13:69–78. 48. Mileman PA, van der Weele LT. The role of caries recognition: treatment decisions from bitewing radiographs. Dento-MaxilloFacial Radiology 1996;25:228–33.
TEXAS DENTAL ASSOCIATION 144TH ANNUAL SESSION
2014 TEXAS Meeting Photo Contest Photographer: Shannon Harmon Title: “A Whale of a Tail” Category: Black & White/Abstract/Artistic Information on the 2015 TEXAS Meeting Photo Contest will be available on texasmeeting.com in December 2014.
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531 7/30/14 11:06 AM
Provided by TDA Perks Program
value for your
profession
Credit-Card Processing Sales Calls: Separating Fact from Fiction By Jennifer Nieto; President, Best Card, LLC
B
est Card gets calls from dental offices all day long asking about intimidating credit-card processing related calls, voicemail messages, or faxes they receive. The intimidating calls are likely from marketers using underhanded tactics to solicit business. We tell offices an easy way to distinguish whether a call is from a marketer or from your processor is: ask the caller what your merchant number is. Your processor will know your merchant number; marketers won’t.
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In this article, I’ll cover some of the most common claims marketers make, and information that will enable you to separate credit-card processing fact from fiction.
“You need new equipment — your existing equipment isn’t EMV-ready.” If you hear this, ask the caller to tell you what equipment you have. If he doesn’t know, he isn’t your processor. How can you tell if your credit-card
processing equipment is EMV-ready or EMV-adaptable? Your terminal may be EMV-ready if there’s a slot on the front for card insertion (in addition to the magnetic card reader—where you slide a card through). Some terminals (with or without a slot) can be adapted to the EMV technology with the addition of an EMV pad. If you’d like help determining if your equipment is EMV-ready or adaptable, you can contact TDA Perks partner Best Card at 877-739-3952 or call your processor.
What does EMV refer to? EMV stands for “Europay, MasterCard® and Visa®.” “Smart” credit cards will contain EMV integrated-circuit (IC) “chip” technology—and eventually replace cards with a magnetic stripe that have been the standard in the United States since 1960. EMV IC technology uses dynamic data (versus static data contained in the magnetic stripe, which can easily be stolen these days). Its purpose is to reduce credit-card fraud and identity theft. Credit card issuers were supposed to begin issuing EMV chip cards in January 2013, but most delayed. (The target date for you to have EMV programmed equipment is now October 2015.) Many processors don’t have software enabled for EMV yet, but most will know which terminals will or will not be EMV-supported.
“You’re not PCI or HIPAA-Compliant.” You may or may not be PCI-compliant; only your processor will know. If the caller can provide you with your merchant number, ask him or her to help you log in to your PCI questionnaire and determine if you’re compliant. If you’re not, ask for help in becoming compliant. You may be charged a monthly fee of approximately $20 if you’re noncompliant. What is “PCI”? PCI stands for “Payment Card Industry.” Just as you need to review your HIPAA policy and procedures annually, you also need to recertify each year that you’re securing credit card information properly. If you use an online system, you generally also need quarterly scans of your IP address to ensure proper firewalls, antivirus protection,
etc. are in place. Also, be aware that if you’re using an online system and using Windows XP, you’re no longer PCI-compliant. Nearly all processors have a monthly or annual fee (most range $25-100 annually). However, recently some companies providing IP-address scans are stating that new HIPAAcompliance requirements mandate new procedures, and are charging $99 per month. You can call Lee Slaton of Smart Training (TDA Perks partner for OSHA and HIPAA compliance) at 469-342-8300 ext. 620 for further clarification of the September 2013 Omnibus bill relating to third-party notification requirements.
to when you swipe it. If you want to know more about a processor’s healthcare rates, ask it to email or fax its rate sheet to you (1). Very few will have something to send you; most simply want to get your statement. Some processors will slightly undercut the rates you’re paying and lock you into a long-term contract with high termination fees ($500+), monthly minimums, lost profitability clauses and leased equipment—and proceed to increase rates. Many have 3-year contracts with auto-renew clauses. However, some processors allow merchants to leave at any time for a low or $0 close fee.
In-depth information about PCI compliance for merchants can be found at: www.pcisecuritystandards. org/merchants/index.php
“I’m a Visa/MasterCard, etc. representative…”
More about HIPAA requirements can be found at: http://www.hhs.gov/ ocr/privacy/hipaa/administrative/ securityrule/techsafeguards.pdf
“You’re paying retail rates. You should be getting health care rates.” Any processor can say it offers “health care rates,” but all processors pay the same fees to card issuers based on the type of card presented. The only card issuer who structures its fees differently for dental practices (than with other businesses) is American Express. You can see the interchange fee schedules of the more than 1,200 types of credit cards at mastercard. com, visa.com, etc. Debit cards are the least costly, followed by credit cards, and finally rewards cards are most costly. You’ll also generally pay more when you key a card, as opposed
If you hear this line, you’re receiving a marketing call from a salesperson. These calls can be intimidating, because the caller would like you to believe he or she is a representative of Visa or MasterCard, and that you‘re in violation of something. Dental offices tell us they receive voicemails stating the practice must return their calls immediately because the practice’s equipment is not compliant with industry requirements. Some callers insist on speaking directly to the dentist regarding his/her merchant account “risk status,” which has “recently changed”—or is no longer eligible for “tier 1” prices. Many companies like to use genericsounding names (“Merchant Services” or “Private Client Center”) and, we’re told, imply they’re with an office’s current processor and state that updates are mandatory now. They’ve been known to tell TDA members they’ve taken over the region for Best Card (TDA Perks Program’s endorsed credit card processing company), Texas Dental Journal l www.tda.org l July 2014
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value for your
profession
and even claim they’re part of Best Card’s staff. Fortunately, the Federal Trade Commission is taking action. If you’ve received a call from a company claiming to be your present processor that you know is not genuine, please report improper activities. You can learn more at: http:// www.ftc.gov/enforcement/casesproceedings/132-3013/merchantservices-direct-llc-et-al. 1. As of April 2014, the average effective rate (total fees paid divided by total dollars processed) for TDA members
processing with Best Card was 2.084%. Jennifer Nieto is former associate executive director of finance for Colorado Dental Association and president of RJ Card Processing Inc. (d.b.a. Best Card, LLC)—TDA Perks Program’s endorsed credit card processor. TDA members save an average of 26% ($1,399 annually) in processing fees through Best Card. To receive a rate sheet, please call Best Card at: 877-739-3952. Receive a complete and confidential cost comparison by sending a recent
Those in the dental community who have recently passed
to the Texas Dental Association Smiles Foundation
Dr Wilfred D Whiteside Corpus Christi Dental Study Group Nueces Valley District Dental Society Dr L.M. Bayouth Sr Seventeenth District Dental Society
Dr Billy Raye Clitheroe Ms Sandy Blum Denton & Delaine Baucum Dr Kurt Loveless Dr Randell Johnson Dr Kurt Loveless
For more information regarding this and other TDA Perks Program, please visit tdaperks.com, or call 512-4433675.
In MEMORIAM
MEMORIAL and HONORARIUM Donors IN MEMORY OF:
credit card processing statement via fax or email to: 866-717-7247 or CompareRates@BestCardTeam.com. Receive a $100 sign-up bonus your third month with Best Card. Or apply the cash toward new EMV-supported equipment or an online system. Offer expires in 60 days, and is prorated if processing is less than $8,000/month.
Wilfred D Whiteside Jr
Corpus Christi, Texas October 16, 1931 – May 26, 2014 Good Fellow: 1984 • Life Member: 1997 • 50 Year: 2004
LaNoard Murad Bayouth
Stamford, Texas February 29, 1936 – June 8, 2014 Good Fellow: 1998 • Life: 2002
James Andrew Moye
Houston, Texas November 10, 1928 – June 7, 2014 Good Fellow: 1984 • Life: 1993 • 50 Year: 2009
Stanley Le Roy Wendt
Your memorial contribution supports: • •
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
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Texas Dental Journal l www.tda.org l July 2014
Llano, Texas January 10, 1921 – October 21, 2013 Good Fellow: 1979 • Life: 1986 • 50 Year: 2003
David W Jackson
Royse City, Texas August 27, 1950 – June 24, 2014 Good Fellow: 2003
Texas Dental Journal l www.tda.org l July 2014
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Oral and Maxillofacial Pathology Diagnosis and Management
Inflammatory Myofibroblastic Tumor Oral and Maxillofacial Pathology Case of the Month (from page 504)
Discussion Inflammatory myofibroblastic tumor (IMFT) is a rare neoplasm of low-grade malignant potential which involves visceral organs and soft tissue (1-7). This lesion was originally believed to represent an inflammatory reactive process and has been reported under a variety of names including “inflammatory pseudotumor” and “plasma cell granuloma.” It is now recognized that these tumors have clonal cytogenetic rearrangements of the ALK (anaplastic lymphoma kinase) oncogene on chromosome 2p23 and therefore, represent true neoplasms. The ALK gene encodes a tyrosine kinase receptor which is rearranged with a variety of other gene partners resulting in cellular proliferation. The most common sites of occurrence for IMFT are the mesentery, omentum, retroperitoneum, pelvis, and abdomen (1). Cases have also been reported in a wide variety of other anatomic sites including the lung, head and neck, somatic soft tissue, gastrointestinal tract, uterus, bladder, pancreas, central nervous system, and heart (1, 2). Cases involving the head and neck region include the larynx, oral cavity, tonsil, parapharyngeal space, sinonasal tract, salivary glands, and trachea (3). Involvement of the oral cavity is
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very uncommon. While most tumors are solitary, multiple nodules may be present. These tumors have ranged in size from 1 to 20 cm (1). IMFT can occur across a broad age range but is most common in children and young adults with a mean age of 10 years (1). Overall, there is a slight female gender predilection. Presenting symptoms are usually related to the presence of a mass lesion and vary according to the anatomic site. The duration of symptoms is usually short, ranging from days to a few months. Patients may present with pain. In one-third of cases, patients have associated systemic constitutional symptoms of fever, night sweats, malaise, and weight loss (1). Clinical laboratory abnormalities including microcytic hypochromic anemia, thrombocytosis, polyclonal hypergammaglobulinemia, elevated sedimentation rate, and elevated C-reactive protein may also be present. These findings may be mediated by the release of inflammatory cytokines. This paraneoplastic syndrome typically resolves following excision of the tumor, but may return with tumor recurrence. IMFT consists of a variably loose myxoid to cellular spindled fascicular proliferation of myofibroblasts
with admixed inflammatory infiltrate consisting predominantly of lymphocytes, plasma cells and eosinophils. The tumor cells do not typically display significant cytologic atypia. Variable mitotic activity may be present but no abnormal mitoses are seen. Sclerotic areas of fibrosis, calcification, and reactive bone formation may be present. Necrosis is uncommon. Immunohistochemistry demonstrates that the myofibroblasts are variably positive for myoid markers including smooth muscle actin, muscle specific actin and desmin. Variable staining for cytokeratin may be present. Approximately 50-60% of tumors will show positive cytoplasmic staining for ALK (1). A histologic differential diagnosis would include nodular fasciitis, myofibroma, pyogenic granuloma, fibroproliferative lesions, and other spindle cell sarcomas. With expression of cytokeratin, and occurrence of IMFT in head and mucosal sites, spindle cell squamous carcinoma should also be excluded. The treatment for IMFT is conservative surgical resection. The recurrence rate for extrapulmonary lesions is 25% (1). Reexcision of the recurrent tumor is usually curative. Partial tumor regression has been reported with the use of corticosteroids and non-steroidal
anti-inflammatory drugs. However, surgery remains the primary treatment modality. IMFT may rarely behave in an aggressive fashion. This is particularly true for a subgroup of tumors with the RANBP2-ALK fusion gene rearrangement and tumors involving the abdomen and retroperitoneum. Distant metastasis to the lung, central nervous system, liver, and bone may rarely occur and result in the death of the patient. Chemotherapy, radiation, and an ALK tyrosine kinase inhibitor (crizotinib) have also been utilized for the management of aggressive IMFT (6). The clinical and histologic features of IMFT are not reliable predictors of biologic behavior and prognosis.
Ji T. Zhang CP. Li J. Wang LZ. Li RR. Sun J. Ma CY. Oral Oncology. 48 (2):141-8, 2012 Feb. 5. Inflammatory myofibroblastic tumors of the head and neck: evaluation of clinicopathologic and prognostic features. Devaney KO. Lafeir DJ. Triantafyllou A. Mendenhall WM. Woolgar JA. Rinaldo A. Ferlito A. European Archives of Oto-RhinoLaryngology. 269 (12): 2461-5, 2012 Dec. 6. Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features
including ALK expression in atypical and aggressive cases. Coffin CM. Hornick JL. Fletcher CD. American Journal of Surgical Pathology. 31(4):509-20, 2007 Apr. 7. Crizotinib in ALK-rearranged inflammatory myofibroblastic tumor. Butrynski JE. Dâ&#x20AC;&#x2122;Adamo DR. Hornick JL. Dal Cin P. Antonescu CR. Jhanwar SC. Ladanyi M. Capelletti M. Rodig SJ. Ramaiya N. Kwak EL. Clark JW. Wilner KD. Christensen JG. Janne PA. Maki RG. Demetri GD. Shapiro GI. New England Journal of Medicine. 363(18):1727-33, 2010 Oct 28.
The patient reported in this case underwent a clinical staging workup without evidence of disseminated disease. A conservative reexcision of the biopsy site was performed. The patient is now being followed closely and is currently alive and well without evidence of disease. References 1. Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F. WHO Classification of Tumours of Soft Tissue and Bone. 4 Ed. WHO Press, Geneva, 2013: 83-84. 2. Goldblum JR, Folpe AL, Wiess SW. Enzinger and Weissâ&#x20AC;&#x2122;s Soft Tissue Tumors, 6th Ed. Elsevier, Philadelphia, 2014: 304-310. 3. Wenig BM. Atlas of Head and Neck Pathology, 2nd Ed. Saunders/Elsevier, Philadelphia, 2008: 454-458. 4. Head and neck inflammatory myofibroblastic tumor (IMT): evaluation of clinicopathologic and prognostic features. Ong HS. Texas Dental Journal l www.tda.org l July 2014
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CALENDAR OF EVENTS SEPTEMBER2014
OCTOBER2014
8-13
9-14
12-13
18-19
20
19-22
538
The American Association of Oral and Maxillofacial Surgeons presents its 96th annual meeting at the Hawaii Convention Center in Honolulu, HI. For more information, please contact Dr Robert C. Rinaldi, AAOMS, 9700 W Bryn Mawr, Rosemont, IL 60018; Phone: 847-678-6200; Fax: 847-678-6286; Email: inquiries@aaoms. org; Website: aaoms.org. The Texas Academy of General Dentistry will hold the Lone Star Dental Conference in Austin. To register, or for more information, please visit tdagd.org. The El Paso Dental Conference will be held at the El Paso Convention Center. To register, or for more information, please visitelpasodentalconference.org. The TDA Smiles Foundation will hold a 20-chair, 1-day Texas Mission of Mercy in Fort Stockton. For more information, please contact Foundation Manager Judith Gonzalez at TDASF, 1946 S IH 35 Ste 300, Austin, TX 78704; Phone: 512-448-2441; Email: judith@tda.org; Website: tdasmiles.org. The American Academy of Periodontology presents its annual meeting in San Francisco, CA. For more information, please contact Mr John Forbes, AAP, 737 N Michigan Ave Ste 800, Chicago, IL. Phone: 312-787-5518: Fax: 312-787-3670; Email: aap-info@perio.org; Website: perio.org.
Texas Dental Journal l www.tda.org l July 2014
12
The American Dental Association presents its annual meeting at the Henry B. Gonzalez Convention Center in San Antonio, TX. For more information, please visit ada.org. The ADA will host a Mission of Mercy dental clinic in San Antonio, in conjunction with the annual meeting, to treat local residents without access to care. For more information, please visit ada.org.
DECEMBER2014 5-6
8-9
12-13
The Southwestern Society of Pediatric Dentistry hold their 2014 2-day CE meeting at the Westin Galleria in Dallas. For more information, please visit aapd.org. The ADA’s Institute for Diversity in Leadership will meet at the ADA Headquarters in Chicago. For more information, please visit ada.org. The ADA’s Council on Ethics, Bylaws, and Judicial Affairs (CEBJA) will meet. For more information, please contact Mr Earl Sewell at ADA, 211 E Chicago Ave, Chicago, IL 60611; Phone 312-440-2499; Website: ada. org.
THE TEXAS DENTAL JOURNAL’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.
SEPTEMBER2014 8-13
The American Association of
Oral and Maxillofacial Surgeons presents its 96th annual meeting at the Hawaii Convention Center in Honolulu, HI. For more information, please contact Dr Robert C. Rinaldi, AAOMS, 9700 W Bryn Mawr, Rosemont, IL 60018; Phone: 847678-6200; Fax: 847-678-6286; Email: inquiries@aaoms.org; Website: aaoms.org.
12-13
The Texas Academy of General Dentistry will hold the Lone Star
18-19
meeting in San Francisco,7-10 CA. For
more information, please contact Mr John Forbes, AAP, 737 N Michigan Ave Ste 800, Chicago, IL. Phone: 312787-5518: Fax: 312-787-3670; Email: aap-info@perio.org; Website: perio. the 20 15 org.
TEXAS
MEETING OCTOBER2014 Dr Edward Pat Allen
Dr George Merijohn
9-14 The American Dental Association Dr George Bambara Ms Diane Millar presents its annual Dr Lynne Brock Dr John meeting Molinari at
Dr Lee Ann Brody Brannon Convention Moncrief the Henry B. Mr Gonzalez Ms Leslie Canham Mark Murphy Center in SanDrAntonio, TX. For more Dr Paul Child
Dr Dolphine Oda
Dr Harold Crossley
Dr Ray Padilla
please visit www.tdagd.org.
Ms Nancy Dewhirst
Dr Edwin Parks
The El Paso Dental Conference Convention Center. To register, or for more information, please visitelpasodentalconference.org.
Periodontology presents May its annual
register, or for more information,
will be held at the El Paso
20
The American Academy of
The TDA Smiles Foundation will
2015 Speakers
Dental Conference in Austin. To
19-22
information, please visit ada.org.
Dr Terry Donovan JoeaPiscatella 12 The ADA will Mr host Mission of
Dr A. Scott Douglas Stephen PossAntonio, Mercy dentalDrclinic in San Dr Robert Fazio
Dr Ron Prehn
Dr Greg Folse
Dr David Rothman
in conjunction with the annual
meeting, to treat localSavage residents Mr Mike Gergen Dr Rhonda
Ms Eva Grayzel Ms to Laurie Semple without access care. For more Dr Henry Gremillion
Lee Silverstein information, Dr please visit ada.org.
Ms Susan Gunn
Ms Gene St Louis
Ms Lisa Harper Mallonee
Mr Jeff Staads
Dr Van Haywood
Dr Geza Terezhalmy
Ms Nicki Henson
Mr Duane Tinker
Dr Frank Higginbottom
Ms Lori Trost
hold a 20-chair, 1-day Texas Mission
THE TEXAS DENTAL JOURNALâ&#x20AC;&#x2122;S CALENDAR will include
of Mercy in Fort Stockton. For
only meetings, symposia, etc.,Ms of statewide, national, Ms Janice Hurley-Trailor Anastasia Turchetta
more information, please contact Foundation Manager Judith Gonzalez at TDASF, 1946 S IH 35 Ste 300, Austin, TX 78704; Phone: 512448-2441; Email: judith@tda.org; Website: tdasmiles.org.
and interest to Texas dentists. Because of Msinternational Theresa Johnson Dr Chuck Wakefield space limitations, education courses Dr Doug Lambertindividual continuing Ms Gail Williamson will be listed. Readers are Dr directed to the monthly Msnot Jeanine Lehman John Wright advertisements of courses thatMrappear elsewhere in the Dr Robert Margeas Gary Zelesky Journal. Ms Judy Kay Mausolf
...and many more!
Ms Sally McKenzie
texasmeeting.com Texas Dental Journal l www.tda.org l July 2014
539
ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ABBEVILLE DENTISTRY: We are seeking an honest, hardworking, patient focused dentist who wants 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, we offer 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 a new, interactive, fun environment that kids and their parents will find refreshing and exciting. If you’d like to talk about this opportunity, please give me a call. I’d be happy to share the vision, the success and
ADVERTISING BRIEF INFORMATION SUBMISSION AND CANCELLATION DEADLINE: 20th, 2 months prior to publication (eg, November 20th for January issue) 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.
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the expectations we have while answering your questions candidly and openly. I hope you’ll consider this position and give me a call. Britt Bostick, DDS. 806-438-5745 or email bbost35821@aol.com. ABILENE: 2- to 4-operatory stand-alone dental office with all equipment included; digital x-ray and pano. Call 325-7620444. ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS AREA: 5 general dentistry practices available (East Dallas, Richardson, Southeast of Dallas, and north of McKinney). FORT WORTH AREA: 2 general dentistry practices (West Fort Worth and Arlington). NORTH TEXAS: 2 pediatric practices. HOUSTON AREA: 1 orthodontic practice. EAST TEXAS AREA: 1 general dentistry practice. WEST TEXAS AREA: 1 general dentistry practice. AUSTIN AREA: 1 general dentistry practice available northwest of Austin. BRYAN/COLLEGE STATION AREA: 1 general dentistry practice available. SAN ANTONIO AREA: 1 general dentistry practice available. OKLAHOMA AREA: 1 general dentistry practice available. For more information and current listings, please visit our website at www.adstexas.com or call ADS Watson, Brown & Associates at 469-222-3200. ALLEN: We are a privately-owned Allen practice looking for a FT Associate to work 4 days a week. Someone with 5 years experience in general dentistry. We focus on family, cosmetic and implant dentistry. The goal is quality, not quantity. Newer building with state of the art equipment, technology, and 4 operatories finished out. Great earning potential with our PPO patient base. If you are interested in becoming a long-term part of a wonderful community with great families, this is the office for you. Please email your cover letter and resume to info@allentexasfamilydental. com. AMARILLO: General 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 Britt Bostick, DDS, bbost35821@aol.com or call 806-438-5745. 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 Britt Bostick, DDS, bbost35821@aol.com or call 806-438-5745. AMAZING PRACTICE OPPORTUNITY IN NORTH DALLAS: Sherri L. Henderson & Associates, LLC has acquired a periodontal practice & building for sale in Canyon Creek Professional Plaza. This is a great location for a general dentist practice group or various specialty professionals. It is perfect for a practice merger or someone needing to
relocate to a larger space. The periodontist is willing to stay on as an associate specialist or move on. The space available is approx. 4,500 sq ft. The space includes 8 unique, large, private treatment rooms; x-ray units in all rooms; private doctor office; administrative private office; 2 large consultation rooms; very large front desk area; beautiful, open reception area with great natural skylights; and ample parking. This is a very busy, high-traffic building complex totalling 9,000 sq ft. The other half of the building is owned by another dental group, and the common area space includes a dental lab that could be beneficial for both sides. For more information, contact Sherri at (972) 562-1072 or email sherri@slhdentalsales.com. Listing #3002. Photos available.
DDR Dental Trust
Serving Texas Dentists for more than 40 Years
• Practice Appraisals • Practice Sales • Associate Agreements
800-930-8017
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ADVERTISING BRIEFS ARLINGTON / FORT WORTH: Associate position available. Full time dentist and specialist needed to join our successful dental group in Arlington and Fort Worth. Interested candidates should email CV to txdentaljobs@gmail.com. ASSOCIATE FOR TYLER GENERAL DENTISTRY PRACTICE: Well-established general dentist in Tyler with over 34 years experience seeks a caring and motivated associate for his busy practice. This practice provides exceptional dental care for the entire family. Our office is located in beautiful East Texas and provides all phases of quality dentistry in a friendly and compassionate atmosphere. The practice offers a tremendous opportunity to grow. The practice offers excellent production and earning potential with a possible future equity position available. Our knowledgeable staff will support and enhance your growth and earning potential while helping create a smooth transition. Interested candidates should call 903-509-0505 and/or send an email to steve.lebo@sbcglobal.net. ASSOCIATE NEEDED FOR DENTAL OFFICE in small, quaint town. Potential for practice purchase. 361-645-8148. ASSOCIATE/BUY-IN PRACTICE OPPORTUNITY IN GOLDEN TRIANGLE AREA OF TEXAS. Fee-for-service private practice seeking a dentist with goals to own a well-respected practice. Patient flow currently accommodates 2 dentists and 2 full-time and 1 part-time hygienists. Practice philosophy is focused on compassionate care with the highest quality dentistry while building relationships on mutual trust and respect. Attractive office in professional complex. Private only, no corporations. Please email curriculum vita and purpose for interest to cathaustin@ mcfallmanagement.com. AUSTIN: Progressive, patient-centric office is seeking an experienced dentist; must be friendly, caring and professional. Opportunity is available (if desired) for practice ownership. Serious inquiries email: fahoosha@ gmail.com, mike@miloinc.com.
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AUSTIN PEDIATRIC PRACTICE SEEKING FULL TIME ASSOCIATE: Great benefits! Progressive, fast-paced practice. Capable, caring staff. We are looking for a bright career-oriented pediatric dentist to join an organization committed to providing high quality dental care to children and adolescents. Our dental team strives to offer exceptional care with integrity. For consideration send your confidential resume to dentalresume27@yahoo.com. AUSTIN PRIVATE PRACTICE SEEKS ASSOCIATES (GPs, Prosthodontists) due to growth and increased capacity. Excellent compensation / benefits. Email resume to operations@omnidentalgroup.com or call 512-773-9239. AUSTIN, CEDAR HILL, CONROE, DENTON, THE WOODLANDS, AND SAN ANTONIO: Pacific Dental Services and its supported owner dentists have exciting associateship opportunities in Austin, Cedar Hill, Conroe, Denton, The Woodlands, and San Antonio, TX. Practices are uniquely named (ie, Spring Creek Dental Group) and owned by general dentists who make all clinical decisions in a traditional, private-practice setting while PDS provides the business support services. Associates see 12 to 13 patients a day in a PPO/FFS setting (no Medicaid). Practices are state-of-the-art, fully digital, and equipped with Cerec CAD/ CAM 4.0, lasers, and intra-oral cameras. Focus on quality, long-lasting dentistry with a career path to ownership and emphasis on continued learning. Exciting comp. package with full benefits, CE, malpractice insurance and partnership/ownership opportunities. To learn more, please email rooneya@pacden.com. AUSTIN, SAN ANTONIO & DALLAS AREA PRACTICE OPPORTUNITIES MCLERRAN & ASSOCIATES: CORPUS CHRISTI AREA (ID # T238): This established, fee-for-service general family practice is located in a single story professional complex with excellent visibility off of a major thoroughfare. The practice has five fully equipped and computerized operatories with digital x-ray. The practice boasts consistent gross collections in the mid-6 figures annually, strong cash flow, a committed and well-trained
ADVERTISING BRIEFS staff, strong hygiene recall and a solid fee for service patient base. This is a turnkey practice with strong growth potential. CORPUS CHRISTI AREA (ID #T231): This is an opportunity to purchase an established, general dentistry practice located on the South Coast of Texas in an area that is experiencing rapid growth as a result of oil drilling in the nearby Eagle Ford Shale. The practice has a large, fee for service/PPO patient base, strong new patient flow, consistent annual revenue in the mid-6 figures, and solid cash flow. The office occupies a free-standing building with 2 fully equipped operatories (digital X-ray units and computers) and ample room to add 2-3 additional operatories. The real estate is owned by the seller and being offered for sale at fair market value. Given its close proximity to the Gulf of Mexico, this turnkey practice is an ideal opportunity for an avid fisherman/outdoorsman or beach lover. SOUTH OF SAN ANTONIO (ID #T235): This established general dentistry practice is located on a main thoroughfare in a quaint, rural town located approximately 90 miles southeast of San Antonio. This practice is in a high growth, low competition area in the Eagle Ford Formation. The practice has realized consistent annual revenue of six figures the past two years while maintaining low overhead, strong profitability of 50%, and solid new patient flow (currently averaging 27 new patients per month). The office space of the practice encompasses 1,200 square feet and has 3 fully equipped operatories with digital X-ray units and computers (one additional plumbed operatory for expansion). The building is also being offered for sale. SAN ANTONIO (ID #T244): This established, general family practice is located in a newly built-out facility located in a vibrant, high traffic retail location in a desirable area of San Antonio. The practice caters to a middle to upper middle income, fee for service/PPO patient base and boasts a strong new monthly patient count as a result of strong patient referrals, online marketing, and a highly visible location. This truly is a one of a kind location in a great area of San Antonio. HILL COUNTRY NORTH OF SAN ANTONIO (ID #T243): Doctor is retiring and selling this established quality general family practice and the building/real estate that is located in desirable hill country community within
close proximity to San Antonio. The practice has seen consistent collections of approximately mid-6 figures per year over the past three years with strong cash flow. The practice caters to a fee for service/PPO, middle class patient base and boasts strong new monthly patient flow with limited external marketing. The real estate will be sold at Fair Market Value as determined by an independent appraiser. WEST OF SAN ANTONIO (ID #T242): This established, fee-for-service general family practice was started from scratch in 1970 and has been in its current location for 28 years. The practice boasts a large active patient base, strong hygiene recall program, and excellent net cash flow after expenses. There is tremendous upside potential due to limited external marketing, no involvement in discounted insurance plans, a good amount of specialty work being referred out, and huge growth related to the Eagle Ford shale oil boom. This practice presents an
Top Associateships WE HAVE ASSOCIATESHIPS FOR EVERYONE > High revenue, high income practices > Solo private practices > Small/Medium Texas and regional groups > Public Health > Medicaid and kids practices > Correctional care positions with good salary + benefits > Native American Health Center positions For the past 12 years, AJ Riggins has been placing dentists in permanent jobs with dental practices and organizations in all parts of Texas. Based in Dallas, we have our finger on the pulse of the Texas market.
AJ Riggins Health Search www.ajriggins.com 1-972-943-5773
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ADVERTISING BRIEFS excellent opportunity for someone who wants to get away from the San Antonio city life, while still having access to its amenities. SAN ANTONIO (ID #T240): This established, fee-for-service general family practice is located in a professional building in a highly visible location on San Antonioâ&#x20AC;&#x2122;s north side. The practice boasts a 100% fee for service patient base with consistent gross collections in the mid-6 figures annually. The practice has four fully equipped operatories, with a fifth plumbed, and is computerized, has digital x-rays and a CEREC. This is an excellent opportunity with strong growth potential. SAN ANTONIO (ID #T239): A thriving multi-office pediatrics practice in the Seguin/San Marcos area is seeking a full time associate to work between both locations. Both facilities are state-of-the-art, featuring 12 treatment areas and the latest amenities, including a movie theater, arcade, ceiling mounted televisions, and toddler play areas. Both offices are designed for high volume patient flow, as they see an average of over 100 patients each day. The patient base reflects the local blue-collar and educational communities. There is a mix of insurance, self-pay and state funded patients. The offices provide a full range of pediatric dental services and have very active sedation general anesthesia schedules. The associate doctor must be a graduate of a US dental school and hold a US pediatric dental training certificate. Spanish speaking is highly desired but not required. To learn more about this associate opportunity, please contact us at 512-900-7989 or texas@dental-sales. com. Please also send a current CV. SAN ANTONIO (ID #T218): This general family practice on the northwest side of San Antonio, just outside of loop 410, is located in a high traffic retail location and presents a unique opportunity to attract and retain patients. The practice is located in a turn-key, seven operatory (six equipped) office, boasts an active patient base of approximately 1,400 patients, and an average of approximately 100 new patients per month. The practice has collected in the mid-high-6 figures the last twelve months with strong cash flow. This is an excellent opportunity with tremendous upside potential. Priced to sell! SAN ANTONIO (ID #T181): This general, family practice is located in West/Central San Antonio and boasts a
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large, PPO/Medicaid patient base with roughly 50 new patients being seen per month. This turnkey office is paperless and computerized, has four fully equipped operatories with recently updated equipment, and provides room for expansion. The practice has seen consistent annual revenue in the mid-6 figures over the past few years with strong net cash flow. This is an ideal solo practice or satellite office with tremendous upside potential. KILLEEN/ HARKER HEIGHTS AREA (ID #T245): This general family practice is located about an hour north of Austin in a large free standing building with excellent visibility. It has 8 plumbed and equipped operatories, with an opportunity to add a total of 4 additional treatment rooms. This practice has a fee-for-service/PPO patient base and has consistent annual revenue of seven figures with strong net income. It boasts an incredibly strong hygiene recall program, large monthly new patient count, a well-trained and committed staff, and turn-key facility. The real estate is owned by the seller and is being offered for sale at fair market value. This is an excellent opportunity with tremendous upside potential. AUSTIN (ID #T241): This is an opportunity to purchase a growing practice in the rapidly developing area of East Austin. The office is situated directly on a busy street and has excellent signage and visibility. The facility has a quality build-out and 4 fully equipped operatories with computers and digital radiography. The practice has healthy new patient flow, low overhead, and tremendous upside potential. This is a great starter practice or satellite location. HILL COUNTRY WEST OF AUSTIN (ID #T236): This predominately fee-for-service general family practice is located in a desirable community in the heart of the Texas Hill Country. It boasts a great reputation and has been in its current location since 1980. The office has 3 fully equipped operatories, with the ability to add an additional operatory. There is a strong opportunity for growth, as the owner is not actively marketing the practice, does not participate in any PPOs and is referring out a fair amount of specialty procedures. The practice has a strong foundation of active patients with a good amount of upside potential. This is an excellent opportunity for someone who enjoys the beautiful Hill County and wants to get away from the big city. AUSTIN
ADVERTISING BRIEFS (ID # T222): This is a unique opportunity to purchase a practice located in a busy retail center in Austin. The practice is ideal for a doctor or company looking for a large facility to establish a multiple doctor and hygienist office for less than the cost of building out a shell space and equipping a startup. The practice has a total of 18 plumbed operatories with 6 operatories currently equipped. The practice revenue was on pace to be around the mid-6 figures in 2013 with only one doctor producing. Serious inquiries only as this is a unique opportunity not suited for most solo practitioners looking to acquire a practice. CENTRAL AUSTIN (ID #T225): Located in a very desirable area of north central Austin, this established fee for service general family practice offers a lot for an incoming dentist. The practice is located in a 1,500 square foot, 4-operatory facility within a small two story professional condominium building. The practice boasts a committed and well-trained staff, strong hygiene program, solid active patient base and gross annual revenues averaging in the mid-6 figures over the last 3 years. While the practice is a strong opportunity “as-is” an incoming owner doctor would have ample opportunity to grow the practice given that the current owner is not accepting any PPOs, relies only on word-ofmouth referral to generate new patient flow and is referring a significant amount of specialty work out of the office. Contact McLerran & Associates: David McLerran or Brannon Moncrief in Austin 512-900-7989, San Antonio 210-7370100. Practice sales, appraisals, buyer representation, and lease negotiations. To request more information on our listings, register at www.dental-sales.com. AUSTIN: A busy pediatric dentistry office in Austin is looking to add a general dentist. Please submit a resume via email to tal@austinchildrensdentistry.com. AUSTIN: A well-established pediatric practice is seeking an energetic dedicated full-time pediatric dentist. We have an extensive client base with continued growth. Our office is a leader in all aspects of pediatric dentistry including sedation and anesthesia dentistry. We have 3 offices with state-of-the art technology and a highly trained support
staff. We are looking for the right fit for our practice. Ideally, someone who is looking for a long-term opportunity. New grads are welcome to apply. Please email resume to tal@ austinchildrensdentistry.com. AUSTIN: Multi-specialty practice in north central Austin is looking for an endodontist twice a month. This could increase to more days soon. The office is a provider for PPO/Cash patients only, no HMO or DMO. The reimbursement is the higher of the 2 4-figures per day or 40% production. Please forward your resume to info@ austin-dentistry.com. AUSTIN: My Kid’s Dentist has an excellent opportunity for a pediatric dentist to work 10 days a month in our Austin offices. Contact Ed at 949-842-7936 or email CV to looname@pacden.com for more information. AWESOME PRACTICE IN EAST TEXAS FOR SALE: SLH is looking for a qualified associate or new graduate, with an option to buy, that would like the opportunity to immediately transition into a general dentistry practice in this growing town of East Texas. The owner is willing to stay for a negotiated amount of time if necessary to ensure a smooth transition. The location of the practice is near the hospital in a beautiful scenic area surrounded by many professional buildings. The staff is excited and ready for a new member and future owner that will allow their current dentist to pursue other opportunities. The office space is 1,500 square feet with 4 treatment rooms equipped, 2 private offices, and 6 highly experienced employees. The new practitioner will lease space from the group dental practice. The group practice occupies a portion of the building complex and is looking to transfer ownership of the patient base and/or equipment within 6 months. Listing #3050 CB. Pictures can be made available. For more information contact our office at 972-562-1072 or email sherri@slhdentalsales.com or visit our website at www. slhdentalsales.com.
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ADVERTISING BRIEFS COLORADO DENTAL PRACTICE FOR SALE. Located in southwest Colorado near the San Juan mountains. Ski, fly fish, hike, and hunt. It’s all in your backyard. Established fee-for-service restorative practice with state-of-theart equipment and furnishings is waiting for you in this mountain town community. Collecting mid-6 figures with the potential to do way more. Owner is relocating to pursue a new phase in his dental career. Get out of the Texas heat and the rat race and enjoy real living again. Practice is attractively priced to sell. Email inquiries to t1h2oyd3@ yahoo.com.
consideration, please email your CV and availability to cv@ erdentist.com.
DALLAS / RICHARDSON: Established Richardson Dental practice for sale. Established 1983 in a professional office complex with 1,220 sq ft and 3 existing treatment rooms. Practice primarily serves 55+ aged families and is surrounded by multiple nursing and long-term care facilities, Methodist Richardson Medical Center, as well as the Richardson Senior Center. Also located just 1 mile from University of Texas at Dallas campus. Will need individual with ability to market and grow gross receipts as present owner has chosen to work part-time hours for several years. As such, this location could make a good area for a satellite practice or start-up. Very Attractive selling price. For more information, contact dantcarrier@yahoo.com.
DDR DENTAL — SOUTHWEST HOUSTON (FONDREN): General practice. High-7 figure gross with mid-high-6 figure net income. Four fully-equipped operatories on small inexpensive footprint. Well-established patient base. Contact Chrissy Roehm Dunn at 800-930-8017 or view the practice at DDRDental.com.
DALLAS AREA: New and beautiful general dentistry practice on I-30 near Rockwall. Over 5 years of clinical experience required. Perfect for dentists who refer endo! Pay based on collections. PPO and Medicaid accepted. M-F 2:00 PM - 8:00 PM and Saturdays available. Visit www. mockingbirddentalgroup.com. DALLAS TOLLWAY & LBJ: Dentists needed part-time and full-time for new, extended-hours, high production, treatment-oriented practice opening just prior to Memorial Day. Must be comfortable with most molar endo and wisdom tooth extraction cases. Implants experience a huge plus. Plenty of C&B. Dentures also an opportunity. 1099 contract position with generous commission. For immediate
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DDR DENTAL — AUSTIN: General practice. Well-established Austin practice in terrific north Austin location. Well designed and decorated office. Fronts high-traffic Hwy 182. Four operatories in use and plumbed for 4 more. Mid-6 figure gross and high net income. Free-standing building also available for sale. Contact Chrissy Roehm Dunn at 800-930-8017 or view the practice at DDRDental.com (DDR Dental Trust Member).
DDR DENTAL — PANHANDLE TEXAS: Oral surgery practice. Seven-figure gross with expected high-6 figure net income. Four fully-equipped operatories with surgical suite. Option to purchase building also available. Well-established referral and patient base. Contact Chrissy Roehm Dunn at 800-9308017 or view the practice at DDRDental.com. To obtain timely information about the practices that we have for sale and recently sold, please visit our website at DDRDental. com. DDR DENTAL — HOUSTON (CHIMNEY ROCK): General practice. Terrific growth opportunity with newly renovated facilities. Fronts high traffic Chimney Rock Road. Four operatories in use and plumbed for 4 more. Free standing building with 7,000 total sq ft also available for sale. Contact Chrissy Dunn at 800-930-8017 or www.DDRDental. com. DDR DENTAL — HOUSTON (WEST SIDE): General practice. Excellent gross with very high net income. Fronts Westheimer near Beltway 8 in established strip center.
ADVERTISING BRIEFS Dentist earns high income on 4 day work week. Three fully equipped operatories, 2 dentists and 1 hygiene. Established patient-base with growth opportunity. Contact Chrissy Dunn at 800-930-8017 or www.DDRDental.com (Dental Trust™ Member). DDR DENTAL — HOUSTON (WOODLANDS / CONROE): Periodontal practice. Two offices in growing Woodlands and Conroe. Exceptional combined gross with very, very high net income. Established patient-base with growth opportunity. Well cared for facilities with 4 operatories in Woodlands office and 4 operatories in Conroe office. Contact Chrissy Dunn at 800-930-8017 or www.DDRDental. com (Dental Trust™ Member). DDR DENTAL — PANHANDLE TEXAS: Oral surgery practice. Extremely high gross with exceptionally high net income. Four fully-equipped operatories with surgical suite. Option to purchase building also available. Well-established referral and patient base. Contact Chrissy Dunn at 800-930-8017 or www.DDRDental.com. DENTISTS: A practice of 1 year looking for a BC/BE pediatric dentist to come on board as employee with possible buy-in. This is an all pediatric dentists’ office. You would be working next to a BC pediatric dentist. Good terms with great pay and work hours. Must be able to get Board Certified within 1 year. OR cases done at El Paso’s Children’s Hospital. Excellent opportunity. Contact 719-671-5617 or tparco@ dentalquestions.com. DENTISTS: Texas. A life with clinical autonomy and time for your family isn’t out of reach. You’ll focus on doing what you do best: treating patients! The marketing and technical administrative expertise is provided for you. Dentists can enjoy opportunities and career rewards such as: significant earnings potential, superior patient flow, and sophisticated marketing. Opportunities throughout Texas include Dallas, San Antonio, Austin, Houston, and Fort Worth. Want to learn more? Contact diane.odom@dentalonepartners.com. EOE.
DENTON COUNTY: Lease space for pediatric dentist for lease or sale. Plumbed and cabinets for gas and suction for 5 chairs in open area and one private operatory. Large waiting room, finance office, consult room, 2 private offices, kitchen/ lounge; 2,560 sq ft. In building with 2 general dentists. 972-317-6211 DFW AREA: Seeking general dentists and specialists. Our offices are located in the Dallas / Fort Worth area. We are looking for caring, energetic associates. New graduate and experienced dentists welcome. We offer benefits, a helpful working environment and an opportunity to grow. We accept most insurance and Medicaid. Please submit your resume via email to jennifer@smileworkshop.com or call our office at 214-757-4500. DFW: Endo practice for sale. Strong collections from a well established office with years of goodwill. The wellappointed office boasts designer décor with luxury finishes. Because of personal and family priorities, the current owner has priced this opportunity well below the historical sales price of comparable and even less attractive practices. Seller will gladly help with the transition at your pleasure, and does not demand to be scheduled in the practice postsale, as required with other transitions. This means all the patients and all the income are scheduled immediately for you, or according to your sole discretion. This is the ideal opportunity for the endodontist who currently practices or wants to relocate to the Metroplex and wants an office with existing patients and revenue rather than a start-up (with zero patients), a price below what a build-out would cost, and a simple transition plan with an accommodating seller who simply wants to help as needed but is eager to practice in another market. TDA advertising guidelines prohibit quotes of revenue, gross or net incomes. Call 832-655-4226 or texaspractice@gmail.com today for more details. EAST TEXAS: Well-established dental practice seeks caring, proficient, and motivated dentist for associate employment. Our office is located in a mid-sized town with abundant
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ADVERTISING BRIEFS outdoor activities including hunting and fishing and a “small town” atmosphere. We offer all phases of dentistry. Interested candidates should email correspondence and resume to mloon242@aol.com. EDINBURG: Falcon Dentistry PA dba Falcon Dental Center seeks dentist in Edinburg. Doctor of Dental Surgery degree required. Texas dental license required. Qualified applications may submit resume directly to Atlantis Gloria Moya, office manager, via fax at 956-287-4926 or via email at falcondentistry@gmail.com. EL PASO: Full-time position for a general dentist. Do not waste your best years at dead end jobs. Great earning potential and future partnership option. Affordable El Paso Dental is looking for a Texas-licensed dentist to work fulltime in our office in El Paso. Applicant must be licensed in the state of Texas and have 1 year of experience. If interested please submit a resume with an accurate contact number and email address to the following: drdarj@gmail.com. EL PASO: We are hiring a skilled and compassionate dentist to join our stable and successful practice. We are seeking a highly professional dentist with a knack for general dentistry. Prospective candidates must be dynamic, fun loving, and looking for a long term commitment. Our practice is highly productive affording our providers an opportunity to attain competitive compensation. If interested, please forward your CV to annette@ vistahillsfamilydental.com.
owner loves to teach sedation, implants, and other surgical procedures. No Medicaid, no DHMO practice in 6 ops, 2 surgical suites, all operatories computerized with digital X-ray and intra-oral cameras; digital panoramic X-ray; paperless charts for easy documentation. Visit www. todaysdentistrytexas.com. The Galveston area is just south of Clear Lake 25 minutes which has planned communities with superior schools, multiple educational, recreational and cultural venues as well as access to all of the Houston cultural and sport venues, shopping and restaurants. We are minutes away from all types of water sports including several large marinas. http://goo.gl/maps/lWkF. Possibility of buy-in and partnership possible after an interim term. Interview today! Email CV to kkcarroll10yahoo.com or call 832-385-8875. GARY CLINTON DENTON-AREA GENERAL PRACTICE FOR SALE. D-1: Retiring dentist owns the facility. Five operatories; outright sale with transition; no low fee plans. Buy at a great price and build a successful practice. Contact Gary Clinton, 1-800-583-7765.
EL PASO: Well-established general practice of over 30 years seeking full-time general dentist associate. Associate would be sole dentist at one of 2 office locations with full staff including hygienist. Income opportunity well above average. Professional opportunity even greater. Send resume to drartbejarano@gmail.com.
GARY CLINTON HOUSTON PRACTICES FOR SALE. H-1 Tomball/Cypress, northeast area: Family practice. Digital equipment; shopping center location with excellent Lease. H-2 Far west Houston, great opportunity: Well-established practice in a high growth area. Trust your life’s work to the most experienced appraiser/broker. For over 40 years, you have seen the name Gary Clinton working as a management consultant, appraiser, consultant and sales broker of general dental and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser member of the Institute of Business Appraisers, Inc. Call Gary Clinton confidentially at 1-800-583-7765.
GALVESTON: Well-established, successful practice of 35 years needs FT associate dentist for FFS/PPO practice. Experienced staff, new equipment, Galveston. Senior
ORAL SURGERY PRACTICES. SA-1 San Antonio, fast growing outlying community: Lakes, hill country beauty; highly-rated schools. Flexible transition. Doctor retiring. Will phase out
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ADVERTISING BRIEFS PRN. High net on 4 days a week. Mid-sized community. D-1 Dallas area: Very nice office; 2-day-a-week practice; excellent referral base. Underserved area. Low overhead. Excellent office. W-1 West Texas central area. Oral surgeon retiring; flexible transition. Seller phase out. High net over 50%. Mid-sized community. All are confidential. Gary Clinton, oral surgery broker/appraiser, 1-800-583-7765. GARY CLINTON DALLAS PRACTICE NEAR TRINITY RIVER GREENBELT FOR SALE. Doctor retiring for health reasons; well-established 30+ year old practice. High demand. Trust your life’s work to the most experience appraiser/ broker. For over 40 years, you have seen the name Gary Clinton working as a management consultant, appraiser, consultant and sales broker of general dental and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser member of the Institute of Business Appraisers, Inc. Call Gary Clinton confidentially at 1-800-583-7765. GARY CLINTON WEST TEXAS PRACTICE (OIL AND AGRICULTURE AREA) FOR SALE. W-1 7-figure collections; 60% Net on 4 days a week. Only dentist in small community. Progressive family dentist retiring to travel. Upgraded equipment. Nice office. Doctor will sell or lease building. Trust your life’s work to the most experienced appraiser/ broker. For over 40 years, you have seen the name Gary Clinton working as a management consultant, appraiser, consultant and sales broker of general dental and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser member of the Institute of Business Appraisers, Inc. Call Gary Clinton confidentially at 1-800-583-7765.
GARY CLINTON FORT WORTH NORTH AND WEST PRACTICES FOR SALE. FW-1 Colleyville area: This is a great “one-to-grow office.” Faces major town boulevard. Digital, all updated dental equipment. Room for 2 dentists. FW-2: Benbrook retiring dentist in this booming growth area. This is a 7-figure practice waiting to happen. Adult restorative. Very nice office with digital equipment, staff and hygienist longevity excellent. Trust your life’s work to the most experienced appraiser/broker. For over 40 years, you have seen the name Gary Clinton working as a management consultant, appraiser, consultant and sales broker of general dental and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser member of the Institute of Business Appraisers, Inc. Call Gary Clinton confidentially at 1-800-583-7765 GARY CLINTON HOUSTON PEDO/ORTHO OR GENERAL PRACTICE OFFICE SPACE. This is the spot to be. Close to Exxon’s new home office, which has 15,000 employees. Close to 5 schools with 7,500 students. Build a practice from start that is a sure bet to be very successful. Call Gary Clinton 214-503-9696. GARY CLINTON SOUTHWEST FORT WORTH DENTAL OFFICE BUILDING TO LEASE/BUY. Lease with first 3 months of rent free. There are no patients. This would be a great low cost start-up. It has been a dental office since 1979. Call Gary Clinton, 214-503-9696 or 1-800-583-7765. GARY CLINTON ORTHO PRACTICES FOR SALE, FORT WORTH/WEST CENTRAL TEXAS. Each has a beautiful building to lease/purchase. High traffic, fast growth areas. The Texas economy especially in these areas is breaking records! Call Gary Clinton, specialized orthodontic practice appraiser/broker and member of the Institute of Business Appraisers, Inc., 1-800-583-7765.
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ADVERTISING BRIEFS GENERAL PRACTICE. Sugarland, Texas. Six-operatory practice for sale. Four operatories equipped; turnkey operations; 2013 collections were mid-6 figures. Working only 3 days per week; all equipment and building less than 2 years old. Very clean, very modern office; all digital. Great opportunity for any specialist as well as general dentist. Asking $325K. For more info, please email sugarrichdental@ gmail.com. GREAT DENTIST TO WORK WITH KIDS: Good opportunity for someone who likes children. Busy practice. Great personality. Competent dentist not afraid to work. Great pay. Sedation will be taught. Send resume ASAP to Carol Erickson, info@txkidsdental.com, 9411 Alameda Avenue Ste P, El Paso, TX 79907. Call 602-309-2180 GREAT OPPORTUNITY FOR SPECIALIST: An endodontic practice in southwest Houston is seeking to share space with a part or full time periodontist, oral surgeon or orthodontist in a state of the art dental office. 4 operatories fully equipped with digital x-rays and microscope. For more information, please contact 713-932-1913. HOUSTON AREA PRACTICE: Jeff Jones, DDS, HS Professional Practice Transitions. Excellent opportunity to capitalize on a fully digital high tech practice. Highly visible location with a great lease. Beautiful finish out includes 5 chairs with room for expansion. Impressive new patient flow with strong hygiene revenue and gross receipts in high 6 figures. Owner willing to stay on as associate needed. To learn more, contact: Jeff Jones, DDS, with HS Professional Practice Transitions (830) 832-5522, or dr.jeff.jones@henryschein. com. HOUSTON AREA PRACTICE OPPORTUNITIES! MCLERRAN & ASSOCIATES-PRACTICE SALES OF TEXAS: NEW! NORTHWEST HOUSTON: Highly productive and profitable general family and cosmetic practice. The office has a visible location in free standing building, 8 fully equipped operatories with digital x-rays and computers throughout, and a very comfortable decor. With approximately 3,000
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active patients, a healthy new patient flow of over 30 patients per month, and a very experienced staff, this office represents a tremendous opportunity! The real estate is also for sale. (#H196) NEW! SUBURB OF HOUSTON: Established 17 years ago this PPO/fee-for-service general, family practice is located in a free standing building with 8 operatories, excellent visibility, easy patient access, was constructed with quality materials and finishes, and has an elegant, comfortable dĂŠcor. The practice is equipped with a digital panoramic unit, digital x-ray sensors, intraoral cameras and computers throughout. With approximately 2,700 active patients and over 60 new patients per month, revenues have been consistently at or above low-7 figures for the last few years. With the growth in the energy sector of the United States economy, the area will enjoy a very stable work force and local economy for many years to come. (#H238) SOUTHEAST HOUSTON: Visible pedo practice located on a major boulevard in the Southeast Houston area in a recently built-out 3,500 sq ft lease space with 7 operatories, digital panoramic x-ray, and an inviting dĂŠcor. Strong net income for a buyer. With an excellent new patient flow of 60+ patients per month, a solid employment base, and numerous marketing opportunities, the practice has tremendous upside. (#H235) HOUSTON: Over 80% Fee for Service orthodontic practice in a highly visible, retail location along a main thoroughfare. With almost 3,000 square feet, 5 equipped treatment rooms, digital radiography, computers throughout, and a very elegant build-out, this office is turn-key. 2013 revenues and production increased over 26% from 2012. Great location with lots of future growth in the area. (#H245) SOUTH OF HOUSTON: Established general practice with a highly visible location, four operatories, strong employment base, and a healthy new patient flow with majority PPO/FFS. The owner is looking for an experienced practitioner that will exhibit an ownership attitude in order to maximize income for both parties. (#H193) UPDATED!! EAST TEXAS: Established, extremely profitable general practice in single tenant, 3,400 sq ft professional building. 5 plumbed and equipped operatories, steady level of annual collections over past 4 years. (#H232) To see our most up to date listings, please go
ADVERTISING BRIEFS to www.dental-sales.com. Contact McLerran and Associates in Houston: Tom Guglielmo, Patrick Johnston, Mac Winston (866)756-7412 or (281)362-1707, houstoneasttx@dentalsales.com. Practice sales, appraisals, buyer representation, and partnership consulting. HOUSTON/CLEAR LAKE â&#x20AC;&#x201D; DENTAL OFFICE: In high visibility smaller professional building at highest traffic corner location in adjacent family oriented, high income master planned community. Adjacent CVS, nearby schools, retail and office centers, NASA and other long-term tenants (UTMB orthopedic and urgent childcare center, podiatrist and chiropractor) drive patient traffic. Nice finishes and all plumbing and electrical in place for 6 or more operatories, offices and consult rooms. Lease incentives, negotiable terms. Dwight Donaldson, Monument Real Estate, 281-2400077, ddonaldson@terramarktx.com. HOUSTON-AREA PRACTICE OPPORTUNITIES! MCLERRAN & ASSOCIATES-PRACTICE SALES OF TEXAS: NEW! NORTH OF HOUSTON: Established general cosmetic practice located in one of the fastest growing communities in the Houston area. The turnkey, 5-operatory facility has a comfortable, cozy ambiance, equipment that is in very good condition, and room for expansion and solid growth potential (#H234). NEW! SOUTHWEST OF HOUSTON: Established general practice with a highly visible location, 4 operatories, strong employment base, and a healthy new patient flow with majority PPO/FFS. The owner is looking for an experienced practitioner that will exhibit an ownership attitude in order to maximize income for both parties. Partial buy-in opportunity will be available in the future for the right doctor (#H93). NEW! NORTH OF HOUSTON: This general family practice was started in 2008 when the seller purchased the existing build-out and equipment of an established dentist who relocated his practice. Upgrades include digital radiography (intraoral and panoramic) and flat screen TVs in the operatories. With an active base of over 800 patients, new patient flow of 25 patients per month, a visible retail strip center location, and opportunity for expanded office hours,
growth potential is solid. Value acquisition with strong upside potential (#H236). SOUTHWEST HOUSTON: PPO/ FFS practice, visible retail location on main thoroughfare in growing southwest family oriented area. With low overhead, a recently remodeled interior, 3 operatories, and 1,100 sq ft, the practice represents a value purchase with significant upside potential. Recent website and social media platform development will also allow the buyer to effectively reach out to the community to further enhance patient flow. Very limited schedule for the owner and significant outbound referrals for endo, perio, oral surgery, and orthodontics (#H243). NORTHWEST HOUSTON: This general and orthodontic dentistry practice is located on a well-traveled road in the northwest Houston/Hockley area. The area is expected to grow tremendously over the next few years with the expansion of major roads in the area. The practice sees approximately 30 new patients per month and hygiene produces 27% of production. With a strong hygiene department, high new patient flow and low overhead, the practice is set for continued profitability and growth (#H231). PRICE REDUCED! UPPER WEST GALVESTON BAY: Profitable General practice located in a highly visible office building in the heart of a vibrant oil and gas commercial center and community. Three fully equipped operatories, strong hygiene revenues, and over 1,100 active patients (#H194). NEW! NORTHEAST OF HOUSTON: Established, extremely profitable general practice in single tenant, 3,400 sq ft professional building; 5 plumbed and equipped operatories, steady level of annual collections over past 4 years (#H232). NORTHWEST HOUSTON: This general dentistry practice has established for 11 years in the Northwest Houston area. The practice is located in a Kroger and CVS Pharmacy shopping center with great visibility and high foot traffic. The practice is conveniently located close to 3 major highways in the Houston area (#H226). GALVESTON: Established fee-for-service practice, collections have been increasing in recent years and are consistently over 6 figures. With a solid economic base, the practice enjoys a strong recall system, an experienced and stable staff, and has seen over 2,500 patients in the last 24 months. The facility is free standing and has 8 equipped Texas Dental Journal l www.tda.org l July 2014
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ADVERTISING BRIEFS operatories with room for expansion (#H161). NORTHWEST HOUSTON ASSOCIATE POSITION WITH FUTURE BUY-IN: Established general dentistry practice is located near a high traffic intersection in the booming northwest Houston/ Copperfield area. Revenues in low-7 figures a strong hygiene department, and a very healthy new patient flow, the practice is set for continued profitability and growth. (#H225) SOUTHEAST HOUSTON: Well established general practice, located in highly visible shopping center, 5 operatories, stable patient base, room for expansion, comfortable dĂŠcor (#H197). SOUTHWEST OF HOUSTON: Established general practice, 4 operatories, stable blue collar patient base, petrochemical economic base, 2,000 sq foot building available. Doctor working only part-time (#H174). To see our most up-to-date listings, please go to dental-sales.com. Contact McLerran & Associates in Houston: Tom Guglielmo, Patrick Johnston, Mac Winston, 866- 756-7412 or 28-362-1707, houstoneasttx@dentalsales.com. Practice sales, appraisals, buyer representation, and partnership counseling. HUMBLE, TEXAS: Carus Dental, established in 1983 in Austin, TX, has always been committed to the traditional doctor-patient relationship and to the highest quality in dental care and service. We currently have 55 doctors on staff across our 21 practices in Austin, Houston and central Texas. We offer dental services in general dentistry, oral surgery, orthodontics, pediatric dentistry, endodontics, and periodontics in some or all of our practices. We are seeking a part-time endodontist for our Humble, TX, practice, 3 days every other week. To learn more about American Dental Partners and Carus Dental please visit us at www.amdpi. com and www.carusdental.com. If interested, please send CV and cover letter to kateanderson@amdpi.com. IMMEDIATE OPENING FOR AN ASSOCIATE DENTIST: Busy, multi-location general practice providing care for the entire family with heavy emphasis on pediatrics, located in West Texas. Supportive owner/doctor and team makes this a great opportunity. Outstanding candidates only. Contact
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terry@smilecraftersad.com or call 325-428-9973 for more information. FAX your resume to 325-646-0516. LAREDO: We are looking for a pediatric dentist for a rapidly growing practice. Strong referral sources. Hospital cases performed twice a week at local hospital. State-of-the-art practice with digital X-rays and charts. If part-time, then dentist can fly in to see patients and still maintain living at their current city. Partnership in future is an option if candidate interested. Please email t2tpdlaredo@gmail.com. LONGVIEW PEDIATRIC PRACTICE SEEKING FULL-TIME ASSOCIATE: Sherri L. Henderson & Associates, LLC is looking for a qualified associate to transition into an active pediatric dental practice. The associate will be working with a knowledgeable staff and a great new patient flow. This practice is dedicated to performing high quality dental care for the children and adolescents of the surrounding communities. The dentist/owner established the practice 14 years ago, and offers a future opportunity to buy-in. This beautiful pediatric practice is 5,000 sq ft, with 4 doctor chairs and 4 hygiene chairs, plus a quiet room and a new patient room. A full-time schedule of 4.5 days per week is offered, with salary based on 40% of production. Health insurance and benefit plans are negotiable. Listing #3435. Photos available. For more information, please contact our office at 972-562-1072, email sherri@slhdentalsales.com, or visit our website at www.slhdentalsales.com. MCALLEN / BROWNSVILLE: We are seeking a full time GP to join our state of the art digital office. Once you join us you will have the support of a loving staff along with the latest in dental technology. We use electric hand pieces, isolites, dentalvibes, digital intra-oral cameras and X-rays, as well as many more the latest dental technology. We are in full compliance with the latest sedation requirements by the TSBDE, with excellent earnings and growth potential. Please feel free to contact me if you have any questions at all. Our offices are in a very family friendly humanistic environment. Please forward CV to hr.dentaljobs@gmail.com.
ADVERTISING BRIEFS MIDLAND: One of the fastest growing cities in Texas needs a dynamic, caring, patient-focused dentist to join our growing practice. Associate and buy-in opportunities are available. Please contact Britt Bostick, DDS, at bbost35821@aol.com or call 806-438-5745. MISSION: General dentistry in highly desirable location. 4,062 active patients, seeing 40+ new patients per month. Four operatories, 1 unequipped, plumbed. 2012 gross receipts high six figures. Contact: John.David.Harris@ henryschein.com or 214-463-8145. NORTH HOUSTON: Pediatric associate opportunity. Unique opportunity with a well established fee-for-service practice with an excellent reputation for providing exceptional quality pediatric dentistry while building long term trusting relationships with families. Our families expect a pediatric dentist that is energetic highly professional with a strong compassionate demeanor. The primary pediatric dentist seeks a career-oriented pediatric dentist who genuinely is transparent and holds integrity with the highest regard. The practice offers excellent earning potential with a possible future equity position available. Please email curriculum vita to cathaustin@mcfallmanagement.com. NORTH TEXAS DENTAL PRACTICE OPPORTUNITY: Lewis Health Profession Services has multiple career opportunities available in the greater Dallas / Fort Worth area. Practices for sale, associate opportunities, finished out dental offices, and specialty practice opportunities. Lewis Health Profession Services has 30 years experience in dental practice transitions, with over 1,000 successful transitions completed. Dentistry is our only business. We confidentially deal with all clients. Lewis Health Profession offers seller representation, buyer representation, opportunity assessments, associate placement and strategic planning services. Please be aware that not all opportunities available appear on our web site, www. lewishealth.com. For additional information, contact Dan Lewis at Lewis Health Profession Services 972-437-1180, or dan@lewishealth.com.
NORTH TEXAS: Pediatric dentist needed for busy north Texas practice. Enjoy life in Sherman, Texas, a familyoriented city conveniently located just 1 hour north of Dallas, but without the hustle and bustle of the big city! Excellent practice opportunity for motivated and nurturing pediatric dentist seeking full-time associate with potential for partnership. Practice has a great reputation and is committed to providing quality comprehensive care for our patients and families in a fun and relaxed atmosphere. State-of-the-art facility with highly trained and dedicated staff. Competitive compensation and benefits. Fee-forservice, limited Medicaid. Must possess high personal standards, strong work ethic, excellent technical and communication skills, and be willing to treat the full range of pediatric dental patients. Opportunities for in office conscious sedation, IV sedation and hospital dentistry. Please email resume/CV to bth1@cableone.net. OPPORTUNITY NORTH OF HOUSTON, TEXAS: Located 35 minutes north of the Woodlands. Unique opportunity with an established fee-for-service practice with an excellent reputation for providing functional comprehensive quality care and smile enhancements. Primary Doctor has advanced education and background in functional dentistry with an emphasis on full mouth reconstruction. Attractive new building with the latest technology and equipment. Please email curriculum vita to cathaustin@ mcfallmanagement.com. OPPORTUNITY TO TRANSITION into a busy oral surgery practice within a multi-disciplined practice. Present oral surgeon is retiring. Practice is private fee for service. New i-CAT (3D) in office. For information contact Paul Kennedy, DDS, at pkennedy@gte.net or 361-960-6484. ORAL SURGEON NEEDED. Oral surgeon will be busy for a full day or two with implant and bone grafts. Competitive pay. Flexible in scheduling. Please call 361-387-3442.
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ADVERTISING BRIEFS ORAL SURGERY OFFICE, WICHITA FALLS, TEXAS: Two operatories, fully equipped, plumbed for nitrous oxide and oxygen, nitrogen for multiple hall handpieces, x-ray room with panorex, periapical machine, autovelepor, Nomad portable, crash cart. 1,475 sq ft building with business office, lab, waiting room, 2 restrooms, ample parking. Excellent location; 6 blocks to hospital. Inactive just 8 weeks due to stroke. Stephen C. Farr, DDS, MS. 2100 Brook Ave, 76301. O: 940-322-5297, H: 940-696-3946, C: 940-781-6721. ORTHODONTIST PT POSITION: Part time position for an orthodontist. Please submit your resume to jobs@ capitalchildrensdentistry.com. PEDIATRIC PRACTICE FOR SALE: Very large private pediatric practice in large metropolitan area in Texas, mix of PPO and Medicaid in a beautiful, free-standing 5,000 sq ft building with 10 chairs. Highly profitable private practice established 30 years. Texas Practice Transitions, Inc. Rich Nicely has been serving Texas dentists since 1990. Visit www.tx-pt.com or call at 214-460-4468; Rich@tx-pt.com. PRACTICE FOR SALE SOUTHWEST OF FORT WORTH in fast growing area. Average gross; 6 operatories; Excellent lease. Seller is relocating. Need to move quickly on this one. DFW 214-503-9696. WATS 800-583-7765. PRACTICE SALE HARKER HEIGHTS: General, in desirable, high traffic area. Approx. 2,700 sq ft w/ 6 ops. Referring out endo, ortho, oral surgery, and implant placement. 2013 GRs mid-six figures. Contact: JohnDavid.Harris@henryschein. com or 214.463.8145. #TX 101. READY TO SELL â&#x20AC;&#x201D; CORPUS CHRISTI AREA: Sherri L. Henderson & Associates. The DDS is relocating to another city. This cosmetic and general dentistry practice was established in 1982 in a professional office complex with 1,400 sq ft and 3 existing treatment rooms. This location would make a great place for a start-up or satellite practice and it has plenty of space next door for expansion. The location is on one of the busiest streets with access to
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Padre Island Drive. This is a cash basis practice with a dedicated loyal staff and great revenue potential. The current owner has extensive experience with TMJ and sleep apnea and would be willing to return to the practice periodically if the new owner was interested. Listing #3070. Pictures available. Contact 972-562-1072 or email sherri@ slhdentalsales.com. Visit www.slhdentalsales.com. SAN ANTONIO NORTH WEST: Associate needed. Established general dental practice seeking quality oriented associate. New graduate and experienced dentists welcome. GPR, AEGD preferred. Please contact Dr Henry Chu at 210-684-8033 or versed0101@yahoo.com. SAN ANTONIO: A general practice (FFS/PPO) having gross receipts in mid 6 figures while practicing only 3.5 days per week with no marketing. This is an exceptional opportunity to profit from day one in a newly remodeled office equipped with 3 chairs for a fraction of the cost of a new start up. Tremendous potential to grow practice rapidly as current dentist refers out majority of endo, ortho, perio, pedo, and oral surgery cases. To learn more about this practice contact: Dr Jeff Jones, 830-832-5522, dr.jeff. jones@henryschein.com. SAN ANTONIO: Part-time associate general dentist needed to join our team. We are a growing childrenâ&#x20AC;&#x2122;s dental practice in San Antonio (privately owned and operated). We provide care primarily for children ages 6 months to 20 years old. We are seeking a self-motivated, hard working practitioner with great ethical and moral standards to work with our highly trained staff in our new state of the art facility. Must be eligible to practice dentistry in Texas. Conscious sedation license and Medicaid credentialing is a plus. Please email your CV to resumes.sanantonio@gmail. com. SLH DENTAL SALES (SHERRI L. HENDERSON & ASSOCIATES): Consulting and staging for your transition! Let us help you make a transition plan. We can analyze the market, review your current patient base, secure the staff,
ADVERTISING BRIEFS spruce up the office space, and much more. We specialize in practice transition consulting and can assist you in a plan to help you create all the right conditions to begin that step from retiring to starting up a new practice. Our team has decades of hands-on experience in the dental market place as practice owners, employees, and management advisors. ASSOCIATES, PARTNERS AND BUYERS AVAILABLE. Are you seeking an associate, partner, or buyer? SLH has qualified candidates ready in all parts of Texas looking for your specific practice profile. There are many graduates as well as very experienced dentists looking for the opportunity to transition into your already established practice. These dentists have great people skills, case presentation experience and can be a very valuable and reliable addition to your bottom line. CONTACT US. If you are unsure about the right timing or simply would like to talk about the opportunities, call us today for a complimentary consultation in person or by telephone. All contact with you is strictly confidential. Call on our experience to assist you in making that transition dream become a reality. Call 972-562-1072 or email sherri@slhdentalsales.com, website slhdentalsales.com. SUGAR LAND, CYPRESS, PEARLAND AND THE WOODLANDS: Full- and part-time positions available. Well established and rapidly growing practices that offer great financial opportunity. High income potential and future equity position. Email CV to Dr Mike Kesner, drkesner@ madeyasmile.com. TEMPLE: Carus Dental, established in 1983 in Austin, TX, has always been committed to the traditional doctorpatient relationship and to the highest quality in dental care and service. We currently have 55 doctors on staff across our 20 practices in Austin, Houston and central Texas. We offer dental services in general dentistry, oral surgery, orthodontics, pediatric dentistry, endodontics, periodontics and prosthodontics in some or all of our practices. We are actively seeking a part-time pediatric dentist for our Temple, TX practice, two days per week. To learn more about American Dental Partners and Carus Dental
please visit us at www.amdpi.com and www.carusdental. com. If interested, please send CV and cover letter to kateanderson@amdpi.com. TEXAS PRACTICE TRANSITIONS, INC.: Rich Nicely has been serving Texas dentists since 1990. Visit www.tx-pt.com or call at (214) 460-4468; Rich@tx-pt.com. PEDIATRIC: Very large private pediatric practice in large metropolitan area in Texas, mix of PPO and Medicaid in a beautiful, free standing 5,000 sq ft building with 10 chairs. Highly profitable private practice established 30 years. HUNTSVILLE: Medium-sized full-fee patient base; digital x-rays; free-standing building; long-term staff; 4 days of hygiene per week. ARLINGTON: Highly visible large sized practice and building on major road; 6 equipped treatment rooms; digital x-rays; 100% paperless; mix of PPO and DHMO patients. EAST TEXAS: Small full fee patient base. Great building with water views from each of the 4 treatment rooms. VICTORIA: Medium sized practice; PPO patient base; free-standing building, long-term staff; doctor refers out lots of dentistry. MIDLAND: Large sized practice; full-fee patient base; digital x-rays; modern free-standing building; long-term staff. EL PASO: East side; large practice; full-fee patient base. EL PASO: West side; medium-sized practice; mostly PPO patient base. OKLAHOMA: 1 hour outside OKC; Large full-fee office, 5 treatment rooms, fantastic building; urgent sale situation. WACO: Great associate opportunity. Waco practice looking for motivated associate with a desire to join a PPO/fee-forservice practice. Great pay, great work environment with two other dentists and top notch staff. Please contact Dr Johnson at 435-237-2339 or email at johnson.2978@gmail. com. WE ARE SEEKING A FULL-TIME GP to join our state-of-theart, fast-growing, digital office. Once you join us, you will have the full support of our loving and friendly staff and management, as well as the newest dental equipment. We use electric handpieces, isolites, dental vibes, digital intra-oral cameras and digital x-rays, as well as many more Texas Dental Journal l www.tda.org l July 2014
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ADVERTISING BRIEFS of the latest dental technology. We are in full compliance with the latest requirements by the TSBDE, with excellent growth potential. Please feel free to contact me if you have any questions. Our offices are a very laid back, family-friendly environment. Please forward your CV to bwolfrodeodental@gmail.com
OFFICE SPACE DALLAS AND ROCKWALL: Orthodontic or other specialty office for lease to share with owner. Furnished and equipped. Dallas office is 4,000 sq ft in Lake Highlands area with 2,500 sq ft leasable residence above. Rockwall office is 1,800 sq ft in antique building and furnishings. Email rcppc@sbcglobal.net. GARY CLINTON HOUSTON PEDO/ORTHO OR GENERAL PRACTICE OFFICE SPACE: This is the spot to be. Close to Exxon’s new home office which has 15,000 employees. Close to 5 schools with 7,500 students. Build a practice from start that is a sure bet to be very successful. Call Gary Clinton 214-503-9696. GARY CLINTON SOUTHWEST FOR WORTH DENTAL OFFICE BUILDING TO LEASE/BUY: Lease with first 3 months’ rent free. There are no patients. This would be a great low cost start-up. It has been a dental office since 1979. Call Gary Clinton 214-503-9696 or 1-800-583-7765. HOUSTON / LEAGUE CITY: Medical/office space available for lease in a stellar location, right outside the largest school in Texas with 4,200 students on campus. In a fast growing area with a lot of young families, located close to the waterfront, boardwalk, Gulf Coast beaches, Houston downtown, NASA and Hobby Airport. Home to one of the state’s top rated Independent school districts, stunning yet affordable waterfront neighborhood developments, NASA, Boeing, UTMB. Contact Vijay Bhagia 832-618-0652 or eduvillageland@gmail.com.
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NORTH TEXAS DENTAL PRACTICE OPPORTUNITIES: Lewis Health Profession Services has multiple career opportunities available in the greater Dallas/Fort Worth area. Practices for sale, associate opportunities, finished out dental offices, and specialty practice opportunities. Lewis Health Profession Services has 30 years experience in dental practice transitions, with over 1,000 successful transitions completed. Dentistry is our only business. We confidentially deal with all clients. Lewis Health Profession offers seller representation, buyer representation, opportunity assessments, associate placement and strategic planning services. Please check out our web site at www. lewishealth.com for current opportunities. For additional information, contact Dan Lewis at Lewis Health Profession Services 972-437-1180 or dan@lewishealth.com. SAN ANTONIO 4-OPERATORY PRACTICE FOR SALE: We have outgrown the space, looking to relocate. Space is perfect for a specialist. Transition available. The space is located right off the Dominion Country Club golf course in San Antonio. Very modern, tranquil, pleasant location, granite countertops, plumbed for nitrous, second floor with balcony. Please contact Dr Stratton at 210-687-1150 or email tiffini@dominiondentalspa.com. SEGUIN: Orthodontic office space for lease in. Office was phased down when orthodontist retired. Office is equipped and functional. Great for a start up or a satellite location. Email inquiries to lmassadds@gmail.com. SHERMAN: 1,800 sq ft office previously occupied by implant dentist. Building has an orthodontist and general dentist. Would like some other dental specialty. Beautifully maintained building that has been a dental center for many years. Available immediately. Sherman is a historic, cultural city 50 miles north of Dallas and 10 miles south of Lake Texoma, a wonderful recreational center. Please call 760889-1163.
FOR SALE EQUIPMENT FOR SALE: New handheld portable X-ray unit. New intraoral wall X-ray unit, new mobile X-ray on wheels. New chairs/units operatory packages, new implant motors. Everything is brand new, with warranty. Contact nycfreed@ aol.com. IMTEC IMPLANT SYSTEM. $600, 24 implants, torque wrenches, surgical items and adapters, sterilization kit, instruction disk. Never used. Integral implants. $200, 11 coated implants and surgical drills, placement and retrieval instruments. $500 (regularly $1,500), 4 Misch basic setup physics forceps. Contact Dr James Grogan, 469-585-9622, docharleyday@sbcglobal.net.
extraction only) ($1195 ortho only) sixmonthbraces@ hotmail.com, drtommymurph@yahoo.com IV SEDATION TRAINING FOR DENTISTS. This “miniresidency” includes 60 hours of didactic and the administration of IV sedation to at least 20 dental patients while supervised. Program meets requirements to obtain TSBDE Permit Level III for Moderate Sedation, Houston, TX September 2014, 888-581-4448 www.sedationconsulting. com LOOKING TO HIRE A TRAINED DENTAL ASSISTANT? 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 800383-3408; Web: schoolofdentalassisting-northdallas.com.
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 512-263-0510 or drzoch@yahoo.com. OFFICE COVERAGE for vacations, maternity leave, illness. Protect your practice and income. Forest Irons and Associates. “Dentists Helping Dentists Since 1983.” Call 800433-2603 (EST). Visit www.forestirons.com.
MISCELLANEOUS DENTIST/CONSULTANT: Part-time (min 4 hrs/day) for national claim review company. Work from your home or office. Must have active TX dental license. Fax resume to 212-686-4703. EXTRACTION/ORTHODONTIC CE: September 26-27, Minneapolis, 18 total CE hours. Dr DePaul will teach PowerProx Six Month Braces, Dr Fletcher and Murph will teach Extractions using Pig Jaws, Dr McCall will teach Immediate Dentures. Tuition: $2294 for both ($1299
PLACE A CLASSIFIED AD IN THE
TEXAS DENTAL JOURNAL It’s a member benefit! Reach more than 9,000 of your dental colleagues. COST
PRINT: $40 fo rthe first 30 words. 10 cents per word after that. ONLINE: $10 a month (no word limit). $60 one-time additional fee to post online immediately.
CONTACT
For more information, please visit tda.org or contact Billy Callis at 512-443-3675 ext 150 or by email: bcallis@tda.org.
Texas Dental Journal l www.tda.org l July 2014
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YOUR PATIENTS TRUST YOU.
WHO CAN YOU TRUST? If you or a dental colleague are experiencing impairment due to substance use or mental illness, The Professional Recovery Network is here to provide support and an opportunity for confidential recovery.
PRN Helpline (800) 727-5152
558
Visit us online www.txprn.com
Texas Dental Journal l www.tda.org l July 2014
ADVERTISERS AACP Institute ...............................................511 ADS Watson Brown & Associates ...............509 AFTCO ............................................................498 AJ Riggins ......................................................543 Anesthesia Education & Safety....................510 Baylor College of Dentistry ..........................494 Best Card........................................................506 Clinton, Gary ..................................................501 DDR Dental Trust ...........................................541 Dental Credentialing of Texas ......................531 Dental Systems ..............................................509 Dentac.............................................................530 Dental Handpiece Repair Guy ......................530 E-VAC, Inc. .....................................................535 Hamilton, Small and Associates ..................491 Hanna, Mark â&#x20AC;&#x201D; Attn. at Law .........................535 Henry Schein Professional Practice Transitions ................................................531 Hindley Group ................................................537 JKJ Pathology................................................507 Kennedy, Thomas John ................................531 Mariner Dental Laboratory ............................499 OSHA Review .................................................500 Paragon ..........................................................505 Professional Recovery Network...................558 Shepherd, Boyd Wilson ................................539 Sherri L. Henderson & Associates ...............497 Special Care Dentistry ..................................505 TDA Financial Services Insurance Program ..................................494/Back Cover TDA Perks Program ............. Inside Back Cover TDA Perks Program .............Inside Front Cover Texas Dental Journal Classifieds.................557 Texas Health Steps ........................................495 TEXAS Meeting Exhibitors & Sponsors ......506 TEXAS Meeting 2015 Speakers ....................539 TopProdeals ...................................................518 UTHSCSA / San Antonio Dental School ......519 UTHSCSA / South Texas Pathology Lab .....506 Waller, Joe ......................................................507