November 2013 Texas Dental Journal by Texas Dental Association

SUV DISINFECTANT & CLEANER 3-in-1 Product

• SURFACE DISINFECTANT • ULTRASONIC SOLUTION • VACUUM LINE CLEANER • Spray bottles are provided FREE with your order. • 1 bottle of SUV’s concentrated formula makes 16 gallons of ready-to-use disinfectant. • Meets Texas State Board of Dental Examiners, OSHA, and EPA requirments and CDC recommendations for surface disinfection.

ALSO AVAILABLE IN READY-TO-USE WIPES

Endorsed by:

BUY DIRECT & SAVE – www.oshareview.com – 800-555-6248

November 2013

Journal TEXAS DENTAL

Texas Dental Associationâ&#x20AC;&#x2122;s Gold Medal Winner

Dr Paul E. Stubbs Texas Dental Journal l www.tda.org l November 2013

1085

When faced With a malpractice claim, Who do you Want in your corner?

Free CE Credits Are Just a Click Away. When your career and reputation are on the line, you want the strongest dog in •your corner. Many dentists don’t realize how important their dental malpractice insurance is until they need it most. Medical Protective • defense that focuses on has more than 100 years of proven experience, national expertise and a balanced • and powerful backing of a your best interest. And, today, more than ever, the big financial strength, integrity • Warren Buffett Berkshire Hathaway Company are crucial to the quality of your dental malpractice protection. • • •

one company has strength and experience that towers over Taking New the Stepsothers. •

✓

•

PROTECTION & PRICE

Trust the dental malpractice experts.

• • • •

Texas Dental Journal l www.tda.org l November 2013

1087

TEXAS Dental Journal Established February 1883

1104

Vol 130, No 11

1108

November 2013

1115

1123

ABOUT THE COVER

Paul E. Stubbs, DDS, of Georgetown is the recipient of the 2013 TDA Gold Medal for Distinguished Service.

1104

GUEST EDITORIAL: Dentistry’s Watershed Moment

1108

The 2013 Gold medal for distinguished service — Dr Paul E. Stubbs

Marko Vujicic, PhD, and Hilton Israelson, DDS

Paul E. Stubbs, DDS, of Georgetown is the recipient of the 2013 TDA Gold Medal for Distinguished Service. Read how he chose a career in dentistry and his proudest accomplishments in the profession.

1115 CAREER TRANSITION AND DENTAL SCHOOL FACULTY DEVELOPMENT PROGRAM

Jeffery L. Hicks, DDS; William D. Hendricson, MS, MA; Mary N. Partida, DDS, MPH; John D. Rugh, PhD; John H. Littlefield, PhD; Mary E. Jacks, MS The authors explain a program at the University of Texas Health Science Center at San Antonio Dental School that is designed to enhance faculty recruitment and retention and maintain a corps of skilled dental educators.

1123

What Dentists should know about sickle cell disease Bill P. Devine, DMD The author gives an overview of sickle cell disease and dental concerns the disease presents to the dentist.

MONTHLYFEATURES 1092 1096 1100 1112 1131 1135

1088

President’s Message The View From Austin Oral and Maxillofacial Pathology Case of the Month Critically Appraised Topic of the Month 2013 TDA Annual Session TEXAS Meeting Photo Contest Winner In Memoriam Texas Dental Journal l www.tda.org l November 2013

1135 1138 1142 1144 1146 1149 1166

Memorial and Honorarium Donors TEXAS Meeting Preview Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management Calendar of Events Value for Your Profession Advertising Briefs Index to Advertisers

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

Editorial Staff

Editorial Advisory Board

BOARD OF DIRECTORS TEXAS DENTAL ASSOCIATION

Stephen R. Matteson, DDS, Editor-in-Chief Daniel L. Jones, DDS, PhD, Associate Editor Harvey P. Kessler, DDS, MS, Associate Editor Nicole Scott, Managing Editor Lauren Oakley, 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 E-mail: tda@tda.org • Website: tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly, one issue will be a directory issue, by the Texas 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 2013 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 not constitute a guarantee or endorsement by the Association of the quality of value of such product or of the claims made of it by Texas Dental Journal is a member of the its manufacturer. American Association of Dental Editors. Member Publication

PRESIDENT David A. Duncan, DDS 806-355-7401, davidduncandds@gmail.com PRESIDENT-ELECT David H. McCarley, DDS 972-562-0767, drdavid@mccarleydental.com IMMEDIATE PAST PRESIDENT Michael L. Stuart, DDS 972-226-6655, mstuartdds@sbcglobal.net VICE PRESIDENT, NORTHWEST David C. Woodburn, DDS 806-358-7471, olddave1@gmail.com VICE PRESIDENT, NORTHEAST Jean E. Bainbridge, DDS 214-388-4453, jbainbridgedds@sbcglobal.net VICE PRESIDENT, SOUTHEAST Gregory K. Oelfke, DDS 713-988-0492, greg@oelfke.com VICE PRESIDENT, SOUTHWEST Yvonne E. Maldonado, DDS 915-855-2337, yvonnedent2000@yahoo.com SENIOR DIRECTOR, NORTHWEST Steven J. Hill, DDS 806-783-8837, sjhilldds@aol.com SENIOR DIRECTOR, NORTHEAST Jerry J. Hopson, DDS 903-583-5715, dochop@verizon.net SENIOR DIRECTOR, SOUTHEAST William S. Nantz, DDS 409-866-7498, wn3798@sbcglobal.net SENIOR DIRECTOR, SOUTHWEST Joshua A. Austin, DDS 210-408-7999, jaustindds@me.com DIRECTOR, NORTHWEST Charles W. Miller, DDS 817-572-4497, cwdam@sbcglobal.net DIRECTOR, NORTHEAST William H. Gerlach, DDS 972-964-1855, drbill@gerlachdental.com DIRECTOR, SOUTHEAST Karen A. Walters, DDS 713-790-1111, kwalters@sms-houston.com DIRECTOR, SOUTHWEST John B. Mason, DDS 361-854-3159, jbmasondds@aol.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@msn.com PARLIAMENTARIAN Michael Vaclav, DDS 806-355-7463, drvaclav@suddenlinkmail.com EDITOR Stephen R. Matteson, DDS 210-215-1515, texdented@gmail.com INTERIM EXECUTIVE DIRECTOR Michael L. Stuart, DDS 512-443-3675, mstuartdds@sbcglobal.net LEGAL COUNSEL Mr. William H. Bingham 512-495-6000, bbingham@mcginnislaw.com

Texas Dental Journal l www.tda.org l November 2013

1089

Dr. Ed Silva, a Fortress Dentist.

When you choose Fortress Insurance Company for your professional

I live in Edina, Minnesota. I came to the States

liability coverage, you can be con-

as an exchange student from Spain. Got my

fident that your practice is protected.

DDS at the University of Minnesota.

We are owned and operated by

I practice general dentistry. I really enjoy

dentists and only insure dentists.

the cosmetic cases, the before and after is

Aggressive claims defense, valuable

very satisfying.

risk management and outstanding

I recharge by playing soccer. Itâ&#x20AC;&#x2122;s a great stress

customer service are why dentists

reliever, mind cleanser. Our team has been

all over the country have selected

together 8 years, playing winter and summer.

Fortress. Our local agents are responsive and knowledgeable

I plan to expand our practice to a network of offices in the metro area. I like the business

too. To get Fortress protection* call

side of dentistry.

Kyle Wallace at Wallace Specialty Insurance Group, 855-505-1121 or

I admire my patients. Sometimes they have

972-663-5190. Tell him Dr. Silva

to sit for hours and they rarely complain.

sent you.

I recommend Fortress professional liability coverage. Great customer service. My agent is always available and helpful. The coverage is very complete, and the prices are competitive.

Protecting & Defending

Over 14,000 dentists trust Fortress with their professional liability insurance.

www.dds4dds.com

*The language contained in each policy of insurance establishes the specific terms and conditions of insurance, and will supersede any statements contained herein.

Protection Throughout Your Life ... Our only business is working with TDA members,their families, staff, and dental students.

Disability Insurance Protection True Own Occupation Coverage Available Exclusive Association Premium Discount Available Business Overhead Expense Policy

Reducing Term Disability for Buy-outs, Loan Coverage

Questions? Q ues Call, 1-800-677-8644 Visit www.TDAmemberinsure.com

1090

Texas Dental Journal l www.tda.org l November 2013

Bleed Area

Retirement Plan Contributions Protection

ADA Members Save on Car Rentals

Three Car Options. Three Ways to Reserve. Car rental services are available at ADA discounts from Alamo Rent A Car®, Enterprise Rent-A-Car®, and National Car Rental®. Three ways to reserve: • Visit alamo.com, enterprise.com or nationalcar.com and use code ADA7745 • Make your reservation at ADA.org/carrental • Call 866.960.5880

Enterprise Rent-A-Car®

Great Cars. Low Rates. Free Pick-up. When you’re ready to go, we make it easy with everyday low rates on great cars, plus a discount.

With the largest fleet in North America and a wide variety of vehicles, Enterprise has you covered. Plus, we’re always nearby at more than 6,000 neighborhood and airport locations. Pick-up and drop-off service is subject to geographic and other restrictions.

Alamo Rent A Car®

Drive Happy with Alamo. Where American Dental Association members save up to 25%.

And, with self-serve check-in you can skip the counter, check-in at the kiosk and drive away. All you need is a valid driver’s license, major credit card and an existing reservation. It’s that easy.

National Car Rental®

As an ADA member, you’ll get up to 25% off rentals at National Car Rental. For ADA members who travel frequently and are looking for the most time-efficient transaction process in the car rental industry, National Car Rental is a perfect fit. National’s Emerald Club® offers the power of speed and choice. Emerald Club members reserve a midsize vehicle, and upon arrival, proceed directly to the Emerald Aisle, a designated area of the lot where members can choose any vehicle (often a higher class than midsize). Emerald Club members then present their driver’s license and credit card at the exit booth, receive a rental agreement and be on their way. Emerald Club members can also earn frequent-flyer miles, hotel rewards or free rental days on every rental. For complimentary enrollment with the Emerald Club, visit emeraldaisle.com. Go National. Go Like a Pro.

President’s Message David Duncan, DDS, TDA President

The TDA Gold Medal for Distinguished Service

Over the course of his career, Dr Stubbs has been a mentor to many aspiring young people wanting to enter the dental field, 1 hygienist and 4 dentists thus far, signifying that he truly loves our profession and wants to see it continue.

The TDA Gold Medal for Distinguished Service was first awarded to a deserving member in 1997. Since then, 16 members of TDA have received the prestigious honor, which is given to a dentist who demonstrates TDA and ADA leadership, commitment to organized dentistry, and community volunteerism and civic duty. This year, I am so proud to congratulate my friend Dr Paul E Stubbs of Georgetown. I know he was surprised when he received the award at the House of Delegates in San Antonio in May 2013, but I wasn’t. He is so deserving. I was beyond words with excitement that my friend was being honored. When I became president of TDA, one of the first people to call me was Paul, offering his assistance in any and every way he could to make my job easier. That’s Paul Stubbs. He’s a giver. Over the years as a TDA member he has given countless hours, as president, as council member, and as a community volunteer. To call Paul Stubbs a gentleman would be an understatement. All who come in contact with Paul immediately know they are in the presence of a genuinely nice, caring, compassionate man. Over the course of his career, Dr Stubbs has been a mentor to many aspiring young people wanting to enter the dental field, 1 hygienist and 4 dentists thus far, signifying that he truly loves our profession and wants to see it continue. Another way he has shown his love for our profession is his key role in the acquisition of our conference center that is next door to the TDA building. In fact Paul has been involved with our buildings in one way or another since his time as TDA president more than 20 years ago. Few, if any, can boast of such service and dedication. I consider myself lucky to not only call Paul my friend, but for him to call me his friend. Over the years in TDA I have been fortunate to have great mentors, many of which are former Gold Medal winners, and I consider it an honor to have Paul as one of those mentors. From Mickey Vaclav to Dick Smith to Rick Black to Paul Stubbs, I am truly blessed. We all are, because dentists like Paul Stubbs and others have dedicated themselves to dentistry and to TDA so that each and every one of us can practice in the greatest profession. To Dr Stubbs and all the other past recipients of the Gold Medal award, congratulations! You are the crème de la crème of the TDA, and I am honored to know you.

1092

Texas Dental Journal l www.tda.org l November 2013

1093

1094

Texas Dental Journal l www.tda.org l November 2013

Join us on Facebook, Twitter and LinkedIn! The Texas Dental Association has created groups on Facebook, Twitter and LinkedIn. The goal of these groups is to provide updates on events and current issues. If you do not have a Facebook or LinkedIn account, you can set one up in minutes! Questions? Contact Stefanie Clegg, TDA web & new media manager at (512) 443-3675 or stefanie@tda.org

Join us on facebook.com/texasdental or groups.to/texasdental Follow us on twitter.com/theTDA Get LinkedIN at linkedin.com, search â&#x20AC;&#x153;Texas Dental Associationâ&#x20AC;?

The View From Austin Stephen R. Matteson, DDS, FICD, Editor-in-Chief

Our Great Professors Where would we be without the great professors in our dental educations? You know, the one who paid special attention to you in the clinic and helped you with a difficult clinical procedure, or the one who made you look up answers to your own questions instead of just giving you the pat answer, or the one who insisted that you improve your diagnostic abilities or showed you why a technique is better than another or demonstrated ethical behavior in the classroom and clinic.

Hard work counts. One well-known teacher spent 40 hours preparing for each lecture and made 3 full dry-runs before class time. Another discarded lecture notes to avoid just giving the same old lecture over and over and searched the literature before each new lecture to ensure the information delivered in class was current. Enthusiasm counts. I know one professor who jumps up on the table in front of the room to get studentsâ&#x20AC;&#x2122; attention. Others write textbooks that mirror their course curriculum and use the book for students to follow during class time. Another engages students to learn from one another in small groups. Dr Louis Grossman was the professor of endodontics at the University of Pennsylvania at my alma mater. He demonstrated many of these characteristics. He authored the endodontics textbook of the day, presented material using the book as a guide for learning, and always began and ended his lectures exactly on time. He insisted that we show 2 negative cultures before completing a root canal and installed blinking lights in the clinic so that students could sterilize their endodontic instruments for 14 seconds in bead sterilizers. His graduate students went on to successful careers in dental education, and he was greatly admired by his students and colleagues. The development of the next generation of great professors is a complex task. In this issue of the Journal, Dr Jeff Hicks and colleagues at the University of Texas Health Science Center at San Antonio Dental School describe a major effort to engage potential future faculty in a formal faculty development program. Letâ&#x20AC;&#x2122;s look to see some excellent educators emerge from that program. I bet the readers can point to a professor or two who influenced them in major ways. How about a letter to the editor about one of your great professors? Email them to me at: texdented@gmail.com.

1096

Texas Dental Journal l www.tda.org l November 2013

Texas Dental Association Notice of Grant Availability 501(c)(3) Non-Profit Dental Organizations The Texas Dental Association (TDA) announces availability of financial assistance for qualifying 501(c) (3) non-profit organization affiliated with dentistry. The monies are derived from TDA Relief Fund interest income earned over the previous fiscal year. Grantees will be determined by the TDA Board of Directors. Eligibility: Grantees must be 501(c)(3) non-profit organizations affiliated with dentistry. Application: Letters of interest detailing the proposed project and associated budget should be mailed to: TDA Board of Directors Attn.: Mr Terry Cornwell 1946 S IH 35 Ste 400 Austin, TX 78704 Deadline: Letters of Interest must be postmarked no later than January 31, 2014. Approval: Letters of Interest will be reviewed and considered by the TDA Board of Directors at its February 2014 meeting. Notification: All recipients will be notified in writing by May 15, 2014. Previous Recipients: In 2013, grants in the amount of $2,100 were awarded to each of the following Texas organizations for direct patient care related expenses: Christian Community Action (Lewisville); Community Health Center of Lubbock; Dentists Who Care (Edinburg); and San Jose Clinic (Houston). Additionally, $2,100 was awarded for Hurricane Sandy Disaster Relief. For more information, please contact TDA Governance Manager Mr Terry Cornwell, 512-443-3675 or terry@ tda.org.

972-943-5773 Errata

The September 2013 Texas Dental Journal inadvertently reported active members rather than total members in the section titled â&#x20AC;&#x153;Officers, Dues, and Membership of the District Dental Societies 2013-2014.â&#x20AC;? The total member numbers are: First District 107 Second District / Southeast Texas 168 Third District / East Texas 311 Fourth District / North Texas 496 Fifth District / Dallas County 1421 Sixth District 82 Seventh District / Brazos Valley 202 Eighth District / Greater Houston 1730 Ninth District 175 Tenth District / Capital Area 726 Eleventh District / Central Texas 202 Twelfth District / Fort Worth 808 Thirteenth District 75 Fourteenth District / Guadalupe Valley 84 Fifteen-A District / Nueces Valley 196 Fifteen-B District / Rio Grande Valley 224 Sixteenth District / El Paso 194 Seventeenth District 99 Eighteenth District / Panhandle 145 Nineteenth District / South Plains 137 Twentieth District / San Antonio 872 Twenty-One A District / San Angelo 55 Twenty-One B District / Heart of Texas 103 Twenty-One C District / Permian Basin 109 Twenty-third District / Laredo 49 Twenty-fourth District / River 117

Texas Dental Journal l www.tda.org l November 2013

1097

Anesthesia Education & Safety Foundation, Inc. Call us at 214-384-0796 or e-mail us at sedationce@aol.com; website: www.sedationce.com

ACLS & PALS Now Available! Contact us for details. OUR MISSION: To provide affordable, quality anesthesia education with knowledgeable and experienced instructors, both in a clinical and academic manner while being a valuable resource to the practitioner after the programs. Courses are designed to meet the needs of the dental profession at all levels. OUR GOAL: To teach safe and effective anesthesia techniques and management of medical emergencies in an understandable manner. WHO WE ARE: We are licensed and practicing dentists in Texas, and we understand your needs. While other providers are in the process of contemplating program development, our courses have met the ADA Guidelines for more than 10 years. The new anesthesia guidelines were recently approved by the Texas State Board of Dental Examiners. As practicing dental anesthesiologists and educators, we have established continuing education programs to meet these needs.

McKinney, Texas: Credit: Time:

Approved PACE Program Provider FAGD/MAGD Credit. Approval does not imply acceptance by a state of provincial board of dentistry or AGD endorsement. 8/1/2011 to 7/31/2014. Provider ID# 217924.

Dr David Canfield

Dr Clark Whitmire

Nitrous Oxide/Oxygen Conscious Sedation Course for Dentists:

Each course date is by appointment with Dr. Canfield, please call for details 14 hours (clinicians must complete the online portion, first) 7:00 am – Registration; 7:30 am – 5:00 pm – Clinical Presentation

Level 1 and Level 2 Enteral Sedation Renewal Courses (only 1 day needed to renew):

McKinney, Texas: Rockport, Texas: Lubbock, Texas: Houston, Texas: Credit: Time:

Fri. or Sat., December 6 or 7, 2013, Fri., January 10 or Saturday, January 11, 2014 Saturday, January 18, 2014 Friday, January 24, 2014 Friday, February 14, 2014 or Saturday, February 15, 2014 8 hours lecture 7:00 am – Registration; 7:30 am – 5:00 pm – Presentation

McKinney, Texas: McKinney, Texas: Houston, Texas: Credit: Time:

Friday & Saturday, December 6-7, 2013 Friday & Saturday, January 10-11, 2014 Friday & Saturday, February 14-15, 2014 18 hours lecture with 20 clinical experiences 7:00 am – Registration; 7:30 am – 5:00 pm – Presentation

Level 1 Initial Minimal Sedation Permit Courses:

Level 1 to Level 2 Transitional Moderate Sedation Permit Course (must have a Level 1 permit):

McKinney, Texas: Houston, Texas: Houston, Texas: Credit: Time:

Sunday, December 8, 2013 or Sunday, January 12, 2014 Saturday, December 14, 2013 Saturday, February 15, 2014 8 lecture/participation hours with clinical experiences and 3 live sedations 7:00 am – Registration; 7:30 am – 4:30 pm – Presentation

ACLS (Advanced Cardiac Life Support) & PALS (Pediatric Advanced Life Support) Program:

Houston, Texas: McKinney, Texas: Credit: Time:

Friday, December 13, 2013 or Friday, January 31, 2014 Friday, February 28, 2014 8 hours lecture/Participation 7:30 am – Registration; 8:00 am – Presentation start time

Austin, Texas: McKinney, Texas: Credit: Time:

Friday and/or Saturday, January 31 - February 1, 2014 Friday and/or Saturday, February 28 - March 1, 2014 16 hours lecture for 2-day program; or 8 anesthesia hours for 1 day program 7:30 am – Registration; 8:00 am – 5:00 pm – Presentation

McKinney, Texas: McKinney, Texas: Houston, Texas: Credit: Time:

Friday – Sunday, December 6-8, 2013 Friday – Sunday, January 10-12, 2014 Thursday – Saturday, February 13-15, 2014 24 hours lecture/participation with clinical experiences and 3 live sedations 7:00 am – Registration; 7:30 am – 5:00 pm – Presentation

Level 3 & Level 4 Parenteral Sedation Permit Renewal & ACLS Course:

Level 2 Initial Moderate Sedation by Oral Administration Permit Course:

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

1098

Texas Dental Journal l www.tda.org l November 2013

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

Visit us online www.txprn.com Texas Dental Journal l www.tda.org l November 2013 1099

Oral and Maxillofacial Pathology Case of the Month Clinical Presentation Four large cystic lesions, 1 in each of the 4 posterior quadrants of the mandible and maxilla were found incidentally in a 35-year-old Hispanic male who presented with an unrelated dental complaint. The duration of the jaw lesions prior to presentation could not be determined. Concurrently, numerous, reddish, papular lesions of the skin of the upper arm area and punctate lesions of the palms were present (Figure 1). Significant medical history included numerous skin lesions histologically diagnosed as basal cell carcinoma, which were subsequently excised. Panoramic view of the mandible showed circumscribed radiolucencies in the second and third molar areas of the left and right mandible (Figure 2). Facial CT scan showed bilateral radiolucencies in the right and left posterior maxilla (Figure 3A and 3B). The right posterior maxillary lesion was found apical to the second molar but extended to involve the third molar area while the left posterior maxillary lesion was localized to the third molar region. Surgical excision (enucleation) of the lesions in all 4

quadrants of the jaws was performed, and excised tissue submitted for histopathologic examination.

Differential Diagnosis The intraoral clinical and radiographic findings suggested a differential diagnosis list that included dentigerous cyst, odontogenic keratocyst, squamous odontogenic tumor, and metastatic disease: intraosseous pathology known to present simultaneously at multiple locations of the jaws. In addition to synchronous, multifocal presentation, dentigerous cysts and odontogenic keratocysts occur very frequently in the posterior jaw area, where they are often associated with impacted molar teeth, most commonly the third molars (1). Squamous odontogenic tumors, while sometimes involving multiple jaw quadrants and sites, otherwise have no particular site predilection (1). Furthermore, squamous odontogenic tumors often are discovered fortuitously on radiographs as triangular radiolucencies lateral to the roots of contiguous teeth (1). The radiographic features of the individual jaw lesions

Figure 1. (A) Skin lesions of the thenar eminence, and (B) Palmar pits.

1100

Texas Dental Journal l www.tda.org l November 2013

Ogbureke

Bachoura

Kalu U.E. Ogbureke, BDS, MSc, DMSc, JD, FRCPath; Diplomate, American Board of Oral and Maxillofacial Pathology; University of Texas School of Dentistry at Houston Alex Bachoura, DDS, Cypress Oral Surgery would normally warrant the inclusion of ameloblastoma in the differential diagnosis. However, we could not find any reported cases in the English literature of multiple, synchronous, and discrete ameloblastomas, indicating that these, at best, must be very rare. Metastases from distant organs to the jaws with multiple discrete deposits are always a consideration when multiple jaw lesions are encountered.

Figure 2. Panoramic view showing bilateral radiolucencies (arrows) in the posterior molar region of the mandible.

Figure 3. Facial CT scan. (A) Coronal view showing bilateral lucency (arrows) in the maxillary posterior (molar), and (B) sagittal view of the right posterior maxilla lesion (arrow).

Histology As shown in Figure 4, histologic examination revealed a fibrous connective tissue capsule lined by keratinized odontogenic epithelium, together with abundant keratinacious debris. The lining epithelium was uniform in thickness and exhibited a luminal layer of corrugated

parakeratin subjacent to which were approximately 4 to 6 layers of polyhedral cells that rested on a prominent basal layer composed of columnar cells with palisaded hyperchromatic nuclei and a flat epithelial — connective tissue interface. Focal areas of so-called daughter cysts within the connective tissue were present (arrow, Figure 4).

Also present were numerous focal areas of dense, mixed inflammatory cell infiltrates chiefly composed of lymphocytes and neutrophils. What is the most likely diagnosis? See page 1142 for the answer and discussion

Figure 4. Hematoxylin and Eosin (H&E) sections of specimens of lesions from all 4 quadrant of the jaw showed similar histopathology. In addition to the classic odontogenic keratocyst histopathologic features, (A) shows focal areas of inflammatory cell infiltrates in the wall of the cyst, while (B) shows the presence of “daughter cysts” (arrow) within the connective tissue wall of the cyst. Texas Dental Journal l www.tda.org l November 2013

1101

1 4 4 TH A N N UA L S E S S IO N

Ms Dr Mr Dr Dr Dr Mr Ms Dr Mr Dr Dr Ms Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Dr Mr Ms Dr Dr Dr Dr Dr Dr Dr Dr Dr Ms Dr Dr Ms

Lois Banta David Beach Kirk Behrendt Patricia Blanton Jeff Brucia Anthony Cardoza Tim Caruso Debbie Castagna Gordon Christensen Bruce Christopher Donald Coluzzi Harold Crossley Karen Davis B. Gail Demko Michael Ditolla Alex Fleury Michael Fling Paul Feuerstein Mitchell Gardiner Howard Glazer Lou Graham J. Mel Hawkins Timothy Hempton Randy Huffines Mark Hyman Mark Kleive Donald Lewis David Little Keneta Lott Denis Lynch Joseph Massad Ed McLaren David Meinz Virginia Moore Uche Odiatu Stephen Poss David Rothman Rhonda Savage Jack Shirley Lee Silverstein Ann Spolarich Jon Suzuki John Svirsky Kelli Vrla Richard Young David Yu Rita Zamora

of the

T E X A S D E N TA L A S S O C I AT I O N

4 1 0 2 TEXAS

meeting

MAY 1-4

HENRY B GONZALEZ CONVENTION CENTER 200 E MARKET STREET SAN ANTONIO, TX

IMPORTANT DATES December 1 Housing Opens January 2 Registration Opens

For more information, please visit texasmeeting.com

Texas Dental Journal l www.tda.org l November 2013

TDA is an ADA Cerp Provider

1103

Dentistry’s Watershed Moment

he American Dental Association (ADA) recently released he American Dental Association (ADA) recently released a comprehensive, forward-looking analysis of the a comprehensive, forward-looking analysis of the future dental care landscape. The report, A Profession future dental care landscape. The report, A Profession in Transition (available for download at ada.org/escan), in Transition, is based on sound empirical evidence and is based on sound empirical evidence and convincingly makes convincingly makes the case that the dental care sector is on the the case that the dental care sector is on the cusp of major, cusp of major, transformational change that poses both significant transformational change that poses both significant challenges challenges and brings new opportunities. We are at a watershed and brings new opportunities. We are at a watershed moment. moment.

Marko Vujicic, PhD, Marko Vujicic, PhD, managing vice managing vice president, Health Policy president, Health Policy Resources Center, Resources Center, American Dental American Dental Association Association

1104 1104

Hilton Israelson, DDS, Hilton Israelson, DDS, Fifteenth District Fifteenth District Trustee, and chair, Trustee, and chair, Strategic Planning Strategic Planning Steering Committee, Steering Committee, American Dental American Dental Association Association

Texas Dental Journal l www.tda.org l November 2013 Texas Dental Journal l www.tda.org l November 2013

One of the critical findings of this first-of-its-kind analysis One of the critical findings of this first-of-its-kind analysis is that the past decade has ushered in important structural is that the past decade has ushered in important structural changes in the dental care sector that had little to do with the changes in the dental care sector that had little to do with the recent economic recession. For example, research showed that recent economic recession. For example, research showed that utilization of dental care has declined among adults, particularly utilization of dental care has declined among adults, particularly the young and the poor, but this trend started in the early 2000s, the young and the poor, but this trend started in the early 2000s, well before the Great Recession. By contrast, dental care use is well before the Great Recession. By contrast, dental care use is up among kids, driven entirely by gains among poor and nearup among kids, driven entirely by gains among poor and nearpoor kids. Dental benefits coverage for adults — a major driver poor kids. Dental benefits coverage for adults — a major driver of utilization — has steadily eroded, again particularly for young of utilization — has steadily eroded, again particularly for young and poor adults. This was driven by reductions in both Medicaid and poor adults. This was driven by reductions in both Medicaid dental benefits and private dental insurance coverage for adults. dental benefits and private dental insurance coverage for adults.

Guesteditorial These critical developments on the population side have had profound effects on dental practices. Average dentist earnings declined considerably beginning in the mid-2000s. According to the most recent data, 2 out of 5 dentists indicate they are not busy enough and can see more patients, a significant increase over past years.

Tomorrow’s health care environment also provides some unique opportunities for the dental profession and for organized dentistry. For example, the importance of practice efficiency, value, and quality in tomorrow’s environment provides an opportunity for dental associations to provide new products and services for member dentists. Other opportunities require a paradigm Texas, for the most part, mirrors the national trends. In shift in the role of oral care providers within the health 2012, according to the most recent data from the Centers for care team and in how dental care is viewed in terms Medicare and Medicaid Services, 59% of Medicaid children in of its contribution to improving whole body health. Texas had a dental visit in 2012. This is the highest of any state Tomorrow’s health care environment will pay providers and is a considerable increase from 37% in 2000. Dental care increasingly for outcomes rather than procedures and will use among Medicaid children in Texas is actually higher than be far less silo-ed. There will be much more interaction the national average for children with private dental insurance, and coordination among various health care providers. which is 57%. However, dental care use among low-income Dentists could potentially have an expanded role in, adults in Texas declined by about 15% percent from 2002 for example, screening and managing chronic diseases, to 2010. This is roughly the same rate of decrease as for the working more closely with primary care and specialist entire U.S., according to the Behavioral Risk Factor Surveillance medical providers. The fact that each year almost 10% System. According to the ADA’s Health Policy Resources Center, of the population — 29 million people — sees a dentist between 2006 and 2009, average general dentist net income but not a physician suggests this idea is worth exploring. declined by 13% in Texas compared to 15% in the United The link between oral and whole body health, although States. In 2011, 35% of general still not well understood, There will be much more interaction and coordination provides dentists with an dentists in Texas reported being not busy enough, slightly lower opportunity to play a larger among various health care providers. Dentists could than the national average of role in improving whole potentially have an expanded role in, for example, 39%. body health and lowering screening and managing chronic diseases, working more health care costs. The ACA Looking forward, there are closely with primary care and specialist medical providers. will provide an incentive for payers and providers to several critical environmental engage the dental community to leverage some of these factors dentists need to consider that are outlined in the returns to investments in oral health. report. First, we are likely heading into a period of sluggish demand for dental care if current trends continue. This “new normal” of flat dental spending in the U.S. is a stark departure With this in mind, where do we go from here? Given the from earlier decades of almost steady 4% annual growth. significant environmental changes on the horizon, dentistry Second, the Affordable Care Act (ACA) is expected to expand is at a crossroads. It is not a time for complacency. The ADA the number of children with dental benefits — by as much as is currently developing its 2015-20 strategic plan that will 8.7 million by 2018 — and expand dental care for children. lay out a strategy for helping member dentists navigate the But the ACA will do very little to address the trends for adults. challenges and leverage the opportunities of tomorrow’s Third, a new wave of health care consumerism will dramatically environment. Given the gravity of the moment, there change how dentists and patients interact. The patient of needs to be much more dialogue with state associations the future will be much more informed, will demand more about where we go from here. This is already planned as information on cost and quality before making decisions, and part of the ADA’s strategic planning process. We are at an will want to be much more engaged in treatment decisions. advantage in that we have some very thoughtful, objective, Dentists need to prepare for this. Fourth, the trend towards empirical research that has provided organized dentistry larger, consolidated multi-site practices will continue, driven with key facts and insights about the future. We must now by changes in practice patterns of new dentists, a drive for collectively consider how we can help chart a course for efficiency, and increased competition for patients. the future of the profession. Download the report at ada.org/escan. Texas Dental Journal l www.tda.org l November 2013

1105

Set Your Site on

Oral Health

Visit the new and improved TDA.ORG today!

1 9 4 6 A u s t i P : 5 1 t d a . o

S I H 3 5 S t e 4 0 0 n , T X 7 8 7 0 4 2 - 4 4 3 - 3 6 7 5 r g

Texas Dental Journal l www.tda.org l November 2013

1107

The 2013 Gold Medal Dr Paul E. Stubbs By Nicole Scott, TDA Managing Editor

aul Edward Stubbs was born in 1939 to a geologist father and a homemaker mother in Pampa.

His family left Pampa when he was 4, moving around the state to Lake Jackson, Houston, and finally Abilene, where he began first grade and continued through high school. A natural leader, Paul was involved in many extracurricular activities, including football, track, and drama, advancing all the way to the State Interscholastic League Poetry Reading Contest and playing his favorite role, Shakespeare’s Richard III. Outside of school, he received the rank of Eagle Scout when he was 12 and worked odd jobs during the summers. Since the first “date” with Jena in junior high to the present, he admits he and his wife make a unique couple. He says that, shortly after their marriage (52 years and counting), they took the Meyers-Briggs assessment, learning they were complete opposites. “Good. We have all the bases covered,” he thought, and so it has been for more than half a century. “When a problem arises, it’s fairly easy to know which one takes the lead on solving the issue.” The couple has 3 children — David of Rockdale, Leah of Austin, and Emily and husband Dale of Austin — and 4 grandchildren — Texas A&M University junior Sharon, junior high student Shanna, 6-year-old Lucian, and 4-year-old Abigail.

“I like to think that all these experiences have helped me keep a sense of humor.”

1108

Texas Dental Journal l www.tda.org l November 2013

Paul credits his family with encouraging him to pursue a career in dentistry; however, the road to dental school was circuitous. He recalls that in junior high and high school he was interested in biological sciences and wanted to pursue a career in the health professions. He says an uncle suggested he study to be a dentist, and Paul entered McMurry College in Abilene as a pre-dental / biology major. He continued graduate studies at Wayne State University College of Medicine in Detroit with a master’s degree in physiology. He worked briefly in research and development with a Philadelphia pharmaceutical company and then taught physiology and general biology at McMurry for 2 years. He eventually determined that a career in research or academia was not the right fit for him and was accepted to Baylor Dental School in 1966. “I knew immediately this was where I was meant to be,” he says.

for Distinguished Service —

Pictured in 1999 are 4 TDA past presidents, all whom graduated from the Baylor College of Dentistry class of 1970: Drs Frank Eggleston of Houston, Paul Stubbs of Georgetown, John Findley of Plano, and Corky Carnahan of San Antonio. Dr Paul Stubbs provides dental care to a young patient during a mission trip to Managua, Nicaragua, in 1983.

About the Honor By Paul H. Schlesinger

The Gold Medal for Distinguished Service is the highest honor one can achieve in the Texas Dental Association. Nominations are submitted to the Awards Committee by the Board of Directors, component society presidents, and component executive staff. Only one person per year may receive the award, and that is only if the Awards Committee believes one of the nominees successfully meets the criteria. The criteria involves service in TDA leadership positions, ADA service, local society contributions that affected state concerns, commitment to organized dentistry through other organizations including teaching, and service to the community. About the Gold Medal Presentation Owing to its stature, the TDA president presents the award before the House of Delegates. The name of the recipient is not revealed to anyone, including the recipient, until the actual presentation takes place. The Awards Committee works behind the scenes with the recipient’s family members to make sure they are in attendance without alerting the recipient. In 2006 the TDA commissioned a nationally renowned Texas artist, Ronadró, to design a unique award piece to represent the Association. The result is a beautiful, bronze relief depicting a dentist caring for a patient. This sculpture was adopted for the Gold Medal award in 2008. Inset into the shadowbox are 2 custom designed medallions: the TDA seal and the gold medal. About the Past Recipients To date, there have been 16 recipients of the Gold Medal: Drs John D. Wilbanks, Michael D. Vaclav, O.V. Cartwright, H.M. “Mit” Sorrels, Jack H. Harris, James E. Bauerle, Robert V. Walker, Frank K. Eggleston, Robert M. Anderton, Rene M. Rosas, Richard M. Smith, Sam W. Rogers Jr, Stephen F. Schwartz, John S. Findley, S. Jerry Long, and Patricia L. Blanton. By the judgment of their colleagues, they represent the best of the TDA; dentists who have dedicated their lives to the Association and profession, and have advanced both through their commitment, strength, and vision.

Texas Dental Journal l www.tda.org l November 2013

1109

Paul chose Austin as his practice location because of its “nice size,” he says. In 1970, Austin’s population was a little more than 250,000 people. Plus, Austin presented opportunities for Jena and him to create the lifestyle they desired. Twenty-five years later, he relocated his practice to Georgetown when Jena entered the retail business and opened a fine gifts store on the town’s historic square. “At that time, I assessed the Austin practice and its future and made a significant business decision to sell that practice. Fortunately, the opportunity opened to relocate in

TDA past presidents congratulate Dr Paul Stubbs as he is awarded the 2013 TDA Gold Medal for Award for Distinguished Service at the House of Delegates in May 2013 in San Antonio.

Georgetown, and I seized the option and still am thriving in this location.” His proudest accomplishments in dentistry have included being the key instrumental guide for the TDA to purchase the adjacent building, which now houses the TDA Conference Center; being involved in early detection of pathology in patients, which has led to early treatment and saved lives; mentoring various employees, patients, or students to enter the dental profession (to date, 1 dental hygienist and 4 dentists); serving as president of the Texas

1110

Texas Dental Journal l www.tda.org l November 2013

Dental Association, the Western Region Examining Board, and the International College of Dentists — USA Section; and being a member of the Texas State Board of Dental Examiners. When he received the Gold Medal award in May 2013, he says he was assured that his efforts in leadership and involvement in all aspects of the dental profession have been worthwhile. When Paul is not practicing dentistry in the office, he continues to participate in at least 4 clinical board

Dr Paul Stubbs, recipient of the 2013 TDA Gold Medal for Distinguished Service, addresses the House of Delegates in May 2013 in San Antonio.

examinations annually with the Western Region Examining Board as well as serving on the ADA’s Joint Commission test construction committees for the National Dental Board Examinations. He also provides his skill and expertise on mission trips to help those less fortunate. He has traveled to the Texas border in the Las Milpas community in Pharr and internationally to Haiti, the Yucatan Peninsula of Mexico, and Nicaragua. Additionally, he participates in Texas Missions of Mercy, sponsored by the TDA Smiles Foundation and supported by the TDA.

An avid cyclist since 1983, he rides the Austin streets, logging up to 25 miles on the weekend days. “In my better days, I trained for the annual big rides like the Jalapeño 100 in Harlingen and the Hotter’N Hell Hundred in Wichita Falls. Fortunately, in Austin there are enough hills to make it interesting,” he says, adding, “In spite of the motorists and unpainted speed bumps, I manage to stay upright most of the time – except for one ‘honker’ speed bump that yielded a crash and hip fracture!”

there’s nothing quite so special as receiving the smile from my grandson as I pass the offering plate by him and watching him and his sister becoming faithful participants in worship.”

Dr Paul Stubbs cycles to the finish line of the Hotter’N Hell Hundred in Wichita Falls in 2007. Dr Stubbs says the temperature that day was 106 degrees.

Drs Beverly Zinser and Paul Stubbs in 2003 take a moment to mime the Oscar Wilde quote that hangs on a plaque in their office: “Life is too important to be taken seriously.”

He and Jena travel abroad, enjoying trips to the Greek Islands, Canadian Rockies, Scotland, and Eastern Europe. He and his granddaughter Sharon recently cruised the Galapagos Islands. “It’s something that all biology majors should see!” On Sundays, you will find Paul teaching Sunday School classes, participating in the choir, and/or serving as an elder at Westminster Presbyterian Church. “I have continued to stay involved with community service. And,

His personal, leadership, and community involvement have helped him communicate with his patients, staff, and those whom he mentors. “My involvement with the examination community has certainly kept me vigilant on excellence of

my techniques of delivery of dental services to the patient, and helped me become a more critical, yet flexible, practitioner. I like to think that all these experiences have helped me keep a sense of humor.” In fact, this mix of professionalism and charismatic humor is evident in one of his favorite photos of him and his dental partner Dr. Beverly Zinser during a “Give Kids a Smile” event. “It’s the office motto and includes a quote by Oscar Wilde, ‘Life is too important to be taken seriously.’”

Texas Dental Journal l www.tda.org l November 2013

1111

1112

Texas Dental Journal l www.tda.org l November 2013

WE’RE FOR DENTISTS. Smile Brands affiliated dentists earn 20% more than the average U.S. dentist in private practice. .d

of soc 0% d as 2 e top filiat over 00 af arn ,0 e 80 $2

YOUR CAREER ISN’T THE ONLY PLACE YOU CREATE SMILES.

We free you, so you can do more in and out of the ofﬁce. Our provider-focused culture is designed to support your ambitions and expand your skills - and be flexible. Through our network of nearly 400 affiliated offices in 18 states, no matter your situation or lifestyle, we’re here to help you reach your goals. Learn just how many ways we’re for you: 972.212.8222 or 949.677.3187

jobs.smilebrands.com/texas

% le 20 ted r top filia ove 00 af arn 0,0 e 33 $

sts

nti

of % 20 lists r top ecia ove 00 sp arn 0,0 e 50 $

OUR PROVIDER PROMISE

CMY

sts

ti en

• Outstanding earning potential • Full business and capital support services • Innovative marketing practices • Dedicated Clinical Board of Directors • Peer-to-peer mentor partnerships to share clinical expertise • Clinical and professional development designed for the way you live and practice • Defined clinical career path • Sustainable and proven business model • Comprehensive patient financing options

CONNECT WI TH US

All ADS companies are independently owned and operated.

Texas Dental Journal l www.tda.org l November 2013

1113

PRACTICES ARE SELLING FOR CASH NOW! INCREASE PRACTICE VALUE ANALYZE KEY AREAS OF YOUR PRACTICE

LOCATION

DEMOGRAPHICS STUDY

APPEARANCE OF YOUR OFFICE

TAKE PHOTOS OF EVERY AREA

SIZE OF PATIENT BASE

3 YEARS OF GROWTH TRENDS

NEW PATIENT FLOW

EXPLORE INTERNET MARKETING

ACTIVE RECALL

20% – 30% OF GROSS

“OPERATING PROFITS”

HYGIENE PROFITS MOST IMPORTANT

As an Appraiser/Consultant, I must know the practice in order to educate the Buyer concerning the practice future potential. A bunch of numbers/proformas do not give necessary information about your practice. My appraisals provide all the data above and more. Numbers alone rarely sell a practice. My appraisal is a 75 – 100 page Management Study with the Goodwill/Intangibles based upon comparable area practice sales (plus Tangibles). Routinely, our Practice Sales will bring 97% – 100% of the Appraised Value.

FOR OVER YEARS NO CHARGE FOR37REAL ESTATE YOU HAVE SEEN THE NAME…

FOR OVER 37 YEARS YOU HAVE SEEN NOT JUST A THE NAME… PRACTICE BROKER

CERTIFIED CEFTIFIED PRACTICE PRACTICE APPRAISALS

(Over 2,200 Dental Practice Sales for Comparison) OUR FEES LOW AS 3.75% – 5.75% IF YOU HAVE ASSOCIATE/BUYER • PMA MARKETING NETWORKS • 100% FUNDING AVAILABLE • NO DUAL REPRESENTATION • NEGOTIATE FAIR PRICE • PROCESS COMPLETE CLOSING • TAX STRATEGY • TRANSITION PLANNING • PARTNERSHIPS

NOT JUST A PRACTICE SELLING PRACTICES BROKER CONSULTING DENTISTS “37 YEARS” SELLING PRACTICES CONSULTING DENTISTS “37 YEARS”

“I PERSONALLY HANDLE EVERY TRANSITION”

GARY CLINTON Senior Appraiser

Member of The Institue of Business Appraisers, Inc. CALL 1-800-583-7765 OR DFW AREA 214-503-9696

1114

Texas Dental Journal l www.tda.org l November 2013

Journal l www.tda.org l June 2011 2011 TexasTexas DentalDental Journal l www.tda.org l October

509 1103

DENTAL EDUCATION REPORT

Career Transition and Dental School Faculty Development Program Jeffery L. Hicks, DDS William D. Hendricson, MS, MA Mary N. Partida, DDS, MPH John D. Rugh, PhD John H. Littlefield, PhD Mary E. Jacks, MS

THE PROBLEM — LOSS OF DENtal Faculty, Training Needed Academic dentistry, as a career track, is not attracting sufficient numbers of new recruits to maintain a corps of skilled dental educators. Since 2000, more than 10% of dental school faculty members have left education for private dental practice or retirement. In 2005, vacant faculty positions in dental schools were reported as 417, and in 2007, dental schools reported an average of 7 vacant faculty positions per institution (1).

Hicks

Hendricson

Partida

Rugh

Dr Hicks is professor, Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio Dental School, San Antonio, Texas. Professor Hendricson is assistant dean for educational and faculty development, University of Texas Health Science Center at San Antonio Dental School, San Antonio, Texas. Dr Partida is associate professor, Department Littlefield of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio Dental School, San Antonio, Texas.

Jacks

Dr Rugh is professor, Department of Developmental Dentistry, University of Texas Health Science Center at San Antonio Dental School, San Antonio, Texas. Dr Littlefield is adjunct assistant professor, Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio Dental School, San Antonio, Texas. Ms Jacks is associate professor, Dental Hygiene Division, Department of Periodontics, University of Texas Health Science Center at San Antonio Dental School, San Antonio, Texas. Corresponding author: Jeffery L. Hicks, DDS, Mail Code 7914, 7703 Floyd Curl Dr, San Antonio, TX 78229-3900; E-mail: hicksj@uthscsa.edu; Phone 210-567-3450; Fax 210-567-3443 Disclaimers: None. Federal grant support; U.S. Health Resources and Services Administration; D84HP19953. This article has been peer reviewed.

Abstract Academic dentistry, as a career track, is not attracting sufficient numbers of new recruits to maintain a corps of skilled dental educators. The Faculty Development Program (FDP) at the University of Texas Health Science Center at San Antonio Dental School received federal funds to institute a 7-component program to enhance faculty recruitment and retention and provide training in skills associated with success in academics including: (1) a Teaching Excellence and Academic Skills (TExAS) Fellowship, (2) training in research methodology, evidence-based practice research, and information management, (3) an annual dental hygiene faculty development workshop for dental hygiene faculty, (4) a Teaching Honors Program and Academic Dental Careers Fellowship to cultivate students’ interest in educational careers, (5) an Interprofessional Primary Care Rotation, (6) advanced education support toward a master’s degree in public health, and (7) a key focus of the entire FDP, an annual Career Transition Workshop to facilitate movement from the practice arena to the educational arm of the profession. The Career Transition Workshop is a capstone for the FDP; its goal is to build a bridge from practice to academic environment. It will provide guidance for private practice, public health, and military dentists and hygienists considering a career transition into academic dentistry. Topics will be addressed including: academic culture, preparation for the academic environment, academic responsibilities, terms of employment, compensation and benefits, career planning, and job search / interviewing. Instructors for the workshop will include dental school faculty who have transitioned from the practice, military, and public health sectors into dental education. Objectives of the Overall Faculty Development Program: • Provide training in teaching and research skills, career planning, and leadership in order to address faculty shortages in dental schools and underrepresentation of minority faculty. • Provide resident and faculty training in cultural and linguistic competency. • Develop and conduct a collaborative interprofessional education project with a Pediatric Medicine department, a nursing school, and other health professions’ education programs. • Provide faculty and residents with financial support to pursue a master’s degree in public health; and • Provide support and assistance for dental practitioners desiring to explore a transition into the educational environment.

Key words: academic training, career choices, career transition, dental faculty, mentorship

Tex Dent J 2013;130(11): 1115-1122.

Texas Dental Journal l www.tda.org l November 2013

1115

DENTAL EDUCATION REPORT

1116

100% 80% 60% 40% 20% 0% Advanced Education

Private Practice

Dental School Graduation

Uniformed Service

Another Teaching Institution

Figure 1.

From: A Survey of U.S. Dental School Programs that Help Students Consider Academic Careers. McAndrew M, Brunson D, Kamboj B. JDE 2011;75(11):1458-1464 (3).

Sources of New Full-time Faculty UTHSCSA Dental School 2006-2013

25 20 15 10 5

Figure 2.

Texas Dental Journal l www.tda.org l November 2013

Fe d

ow n kn Un

en t

er al

Go ve r

ol Sc ho nt al

ot he r

Pr ac tic e An

Pr iva te

ra m

Pr og

Faculty replacements may have limited teaching experience and little exposure to academic environments (6). Also, the retirement of mature faculty and their replacement with younger faculty having limited academic experience and minimal training or experience in teaching, results in fewer faculty qualified to serve as role models and mentors for students and also for junior faculty members. Recent data show that more than 90% of dental schools offer community-based rotations for dental students (7). A recent national study indicates that dental faculty perceive that they have limited access to professional development / career planning advice, and only 42% of faculty survey respondents indicated satisfaction with professional development support at their institutions (8). These trends contribute to an increased need for

Sources of New Dental School Faculty Members

Gr ad ua te

Livingston calculates that, if current trends continue, 900 faculty vacancies will result by 2020 (2). Of note, individuals under age 45 form the single largest demographic leaving dental education, while faculty replacements are most commonly 5065-year-old individuals ending military careers or community practice (Figure 1) (1,3). This data partially explains why the most recent survey of dental faculty shows the average age of faculty in 2001 was 49.6 years whereas in 1975 the average age was 43 (4). Dental schoolsâ&#x20AC;&#x2122; recent graduates are not a common source of new faculty as there is a report from a survey of dental school seniors indicating that less than 1% of graduating seniors are considering a career in academic dentistry (5).

DENTAL EDUCATION REPORT

faculty development for community dentists serving as faculty in these sites. Our own dental school (University of Texas Health Science Center at San Antonio Dental School — UTHSCSA) has recruited new full-time faculty members from a variety of sources. Figure 2 details the sources of fulltime faculty appointed to our school in years 2006-2013. The dental graduate programs at San Antonio and at other schools supplied the largest number of faculty, followed by private practice. San Antonio, due to the presence of 4 military bases/ posts with large dental services, successfully recruited 8 faculty from military or other government sources. Other dental schools were the source of 14 faculty, not unusual as faculty are often recruited from other dental schools. The large number of faculty from private practice and graduate programs supports our school’s initiative of recruiting and training faculty from these sources through a formal, structured Faculty Development Program.

Potential solution — faculty development Our institution has responded to the faculty shortage with a comprehensive, 7-element program to recruit and train potential new and existing faculty, residents, and students. Besides ensuring that our dental schools are adequately

staffed with faculty who have been prepared for teacher responsibilities, what other types of support are needed to develop a well-trained faculty? These other areas of faculty support include: development of mentors, equipping faculty with the skills needed to provide patient care within interprofessional teams, training students and residents to care for vulnerable and socially diverse populations, developing a substantial cohort of community-based faculty, and enhancing cultural and linguistic competence among our students, residents, and faculty members. Our program’s approach is based on the literature regarding these trends, summarized below.

health care system (10). Current dental professionals and faculty largely have not been trained in this manner and must be equipped to teach others how to work in interdisciplinary teams. Members of the dental team need to be integrated into the health care system, involving the need for difficult but necessary changes in the education of all types of dental professionals. Additionally and directly to the point, Standard 2-19 of the Accreditation Standards for Dental Education Programs (Commission on Dental Accreditation) now mandate the “graduate must be competent in communicating and collaborating with other members of the health care team” (11).

• Mentorship training

Vanchit states that one goal of a dental careers fellowship program is to create a “cadre of dental school faculty members with the skills to function as academic career mentors for future fellows and dental students; these then would serve as role models for research and teaching” (9). Therefore, an element of a faculty development program should include training in mentoring students/residents and fellow faculty.

• Training in underserved and vulnerable populations

• Interprofessional training

The Institute of Medicine (IOM) has concluded that, in order to adequately address a patient’s entire health care needs, the dental health care education system and the patient care system need to be integrated at all levels of the oral health team and within the overall

The dental education literature reports the opinion that the current oral health workforce fails to meet the need of many segments of the U.S. population (12). By and large, most current dental faculty do not possess adequate knowledge for providing care for vulnerable patients resulting in underserved populations (13). While all dental students receive classroom training in the care of medically ill patients, few dentists obtain clinical experience in the care of patients who have significant medical illness.

• Cultural Competence

Multiple papers have stated that enhancing the number of

Texas Dental Journal l www.tda.org l November 2013

1117

DENTAL EDUCATION REPORT

oral health practitioners from underrepresented minority and disadvantaged groups improves access to care for persons from these same groups (14,15,16). The U.S. Surgeon General concluded in 2000 that oral health problems disproportionately affect URM groups and low-income populations (17). Social, economic, and cultural factors and changing population demographics affect how health services are delivered and used. Faculty recruitment and development programs should consider training in the care of vulnerable populations as required training for a wellequipped faculty.

Program Objectives and Methodology The Faculty Development Program (FDP) is conducting activities in years 2012-2017 that enhance the skills of private practice and military dentists and hygienists, dental school faculty members, dental residents, dental students and dental hygiene faculty and students in teaching strategies including mentorship training, interprofessional education, provision of oral health care for vulnerable populations, cultural competency, curriculum planning, assessment of learner performance, academic leadership, public healthoriented scholarship, and research methodologies and evidence-based practice.

1118

A. FDP Components The Faculty Development Program consists of 7 components to provide a comprehensive educational continuum for current and future faculty in primary care dentistry. 1. Career Transition Program. A free-of-charge, 1-day conference will be conducted in May/June in years 2014-2017 for private practitioners, military dentists, and dentists working in public health clinics who are exploring a transition into academia. Instructors for the Career Transition Program will include UTHSCSA dental school faculty who have transitioned from the private practice, military, and public health sectors into dental education in positions that involve delivery of primary care dentistry curriculum or public health research. This opportunity will be promoted to interested persons through professional publications and society newsletters, presentations at dental and dental hygiene meetings, our programâ&#x20AC;&#x2122;s website, and mail-out materials. The goal is to engage 20 practitioners annually in the Career Transition Program for a total of 80 during all years. 2. Teaching Excellence and Academic Skills (TExAS) Fellowship. Through this component in years 2013-2017, faculty, residents, and students will acquire skills for success in academic dentistry with focus on teaching methodologies,

Texas Dental Journal l www.tda.org l November 2013

Figure 3. William Hendricson, director of the TExAS Fellowship.

educational planning, scholarship (designing educational research), career planning, and educational leadership. The fellowship includes a theme devoted to cultural considerations in patient care for ethnically diverse and economically vulnerable communities. Twenty participants per year or a total of 100 current and future primary care dentistry and dental hygiene faculty, residents, and students will develop skills by completing the TExAS Fellowship over 5 years. 3. Research Methodology and Evidence-Based Practice Course. This 2-element course in years 2013-2017 enhances traineesâ&#x20AC;&#x2122; capacities to conduct research and incorporate evidence-based practice into patient care. The first element is Scientific Inquiry and Research Methodology,

DENTAL EDUCATION REPORT

and the second element is Establishing an EvidenceBased Practice, including an introduction to the UTHSCSA Dental Schoolâ&#x20AC;&#x2122;s Practice Based Research Network. Our goal is for 20 participants per year for a total of 100 current and future primary care dentistry and dental hygiene faculty, residents, and students will complete this course during this 5-year training grant. 4. Teaching Institute for Dental Hygiene Educators. The Dental Hygiene Division of the Department of Periodontics at UTHSCSA will conduct an annual educators institute in years 2013-2017 for U.S. dental hygiene faculty focusing on innovative teaching and assessment strategies, career planning, strategies for implementing community-based service learning and interprofessional education, incorporating cultural competency and health literacy into the curriculum, and strategies for facilitating studentsâ&#x20AC;&#x2122; capacity to work with vulnerable populations. Fifty dental hygiene faculty will complete the Teaching Institute each year. 5. Teaching Honors Program. The Teaching Honors Program (THP) for dental students at the UTHSCSA Dental School will be expanded in years 2013-2017 to include dental hygiene students and additional faculty mentors. The program will be augmented to facilitate participation of student / faculty teams in the Academic Dental Careers

Figure 4. Dentists participating in the TExAS Fellowship. Fellowship Program (ADCFP) conducted by the American Dental Education Association. The ADCFP allows dental and dental hygiene students to explore academic careers during a year-long fellowship where students function in teaching roles, conduct research, interview faculty, and assist mentors with educational tasks. The THP will be expanded to include dental hygiene students and faculty mentors and 10-15 additional dental students and associated faculty mentors and 10-15 additional dental students and associated faculty mentors annually. Training of THP faculty mentors, who serve as academic career guides and role models for students, will be expanded to provide 40 faculty mentors by 2017.

Figure 5. John Rugh, PhD, director of the Research Methodology and Evidence-Based Practice course.

Texas Dental Journal l www.tda.org l November 2013

1119

DENTAL EDUCATION REPORT

6. Interprofessional Primary Care Rotation (IPCR). A multidisciplinary clinical team rotation promotes interprofessional learning and patient care. Teams of residents and students from medicine, nursing, dentistry, and dental hygiene work with homeless families at the San Antonio Metropolitan Ministries Transitional Living and Learning Center to assess health care needs, develop plans, and provide prevention and education. The IPCR will ultimately include seminars on implementing teambased patient care, working with vulnerable populations, health literacy, and cultural competency. The goal by 2014 is to establish 10 4-member IPCR teams annually consisting of general dentistry, pediatric dentistry and/ or dental public health residents, pediatric and internal medicine residents, BSN and advanced practice nursing students, and dental hygiene students for a total of 40 participants annually. 7. Advanced Education Support. Ten residents in general dentistry, pediatric dentistry, and dental public health and/or faculty members in primary care will acquire skills in years 2013-2017 to conduct community-based public health research by their completion of a Masters in Public Health program at The University of Texas School of Public Health San Antonio Regional Campus.

1120

B. Outcomes All program goals and component objectives have been met in the first year of the program, 2012-2013 (Table 1). A total of 246 faculty, residents, and students attended the educational offerings of the Faculty Development program in its first year. An additional 57 persons also were added to existing educational opportunities closely allied with the Faculty Development Program.

Table 1. First-year Outcomes of the Faculty Development Program Component

Goal

2012-2013 Outcomes

Career Transition Program

Planning/Promotion

In progress

Dental Educational Fellowship

20 completers

26 completers

Research Methodology/EBP Course

20 completers

42 completers

Dental Hygiene Teaching Institute

50 completers

84 completers

Teaching Honors Program Increase completers 10-15

61 Yr 1 students & 118 overall, Increase of 22 from 2011

15 faculty mentors in 2011

31 faculty mentors in 2012-13. One student & 2 faculty mentors accepted in ADCFP

Interprofessional Care Rotation

Planning

In progress

Advanced Education Support

2 MPH students 2 MPH students enrolled enrolled

1. Career Transition Program. The component is being promoted to interested persons through publications, presentations at dental and dental hygiene meetings, our programâ&#x20AC;&#x2122;s website, and mail-out materials. 2. TExAS Educational Fellowship. Twenty-five dental faculty, residents, postdocs, and students completed the semester-long fellowship. TExAS was conducted in a team format mixing faculty, residents, students, and postdocs on project teams. 3. Research Methodology and Evidence-Based Practice Course. Forty-two dental and dental hygiene faculty, residents, students, and community dentists completed this semester-long component. Participants worked in teams in developing more than 40 critically appraised topic summaries (CATs) reporting best evidence pertinent to clinical research questions.

Texas Dental Journal l www.tda.org l November 2013

DENTAL EDUCATION REPORT

4. Teaching Institute for Dental Hygiene Educators. Eighty-four dental hygiene faculty attended the Teaching Institute, which focused on clinical teaching strategies. 5. Teaching Honors Program. Sixty-one first-year students, 19 second-year, 18 junior and 20 senior students participated in the Teaching Honors Program. Thirty-one faculty served as career mentors for first-year students, and a junior student was selected as the schoolâ&#x20AC;&#x2122;s first ever ADCFP Fellow along with 2 faculty mentors. 6. Interprofessional Primary Care Rotation (IPCR). Identification of IPCR sites and opportunities has been performed. Planning has begun on the rotations for the teams. 7. Advanced Education Support. One resident and 1 faculty member have enrolled in the Masters in Public Health Program and have successfully completed year 1 courses.

Future Program Activities/ Expansion All 7 components of the FDP will be offered in academic year 2013-2014. The Faculty Development program will add an eighth component in academic year 2013-2014. The Research in Dental Education (RIDE) course will be enacted for dental school and dental hygiene faculty, residents in advanced dental education programs, and dental students pursuing the

Figure 6. Dentists enrolled in the Research Methodology course.

Distinction in Dental Education who desire to acquire skills in educational research. The course goal is to enhance the capacity of participants to design research studies that explore educational issues, to obtain funding to support research, and to disseminate findings via publication. RIDE will have 3 components: designing educational research, grant writing, and writing for publication. Faculty, residents, and students work in teams to plan and implement an educational research project, with the outcome of submitting an abstract to the American Dental Education Association for presentation at its national meeting. During seminars on grant writing, teams will develop and present a grant application to fund an educational project and receive a

critique. During seminars on writing for publication, participants will complete writing exercises, critique a manuscript, and write an abstract to be presented to the class for peer feedback.

conclusion The Faculty Development Program at the University of Texas Health Science Center at San Antonio (fdp. uthscsa.edu) has been instituted and all objectives and attendee goals have been met for the current year. Of particular note to dental health practitioners, interested dentists and dental hygienists will be recruited for the Career Transition Program component, a free-of-charge, 1-day

Texas Dental Journal l www.tda.org l November 2013

1121

DENTAL EDUCATION REPORT

workshop to be instituted in May/ June 2014. This workshop will aid those considering a career transition to an academic career. The workshop will ease doubts, uncertainty, and answer questions for those interested in dental education but are unsure of a career transition. The workshop will present on a variety of topics including: understanding academic culture, successful preparation for the academic environment, academic responsibilities, terms of employment, compensation and benefits, career planning, and job search / interviewing techniques. Instructors for the Career Transition Program will include UTHSCSA Dental School faculty who have transitioned from private practice and military sectors into dental education. References 1. Okwuje I, Sisson A, Anderson E, Valachovic. Dental School Vacant Budgeted Faculty Positions, 2007 08. J Dent Educ. 2009; 73(7):1415-1422. 2. Livingston H, Dellinger T, Hyde J, et al. The Aging and Diminishing Dental Faculty J Dent Educ 2004; 68(3): 345-354. 3. McAndrew M, Brunson D, Kamboj B. A Survey of U.S. Dental School Programs that Help Students Consider Academic Careers. J Dent Educ. 2011; 75(11):1458-1464. 4. Chmar J, Weaver R, Valachovic R. Dental School Vacant Budgeted Faculty Positions, Academic Years 2005-06 and 2006-07. J Dent Educ. 2008;71(3):370-385.

1122

5. Okwuje I, Anderson E, Valachovic R. Annual ADEA Survey of Dental School Seniors: 2009 Graduating Class. J Dent Educ. 2010; 74(9):1024-1045. 6. Haden N, Hendricson W, Killip J, et al. Developing Dental Faculty for the Future: ADEA/ AAL Institute for Teaching and Learning, 2006-09. J Dent Educ. 2009; 73(12):1320-1335. 7. Haden N, Hendricson W, Kassebaum D, Weinstein G, E. Anderson, Valachovic R. Curriculum Change in Dental Education. J Dent Educ. 2010;74(5):539-557. 8. Haden K, Hendricson W, Ranney R, et al. The Quality of Dental Faculty Work-Life; Report on the 2007 Dental School Faculty Work Environment Survey. J Dent Educ. 2008; 72(5):514-31. 9. Vanchit J, Papageorge M, Jahangiri L, et al. Recruitment, Development and Retention of Dental Faculty in a Changing Environment. J Dent Educ. 2011; 75(1)82-89. 10. Institute of Medicine, The U.S. Oral Health Workforce in the Coming Decade. Washington DC: National Academy Press. 2009. 11. Commission on Dental Accreditation, Accreditation Standards for Dental Education. Chicago, Il: American Dental Association. 2013 12. U.S. Department of Health and Human Services, Public Health Service, NIH, NIDCR. National Call to Action to Promote Oral Health. Rockville, MD: NIH Publication 03-5303, Spring, 2003.

Texas Dental Journal l www.tda.org l November 2013

13. Seale N, McWhorter A, Mouradian W. Dental Educationâ&#x20AC;&#x2122;s Role in Improving Childrenâ&#x20AC;&#x2122;s Oral Health and Access to care. Acad Pediatr. 2009; 9(6):440-5. 14. Unequal Treatment: Confronting Racial and Ethnic Disparities in the Health Care Workforce. Institute of Medicine. Washington DC: National Academy Press. 2003. 15. Addressing Health Care Disparities and Increasing Workforce Diversity: Next Step for the Dental, Medical and Public Health Professions. Am J Pub Health. 2006; 96(12):2093-2097. 16. Andersen R, Carreon D, Davidson P, Nakazono T, Shahedi, S, Gutierrez J. Who Will Serve? Assessing Recruitment of Underrepresented Minority and Low-Income Dental Students to Increase Access to Dental Care. J Dent Educ. 2010; 74(6):579-592. 17. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Public Health Service, May 25, 2000.

CLINICAL REPORT

What Dentists Should Know About Sickle Cell Disease Bill P. Devine, DMD

Introduction The medical history should be a communication between the patient and the dentist. A good history will reveal a patient’s medical problems, concerns, ideas, and expectations. Understanding medical conditions on a patient’s medical history is of upmost importance in providing the patient with the best possible individualized standard of care. Taking the time to get to know a patient, and what’s going on in their lives, can certainly help us to create a great patient/provider relationship. You cannot stress the importance of this relationship too much. It is vital, especially to those who have chronic diseases. This paper gives an overview of sickle cell disease and some dental concerns the disease presents to the dentist. Sickle cell disease is an inherited blood disorder that affects red blood cells. Normal red blood cells contain hemoglobin A. People with sickle cell disease have red blood cells containing mostly hemoglobin S, an abnormal type of hemoglobin. Sickle cell anemia (SCA) is the most common form of sickle cell disease (SCD). The disease results in a person not having enough healthy red blood cells to

Abstract The medical history should be a communication between the patient and the dentist. A good history will reveal a patient’s medical problems, concerns, ideas, and expectations. Understanding medical conditions on a patient’s medical history is of upmost importance in providing the patient with the best possible standard of care. Sickle cell disease is an inherited blood disorder that affects red blood cells. Normal red blood cells contain hemoglobin A. People with sickle cell disease have red blood cells containing mostly hemoglobin S, an abnormal type of hemoglobin. These mutated sickle cells do not have the smooth motion needed for oxygenation and deoxygenation. One of the main concerns in sickle cell disease is the reversible extreme pain episodes called “sickle cell crisis.” Pain episodes occur when sickle cells clog small vessels, depriving the body of adequate blood and oxygen. Treatment of the sickle cell patient should be a team approach between dentist, patient, and physician. Dental treatments should be conservative and stress free for the patient. Prevention of dental disease and infections are of the upmost importance to the sickle cell patient. If your patient has sickle cell disease, know about it and talk to your patient about the disease. Maintaining excellent oral health to decrease the possibility of oral infections will ensure the best care for these patients.

Key words: communication, sickle cell Devine

Dr Devine is staff dentist at the JPS Health Network in Tarrant County, Texas. Correspondence: Dr Bill P. Devine, JPS Community Health Dental Services, Healthy Smiles, 2500 Circle Dr, Fort Worth, TX 76119; Email: bdevine@ jpshealth.org. The author has no declared potential conflicts of financial interest, relationships and/or affiliations relevant to the subject matter or materials discussed in the manuscript.

disease (SCD), sickle cell anemia (SCA), blood inherited disorder, sickle cell trait, crisis, African Americans, deoxygenation, hemoglobin, supporting dentist, prophylactic antibiotics, and infection. Tex Dent J 2013;130(11): 1123-1127.

This manuscript has been peer reviewed.

Texas Dental Journal l www.tda.org l November 2013

1123

CLINICAL REPORT

carry oxygen throughout the body. These red blood cells become sickle shaped and have difficulty passing through small blood vessels. This can interrupt healthy blood flow and cut down even more on the amount of oxygen flowing to body tissues (1). This shape can also cause the cells to clog in blood vessels of the body and lead to pain and tissue damage. Sickle cell anemia can lead to many systemic complications especially in areas that are most compromised by hypoxia and infarction (2). According to the Sickle Cell Disease Association of America (SCDAA), it is the most common genetic disease in the U.S. affecting 70,000-80,000 Americans. African Americans have the highest

rate of sickle cell disease, but it is a nondiscriminatory disease that can affect any race. Two genes for the sickle hemoglobin must be inherited from one’s parents in order to have the disease. A person who receives a gene for sickle cell disease from one parent and a normal gene from the other has a condition called “sickle cell trait.” Sickle cell trait produces no symptoms or problems for most people. Most people with sickle cell trait lead completely normal lives. What really causes the deformed shape of the blood cells in sickle cell anemia? From a textbook standpoint,

the sickle cell anemia is due to a homozygous state of the abnormal hemoglobin S. An alteration occurs on the DNA molecule involving the substitution of the amino acid valine for glutamic acid at the sixth position on the beta polypeptide chain. This biochemical variation on the DNA molecule creates a physiological change that causes sickle-shaped red blood cells to be produced. The sickleshaped cells are the result of the hemoglobin S being deoxygenated. With a decrease in affinity of oxygen to abnormal hemoglobin, deoxygenation will occur, again producing more sickle-shaped cells (3).

One of the main concerns in sickle cell disease is the reversible extreme pain episodes called “sickle cell crisis.” Pain episodes occur when sickle cells clog small vessels, depriving the body of adequate blood and oxygen.

1124

Texas Dental Journal l www.tda.org l November 2013

CLINICAL REPORT

Discussion of sickle cell crisis One of the main concerns in sickle cell disease is the reversible extreme pain episodes called “sickle cell crisis.” Pain episodes occur when sickle cells clog small vessels, depriving the body of adequate blood and oxygen. These mutated sickle cells do not have the smooth motion needed for oxygenation and deoxygenation. Unlike normal red blood cells that last at least 4 months in the bloodstream, fragile sickle cells break down after only 10-20 days, eventually leading to anemia in which the person feels tired and run down. Pain frequently occurs in the extremities, back, chest and abdomen. Severity of pain has been reported to be from mild attacks lasting 5 minutes, to pain lasting days or weeks and requiring hospitalization. The frequency of pain crisis varies with each individual and can depend on their hemoglobin type, physical condition, current illness, and social variables (4). The pain is typically described as sharp, intense, and throbbing. Chronic pain can be hard to bear and mentally draining. This pain may severely limit daily activities, work, and education. Almost all people who have sickle cell disease have painful crises at some point in their lives. Some have these crises less than once a year, while others may have 15 or more pain crises in a day. Although infection, dehydration, and acidosis (all of which favor sickling) can act as triggers, in most instances no predisposing causes are identified (5). The risk for a sickle cell crisis is increased

by any activity that boosts the body’s requirement for oxygen, such as illness from infections, physical stress, or high altitudes (6). Shortness of breath is a common complaint. Another complication of sickle cell disease is the abnormal function of the spleen. This results in an increased risk of infection in the blood, bones, lungs, and urinary tract. Some crises can be managed at home with pain medications, rest and extra fluids, but intense crises may dictate a hospital visit for IV fluids and stronger pain medications.

Dental treatment and the sickle cell patient The main oral manifestations and complications of sickle cell disease are mucosal pallor, yellow tissue coloration, radiographic abnormalities, delayed tooth eruption, disorders of enamel and dentine mineralization, changes to the superficial cells of the tongue, malocclusion, hypercementosis, and a degree of periodontitis. Although oral appearances are not exclusive to the disease, they may suggest sickle cell disease (6). Special emphasis should be placed on oral hygiene procedures to avoid caries, gingival inflammation, and infection that can lead to osteomyelitis (7). Assessing a patient’s motivation and his or her desire for good oral health is an important part of the treatment plan. Maintaining excellent oral health to decrease the possibility of oral infections will ensure the best care for these patients. The dentist should be firm and positive in educating the patient on preventive dental care options, and strong recall visits are emphasized. Treatment should never be initiated during a crisis unless in an emergency situation, and then treatment should be designed only to decrease infection and discomfort (8). Treatment of the sickle cell patient should be a team approach between dentist, patient, and physician. A thorough medical history for the sickle cell patient is important, noting medications, treatments for the disease, pain crisis, and any present symptoms the patient is having. Acute dental infections

Texas Dental Journal l www.tda.org l November 2013

1125

CLINICAL REPORT

should be treated immediately since they may precipitate a sickling crisis. Whenever possible, conservative dental treatment should be carried out under local anesthesia (9). Most dental procedures produce some form of bacteremia. Patients with sickle-cell anemia are at increased risk for bacterial infections and should receive prophylactic antibiotics before any dental procedure that may cause a transient bacteremia (10). Prophylactic antibiotics are recommended for surgical dental procedures and use nitrous oxide oxygen with greater than 50% oxygen high flow rate (11). Elective dental surgical procedures should probably be done only in a hospital setting to avoid a stressinduced crisis (12).

Helpful Information in Treating the Sickle Cell Disease Patient: 1. It is appropriate before extensive dental work to confirm with the patient’s physician that the condition is stable. 2. In treating patients with sickle cell disease, arrange short, stress-free appointments. 3. A local anesthetic without epinephrine is a good choice for routine dental treatment. 4. General anesthesia should be done in a setting that has adequate medical back-up for any potential problems. 5. Painful teeth should be treated aggressively and quickly. 6. Restorations are preferable to extractions when possible. 7. Facial swelling or cellulitis may warrant hospitalization, so check with patient’s doctor. 8. Nitrous oxide is fine for conservative treatments and patients should breathe 100% O2 for 5 minutes following. 9. There are no contra-indications for orthodontic treatment with acceptable oral hygiene compliance. 10. Avoid long and complicated procedures. 11. Make the patient as comfortable as possible; stress should be minimized to avoid a crisis. 12. Show concern for the patient’s disease and assure that his or her dental treatments are safe.

1126

Texas Dental Journal l www.tda.org l November 2013

Treatment should never be initiated during a crisis unless in an emergency situation, and then treatment should be designed only to decrease infection and discomfort.Treatment of the sickle cell patient should be a team approach between dentist, patient, and physician.

CLINICAL REPORT

Conclusion

References

If your patient has sickle cell disease, know about it and talk to him or her about the disease. Encourage healthy oral and lifestyle habits! Sickle cell disease patients can present variable clinical manifestations and different degrees of severity depending on the stage of the disease. You should make sure the patient understands the importance of daily dental preventive care. Be aware of the warning signs of the disease such as fever, chest pain, shortness of breath, headaches, or loss of feeling. Above all, be the supporting dentist and encourage your patient to stay on the best plan of action to live with this disease. Remember, assessing a patientâ&#x20AC;&#x2122;s motivation and his or her desire for good oral health is an important part of the treatment plan. Maintaining excellent oral health to decrease the possibility of oral infections will ensure the best care for these patients. The life expectancy has increased over the past 30 years, and most sickle cell disease patients can expect to live a long life. Advances in preventive care and new medications have reduced life-threatening complications of sickle cell; however, it is still a severe, chronic, and sometimes fatal disease.

1. Source: Sickle cell anemia | University of Maryland Medical Center, Retrieved July 25, 2013 from: http://umm.edu/health/ medical/ency/articles/sicklecell-anemia#ixzz2bHy99PhG University of Maryland Medical Center. 2. Nagel RC, Fabry MC, Steinberg MH, The paradox of Hemoglobin SC disease, Blood Review, 203,17:169-178. 3. Rose LF, Kaye D: Sickle cell Anemia, Internal Medicine for Dentistry. St. Louis: CV, Mosby Co, 1983. 4. Schneider RG, Hightower B, Hosty TS, et al. Abnormal hemoglobin in a quarter million peoples Blood. 1976; 48(50 629-637. 5. Plat OS, Torrington BD, Bramdilla DJ, et. al. Pain in sickle cell disease. Rates and risk factors, N. Engl Jour Med, 1991; 325, 11-6, Pain treatment. 6. Luna ACA, Rodriqez MJ. Menezev VA, Marques KMG, Santos FA, Crisis prevalence and socio economic factors in children with sickle cell anemia, Brazilian Oral Health research, 2012 26: 43-49. 7. Little JE, Falace DA, Miller CS, Rhondus NL, (2008) Dental Management of the Medically Compromised Patient, 7th edition, Mosby. 8. Rada RE, Bronny AT, HasiakosPS; Sickle cell crisis precipitated by periodontal infection; report of two cases, j Am dent Assoc 114:799-801, 1987.

9. Ramakrishna Y., Dental considerations in the management of children suffering from sickle cell disease: A case report, J Indian Soc. Pedod Prev Dent 2007; 25:140-3 10. Lockhart PB, Loven B, Brennan MT, Baddour LM, Levision m. The evidence base for the efficiency of antibiotics prophylaxis in dental practice J Am dent Assoc 2007; 138(4), 458-74. 11. Dental Management of Medically Compromised Patient 7thEdition Mosby 2007, p.63. 12. Oral Diagnosis, Oral Medicine, and Treatment Planning By Steven L. Bricker, Robert P. Langlais, Craig S. Miller, p.378.

Texas Dental Journal l www.tda.org l November 2013

1127

JKJ Pathology Oral Pathology Laboratory

John E Kacher, DDS • Available for consultation by phone or email • Color histology images on all reports • Expedited specimen shipping with tracking numbers • Reports available online through secure web interface

Professional, reliable service with hightechnology solutions so that you can better serve your patients. Call or email for free kits or consultation. jkjpathology.com 713-598-9284 (T) 281-292-7372 (F) johnkacher@jkjpathology.com

Protecting your patients, limiting your liability

1128

Texas Dental Journal l www.tda.org l November 2013

Rajeswari Guntnur, D.D.S. has acquired the practice of

AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.

Gary E. Bennett, D.D.S. - Mesquite, Texas Paul V. Apilado, D.D.S. has joined the practice of Walter L. Tippin, D.D.S. -

El Paso, Texas

Ben H. Giang, D.D.S. has acquired the practice of James L. Grigsby, D.D.S. -

Garland, Texas

AFTCO is pleased to have represented all parties in these transactions.

Call 1-800-232-3826 or visit us online at www.aftco.net for a Free Practice Appraisal, a $2,500 value!

Your online dental industry job board

Find your next employee!

• Post job openings, search resumes, or both. • Postings syndicated to Twitter, Facebook, Indeed.com, and more... • Dental professionals apply online or using our new Mobile App. • Ads are public or confidential...your choice.

Register your dental practice or yourself today - www.DentalPost.net Questions? Email us at contactus@dentalpost.net Texas Dental Journal l www.tda.org l November 2013

1129

VISUALIZING THE Join us at 43rd annual Star of the South Dental Meeting, “VISUALIZING FUTURE OF DENTIS TR Y,” and see how new technologies, materials, and techDENTISTR TRY niques are changing the way we practice dentistry today! Make Houston and the Star of the South your destination of choice for quality continuing education! Social Activities include a Thursday “Lift Off” reception, Exhibit Hall Happy Hours, Astronaut meet and greet and book signings, and the ever so popular SOS Friday Night Party featuring the music of “The Klocks.” The 2014 Star of the South will offer attendees a meeting App that will provide all the information needed to navigate the meeting. Registration will begin in November. For more information, visit www.starofthesouth.org or call 713-961-4337.

FREE Practice Valuation

Know the value of your most valuable asset. Contact us today.

(888) 814-1783 ADStexas.com/TDA

ADS Watson, Brown & Associates has been serving Texas Dentists and selling hundreds of practices since 1991. The only team with both the experience of a Dentist and Tax Attorney/Accountant. All ADS companies are independently owned and operated.

1130

Texas Dental Journal l www.tda.org l November 2013

Texas Dental Association 143rd Annual Session 2013 TEXAS Meeting Photo Contest Photographer: Steven M. Aycock, DDS, of San Marcos Title: â&#x20AC;&#x153;Davis Mountain Railsâ&#x20AC;? Category: Black-white/abstract/artistic Information on the 2014 TEXAS Meeting Photo Contest will be available on texasmeeting.com in December 2013.

Texas Dental Journal l www.tda.org l November 2013

1131

Are You Relying on Selling your Dental Practice for Retirement? Did you know that 80 percent of practices with the doctors over age 50 couldn’t be sold with the selling doctor continuing to work in his old practice? Let us help you protect your retirement and position yourself to work in your practice for as long as you wish.

Dental Practice Specialists a Growth & Management Consulting Firm

Clyde Dollens, DDS cdollens@aftco.net 281-639-4703

We can help with: • Increased Schedule Production • Increased Hygiene Production • Staff Assessment and Coaching

www.DentalPracticeSpecialists.com

Free Practice Appraisal and Evaluation Dental Transitions & Sales through the AFTCO Network

1132

Texas Dental Journal l www.tda.org l November 2013

Dental Practice Specialists is a Growth & Management Consulting Firm

Clyde Dollens, DDS cdollens@aftco.net 281-639-4703

We can help with: • Increased Schedule Production • Increased Hygiene Production • Staff Assessment and Coaching

www.DentalPracticeSpecialists.com

ACCOUNTANT FOR DENTISTS & DENTAL PRACTICES

Accoun�ng / Bookkeeping QuickBooks / Peachtree Tax Prepara�on / Planning Consul�ng En�ty Selec�on / Setup

214‐277‐8118 www.bholacpa.com

Free Practice Appraisal and Evaluation

Email: info@bholacpa.com

Dental Transitions & Sales through the AFTCO Network

2300 Valley View Ln, Suite 216, Irving TX 75062

Texas Dental Journal l www.tda.org l November 2013

1133

1134

Texas Dental Journal l www.tda.org l November 2013

Memorial and Honorarium Donors

In Memoriam Those in the dental community who have recently passed

to the Texas Dental Association Smiles Foundation

In Memory of:

Blonstein, Maurice L. Houston, Texas May 8, 1923 – October 1, 2013 Good Fellow, 1971 • Life, 1988 • Fifty Year, 1997

Trudy Derse

Robert J Utterberg

Shirley Bostwick

Donna Johnson

Dr Beverly Zinser

Jolly, Jeptha O. Eastland, Texas November 17, 1924 – September 4, 2013 Goof Fellow, 1976 • Life, 1989 • Fifty Year, 2001

Dr Beverly Zinser

Ellen Cunningham Dr Beverly Zinser

Sandy Blum

James E Cobb

Dr Beverly Zinser

Milles, Roger B. Corpus Christi, Texas May 4, 1914 – September 4, 2013 Good Fellow, 1966 • Life, 1979 • Fifty Year, 1995

Selma Lee McClain Mills Larry Howard

Claric Mellard

Dr Susan Joliff

Dr Beverly Zinser

Your memorial contribution supports:

St John, Robert L. Bowie, Texas June 1, 1954 – September 25, 2013

• •

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

ORAL and MAXILLOFACIAL PATHOLOGY LABORATORY Anne Cale Jones, DDS H. Stan McGuff, DDS

Affiliation with a major health center with a large general and special surgical pathology faculty

Free local courier or overnight mail service

24 hour turn-around time following receipt of specimens in the majority of cases

Free biopsy bottles, cytological smear kits, consultation request forms, and biohazard bags

Telephone consultation available For additional information, please call (888) 728-4211 or (210) 567-4073.

Texas Dental Journal l www.tda.org l November 2013

1135

TDA Member

Spotlight Is there something extraordinary about you that your peers might not know? Do you have a hobby you’d like to tell us about? Are you working on a project that others might find interesting?

WE WANT TO HEAR FROM YOU! The TDA Today newsletter will include a new feature — “TDA Member Spotlight” — so you can learn more about your fellow dentists, their families, and their lives away from the office. However, in order to get started, we need to know more about you! Contact the publications team in the TDA Department of Member Services with your story ideas. E-mail TDA Managing Editor Nicole Scott at nicole@tda.org or call 512-443-3675.

• Join us on facebook.com/TDA • Follow us on twitter.com/theTDA • Get LinkedIN at linkedin.com, search “Texas Dental Association”

PLACE YOUR NEXT DISPLAY AD HERE! Display advertising in the Texas Dental Journal is one of the best ways to reach the majority of Texas dentists. The Texas Dental Journal is the official publication of the Association. Established in 1883, it is the longest, continuously published dental journal in the Americas and second in the world to the British Dental Journal. Published monthly, the Journalâ&#x20AC;&#x2122;s circulation exceeds 9,000, its readership exceeds 50,000, and itâ&#x20AC;&#x2122;s the only statewide publication of its kind to reach the majority of Texas Dentists. TDA Perks Partners, allied groups, and non profits receive discounts! For more information, contact TDA Publications Coordinator Lauren Oakley lauren@tda.org 512-443-3675 ext 150 Texas Dental Journal l www.tda.org l November 2013 halfpage_Displayad.indd 1

9/9/2013 1:37:03 PM

1137

PREVIEW Photographic Images: A Process for Increased Patient Awareness and Engagement Mark Kleive, DDS

Dr Mark Kleive’s Class Schedule at the TEXAS Meeting: Successfully Integrating Digital Dental Photography in the Practice Thursday, May 1, 2014 8:30 am - 11:30 am

Kleive Dr Mark Kleive is a cosmetic dentist in Black Mountain, NC. He is also a visiting faculty member at the Pankey Institute and Spear Education.

The Fun Way to Proficiency with Digital Dental Photography 1:30 pm - 4:30 pm The Fun Way to Proficiency with Digital Dental Photography Friday, May 2, 2014 8:30 am - 11:30 am (repeat) Exquisite Temporaries Made Simple 1:30 pm - 4:30 pm

1138

Texas Dental Journal l www.tda.org l November 2013

s a young dentist I remember clearly the frustration that I had when patients did not accept my treatment recommendations. The selftalk from a little voice in my head convinced me that either I was not very good at “selling” dentistry or my patients were not smart enough to recognize my knowledge of dentistry. Wow, was I naive! Because I am a persistent learner and self-evaluator of my skills and talents, I discovered that I am most successful in helping patients move from a “crisis” orientation to a “health” orientation when they have greater ownership in their current condition. While it may take multiple patient visits for my patients to develop a deeper awareness of their current condition and trust in my skills, the tools that I use to develop this ownership can influence their awareness timeline. Beginning in the year 2000, I incorporated digital intraoral photography in my practice. I have found its use to be my most powerful tool for increasing patient awareness and developing deeper ownership. With appropriate technique, nearly every area of the mouth can be clearly viewed with as few as 6 images. I still remember trying to show a patient a shadow of decay, under a silver filling in a posterior tooth, using a hand held mirror. The patient obviously could not see what I was trying to describe. Not only was the patient frustrated they were unable to visualize it, I was frustrated I was unable to show it to him in a way which help facilitate his visualization. Of course, with excellent photographic images, this experience is now infrequent. Additionally, an image helps people see things in the way I see them. My goal in utilizing digital photographs is to help patients see their mouths, in a way

which will enlighten them and prompt them to ask about what could be different. Let me share with you how I facilitate this process during a patient visit. The typical workflow of a comprehensive exam for a new or existing patient in our practice is: 1. The patient is engaged in a preclinical interview with the assistant and/or doctor.

2. Six digital photographic images are taken of the patientâ&#x20AC;&#x2122;s mouth (smile, lips retracted, upper occlusal, lower occlusal, left buccal retracted and right buccal retracted) then printed [below]. 3. The appropriate radiographs are taken. 4. The patient reviews the photographic images and highlights any areas of interest or curiosity with a permanent ink marker.

5. The patient and doctor review the images together. 6. The extra-oral and intra-oral exam is completed. Please note the photographs are reviewed with the patient prior to the clinical examination. This encourages a higher level of awareness, engagement, and understanding in the patient. It is exciting to be involved in a process in which the patient is the first one to

Figure 1. Smile photograph.

Figure 2. Lips retracted photograph.

Figure 3. Upper occlusal photograph.

Figure 4. Lower occlusal photograph.

Figure 5. Left buccal retracted photograph.

Figure 6. Right buccal retracted photograph. Texas Dental Journal l www.tda.org l November 2013

1139

describe what he or she sees. They are also encouraged to claim their learning. Most every patient expresses appreciation for seeing his or her mouth in a way which makes sense to him or her. As you take a photographic tour, I suggest your focus also be on health and not narrowed to only pathology; the opportunity exists to compare areas of health with areas of concern. If you are concerned about a patient’s periodontal situation, for example, show him/her an area they are maintaining well and compare it with an area of concern. Help the patient experience your intention of partnering with them in all aspects of his or her mouth, offering an opportunity of health and hope.

they “need.” My role as a dentist has become clearer because I want to be a partner with my patients — a facilitator of positive health choices. I have learned 3 concepts from Frank Spear, which when addressed with a patient, can lead to greater ownership and commitment to health: 1. 2.

Experience is showing me this process can not be rushed. Patient commitment to care often does not

Some dentists can get engagement with a still image from an intra-oral video camera. However, typically an image from an intra-oral camera shows detail of usually 1 tooth. Let us assume your goal is to move from single-tooth dentistry to a more comprehensive approach. An image visualizing a quadrant, or better yet an entire arch, is more helpful in this regard. A patient can more easily see how different areas of their mouth relate to each other if we help them see a “bigger picture” perspective. Considerable emphasis in dental marketing is based upon using the right scripts to “sell” dentistry. I realized early, this approach did not fit with my temperament or my values. I do not want to be a salesman. I do not want to be guilty of being one of those people telling patients what

1140

They can become aware of their current condition. They can become aware of the consequences of doing nothing in response to knowing. They can become aware of the benefits of treatment.

Texas Dental Journal l www.tda.org l November 2013

follow a linear path or timeline and is rather a developmental process. It is within our purview and responsibility to pace this process with the patient while continuing to offer possibility and hope for positive health choices in his or her life. If you would like to learn more about how to use digital intra-oral photography in this way, please consider attending my programs at the TDA annual session in May 2014. You can gain confidence and skills to improve your effectiveness through quality digital photography and really get your patient’s attention with increased engagement and ownership!

Peer Review: Process Snapshot Peer review is organized dentistryâ&#x20AC;&#x2122;s dispute resolution process that generally handles complaints from patients against dentists regarding the quality or appropriateness of clinical dental treatment received.

Need a peer review sign for your office? You may print a copy of the peer review sign from the Resources section of the members homepage on the TDA Website (tda.org).

For more information about peer review please contact the Council on Peer Review via Donna Cortez at 512-443-3675 ext. 152.

Oral and Maxillofacial Pathology Diagnosis and Management

Multiple Odontogenic Keratocysts in Association with Nevoid Basal Cell Carcinoma Syndrome (NBCCS) Oral and Maxillofacial Pathology Case of the Month (from page 1100)

Diagnosis and Management A diagnosis of Multiple Odontogenic Keratocysts in Association with Nevoid Basal Cell Carcinoma Syndrome (NBCCS) was made, and enucleation and curettage of all 4 lesions was performed. This diagnosis was based on the coexistence of skin lesions described above with multiple odontogenic keratocysts and a history of multiple basal cell carcinomas (see Table 1 for a list of criteria) (2).

Discussion NBCCS, also known as Gorlin-Goltz syndrome, was first described by Gorlin and Goltz in a patient who presented with multiple skin lesions in association with jaw cysts diagnosed as primordial cysts (3, 4). Subsequently, NBCCS was determined to be an autosomal dominant inherited condition with a high penetrance and variable expressivity (3-5). It is now known that NBCCS results from a mutation on the long arm of chromosome 9 at band 9q22.3 in the region of the PTCH (protein patched homolog) gene, a homolog of the Drosophila patched (PTC) gene (6). Mutation of the PTCH gene is found

1142

in about 50% of NBCCS patients (7). The incidence of NBCCS in the general population varies and is estimated to be between 1:57,000 and 1:150,000; therefore, diagnosis is often delayed largely because of its relative rarity and phenotypic variability (8). In the present case, the index of suspicion for a diagnosis of NBCCS was quite high, given the salient clinical and radiographic findings, and the pointed medical history of this patient that included multiple skin lesions, palmer pits, multiple, discrete radiolucencies of the jaws, and a history of surgical excisions of multiple basal cell carcinomas. Although the presence of multiple odontogenic keratocysts should raise the possibility of NBCCS, a combination of additional diagnostic criteria summarized in Table 1 must be present in order to make a definitive diagnosis of NBCCS. As shown in the table, a diagnosis of NBCCS requires the finding of at least 2 major criteria, or 1 major and 2 minor criteria (2). In the present case, the finding of multiple odontogenic keratocysts and skin lesions consistent with palmar pits as well as history of multiple basal cell carcinomas (all major criteria) confirms a diagnosis of NBCCS.

Texas Dental Journal l www.tda.org l November 2013

Odontogenic keratocysts are a component of the syndrome in about 50% of patients, and these cysts have a very high local recurrence rate following surgical removal (9). As a result it has been advocated that the benefit of surgical removal of odontogenic keratocysts associated with NBCCS be carefully weighed against the overwhelming odds of subsequent multiple recurrences (10). In cases where it is possible to arrive at a definitive diagnosis via a combination of the diagnostic criteria, it may be preferred to reserve surgery for cases where the jaw cysts present the patient with additional functional and/or esthetic challenges that make surgery necessary. References 1. Nevelle BW, Damm DD, Allen CM Bouquot JE. Oral and Maxillofacial Pathology. 3rd Ed. St. Louis, MI 2009, 2000 Saunders Elsevier. 2. Kimonis VE, Goldstein AM, Pastakia B, et al., Clinical Manifestations in 105 persons with nevoid basal cell carcinoma syndrome. Am J Med Genet 1997; 69: 299-308. 3. Gorlin RJ, Goltz RW. Multiple basa-cell epithelioma, jaw cysts and bifid ribs: a syndrome. N Engl J Med 1960; 262: 908-912.

4. Gorlin RJ. Nevoid basal cell carcinoma syndrome. Medicine (Baltimore) 1987; 66 (2): 98-113. 5. Gorlin RJ. Nevoid basal cell carcinoma syndrome. Dermatol Clin 1995; 13 (1): 113-125. 6. Hahn H, Wicking C, Zaphiropoulous PG, et al. Mutations of the human homolg of Drosphila patched in the nevoid basal cell carcinoma syndrome. Cell 1996; 85(6): 841851.

7. Yamamoto K, Yoshihashi H, Furuya N, et al. Further delineation of 9q22 deletion syndrome associated with basal cell nevis (Gorlin) syndrome: report of two cases and review of the literature. Congenit Anom (Kyoto) 2009; 49(1): 8-14. 8. Acocella A, Sacco R, Bertolai R et al., Genetic and clinicopathologic aspects of Gorlin-Goltz syndrome (NBCCS): presentation of two case reports and literature review. Minerva Stomatol 2009; 58(1-2): 43-53.

9. Dominguez FR, Keszler A. Comparative study of keratocysts, associated and non-associated with nevoid basal cell carcinoma syndrome. J Oral Pathol 1988; 17: 39-42. 10. Wilson C, Murphy M. Conservative management of multiple keratocystic odontogenic tumours in a child with GorlinGoltz syndrome: a case report. Eur J Paediatr Dent 2008; 9(4): 195-198.

Table 1. Major and Minor Criteria for the Diagnosis of NBCCS (Adapted with modifications from Kimonis et al, 1997) Major Criteria

Minor Criteria

*More than 2 basal cell carcinomas, or 1 in a patient under the age of 20 years

Macrocephaly determined after adjustment for height

*Odontogenic keratocysts of the jaw diagnosed by histology

Congenital malformations: cleft lip or palate; frontal bossing; â&#x20AC;&#x153;coarse faceâ&#x20AC;?; moderate-to-severe hypertelorism

*Three or more palmer or planter pits

Other skeletal abnormalities: sprengel deformity; marked pectus deformity; marked syndactyly of the digits

Bilamellar calicifications of the falx cerebri

Radiologic abnormalities: bridging of the sella turcica; vertebral anomalies (hemivertibrae, fusion/elongation of the vertebral bodies); modeling defects of the hand and feet, or flame-shaped lucencies of the hand or feet

Bifid, fused, or markedly splayed ribs

Ovarian fibroma

First degree relative with NBCCS

Medulloblastoma

*All 3 are major criteria confirmed in current case report.

Texas Dental Journal l www.tda.org l November 2013

1143

CALENDAR OF EVENTS JANUARY2014 26-28

The American Dental Association will host its annual presidents-elect conference in Chicago, IL. For more information, please contact the ADA, 211 E Chicago Ave Ste 730, Chicago, IL 60611-2678. Phone: 312-4402500; FAX: 312-440-2707; Website: ada.org.

FEBRUARY2014 30-1

1144

The Dallas County Dental Society will host its annual Southwest Dental Conference in Dallas, TX. For more information, please contact Jane Evans, Southwest Dental Conference Director, DCDS, 13633 Texas Dental Journal l www.tda.org l November 2013

Omega Rd Dallas, TX 75244. Phone: 972-386-5741; FAX: 972-233-8636; E-mail: jane@dcds.org; Website: swdentalconf.org.

7-8

The TDA Smiles Foundation will hold a 60-chair Texas Mission of Mercy in Houston. For more information, please contact Foundation Manager Judith Gonzalez at TDASF, 1946 S IH35 Ste 300, Austin, TX 78704; Phone: 512-448-2441; E-mail: judith@tda.org; Web: tdasmiles.org.

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

MARCH2014 27-29

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

APRIL2014 3-5

11-12

The Louisiana Dental Association will host its annual session and New Orleans Dental Conference at New Orleans Morial Convention Center in New Orleans, LA. For more information please contact Ms Normalee Ward, LDA, 2121 N Causeway Blvd Ste 153, Metairie, LA 70001; Phone: 504-834-6449; FAX: 504-838-6909; E-mail: norma@ nodc.org; Website: nodc.org. The Arkansas State Dental Association will host its scientific annual session at Statehouse Convention Center in Little Rock, AR. For more information, please contact Ms Angela Rogers, ASDA, 7480 Hwy 107, Sherwood, AR 72120; Phone: 501-834-7650; FAX: 501-834-7657; E-mail: angela@angelarogersgroup. com; Website: arkansasdentistry.org.

26-28

The Oklahoma Dental Association will host its annual meeting at the Cox Convention Center in Oklahoma City, OK. For more information, please contact Ms Lynn Means, ODA, 317 NE 13th St, Oklahoma City, OK 73104; Phone: 405-848-8873; FAX: 405-848-8875; E-mail: lmeans@okda. org; Website: okda.org.

MAY2014 1-4

The Texas Dental Association will host its annual TEXAS Meeting at the Henry B. Gonzalez Convention Center in San Antonio, Texas. For more information, please contact Sandy Blum, Annual Session Director, TDA, 1946 S IH 35 Ste 400, Austin, TX 78704; Phone: 512-4433675; FAX: 512-443-3031; E-mail: sandy@tda.org; Web: texasmeeting. com.

19-21

The American Dental Association will host its annual Washington Leadership Conference in Washington, DC. For more information, please contact Brian Sodergren, ADA, 1111 14th St NW Ste 1100, Washington, DC 20005; Phone: 202-789-5168; FAX: 202-7892258; E-mail: sodergrenb@ada.org; Website: ada.org.

Texas Dental Journal l www.tda.org l November 2013

1145

Provided by TDA Perks Program

value for your

profession

Texas Private Practices Gain the Volume Purchasing Power of Corporate Practices TDA Perks Program’s newest partner provides independent private practices with volume purchasing power formerly only available to corporate practices. Provided by TDA Perks Supplies

sk dentists what their top 3 concerns are regarding the business of their practice, and one of the most common answers you’ll hear is “overhead.” For private-practice dentists, reducing the costs of dental supplies would mean a significant reduction in overhead, but doing so hasn’t been simple. No matter the practice type, most overhead costs are relatively fixed. Relocating to reduce rent or mortgage costs, or decreasing staff or staff pay is perilous. Another main contributor to overhead is the cost of the wide variety of supplies needed to operate a modern practice. The average practice

1146

Texas Dental Journal l www.tda.org l November 2013

spends an amount equal to 30% of net profit on consumable dental supplies. Dentists can decrease the cost of supplies by using lower quality products, or buying in bulk or directly from manufacturers instead of a one-stop-shop distributor. Dental manufacturers long ago realized that selling directly to dentists was difficult because there were too many of them. They also saw it didn’t produce the best profit margins, because individually dentists don’t spend thousands of dollars on items like bibs, burs, or impression trays. As a result, about 80% of dental product manufacturers only sell their products though dealers. Though some manufacturers do sell directly— and offices could save money by purchasing from them—a practice would almost need a full-time staff person to place dozens or even hundreds of separate orders each month, since no one manufacturer makes everything a practice needs. The overwhelming majority of dentalproduct sales are made through a handful of large dealers that purchase and resell thousands of products from a variety of manufacturers. Working with a distributor saves time and is convenient, because an office typically works with a single representative and only needs to place one order a month. But distributors rarely provide the best deal. Convenience comes with the cost of a middleman. For each sale generated, most distributors have to pay variable costs — sales representative salary and commissions, new-customer marketing costs, etc. Many dealers charge prices at or above MSRP,

and offer discounts of just a few percentage points on only certain items to attract new customers. Most practices buy from territory sales representatives and could shop the few vendors available to them to try to negotiate discounts; but doing so usually amounts to no more than single-digit percent savings. The key point is, because private practices don’t purchase in bulk volume, they have little wiggle room in price negotiation with suppliers. This is an area where corporate practices have a major advantage over private practices: negotiating power with suppliers.

Cost-Plus vs. Retail-Minus Pricing A corporate practice with 500 dentists will use in excess of $25 million per year worth of consumable dental supplies, and millions more in equipment, office supplies, and other products. A private practice spends an average of about $55,000 on consumable supplies alone. Because corporate dental practices have the ability to purchase dental supplies on contracts worth tens of millions of dollars, they can negotiate prices on a cost-plus model (dealer cost plus a few percentage points) — instead of having their discount potential limited to 10% off retail. Given the volume a dealer would receive by converting a corporate practice, a dealer could afford to earn a much smaller margin. After all, 5% of $10 million is quite a bit more than 45% of $55,000.

On October 1, 2013, TDA Perks launched a new program that leverages the group buying power of more than 7,400 TDA members, who collectively have an annual dental supplies spend of more than $370 million.

Volume-Purchasing Power for Private Practices On October 1, 2013, TDA Perks launched a new program that leverages the group buying power of more than 7,400 TDA members, who collectively have an annual dental supplies spend of more than $370 million. TDAPerksSupplies.com enables members to save an average of more than 35 percent on dental supplies. More than 40,000 products are listed—including brands typically available only through dealers—as well as the products of more than 60 direct manufacturers (companies whose products are not available through dealers). This new program attempts to offer TDA-member private practices the same buying power of corporate dental practices. The program will add more manufacturers and further reduce prices regularly as the number of members using the service grows. Following is information needed to start taking advantage of the program: •

• •

•

Get a price estimate by sending a list of items (using SKU or distributor item numbers) via email, phone, or fax. Order online at TDAPerksSupplies. com (or via e-mail, phone, or fax). ADA membership numbers will be required. All active TDA members have pre-activated accounts. Customer support is available Monday through Friday, 8:00 am to 7:00 pm. Contact TDA Perks Supplies at: o support@tdaperkssupplies.com o T: 512-270-6999 o F: 888-740-4154

For more information regarding other TDA Perks programs, please visit tdaperks.com or call 512-443-3675.

Texas Dental Journal l www.tda.org l November 2013

1147

Place a classiﬁed ad in the Journal! It’s a member beneﬁt! Reach more than 8,500 of your colleagues!

Cost: Deadline:

$40 for the ﬁrst 30 words 20th, 2 months prior

Click here to order your ad today!

Lauren Oakley Publications Coordinator Lauren@tda.org

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

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.

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 the expectations we have while answering your questions candidly and openly. I hope you’ll consider this position and give me a call. Call Britt Bostick, DDS, 806-438-5745 or e-mail bbost35821@aol.com. ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS AREA: 5 general dentistry practices available (North Dallas, Richardson, East Dallas, and Dallas); 2 orthodontic practices available (Plano, Carrollton). FORT WORTH AREA: 1 general dentistry practice (West Fort Worth). NORTH TEXAS: 2 pediatric practices. HOUSTON AREA: 1 general dentistry practice available; 1 orthodontic practice available. SAN ANTONIO AREA: 1 general dentistry practice available. EAST TEXAS AREA: 2 general dentistry practices. WEST TEXAS AREA: 1 general practice available. AUSTIN AREA: 1 general dentistry practice available. BRYAN/COLLEGE STATION AREA: 1 general dentistry practice available. OKLAHOMA AREA: 1 general dentistry practice available. For more information and current listings, please visit our website at adstexas.com or call ADS Watson, Brown & Associates at 888-419-5531. 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 Dr Britt Bostick, DDS, bbost35821@aol.com or call 806-438-5745.

Texas Dental Journal l www.tda.org l November 2013

1149

ADVERTISING BRIEFS AMARILLO: Pediatric dentist for a locally owned practice looking to provide care for our patients as well as build their own patient base. Ownership opportunity available. Please contact Dr Britt Bostick, DDS, bbost35821@aol.com or call 806-438-5745. AMAZING PRACTICE SELL: (Sherri L. Henderson & Associates, LLC) Northeastern Oklahoma Green Country. This great general practice draws from 5 large surrounding counties and is 35 minutes from Tulsa. Busy traffic location; 1,550 sq ft 2 ops, 1 hygiene op, and 1 additional shared hygiene op. The doctor is retiring after 45 years in practice. Great production potential and chance to own or lease half of the beautiful free standing building (3,100 sq ft). Pictures available â&#x20AC;&#x201D; #3001. Call Sherri at 972562-1072. Visis www.slhdentalsales.com. 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 e-mail CV to txdentaljobs@gmail.com. ARLINGTON, EULESS, SAN ANTONIO: Soumava Sen, DDS, PC, seeks dentists for offices in Arlington, Euless, and San Antonio. Must have DDS and valid Texas dental license. E-mail resumes to lcuica@hotmail.com. ASSOCIATE FOR TYLER GENERAL DENTISTRY PRACTICE: Well-established general dentist in Tyler with over 30 years experience seeks a caring and motivated associate for his busy practice. This practice provides exceptional dental care for the entire family. The professional staff allows a doctor to focus on the needs of his or her patients. Our office is located in beautiful East Texas and provides all phases of quality dentistry in a friendly and

1150

Texas Dental Journal l www.tda.org l November 2013

compassionate atmosphere. The practice offers a tremendous opportunity to grow a solid foundation with the doctor. 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 903-5090505 and/or send an e-mail to steve.lebo@sbcglobal. net. Associate needed for dental office in small, quaint town. Potential for practice purchase. Call 361-645-8148. ATTRACTIVE EAST TEXAS DENTAL PRACTICE: SLH Dental Sales is looking for a qualified buyer that would like the opportunity to immediately transition into a general dentist office. This well-established practice has been in its current location since 1993 and is in a beautiful home surrounded by many professional buildings and a stable community. The current dentist is transitioning, and both the practice and building are for sale. This predominantly feefor-service practice contains 2 dentist operatories and 2 hygienist operatories, along with a welcoming reception area, business and private offices, lab, etc., with room for expansion. For more information, please contact our office at 972-562-1072, e-mail sherri@slhdentalsales.com, or visit our website at www.slhdentalsales.com (video available). Listing #3005. 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 e-mail fahoosha@gmail.com or mike@miloinc.com.

ADVERTISING BRIEFS AUSTIN AREA: Associate dentist needed in busy, privately owned group practice. Our present associate dentist is moving, so a good opportunity for someone to take over her schedule. See our website at advancedfamilydentist.com. For more information, please contact Jeffery or Cortni at 512-257-2483. 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. Send your confidential resume to dentalresume27@ yahoo.com for consideration. AUSTIN, SAN ANTONIO & DALLAS AREA PRACTICE OPPORTUNITIES MCLERRAN & ASSOCIATES: RIO GRANDE VALLEY (ID #T224): This is an established general/cosmetic family practice with a large, predominantly fee-for-service patient base and excellent location on a high traffic thoroughfare near major retailers. The practice has annual revenue of mid-6 figures and solid net cash flow despite the office being open only 3 days per week, not being in network with any PPO plans, and doing very little external marketing. The office boasts 5 fully equipped operatories, digital X-ray units, pano, and computers in each operatory. 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 turnkey, 7 operatory (6 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 high-6 figures the last 12 months with strong cash flow. This is an excellent opportunity with tremendous upside potential. SAN ANTONIO (ID #T215): Established in 2003, this general family practice is located in a 1,875 sq ft, 4-operatory office space within an affluent area of San Antonio. The practice boasts a large, PPO/fee-for-service patient base, experienced/ committed staff, and annual revenue averaging in the mid-6 figures over the last 3 years. WEST TEXAS (ID #T211): Associate to purchase opportunity in this thriving, well-established periodontal specialty practice located in low competition and growing area. SAN ANTONIO (ID #T209): Located on the east central side of town in a medical/dental building, this established pediatric specialty practice has seen consistent revenue in the mid-6 figures with low overhead. Excellent stand-alone or satellite office! SAN ANTONIO (ID #T206): Established, 2-location general family practice with total collections in the mid-6 figures on a limited schedule and no external marketing. Low overhead and tremendous upside potential make this a great starter opportunity. SAN ANTONIO (ID #T185): Well-established periodontal specialty practice available for purchase. Contact us now for more information on this excellent opportunity. SAN ANTONIO (ID #T159): This oral surgery practice has a solid referral base, great location, attractive build-out, excellent equipment, and stable revenue/cash flow. The practice owner is available for a transition. SAN ANTONIO (ID #T181): Low overhead general family practice located in 4-operatory, paperless and digital office. Large Medicaid/PPO patient base, well-established location and upside potential make this a solid opportunity. EAST OF SAN ANTONIO (ID #T140): Quality, comprehensive family practice located in free-standing building with 3 equipped operatories. This practice has seen strong growth the last 3 Texas Dental Journal l www.tda.org l November 2013

1151

ADVERTISING BRIEFS years and is a great opportunity for doctor looking for a practice in lower competition area near San Antonio. The practice and real estate are available for purchase. HILL COUNTRY WEST OF AUSTIN (ID #T220): This well-established, fee-for-service general family practice is located in a scenic, quickly growing hill country town about an hour outside of Austin. The practice is located in a large freestanding building and currently has 2 equipped operatories with 4 additional (unplumbed) treatment rooms. Revenue has consistently been 6 figures per year with very low overhead, no involvement in discounted insurance/PPO plans, limited marketing and a limited schedule. This practice presents an opportunity to get into a well-established office with strong cash flow at far less than the cost of a startup. Both the practice and real estate are available for purchase. SOUTH OF AUSTIN (ID #T219): This is an opportunity to purchase a small, established practice in a growing community just 20 minutes south of Austin. The practice has a fee-for-service/PPO patient base, annual revenue of 6 figures and 3 fullyequipped operatories. This office has strong upside potential and would be a great starter practice or satellite location. AUSTIN (ID #T210): This large oral surgery practice has an established, diverse referral base and 2 attractive locations in the Austin area. The practice boasts incredibly strong gross collections and strong profitability over the past few years and still offers the opportunity for further growth. The sellers are looking for a dual degree doctor (DDS, MD) to purchase 50% or 100% of the practice and are willing to continue working parttime for several years following the sale to maintain production and transfer the referral relationships. WEST OF AUSTIN (ID #T208): This attractive, general dentistry practice is located in a beautiful, vibrant town in the Texas Hill Country approximately 1 hour west of Austin. The office is located in a charming

1152

Texas Dental Journal l www.tda.org l November 2013

craftsmen style bungalow situated on a busy street and encompassing 1,800 sq ft with 3 fully equipped operatories (the real estate is also for sale). The practice has a fee-for-service/PPO patient base and consistent annual revenue in the mid-6 figures. You can purchase this established practice for less than it would cost to start an office from scratch! KILLEEN AREA (ID #T213): This is an opportunity to purchase a small, established general dentistry practice with solid cash flow and a predominantly fee-for-service/ PPO patient base. Even with reduced office hours, the office realized annual revenues of in the mid6 figures over the last 3 years. This practice has tremendous upside potential, evidenced by the fact that it collected in the high-6 figures in 2009. The office has 4 fully equipped operatories and is located within a professional building right in the heart of a high traffic vicinity of the Killeen/Fort Hood area. This is a great starter practice for any motivated and eager dentist! WACO AREA (ID #T189): Well established family practice in low competition area. Minimal investment, strong upside potential and opportunity to own real estate makes this an attractive opportunity. Contact McLerran & Associates: David McLerran or Brannon Moncrief in Austin 512-900-7989, San Antonio 210-737-0100; practice sales, appraisals, buyer representation, and lease negotiations. To request more information on our listings, register at www.dental-sales.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 stateof-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

ADVERTISING BRIEFS opportunity. New grads are welcome to apply. Please e-mail resume to tal@austinchildrensdentistry.com. BROWNSVILLE SEEKING ASSOCIATE: Established general dental office in Brownsville (30 minutes away from South Padre Island) is seeking a caring, energetic associate. We are a busy office providing dental care for mostly children. Our knowledgeable staff will support and enhance growth and earning potential allowing the associate to focus on patient dental care. Interested candidates should call 956546-8397. 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 sq ft 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. For more information contact our office at 972-5621072 or e-mail sherri@slhdentalsales.com or visit our website at www.slhdentalsales.com #3050 CB (pictures can be made available). DALLAS: Looking for an associate for general dentistry practice. Well-established private practice

general dentist with over 30 years experience seeks a caring and motivated associate for his busy practice. Dentist should be comfortable with endodontic procedures, as well as other general skills. Our office is a compassionate, drama-free professional environment, with a staff eager to support the efforts of a like-minded associate. The practice offers a tremendous growth opportunity for an associate, with generous compensation and guarantees. Located in a beautiful modern building in busy part of Dallas. Interested candidates should send their resumes to afforddent@gmail.com or PO Box 850252, Mesquite, TX 75185. All responses will be kept strictly confidential. Full-time or part-time positions available. DALLAS / FORT WORTH: Area clinics seeking associates. Earn significantly above industry average income with paid health and malpractice insurance while working in a great environment. Fax 312-9449499 or e-mail cjpatterson@kosservices.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 mockingbirddentalgroup. com. DENTALONE PARTNERS is opening new offices in Austin and the surrounding areas. Each practice is unique in that it has an individual name like Preston Hollow Dental Care or Waterside Dental Care. Our patient base consists of approximately 70% PPO and 30% fee-for-service. All our offices have topof-the-line Pelton and Crane equipment, digital X-rays, and intra-oral cameras. We offer competitive compensation packages with benefits. To learn Texas Dental Journal l www.tda.org l November 2013

1153

ADVERTISING BRIEFS more about working with one of DentalOne Partner practices, please contact Andrew Risolvato at 972755-0838 or andrew.risolvato@dentalonepartners. com. DENTALONE PARTNERS is opening new offices in Dallas and the surrounding areas. Each practice is unique in that it has an individual name like Preston Hollow Dental Care or Waterside Dental Care. Our patient base consists of approximately 70% PPO and 30% fee-for-service. All our offices have topof-the-line Pelton and Crane equipment, digital X-rays and intra-oral cameras. We offer competitive compensation packages with benefits. To learn more about working with one of DentalOne Partner practices, please contact Andrew Risolvato at 972755-0838 or andrew.risolvato@dentalonepartners. com. DENTALONE PARTNERS is opening new offices in San Antonio and the surrounding areas. Each practice is unique in that it has an individual name like Preston Hollow Dental Care or Waterside Dental Care. Our patient base consists of approximately 70% PPO and 30% fee-for-service. All our offices have topof-the-line Pelton and Crane equipment, digital X-rays, and intra-oral cameras. We offer competitive compensation packages with benefits. To learn more about working with one of DentalOne Partner practices, please contact Andrew Risolvato at 972755-0838 or andrew.risolvato@dentalonepartners. com. DENTALONE PARTNERS seeks a general dentist to join our San Antonio team. Degree from accredited dental school and current dental license issued by the state of Texas required. Generous benefits package. To Apply: http://jobs.dentalonepartners. com/jobs/821607-General-Dentist.aspx EOE.

1154

Texas Dental Journal l www.tda.org l November 2013

DENTALONE PARTNERS is opening new offices in the upscale suburbs of Houston. Each practice is unique in that it has an individual name like Gulf Breeze Dental Care or Waterside Dental Care. All of our offices have top-of-the-line Pelton and Crane equipment, digital X-rays, and intra-oral cameras. Our patient base consists of approximately 70% PPO and 30% fee-for-service. We offer competitive compensation packages with benefits. To learn more about working with DentalOne Partner practices, please contact Andrew Risolvato at 972-755-0838 or andrew.risolvato@dentalonepartners.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: Associate general dentist wanted; fulltime or part-time, proficient in endodontics and simple extractions. Our practice performs root canal treatment for Medicaid and PPO patients, children and adults, under guidance of experienced endodontists. Great opportunity to learn while you earn. Minimum of 2 years experienced required. Please contact endo.dr.888@gmail.com. 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

ADVERTISING BRIEFS via e-mail to jennifer@smileworkshop.com or call our office at 214-757-4500. EAST DALLAS practice for sale near White Rock Lake and Arboretum. Practice established in 1957. It is presently being worked from 8:00 AM to 12:00 PM 4 days per week. Has 2 operatories with very low rent. A perfect practice for a senior dentist looking for something to do or a younger dentist wanting to supplement his income. Minimum investment required. Please call 972-740-9454. 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 outdoor activities including hunting and fishing and a â&#x20AC;&#x153;small townâ&#x20AC;? atmosphere. We offer all phases of dentistry. Interested candidates should e-mail 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 e-mail at falcondentistry@ gmail.com EL PASO PRACTICE FOR SALE: Large west side El Paso practice in a professional building with strong collections. Each treatment room has large windows with fantastic views. The practice is computerized and has digital X-rays. Majority full fee with some PPO plans. Visit tx-pt.com or call at 214-460-4468; rich@tx-pt.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 Texaslicensed dentist to work full-time in our office in El Paso, TX. Applicant must be licensed in the state of Texas and have 1 year of experience. If interested please submit a resume to drdarj@gmail.com. Please provide an accurate contact number and e-mail address. EL PASO: Selling a state-of-the-art general practice with orthodontic patients. Building is 6,000 sq ft for sale or lease. Whole building available. Partnership also available as well as many other options. Building is beautiful and only 1 year old with 11 ops fully equipped with digital X-rays, Softdent, Adec, Marcus equipment. Located on east side of El Paso. For more information please contact Dr Oscar Vargas at 915276-2242. 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 longterm 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. EP DENTISTRY 4 KIDS (epd4k.com/www.facebook. com/epd4k) is searching for associate dentists to join our teams in El Paso. Our practice provides care primarily for children from 6 months to 21 years old. As an associate, you will examine, diagnose, and provide treatment counseling to patients in a comprehensive manner. You will also be trained on treatment via conscious sedation. We are closely knit company which is wholly internally owned. The Texas Dental Journal l www.tda.org l November 2013

1155

ADVERTISING BRIEFS best way to describe the company is as a co-op. Many associates have gone on to become members of the co-op and enjoy the benefits of ownership. Requirements: Prefer general and pediatric dentists with 2 to 3 years minimum experience and eligible to practice dentistry in Texas. However, other candidates that prove capable will be considered. Please submit your resume to brentcroberts@gmail. com. A comprehensive benefits package is offered. You’ll be guaranteed a minimum of 6 figures. The package also includes medical and vision insurance plans, 401K opportunities, malpractice insurance and in-house CE opportunities. EOE. GALVESTON: Well-established, successful practice of 35 years needs FT associate dentist for FFS/ PPO practice. Experienced staff, new equipment, Galveston. Senior 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 todaysdentistrytexas.com. The Galveston area is just 25 minutes south of Clear Lake, 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! E-mail CV to kkcarroll10yahoo. com or call 832-385-8875. GARY CLINTON DALLAS PRACTICE NEAR TRINITY RIVER GREENBELT FOR SALE: Doctor retiring for health reasons; well-established 30+-year-old

1156

Texas Dental Journal l www.tda.org l November 2013

practice. High demand lower income area. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27-year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete professional certified appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214503-9696. WATS 800-583-7765. GARY CLINTON FORT WORTH AREA EXCELLENT PRACTICE FOR SALE: Adult restorative practice; doctor retiring for health reasons; great Southwest area. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27 year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete professional certified appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional

ADVERTISING BRIEFS charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765. GARY CLINTON HOUSTON PRACTICES FOR SALE: H-1 NORTH OF HOUSTON AREA. Premier practice; Near 7-figure gross with 5 operatories; exceptional recall; 30+ years; well-established. Digital equipment. Hygiene profits will cover debt service. H-2 Northwest Houston in Lake Houston Area. Well established practice; High 6-figure gross on 3 days. Excellent recall. This is a practice waiting to happen. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27 year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete professional certified appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765. GARY CLINTON NORTH DENTON FAST GROWING AREA PEDO/ORTHO PRACTICE FOR SALE: Fourchair bay + 2 operatories equipped; another bay unequipped for 4 more chairs; fast growing area; excellent opportunity. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27 year member of the Institute

of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete professional certified appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765. GARY CLINTON NORTH OF DALLAS/DENTON AREA GENERAL PRACTICES FOR SALE: D-1 Denton Practice: Five operatories; nice equipment. 30-plusyear dentist retiring. Flexible transition; No low fee plans. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27 year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete professional certified appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765. Texas Dental Journal l www.tda.org l November 2013

1157

ADVERTISING BRIEFS GARY CLINTON PANHANDLE & WEST TEXAS PRACTICES FOR SALE: W-1 7-figure gross; 60% net. Only dentist in small progressive community. Progressive family dentist retiring to travel. Upgraded equipment. Nice office. Doctor will sell or lease building. P-1 Amarillo/Panhandle-area wellestablished practice; excellent operating profits. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27-year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete professional certified appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214503-9696. WATS 800-583-7765. GARY CLINTON, BROKER/SENIOR APPRAISER/ CONSULTANT WITH 40 YEARS IN DENTISTRY: We need sellers…general and specialty practices! We have pre-qualified buyers. When we sell your practice, if you own your office, there is no Real Estate Commission. Gary Clinton, PMA. I need practices in or near Austin, San Antonio, DFW, and Houston area and other metro Texas locations which are in high demand. Call me confidentially. 1-880583-7765 or 214-503-9696, Dallas area.

1158

Texas Dental Journal l www.tda.org l November 2013

GENERAL: Golden Triangle (Port Arthur): Six-figure gross and very high net income practice in small gulf coast town. Dentist earns 6 figures per year for work 4 days a week. 2,200 sq ft with 6 fully-equipped operatories, 4 dentist and 2 hygiene. Extensively remodeled in 2001. Real estate for sale. Single tenant, stand-alone building, 30-plus space parking bordered by 2-lane street and residential area. High patient growth. Patients from major employers such as Shell, DuPont, Texaco, Chevron, and Shell. Call DDR at 800-930-8017 or www.ddrdental.com. GENERAL: Houston (Bellaire/Post Oak): Terrific growth practice with great facilities nested in neighborhoods and schools. Fronts high traffic Chimney Rock. Interior and equipment rebuilt in 2009. Total of 8 operatories plumbed with 4 operatories in use. Free-standing building with 7,000 total sq ft also for sale. Call DDR AT 800-930-8017 or www.ddrdental.com. GENERAL: Houston (I-45 North) 6-figure gross with high net income. Six-figure income for dentist. Growth opportunity within patient base. Well cared for facilities with 7 operatories. Call DDR AT 800-9308017 or www.ddrdental.com. GOLIAD: Associate/buy-in partnership opportunity available in high producing and high collection practice. 100% fee-for-service practice. If you have excellent communication skills, a light touch and above average skills, we should meet. Our practice uses Cerec technology, places and restores implants, is 100% digital and has a high emphasis on cosmetic dentistry. Great emphasis on patient comfort with oral sedation used extensively. Our town has an excellent school district and our patients have a great appreciation for quality dentistry. Visit our website

ADVERTISING BRIEFS atgoliaddentalcare.com. Call Dr Dan Garza at 361645-2381 or e-mail dmolar@sbcglobal.net.

retention. Contact Dr Guy Walker, Paragon Dental Transitions, 573-225-2877, paragon.us.com.

HOUSTON AND SAN ANTONIO: Care For Kids, a pediatric focused practice, is opening new practices in the San Antonio and Houston area. We are looking for energetic full-time general dentists and pediatric dentists to join our team. We offer a comprehensive compensation and benefits package including medical, life, long- and short-term disability insurance, flexible spending, and 401(K) with employer contribution. New graduates and dentists with experience are welcome. Be a part of our outstanding team, providing care for kids of Texas. Please contact Anna Robinson at 913-322-1447; e-mail arobinson@amdpi.com; FAX: 913-322-1459.

LONGVIEW PEDIATRIC PRACTICE SEEKING FULLTIME 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 to 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. For more information, please contact our office at 972-562-1072, email sherri@slhdentalsales. com, or visit our website at www.slhdentalsales.com (Photos available). Listing #3435.

HOUSTON AREA: Great opportunity for a pediatric dentist. A part-time position available now in the Houston area. Flexible scheduling and a great work environment. Already established a flow of patients. Requirements: Texas state license. For more information, please e-mail mydentalsmile@gmail. com. HURST, EULESS, BEDFORD: Outstanding general practice serving 2,200 active patients, comprised of FFS and insurance. No Medicaid or capitation. Five complete operatories with newer equipment in 1,600 sq ft. Digital radiographs with combination of computerized and paper charting. The selling doctor has built this fantastic practice over the last 39+ years, and is highly esteemed in the dental community. Very attractive net income-to-expense ratio. The seller desires to stay and practice part-time and allow a very smooth transition. A willing, loyal, staff that has been with the practice many years and knows the patient base will remain to insure patient

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 Dr Britt Bostick, DDS, at bbost35821@aol.com or call 806438-5745. NORTH TEXAS: Pediatric dentist needed for busy north Texas practice. Enjoy life in Sherman, Texas, a family-oriented city with the convenience 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

Texas Dental Journal l www.tda.org l November 2013

1159

ADVERTISING BRIEFS 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-for-service, 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 e-mail resume/CV to bth1@cableone.net.

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 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. #3070 (pictures available). Contact 972-562-1072 or e-mail sherri@ slhdentalsales.com; www.slhdentalsales.com.

ORAL SURGERY PRACTICES: D-1 Dallas Suburban Mid-Sized City. Very nice office. Bread and butter practice. Three day a week practice; excellent referral base. SA-1 San Antonio Outlying Area. Oral surgeon retiring; flexible transition. Will phase out PRN. High net. Mid-sized community. 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 Appraiser. Call 1-800-583-7765.

SAN ANGELO: For sale: Excellent 5 operatory, 35-year-old general practice. Recently remodeled location in a busy complex. Solid fee-for-service patient base. All modern equipment. Solid hygiene program. Mid- to high-6 figure collections consistently, 98% collections rate. Recent practice appraisal. Other unique perks to this practice. Doctor moving out of state, willing to negotiate on price, and transition details as well as sell/lease of building. Please inquire by e-mail at texasdentistry@hotmail. 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. 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

1160

Texas Dental Journal l www.tda.org l November 2013

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: Pediatric dentist. Well-established and growing pediatric practice is seeking a caring and energetic associate for a full-time and parttime position. We offer excellent production with incredible earning potential, vacation and other benefits. New graduates are welcome. Please submit your resume to velezluke@yahoo.com.

ADVERTISING BRIEFS 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, 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 e-mail 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. E-mail CV to Dr Mike Kesner, drkesner@madeyasmile.com.

TEXAS PRACTICE TRANSITIONS: Rich Nicely has been serving Texas dentists since 1990. Visit www. tx-pt.com or call at 214-460-4468; rich@tx-pt.com. Orthodontic Practices: Five-chair orthodontic practice in McKinney. Eight-chair orthodontic office in Arlington. 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. MCKINNEY: mid-sized collections in 5 treatment rooms in a beautifully finished facility, paperless, 100% digital practice with a digital pano. NORTH TEXAS: Large prosthodontic practice 30 minutes from Dallas, premier free-standing building with 7 ops, 100% digital, 100% full fee. RURAL 30 MINUTES FROM DALLAS. Smaller practice in a nice free-standing building, digital X-rays, 100% full fee. DALLAS SUBURB: Large practice, 6 ops, 100% digital, 1,900 full fee patients, 8 days of hygiene. WEST TEXAS, small practice in Panhandle area. ONE HOUR NORTH OF HOUSTON: Medium-sized full-fee practice, freestanding building, digital X-rays. EAST TEXAS: Very low overhead, medium-sized full-fee practice in freestanding building. THE HINDLEY GROUP, LLC Dental Practice Sales NEW LISTING! WEST HOUSTON PRACTICE FOR SALE: Small general dental practice with high percentage restorative revenues. Average 8 new patients per month. Two fully-equipped operatories with 1 additional hygiene room and another room plumbed for expansion. Digital pano. Same location for 13 years. Cash and Insurance revenues. Motivated seller! Excellent opportunity for start up at low cost. SOUTH OF HOUSTON, TEXAS COASTAL PLAINS GENERAL DENTAL PRACTICE FOR SALE â&#x20AC;&#x201D; Wellestablished for 28 years and in same location for

Texas Dental Journal l www.tda.org l November 2013

1161

ADVERTISING BRIEFS last 17. Strong revenues and healthy profit margin on 4 days per week! 2,500 sq ft building with 4 fully equipped operatories also for sale. Experienced, dependable staff. Great opportunity! WEST CENTRAL TEXAS PRACTICE FOR SALE: 25-yearold well-established family dental practice for sale. Open 4.5 days per week; 2,400 sq ft building with 4 fully equipped operatories. Three direct digital X-ray units in operatories plus numerous other upgrades to equipment and building, which is also for sale. Steady new patient growth and outstanding staff. NORTHWEST HOUSTON GENERAL DENTAL PRACTICE: Well established, very traditional practice with moderate fee-for-service revenues and healthy profit margin. Open 4 days a week. 1,200 sq ft facility with 3 fully equipped operatories. Doctor retiring. NORTH OF HOUSTON GENERAL DENTAL PRACTICE: Very well established practice in the same location for 31 years. Moderate cash revenues with some PPO insurance. Practice open 4 days per week. 2,200 sq ft with 2 fully equipped operatories and 3 additional plumbed. Loyal, experienced staff. Doctor is retiring. TEXAS PANHANDLE GENERAL DENTAL PRACTICE: Twenty-five year established practice with strong high percentage restorative revenues and healthy profit margin. Open 3 full and 2 half days a week. Four fully equipped operatories on busy I-40 corridor with nice curb appeal! Building is also for sale. Significant Medicaid component. Motivated seller. ALBUQUERQUE, NEW MEXICO GENERAL DENTAL PRACTICE: Same location for 8 years. Three fullyequipped operatories. Steady growth with 20 to 40 new patients per month. Significant Medicaid with growing PPO revenues. Call 800-856-1955 or e-mail jenny@thehindleygroup.com. WACO: Great associate opportunity. Waco practice looking for motivated associate with a desire to join a PPO/fee-for-service practice. Great pay, great work

1162

Texas Dental Journal l www.tda.org l November 2013

environment with 2 other dentists and top notch staff. Please contact Dr Johnson at 435-237-2339 or e-mail at johnson.2978@gmail.com. WESLACO: Pediatric dentist needed Weslaco Pediatric Dentistry has an immediate position for a full-time pediatric dentist at our office in Weslaco. Our core value is to treat our patients as if they were our own family. Our office has state-of-the-art equipment including digital X-rays and computerized patient records. We offer conscious sedation in office and general anesthesia at local hospital. We have a well-trained staff who excel in patient care and truly love their work. Our practice is located in a family friendly community and is a short 1 hour drive to South Padre Island and the gulf of Mexico. Interested candidates please contact Dr Daniel Mego at 956854-4146, e-mail resume to dfmego@gmail.com. WESLACO: Private practice is looking for a licensed full-time general dentist. Hours are Monday through Friday, 8:00 AM to 5:00 PM. Call 956-655-8295.

Office Space BEAUMONT: New beautiful orthodontic office for lease, completely furnished and equipped on the best location in Beaumont; 6-chair bay, 2 business offices; 2,300 sq ft with lots of supplies. For more information, please call 409-861-2851 or e-mail drtsyler@gmail.com. Corpus Christi: Dental office, equipped and furnished for sale or lease. Dental medical specialty center. Five ops, 2 doctor offices, lab space, garden area, 1,421 sq ft. Call Don Deaver 361-813-7262 or Allen Doty, Broker 361-851-0214.

ADVERTISING BRIEFS 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. E-mail rcppc@ sbcglobal.net. EAST TEXAS DENTAL PRACTICE: Malakoff, Texas, dental practice for sale. Malakoff is near Athens, Texas. Dentist retiring due to health. General practice established in this location in 1974. Location will make a great place for a start-up or satellite practice due to numerous surrounding small towns. The practice, equipment and real estate are available

for purchase. Lot on main highway is also available for future office site. There is a great potential for growth. Current practice is only 3 days a week. For more information contact either of the following: Stanley Fulgham, 817-657-7239, 9:00 AM to 8:00 PM Monday through Saturday or e-mail to stanleyf@ sbcglobal.net. Donna Fulgham, 214-642-2038 9:00 AM to 8:00 PM or e-mail to rodneyshouse@comcast. net. EL PASO: Lease space previously occupied for 23 years by oral surgeon. Plumbed for gases and suction; 2 operatories, 2 consult rooms; large storage area; finance room; private office; kitchen/lounge. Just off the busiest street on the Westside. Located

DDR Dental Trust

Serving Texas Dentists for more than 40 Years

• Practice Appraisals • Practice Sales • Associate Agreements

800-930-8017

James L. Dunn, Trustee Texas Dental Journal l www.tda.org l November 2013

1163

ADVERTISING BRIEFS in between 2 general dentists and orthodontist next door. Well kept building. Very reasonable rent. Contact Rick Ponsford at 915-581-4440 or 915-5260109. EL PASO: New dental offices for lease at Renova Plaza. Seeking complimentary specialties to 3 general practitioners and 1 periodontist. Suites can be finished to suit. Highest quality architecture and construction in upscale neighborhood; strong demographics. Agent: Etzold & Co 915-845-6006. FORT WORTH: Fully equipped dental suites for lease in growing North Fort Worth. Ideal for dental specialist — oral surgeon, endodontist or periodontist. Please contact Jennifer at 817-3662268. GRANBURY: Great location, high visibility and traffic. Approx 6,000 sq ft building, approx 3,000 sq ft of dental; 6 ops. For lease or possible sale. Call 817-2639014 or e-mail jeremy@mirandadentistry.com. 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. LUBBOCK: Good location. Two blocks from Texas Tech. Close to a very populated area. Two-story house converted into office — can accommodate

1164

Texas Dental Journal l www.tda.org l November 2013

2 dentists. Building is 7,848 sq ft. There are living quarters upstairs. Please contact Dr Williams for more information, 806-282-5682. 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. Contact Dan Lewis at Lewis Health Profession Services 972-437-1180 or dan@ lewishealth.com for additional information. ROUND ROCK: Orthodontist needed next to dentist in high growth high traffic area in Round Rock, north of Austin in one of the fastest-growing counties. For more information, e-mail john@herronpartners.com or call 512-457-8206. 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 e-mail tiffini@dominiondentalspa.com.

ADVERTISING BRIEFS 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. E-mail inquiries to lmassadds@ gmail.com.

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. EQUIPMENT FOR SALE: Panoramic/Ceph (1), panoramic X-ray (1), 70 KVP x-rays (3), dental chairs (3), dental lights (3), Porter N2O units (3), Steri Source Sterilization Center (1), and misc items. Inquire with Nora or Bev 361-992-9500 or e-mail beverly@paulkennedydds.com.

miscellaneous EXPERTS IN DENTAL BOOKKEEPING JN & Associates, LLC is a professional certified bookkeeping service. Our services free up your time by taking over compliance and back office tasks. www.JNABookkeepers.com Contact us at 512-4325029. You run your business, we watch your books! 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 800-383-3408; 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, 800-433-2603 (EST). Web: www. forestirons.com. “Dentists Helping Dentists Since 1983.”

Texas Dental Journal l www.tda.org l November 2013

1165

ADVERTISERS ADS Watson, Brown & Associates ......................690 AFTCO ....................................................................667 A.J. Riggins ............................................................661 American Academy of Facial Esthetics ...............668 Anesthesia Education and Safety Foundation ..........................................................664 DDR Dental Trust ...................................................727 Dental Handpiece Repair Guy ..............................669 Dental Post .............................................................678 Dental Practice Specialists ...................................705 Dental Spots.......................................................Insert Dental Systems ......................................................680 The Professional Recovery Network (PRN) Dental 3D Solutions ...............................................667 addresses personal needs involving counseling services for dentists, hygienists, students Dentaldental Trust ............................................................691 and hygiene students withDJ alcohol or chemical Bhola CPA .........................................................661 dependency, or any other Fortress mental or emotional Insurance ................................................654 difficulties. We provide impaired dentalâ&#x20AC;&#x201D;profesGary Clinton PMA .............................................658 sionals with the support and means to confidenHanna, Mark â&#x20AC;&#x201D; Attn. at Law .................................706 tial recovery. HighTex...................................................................661 Hindley Group ........................................................680 If you or another dental professional are conJKJ Pathology........................................................668 cerned about a possible impairment, call the Kennedy, Thomas John, DDS, P.L.L.C. ................707 Professional Recovery Network and start the .................................................651 recovery process today. If Medical you callProtective to get help North Dallas Anesthesia for someone in need, your name and location .......................................678 Ocean Dental..........................................................655 will not be divulged. The Professional Recovery OSHA ............................................ Inside Back Cover Network staff will ask for your name and phone Paragon ..................................................................691 numbers so we may obtain more information Patterson Dentaldone. ..........................Inside Front Cover and let you know that something is being Professional Recovery Network...........................730 Professional Solutions..........................................662 Resolve Dental Lab ...............................................706 Statewide Toll-free Helpline Shepherd, Boyd W. ................................................681 800-727-5152 Sherri L. Henderson & Associates .......................657 Smart Training, LLC ..............................................706 Emergency 24-hour Cell: Smile Brands/Bright Now Dental .........................662 512-496-7247 TDA Financial Services Insurance Program ..........................................654/Back Cover TDA Member Spotlight ..........................................702 TDA Network Perks Program ...............................................663 Professional Recovery Texas Dental 12007 Research Blvd. Suite 201Journal Classifieds.........................729 Texas Dental Journal Display Ads .......................705 Austin, TX 78759 TEXAS Meeting ......................................................659 www.rxpert.org UTHSCSA Dental School ......................................665 UTHSCSA / South Texas Pathology Lab .............661 Veatch Consulting .................................................669 Waller, Joe ..............................................................681

Your Patients Trust You. Who can YOU Trust?

1166 Texas 730 TexasDental DentalJournal Journall

lwww.tda.org www.tda.orgl lAugust November 20132013

When Whenfaced facedWith Withaamalpractice malpracticeclaim, claim, Who Whodo doyou youWant Wantininyour yourcorner? corner?

DENTAL DENTAL SUPPLIES SUPPLIES

Free FreeCE CECredits CreditsAre AreJust JustaaClick ClickAway. Away. TDAPerksSupplies.com TDAPerksSupplies.com leverages leverages the group group buying buying power power ofdog of more than 7,400 7,400 TDA TDA members. members. •your •your When When your your career career andand reputation reputation are are on on thethe the line, line, you you want want thethe strongest strongest dog inmore inthan corner. corner. Many Many dentists dentists don’t don’t realize realize howhow important important their their dental dental malpractice malpractice insurance insurance is until is until theythey need need it most. it most. Medical Medical Protective Protective • defense • defense hashas more more than than 100100 years years of proven of proven experience, experience, national national expertise expertise andand a balanced a balanced thatthat focuses focuses on on On On October October 1, TDAPerksSupplies.com 1, TDAPerksSupplies.com launched launched withwith more more GetGet a price a price estimate estimate by sending by sending a list a list of items of items • • your your bestbest interest. interest. And, And, today, today, more more than than ever, ever, thethe bigbig financial financial strength, strength, integrity integrity andand powerful powerful backing backing of aof a than than 40,000 40,000 products products from from more more than than 200200 dental dental brands brands using using SKUSKU or• distributor or• distributor item item numbers—or numbers—or Warren Warren Buffett Buffett Berkshire Berkshire Hathaway Hathaway Company Company areare crucial crucial to the to the quality quality of your of your dental dental malpractice malpractice protection. protection. (most (most available available through through dealers). dealers). Product Product lines lines of more of more than than place place an order—via an •order—via email, phone phone or fax. or fax. There There • email, 60 60 direct direct manufacturers manufacturers thatthat don’t don’t sellsell through through dealers dealers are are are are no membership no membership fees; fees; all current all current TDATDA memmem• • •accounts. • alsoalso available. available. Perks Perks Supplies Supplies is projected is projected to save to save TDATDA memmem- bersbers have have pre-activated pre-activated accounts. YourYour ADAADA membership membership bersbers an average an average of more of more than than 35%35% on dental on dental supplies. supplies. number number willwill be required be required to access to access TDAPerksSupplies.com TDAPerksSupplies.com or or Taking Taking New New Steps Steps •service • staff. to speak to speak withwith customer customer service staff. • •

one onecompany companyhas hasstrength strengthand andexperience experience that thattowers towersover overthe theothers. others.

PROTECTION PROTECTION & PRICE & PRICE contact contact us today us today for for a a protection protection & price & price check-up check-up

✓✓

Trust Trust thethe dental dental malpractice malpractice experts. experts. • •

• •

email email dental@medpro.com dental@medpro.com VisitVisit www.medpro.com www.medpro.com • • call call 800-4medpro 800-4medpro • • ToTo view view courses courses online, online, visit visit www.txhealthsteps.com. www.txhealthsteps.com. E: Support@TDAPerksSupplies.com E: Support@TDAPerksSupplies.com | Fax: | Fax: 888-740-4154 888-740-4154 M-F,2013 M-F, 8 AM 8 AM to 7toPM 7 PM TexasTexas DentalDental Journal Journal lCustomer www.tda.org lCustomer www.tda.org lsupport November lsupport November 2013 1167 1167

TDAPerksSupplies.com TDAPerksSupplies.com

512-270-6999 512-270-6999

GET HELP WITH YOUR HEALTH INSURANCE TRANSITION. Purchasing insurance through Perks’ TDA Financial Services Insurance Program means you’ll always have attentive customer service from a team dedicated to TDA members and staff. TDA Financial Services Insurance Program is working with Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, to make the insurance transition easier for insured TDA members and staff.

service from a team dedicated to TDA members. The portal will be available on October 1, 2013, at tdamemberinsure.com. Coverage will be effective January 1, 2014.

SIGN UP FOR COVERAGE ON OUR PORTAL. Use TDA Financial Services Insurance Program’s portal to purchase a guaranteed issue basis policy with no pre-existing condition riders or exclusions and receive attentive customer

Enroll or learn more at: 1168

Independent, Authorized Agent for

An Independent Licensee of the Blue Cross and Blue Shield Association

tdamemberinsure.com

Texas Dental Journal l www.tda.org l November 2013

For more information, call:

(800) 677-8644