Texas GP Spring 2009 by Texas Academy of General Dentistry

SPRING 2009, VOLUME 35, ISSUE 2

Stresses & Strengths of Dentistry Strategic Planning

3rd Party Providers

Mentoring: FellowTrack & MasterTrack

Access to care Advocacy & TDA Legislative Day

Leadership Development

Inside This Issue: Advocacy Updates From TAGD

Texas AGD Wants to Help You Achieve AGD Fellowship and Mastership

2009 Texas AGD MasterTrack Schedule Dallas

Austin

Houston

August 6 - 9 Dallas County Dental Society Building

June 4 - 7 Omni Southpark Hotel

September 24 - 27 Norris Conference Center

Removable Prosthodontics “Exquisite Complete & Implant Retained Over Dentures Calibrated for the General Practitioner” Presented by Joseph Massad

Periodontics & Operative Both topics presented by Dr. Eric Rindler

Oral Surgery Speaker to be announced

Special Patient Care Presented by Dr. Jackie Plemmons

November 5 - 8 Omni Southpark Hotel

Pediatrics “The Magic of Pediatric Dentistry” Presented by Dr. Ben Taylor

Clinical Photography Presented by Dr. Douglas Damm Endodontics “Advancing Your Endodontic Skills” Presented by Dr. Ron Lebby

Fellowship Exam Review

June 26 & 27, 2009 • Austin, Texas The Fellowship Exam Review course aims to prepare participants to successfully complete the FAGD Exam in pursuit of their Fellowship in the Academy of General Dentistry. This course is designed to: • Instruct participants how to prepare for the examination • Familiarize participants with exam format • Preview material from the areas that will be covered on the exam • Use the AGD Study Guide as a testing aid

Participants may join MasterTrack at any time and will earn up to 48 hours of participation credit at each session with protocol presentations. Participation hours earned while working on Fellowship can now be applied to Mastership. You do not have to complete the required three years of membership or 500 hours of CE to take the Fellowship Exam. It can be taken at any time.

*This review will also prepare you for the ABGD written exam • • • • • •

Biomaterials Endodontics Fixed Prosthodontics Implants Infection Control Occlusion

• • • • • •

Orthodontics Patient & Risk Management Pediatric Dentistry Periodontics Radiology Removable Prosthodontics

• •

Oral Pathology Oral Surgery

•

Restorative Dentistry

For more information on either of these programs contact Jeannie at 512-244-0577 or Jeannie@tagd.org 2

JOURNAL OF THE TEXAS ACADEMY OF GENERAL DENTISTRY

2008/2009 OFFICERS President Ron Theiss, DDS, MAGD Nacogdoches President-Elect Dan McCauley, DDS, FAGD Mount Pleasant

J O U R N A L

O F

T H E

T E X A S

O F

6 Disaster Management - Are you prepared?

10-11

Director (2009) Marko Alanis, DDS Alamo

2009 Lone Star Dental Conference Preview

Director (2009) Arnold Chavarria, DDS El Paso

Director (2010) Dean Armstrong, DDS, FAGD Amarillo Director (2011) Jamie Bone, DDS, FAGD Kerrville Director (2011) Gary Jennings, DDS, MAGD Houston AGD Regional Director Douglas Bogan, DDS, FAGD Houston AGD National Trustee Ralph Cooley, DDS, FAGD Conroe Executive Director Connie Sonnier, CAE Round Rock

TAGD Staff Meg Hulse Director Jack T. Clark Foundation Amy Knitt

Membership & Communications Director

Jeannie Russell Education Director SPRING 2009

D E N T I S T R Y

Trials & Heroes of Texas Politics

Secretary/Treasurer Mark Peppard, DDS, FAGD Austin

Director (2010) Craig Armstrong, DDS, FAGD Houston

G E N E R A L

SPRING 2009

Immediate Past-President Mickey Walker, DDS, MAGD San Antonio

Editor Michael Payne, DDS, FAGD Mesquite

A C A D E M Y

12-13 Dental Fillin’s..........................................................................................4 Pearls of Wisdom.....................................................................................4 President’s Message.................................................................................5 Protecting Your Profession.........................................................................7 TAGD Headlines........................................................................................8 Summer CE Schedule...............................................................................13 Welcome New Members...........................................................................15 Membership Application..........................................................................16

NEXT ISSUE:

Important Contacts

2009 Texas Dentist of the Year™ Nominees Information changes requested: Send your new address, phone, fax and e-mail to Amy@TAGD.org

TAGD

512-244-0577 Toll-free 877-464-8243 Fax 512-244-0476 www.tagd.org

Disclaimer: The TAGD does not necessarily endorse opinions or statements contained in articles or editorials published in the TexasGP. The publication of advertisements in the TexasGP does not indicate endorsement for products and services.

AGD

888-243-3368 www.agd.org

Texas GP is published quarterly by the Texas Academy of General Dentistry,409 West Main Street, Round Rock, TX 78664. Address changes should be sent to the TAGD. Texas GP is provided as a member service to members of the TAGD. Nonmember subscription rates are $25.00 individual and $40.00 institutional. Canadian orders add $5.00; outside the U.S. or Canada, add $10.00. Single copy rates are $3.00 to individuals and $4.50 to institutions (orders outside the U.S. add $1.00 postage). All orders must be prepaid in U.S. dollars.

ADA

800-621-8099 www.ada.org

TDA

800-832-1145 www.tda.org

TSBDE

512-463-6400 www.tsbde.state.tx.us

No portion of Texas GP may be reproduced in any form without prior written permission from the TAGD. The opinions expressed by Texas GP are not necessarily endorsed by the TAGD. The publication of an advertisement in Texas GP does not indicate endorsement for products and services. TAGD/AGD approval for continuing education courses or course sponsors will be clearly stated.

In Memoriam • Dr. Christopher Anderson

entistry has lost one of its great leaders. Dr. Christopher Anderson passed away on January 18, 2009. I was fortunate to have met Dr. Anderson some years back. Upon meeting him, I was captivated by his character. He was soft spoken, kind, compassionate, and exuded an air of pleasantness. As time passed, I became aware of his tremendous knowledge and amazing passion for dentistry. It became readily apparent he was a true leader, one who led by example. Those who have served with Dr. Anderson know that even in the face of uncertainty or adversity, he always remained calm while working to find the best possible solution. Upon graduating from Baylor College of Dentistry in 1969, Dr. Anderson received his Masters in Orthodontics in 1972. While maintaining his private practice in Lubbock,

Texas, he was a member of the South Plains District Dental Society, Dallas County Dental Society, Texas Dental Association, American Dental Association, American Association of Orthodontists, American Cleft Palate Association, American Academy of Orofacial Pain, and the American Association of Dental Editors. In addition to being an ordained minister, Dr. Anderson served on the South Plains Boy Scout Council Review Board and District Camping Committee. He was also active in the Christian Life Center and Christian Resource Center of Lubbock. In 2004, Dr. Anderson was nominated for the Texas Academy of General Dentistry’s Dentist of the Year Award. Also in 2004, the Texas Dental Association awarded him a Service Recognition Award for incomparable service for his work as editor of the Texas Dental Journal; a position he had held

since 1999. The following year he received the American Association of Dental Editors Distinguished Dental Editor Award. I have stated before Michael Payne, DDS, FAGD in this publication that one of the truly wonderful aspects of being a member of the dental profession is formulating relationships with some of the most kind, compassionate, generous, and knowledgeable individuals in the world. Dr. Anderson was one of those individuals. I felt privileged that our paths had crossed and that he was a colleague. Since his death, there has been an outpouring of love and respect for Dr. Anderson from family, friends, colleagues, and patients. He will be greatly missed by those who knew him. Those wishing to make a memorial contribution on behalf of Dr. Anderson may do so to the Felix C. Crawford Memorial Fund of the TDA’s Smiles Foundation. Even though his time on this earth is over, he is still seeking to help serve others in need.

LETTERS TO THE EDITOR/PEARLS OF WISDOM: If you have a comment, suggestion, or question or would like to send a pearl of wisdom to share with other dental professionals please contact the editor at mbpayne24@sbcglobal.net

Pearls of Wisdom

Pay Before Service

n my experience with Peer Review and the State Board, attempts to collect a fee by a dentist will frequently be the instigator of a complaint by a patient. It is for this reason that I urge the collection of the fee prior to service, or, at the very least, on the day of

the initial visit of a procedure requiring two or more appointments. Once a procedure begins, the dentist is legally and ethically obligated to complete it or face charges of patient abandonment. Assume a patient having a crown preparation requests to pay half of the total fee at the initial appointment and the balance at the delivery appointment; if the patient does not pay the second half at delivery, the crown must still be seated. It cannot be held hostage for the balance of the fee. In the case of a full mouth restoration the entire fee should be collected prior to any services being initiated. This requires some patient management, to handle the payment prior to seating the 4

patient in the operatory. Establish with the patient that the fee for a service such as this will be paid in full prior to the appointment. This can be collected days in David Wilhite, DDS, MAGD advance or on the appointment day just before seating the patient. The fee for the procedure is part of Informed Consent. Since the fee is paid prior to the procedure, it avoids allegations by the patient that the fee was unknown to him and that without knowledge of the fee, full consent was impossible. JOURNAL OF THE TEXAS ACADEMY OF GENERAL DENTISTRY

A MESSAGE FROM THE PRESIDENT

W.I.N. • What’s important now

I want to thank each and every member of TAGD for allowing me the privilege of serving as your President. As I have looked back over the past six months, I have had a chance to reflect on the many positives in dentistry; but I am also reminded on a daily basis of the stresses and struggles, as well. Stressful situations in life are inevitable, particularly as a general dentist. But the key to success is how one reacts to them - the contingency plans we have in place and the advanced preparation to handle the unexpected. Lou Holtz, one of the most successful college football coaches of all time, has said in his book, Wins, Losses and Lessons, “No individual or team can perform under pressure without preparation.” He said that when faced with tough decisions he would always reflect back on the W.I.N. principle, that is, “What’s Important Now.” In aviation, in order to have a successful flight, a pilot must evaluate and consider several areas. The pilot must objectively evaluate himself to determine that he is mentally, physically and emotionally prepared to safely embark on a flight. Additionally, he must be sure that the aircraft is in safe operating condition through the review of the maintenance books and a pre-flight inspection of the plane before committing to a flight. One must evaluate current and forecasted weather conditions of departure and destination airports. Pilots are familiar with a well-known quote, “it’s better to be on the ground wishing you were in the air, than to be in the air wishing

SPRING 2009

you were on the ground.” These checkpoints find ourselves suscepmust all be in agreement for you to determine tible to the threat of the go/no-go decision. tornadoes, flooding and fires. Just In our recent memory is the US Airways this past September, crash that occurred in New York City three many of us encounmonths ago, where Captain Chesley “Sully” tered Hurricane Ike Sullenberger successfully landed his plane in which brought wide- Ron Theiss, DDS, MAGD the Hudson River. He was faced with mak- spread devastation to many. In addition, we ing a quick decision: to attempt landing at have had several members of TAGD who nearby Teterboro Airport in New Jersey or to have dealt with similar disasters, losing their land in the Hudson River under controlled offices to floods or fire. Even though insurconditions. With only seconds to respond, ance helps with these disasters, most of the his many hours of emergency training al- time it is not enough. There is a trickle down lowed him to apply the W.I.N. principle. He effect not only on the dentist, but on the staff, simply reacted appropriately to what he had patients, dental labs, suppliers, etc., when the practiced hundreds of times in the simulator daily routine of a dental office is altered. throughout his many years of training. His ability to discern what’s important now was Being a member of TAGD has many bennothing short of a heroic effort which resultefits, and one is the strength of our members ed in no loss of life. helping one another. I am reminded of many As a practicing general dentist, it is a privilege stories related to me about TAGD members and an honor to provide oral health care to helping colleagues who were without power, deserving patients. The relationships we have needing a generator or temporary office space with our patients, TAGD members and col- when their office flooded or was damaged by leagues in other dental organizations make fire. These bumps in the road remind us that the practice of dentistry so very special. We the pathway to achieving a goal may not always deal with stressful situations most every day be a straight course. However, by regularly foin our dental offices. However, it is the unex- cusing on our checkpoints, such as reviewing pected situation outside of patient care that our insurance coverage, having emergency may impact us the hardest. Living and prac- power sources, food and water reserves, and ticing in our beautiful state of Texas has many an emergency exit route, etc., we will have apwonderful benefits but also some weather plied Lou Holtz’s philosophy of preparation threats as well. Due to our proximity to the for performing under pressure - that moment Gulf of Mexico, we are threatened almost when applying his W.I.N. principle is critical: yearly by the possibility of hurricanes. We also doing “What’s Important Now.”

Trials and Heroes of Texas Politics

he 81st Texas Legislature is currently about half way through its 140-day regular session. As of the March 13 bill filing deadline, legislators had introduced more than 7,150 bills, a 20 percent increase over last session. Thank goodness that Texas’ founders established a Legislature that only meets once every two years. Legislators are currently considering several bills affecting dentistry and your TAGD is working hard to help pass the bills that only strengthen our profession. At the Senate Finance and House Appropriations Committees, the TAGD registered support for the Texas State Board of Dental Examiners’ (TSBDE) request for additional funding, amounting to approximately $1.4 million above their current budget. The additional funding would provide salary increases and replace the agency’s obsolete licensing database. If approved, the additional funding may require a $25 dental license renewal fee increase. (See next page for table regarding the TSBDE summary report). But simply put, TSBDE can no longer operate with its outdated computer system. In addition, the agency has had difficulty attracting and retaining professional staff because its salaries are significantly lower and case loads higher than similar positions at other state agencies. Unfortunately, the Board recently lost its lead investigator and has had an 87 percent turnover of its legal

Members of Rio Grande Valley AGD at TDA’s Legislative Day

staff during the last fiscal year. This under- and increased its scores the need for additional funding. overall effectiveness. Dr. Gary McThe TAGD supports legislation (SB 455 Donald, Presiding and HB 3670) that would create a coronal Officer of the TSpolishing certificate for dental assistants and BDE; Dr. Norman allow more dental assistants to place pit and Mason; and Dr. fissure sealants. If enacted, the legislation George Strunk are would also permit dental assistants to apply the current dentist fluoride under direct supervision and make Board members David Tillman, DDS, MAGD dental radiographs and perform reversible whose terms expire this year. They have all procedures to treat “minor emergency denadmirably served dentistry and the public; tal conditions” under general supervision. for their service, they are all heroes. The TAGD strongly opposes legislation (SB 536 and HB 168) that would enable dental Another hero in dentistry is Dr. Linda Altenhygienists who complete a TSBDE-approved hoff, Manager of the Oral Health Program course to administer local anesthetic by in- at the Texas Department of State Health filtration or block. The TAGD also opposes Services. Dr. Altenhoff has helped lead the SB 97 and HB 456, which would expand effort to boost Medicaid dental reimbursethe scope of practice for dental hygienists by ment rates as part of the Frew agreement to allowing them to treat patients in Head Start improve dental care for children enrolled in facilities and Community Health Centers the Texas Medicaid program. However, the battle to improve access to care has not been before a dentist examines those patients. won. Increased Medicaid reimbursement Your TAGD also supports the TSBDE was essential and has been achieved through “housekeeping” bill (SB 887) that would the Frew agreement. General dentists should make technical and clarifying amendments become Medicaid providers. As a Medicaid to the Dental Practice Act. The bill includes provider, dentists can deter the role these a provision that would allow the Gover- patients fit within their practice: the mininor to appoint TSBDE members to serve mum patient age and frequency of visits is up to two six-year terms, rather than the determined by the dentist. Currently there single six-year term allowed under current are simply not enough pediatric and orthlaw. Another provision would authorize the odontic dentists to reach all of the children TSBDE to assess “administrative penalties” who need care. General dentists can fill the (fines) for violations of the Dental Practice void. To become a Medicaid provider comAct that do not involve direct patient care. plete the application on www.tmhp.com. That provision would require the agency to The children of Texas will thank you. provide a mechanism to “expunge” (delete) the record of such violations under certain Also high on my hero list are the leadership of the TDA , Executive Director Mary conditions. Kay Linn, and the entire staff. I particularly The TAGD’s Board and Legislative Com- appreciate TDA’s willingness to facilitate mittee have worked tirelessly to represent its TAGD’s advocacy efforts. members on bills that affect dentistry. We Last, but not least, my newest hero is TAGD hope you share our opinion on them but lobbyist David Mintz. After he was hired in please understand that many are complex December, David’s knowledge and experiand could have far-reaching ramifications. ence have significantly bolstered our advoThat’s why TAGD’s Board and Legislative cacy at the Capitol. I’ve called David at all Committee are heroes to me. hours to ask about a bill or fulfill a task and TSBDE executive director Sherri Sanders his insight has always proven invaluable. So Meek is another hero for navigating the while it’s been said that “No one’s life, libagency towards smoother waters. During erty, or property is safe while the Legislature her tenure as ED, she has strengthened the is in session,” the efforts of these heroes of agency’s relationship with the Legislature dentistry help us sleep at night. 6

JOURNAL OF THE TEXAS ACADEMY OF GENERAL DENTISTRY

Protecting Your Profession Some folks lead the parade, some watch the parade, and some don’t know that there is a parade. So goes dentistry in Texas and the legislative year. The Academy of General Dentistry members have stated that continuing education and the pursuit of personal professional excellence are our first priority. Our second most important priority is advocacy. Our Academy wants to be represented and protected as a profession. Your TAGD board of directors is monitoring legislation and practice changes daily that will directly affect how you practice dentistry, how you will be paid, and how much government regulations will require of you as an independent practitioner. Whether attending

all of the TSBDE meetings or representing you at Texas Medicaid Stakeholder’s meetings, we are there. Your board of directors has also developed position papers in dental assisting, hygiene anesthesia, and has supported legislation improving the salary schedules for the TSBDE. We have provided testimony to the legislators as they debate dental issues in the Texas House and Senate. We are working with the TDA to represent dentistry as one collective voice, but also are keenly aware of your needs as general dentists, as we all live the same challenges in our own practices. Your board is proactive and will continue to address practice issues such as identity theft legislation, cosmetic

dentistry taxes, mobile dental van issues, mall bleaching, and even Botox usage in offices. Organized dentistry and the TAGD lead our profesDan McCauley, DDS, FAGD sion, protect our profession, and help you to practice with limited taxation, limited government intervention, and keep you, the general dentist, as the gatekeeper of our profession. So tonight as you leave the office, I encourage you to kiss your license to practice in Texas and to say thanks to those who diligently are protecting our profession.

TAGD advocates for its members on the national level AGD held its third annual A Great Dentist Goes to Washington government relations conference March 9-10, in Washington, D.C. Nearly 60 leaders from across the nation attended the conference and completed over 100 meetings with members of Congress. Members asked lawmakers for continued Title VII residency program funding after applauding funds included in the American Recovery and Reinvestment Act. They also shared the AGD’s White Paper on Access to Care and spoke about AGD’s support of both the Federal Dental Emergency Responders Act and the Meth Mouth Prevention and Community Recovery Act.

TSBDE Summary Report Agency Performance: Number of Complaints Resolved: Total Number of Complaints: Number of Jurisdictional Complaints Received: Average Time of Complaint Resolution (days): Percent of Complaints Resulting in Disciplinary Action: Number of Board Orders: Active Cases: * - Includes Multiple Board Orders Regulated Population:  Dentists:  Registered Dental Hygienists:  Registered Dental Assistants:  Dental Laboratories:

FY 2006 956 1,089 909 372 13% 125* 252

FY 2008 674 1,087 945 372 10% 80* 382

* Effective September 1, 2004 all dental assistants exposing radiographs in Texas were required to register with the State Boards of Dental Examiners no later than September 1, 2007

Total: 46,100 13,000 10,000 22,000 * 1,100

References: SB 263 - Leg. 79(R) and SB 610 - 80(R)

Number of New Licenses/Registrations Issued:  Dentists:  Registered Dental Hygienists:  Registered Dental Assistants:  Dental Laboratories: SPRING 2009

FY 2007 818 982 844 304 10% 89* 441

FY 2006 560 465 3,916 49 7

FY 2007 546 548 10,869 58

FY 2008 675 564 5,754 59

TAGD HEADLINES You’ve Got Mail! TSBDE License Renewal Notice

Dr. John Valenza Named Interim Dean of UT Dental Branch

Effective January 1, 2009 the Texas State Board of Dental Examiners stopped mailing renewal forms. Instead, the Board will mail a postcard approximately 60 days before the license expiration date.

TAGD member, Dr. John A Valenza, executive associate dean and associate professor in the Department of Diagnostic Science at the UT Dental Branch at Houston, has been named the school’s interim dean, effective May 23, 2009. Dr. Valenza will transition into this new leadership role after the UT Dental Branch’s commencement ceremony on May 22 when Dr. Catherine Flaitz steps down as dean to pursue her passion for academic oral pathology and pediatric dentistry.

License renewal may be done online by going to www.tsbde.state.tx.us and following the instructions. This applies to all dentists, hygienists, dental assistants, and dental laboratories. The renewal may be done up to 45 days prior to expiration date.

Update your address TAGD would like to remind everyone to keep us up-to-date in changes with your contact information so we can be sure you receive the latest TAGD news and information. For changes please contact Amy at 512-244-0577 or amy@tagd.org.

Dr. Valenza is a 1981 graduate of the UT Dental Branch and completed a residency in general practice at the University of Tennessee Memorial Hospital. He joined the faculty at the UT Dental Branch in 1987 and has since held numerous leadership roles at the school. Dr. Valenza is a Fellow in the Academy of General Dentistry, American College of Dentists and International College of Dentists.

New Web site & Facebook

TAGD New Dentist Committee

The TAGD web site has undergone some renovations to make a more user-friendly and navigable tool for our members. Please visit the site, www.tagd.org and let us know your thoughts or suggestions. TAGD has also added a Facebook page so be sure to become a fan in order to view photos from out latest events and receive news about the organization.

Congratulations to Dr. Mary Mellard She is the latest Recipient of the AGD Lifelong Learning and Service Recognition Award which was awarded to her during Dr. Berman’s course at the Star of the South Meeting. TAGD will award the LLSR to four members this year

TAGD would like to announce the newest task force helping with membership initiatives; the New Dentist Committee

Charge to NDC: A COMPREHENSIVE STUDENT AND NEW DENTIST OUTREACH PROGRAM Roster of New Dentist Committee Dr. Jamie Bone, Membership Chair Dr. Brooke Loftis Dr. Jackie Vo Dr. Aly Sergie Dr. Manual Gonzales Dr. Anna Windham Dr. Tifani Shuttlesworth Dr. Josh Austin Dr. Shane Ricci Kim Turnbow Anthony Maggio 8

In Memoriam • Elena Clark

Elena Beauchamp Clark, 89, passed away Thursday, April 9, 2009, at home with family. Mrs. Clark was born Aug. 4, 1919, in Greenville to Lena and John Beauchamp. She graduated from East Texas State University. On June 7, 1941, she married Dr. Jack T. Clark. Mrs. Clark was an active community volunteer and was past president of both the Texas State Dental Auxiliary and the Fort Worth Dental Auxiliary. Other activities included memberships in the Fort Worth District Dental Alliance, Fort Worth Woman’s Club, Fort Worth Chapter of DAR, Child Study Center Foundation, Fort Worth Alpha Delta Pi Alumnae Association, Rejebian Club, Lone Star Officers Club, Fort Worth PEO, Ridglea Garden Club, and All Saints Episcopal Church. She was preceded in death by her parents; her husband, Dr. Jack T. Clark; and son, Jack T. Clark Jr. Survivors: Daughter, Gale Clark Richardson and husband, Tommy; daughter-inlaw, Sandy Clark; granddaughters, Kristen Hunter and husband, Brandon, Kendall Goldstein and husband, Michael, and Kristina Robertson and husband, Josh; and great-grandchildren, Aidan Hunter, Avery Hunter and Taylor Goldstein. The family respectfully suggests donations to the JTC Foundation, 409 W. Main St. Round Rock, TX 78664; Community Hospice, 6100 Western Place, Suite 500, Fort Worth, Texas 76107; or All Saints Episcopal Church, 5001 Crestline Road, Fort Worth, Texas 76107. JOURNAL OF THE TEXAS ACADEMY OF GENERAL DENTISTRY

Texas

Academy of General Dentistry

Dallas MasterTrack

Exquisite Complete and Implant Retained Over-Dentures Calibrated for the General Practitioner Presented by Dr. Joseph Massad

Friday, August 7, 2009 DCDS Building • Dallas, TX 8:00 a.m. - 5:00 p.m. • 8 hours lecture credit This presentation will cover the most important aspects of complete removable dentures reloaded to include implant retained over-dentures and why unsuccessful cases are generally a result of an inadequate assessment thereby leading to a weak treatment plan. Helpful tips to eliminate this situation will be detailed. An assessment checklist designed to investigate and review those areas generally attributed to unsuccessful results will be highlighted. Making the most desirable impressions both internal and external will bring the audience up to current methods. The number two problem plaguing removable prosthetics is an inaccurate repeatable bite. A precise bite registration will be described in detail, followed by post insertion equilibration accomplished simply and accurately in minutes utilizing the intro-oral establisher. Why some relines work and others may require so many adjustments that making a new denture is easier. See how the delivery appointment will eliminate postoperative problematic situations by utilizing the titration technique. To sum it all up come ready to learn and have fun. Joseph Massad, DDS is an internationally renowned clinician in the field of prosthodontics. He has lectured literally around the world. Named one of the top clinicians in CE for 2001, 2002, 2003, 2004 and 2005 by Dentistry Today, Massad regularly lectures at meetings of dental organizations such as the American Prosthodontic Society, the American Dental Association, the Canadian Dental Association, and the Federation Dentaire International. A graduate of the Loyola University School of Dentistry, Massad has published scientific articles in publications such as the International Journal of Periodontics and Restorative Dentistry, Compendium of Continuing Dental Education, Dentistry Today, Dental Economics, and The Journal of Prosthetic Dentistry. Dr. Massad currently holds faculty positions at the Pankey Institute in Florida, Tufts University School of Dental Medicine in Boston, the University of Texas Health Science Center at San Antonio Dental School, and the Oklahoma State University College of Osteopathic Medicine. Dr. Massad is a Fellow of the American College of Dentists and the International College of Dentists. Fees:

*AGD Dentist ..........................$195 Staff.............................................$95 Non AGD Dentist or Staff ...$295

*Members part of MasterTrack, need to register with a MasterTrack form (Breakfast and lunch included in fees)

To register for this course call the TAGD office at 512-244-0577 or toll-free 877-464-8243 or visit www.tagd.org for a registration form.

Provider # 219328 FAGD/MAGD Credit 12/1/89-12/31/09

This course is provided by TAGD’s MasterTrack Program. MasterTrack is a protocol type program set up in two-session segments for each track. We have two-session tracks in Austin, Houston and Dallas. Each session is 31/2 days beginning with protocol presentations on Thursday. Friday, Saturday, and Sunday begin new topics. Participants that complete four year tracks in Houston, Austin or Dallas will earn the minimum 400 participation hours needed for Mastership. SPRING 2009

Up in Smoke

By Dr. James Donnelly What if your dental office was severely damaged or even lost due to a natural disaster? What would you do and how would you recover? Dr. Donnelly, a San Marcos dentist who had a fire at his office, recounts in his own words the days that followed.

he fire started one morning when my entire dental team and I were at the office and we had patients in the chair. It began in the compressor room and the special investigator deducted that the fire was due to a short in a breaker box. I have a double fire wall in that room and it was determined that the fire had burned for 20 minutes before coming out of the closet and sending flames upstairs. The compressor did not stop running during the fire even though it was burning so it continued to bring smoke into all the units in the treatment areas. The smoke was very acidic and things that we thought escaped damage started to deteriorate. Serve Pro came in the office starting the next morning with a full crew and started cleaning it. The smoke damage was extensive and amazing, the smell was so strong the first week that being in there I could imagine

was like sitting in a barbecue pit! During the initial clean up all of our mobile cabinets were emptied into boxes along with everything in our supply closets. Opened things had to be thrown out by the clinical staff but also inventoried for insurance to pay for the contents loss on supplies. That alone was a major task and almost overwhelming. Imagine everything in your office being pulled out and boxed up by non-dental people and then having to come back in and sort through and inventory every item before discarding and determining what stays and what goes. Luckily I was able to keep all our staff in place thanks to having insurance in place to cover our expenses in case of fire and other unforeseen and unfortunate events. Each staff member was paid their full salary during the two months we were closed. During that time a couple of other offices offered to let us use their facility for seeing emergency patients. We found that for the most part our patients were very understanding and waited for our re-opening. I also have loss of income coverage which I highly recommend. It made a bad situa-

Dr. Donnellyâ&#x20AC;&#x2122;s compressor room where the fire started 10

tion much more manageable. Our insurance company took my profit and loss statements for the last year and a half and figured my monthly income and compensated me that way. Our insurance company overall was very helpful and we did not have too many difficulties with them. I would advise everyone to check your policy for your building coverage and your contents and make sure you have enough. Look around at everything in your office and what would it be worth if you had a complete loss. Make sure you have replacement value on everything and overhead expense coverage as well as loss of income coverage. We were not sure what our coverage was because of course you never think you will need it! Benco Dental handled all of our equipment needs. All x-ray units, panorex, computers, laser, air abrasion units, delivery systems, cavitrons, digital cameras, appliances, window shades, disposable items, and many other items were replaced due to smoke damage and corrosion. The claim totaled over $500,000 for the damage by this fire. Having Benco Dental on-hand minimized the time we were closed and it was extremely helpful to have a full service dental supply company assisting us. I have never believed in spending time pouring over catalogs to save a few dollars, using a staff member that could be utilized elsewhere in the office for our patients. Benco Dental and our sales representative were awesome and due to our relationship with them they were willing to go the extra mile for all our needs and that helped tremendously. I could call on our sales representative and dental equipment techs at anytime and they were here for me. Many people probably felt that I had a two month vacation, but believe me it was far from it. Of course, I was here to oversee everything and in a rush to get back up and running as any dentist can understand. Thanks to a great staff and all the other people I mentioned, the fire is completely behind us, and though it definitely was a learning experience it is one I hope to never re-live. JOURNAL OF THE TEXAS ACADEMY OF GENERAL DENTISTRY

Life lessons After the Fire Similar to Dr. Donnelly, Austin dentist Dr. Michael Bell recently finished rebuilding his office after a fire in 2007 destroyed most of it. Once damages were totalled, Dr. Bell had to file a $1 million claim to his insurance company. Here, Dr. Bell lends his advice to help anyone in the unfortunate situation similar to his: 1. Important to have the right insurance. • Know your policy - It is vital to completely know and understand your policy and what you are covered for. Most people won’t actually find this out until they have to file a claim so it’s very important to contact your agent and find this out beforehand. • Get all the “bells and whistles” Farmer’s insurance helped Dr. Bell tremendously because of all the add-ons he included on his policy. Through this, he was able to receive side benefits like money to recover his computers and even a deodorizing service for the patient records he was able to salvage.

as ambulance chasers. In hindsight they could have been very helpful in negotiating with his building insurance company over claims and bids for construction. A public adjuster would also be valuable if you declined to hire an attorney. The adjuster is looked at as your insurance expert and they are licensed by the state of Texas so they don’t have any special arrangements or agreements with contractors. Public adjusters are also less expensive than an attorney. 3. Have a copy of your old building plans - this streamlined the rebuilding process and helped the contractors. 4. Check to make sure your building is up to code - Dr. Bell incurred additional construction costs because he had to bring his office up to current city codes and up

• Business continuation insurance This is what helped keep Dr. Bell’s business up and running during his rebuild. Though he didn’t have his office up and running he was able to recover lost profit through his insurance enabling him to retain all of his staff and paying them their full-time salary. This type of insurance looks at the average over the last few years of your production, for example, if your production drops 15 percent it’ll subsidize it back up to where it was. If you’re only doing half of what you were they’ll subsidize the other half and this includes looking at all expenses, including salaries. 2. Hire a Public Adjustor or Attorney immediately after the fire - After any disaster where there has been significant damage and insurance will be heavily involved, hire a public adjuster or an attorney to work with your insurance. Initially after Dr. Bell’s office fire he had many attorneys contacting him that he dismissed SPRING 2009

to standards with the American Disabilities Act. However, his building insurance did not cover this cost since their priority was to help bring the building back to it’s original condition prior to the fire. Be sure to check with your insurance if code compliance and updates are covered. 5. Get metal filing cabinets that turn around - Fortunately, Dr. Bell was able to save all of his patients’ paper charts and records that they stored in their metal filing cabinets. Some of them were burnt and had quite a stench but were able to be deodorized. The cabinets proved effective, though if the fire had lasted a little longer the charts would have perished. 6. Have an off-site back-up - You should always have an off-site back-up to protect your files.

2009 Lone Star Dental Conference September 11 & 12  Austin, TX

At the brand new AT&T Executive Education Conference Center

Come for the education  Take home the memories Friday Courses

Both courses are open to the entire dental team The Hottest Topics in Dentistry Today • A Team Approach Presented by Dr. Louis Malcmacher 8:00 a.m. - 4:00 p.m. • 7 hours lecture credit

The primary goal of this seminar is to teach dentists and staff how to easily integrate the hottest topics in dentistry into their practices such as less than an hour teeth whitening, no prep porcelain veneers, resin bonding, overhead control, treatment acceptance, and patient affordability. These practical concepts will enable you to offer new dental services, reduce your stress, significantly increase your production, substantially lower your overhead, and have fun doing dentistry.

Enteral Sedation Review & Medical Emergencies Presented by Dr. Ernie Luce

8:00 a.m. - 3:00 p.m. • 6 hours lecture credit This course will review recognition and management of common medical and sedation related urgencies and emergencies in the dental office. There will be an emphasis on the critical role of the entire dental team, not just the doctor in these situations.

Saturday Workshops Unraveling the Mysteries of Orthodontics Presented by Dr. Jon Romer 8:00 a.m. - 12:00 p.m. 4 hours hand-on credit

Differential Diagnosis of Oral Cancer & Biopsy Techniques Speaker to be announced 8:00 a.m. - 12:00 p.m. 4 hours hands-on credit

Practice Management

Presented by Dr. Andy McKamie Sponsored by Pinnacle Practices 8:00 a.m. - 12:00 p.m. 4 hours lecture credit

2009 LSDC Events Thursday • September 10 TAGD Component Reception

Friday • September 11 2009 Texas Dentist of the Year Gala™

All LSDC attendees are invited to the TAGD Component Reception on Thursday night where we celebrate the achievements of our local state components as well as local leaders who have demonstrated their commitment to dental excellence through education. Attendance is complimentary, guests are welcome, just RSVP with the TAGD office.

TAGD invites all attendees and their guests to the 2009 Texas Dentist of the Year Gala™ to celebrate dentists throughout the state who exhibit a commitment to continuing dental education, service to the community and have an impact in the dental profession. This is a formal, black tie event. The gala

will be themed this year; black and white attire is requested.

For more information on 2009 LSDC courses or events please visit our web site www.tagd.org or contact the TAGD office at 512-244-0577 12

JOURNAL OF THE TEXAS ACADEMY OF GENERAL DENTISTRY

TAGD CONTINUING EDUCATION SCHEDULE May

June Continued

August Continued

September Continued

Saturday, May 16 Jack T. Clark Foundation Differential Diagnosis Richardson, TX 6 hours CE credit Contact Meg Hulse at 512-244-0577 or meg@tagd.org

Saturday, June 6 JTCF & Smiles on Wheels Volunteer Opportunity Marlin, TX Contact Meg Hulse at 512-244-0577 or meg@tagd.org

Friday, August 7 Texas AGD Exquisite Complete and Implant Retained Over Dentures Calibrated for the General Practitioner Presented by Dr. Joseph Massad Dallas, TX Contact Jeannie Russell at 512-244-0577 or Jeannie@tagd.org

Friday, September 18 Fort Worth AGD The Virtues of Profitable Dentistry Presented by Dr. Howard Farran Fort Worth, TX 7 hours lecture credit For questions call Dr. Helmer at 817-924-1111

Friday, May 22 Predictable & Profitable Complete Dentures & ImplantBased Dentures Presented by Dr. Steve Wagner & Dennis Purinton Fort Worth, TX 7 hours lecture credit For questions call Dr. Helmer at 817-924-1111

Friday, June 12 Fort Worth AGD Restorative Disappointments & Their Impact on Dentists & Their Loved Ones Presented by Dr. Bruce Small Fort Worth, TX 7 hours lecture credit For questions call Dr. Helmer at 817-924-1111

June

August

Thursday – Sunday, June 4 – 7 Austin MasterTrack Periodontics & Operative Presented by Dr. Eric Rindler Contact Jeannie Russell at 512-244-0577 or Jeannie@tagd.org

Thursday – Sunday, August 6 – 9 Dallas MasterTrack Removable Prosthodontics Presented by Dr. Joseph Massad Special Patient Care

September Friday – Saturday September 11 - 12 2009 Lone Star Dental Conference Featuring: The Hottest Topics in Dentistry Today: A Team Approach Presented by Dr. Louis Malcmacher

Enteral Sedation Review and Medical Emergencies Presented by Dr. Ernie Luce Austin, Texas Contact Jeannie Russell at 512-244-0577 or Jeannie@tagd.org

Presented by Dr. Jackie Plemmons

Contact Jeannie Russell at 512-244-0577 or Jeannie@tagd.org

Thursday – Sunday, September 24 – 27 Houston MasterTrack The Magic of Pediatric Dentistry w/ Dr. Ben Taylor Oral surgery Speaker TBA Contact Jeannie Russell at 512-244-0577 or Jeannie@tagd.org Please visit the Texas AGD web site www.tagd.org for more information about these events or updates on new CE courses around the state.

Let us be your dental health partner . . . And help grow your practice to include patients from the largest dental customer in the world—the TRICARE Dental Plan—which has over 167,000 enrollees in Texas.* Plus, you’ll join over 66,500 dentists nationwide and over 4,000 dentists in Texas* who enjoy network benefits, including: • Competitive and timely compensation and reimbursement • Claims submissions through our free online processing system • Online access to patients’ benefits and claims information through My Patients’ Benefits • Program updates and corporate and industry 1-866-300-9426 • www.unitedconcordia.com news in the quarterly Connection newsletter TXAGD-0608 • Texas dental products are offered by the following operating subsidaries of United Concordia Companies, Inc.—United Concordia Insurance Company for Fee-for-Service products and United Concordia Dental Plans of Texas, Inc. for DHMO products. *Based on United Concordia internal research & reports, 04/08. SPRING 2009

Texas Made. Innovative. Committed. No matter where you practice in Texas, modern dentistry carries the risk of claims and lawsuits. How strong is your dental liability coverage? Texas Medical Insurance Company is a new name to Texas dentists, but TMIC was established in 1995 as a wholly owned subsidiary of the leading medical liability carrier for Texas physicians. Headquartered in Austin, TMIC is an Exclusively Texas dental liability provider for Texas dentists offering: • • • • •

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JOURNAL OF THE TEXAS ACADEMY OF GENERAL DENTISTRY

WELCOME NEW MEMBERS Ms. Shawna Adam, San Antonio Dr. Saba Ahmed, Houston Ms. Moyosola Ajaja, Dallas Dr. Jose Alamo, Waco Ms. Giselle Alvarez, San Antonio Dr. Michael Atkins, Azle Ms. Lola Atobajern, Dallas Ms. Sherifat Audu, Katy Mr. Sylvester Awago, Dallas Mr. Kaveh Azarnoush, San Antonio Mr. Sam Baber, San Antonio Ms. Luana Badea, San Antonio Mr. Doug Baldwin, San Antonio Mr. James Ball, San Antonio Dr. Angela Barnes, The Woodlands Dr. Mac Bennett, Madisonville Dr. David Bertino, Whitesboro Mr. Brian Black, San Antonio Dr. Danita Bolin, Fort Worth Mr. Jon Bonnet, Dallas Dr. Jackson Booth, Austin Ms. Aparna Borole, San Antonio Dr. Samantha Bousigues, San Antonio Dr. Jose Brigman, Helotes Dr. William Brown, Fort Worth Ms. Heather Brown, Arlington Dr. James Bruce, Dallas Dr. Steven Bui, Texas City Dr. David Burden, Round Rock Ms. Brandi Burgan, Dallas Dr. Patrick Burchfield, College Station Ms. Ellyssa Canales, Lancaster Dr. Michael Caparas, Dallas Mr. Alejandro Cavazos, San Antonio Mr. Brett Chapman, San Antonio Ms. Delia Chitimus, San Antonio Mr. Steven Chumbley, Houston Mr. Casey Clements, Houston Ms. Lauren Clevenger, Dallas Dr. Kristine Cody, McAllen Dr. Ronald Cook, Willow Park Mr. Justin Crockett, Conroe Dr. Elyse Cronin, Austin Dr. Ricky Cross, Plainview Dr. Sarra Cushe, San Angelo Ms. Lilia Cyr, San Antonio Mr. Stephen Dao, Dallas Ms. Diane Deng, San Antonio Dr. Timothy DePalma, Dallas Ms. Sanaz Ekhlassi, Houston Dr. Travis Epperson, Lubbock Ms. Clarissa Esparza, Arlington Mr. Daron Evans, Dallas Ms. Kyla Fant, San Antonio Ms. Teri Foreman, San Antonio Ms. Jennifer Fu, San Antonio Ms. Lauren Gaines, Dallas Mr. Luis Galvan, San Antonio SPRING 2009

Ms. Amber Garcia, Houston Ms. Patricia Garcia-Estrada, San Antonio Ms Rachael Garrett, Houston Mr. Esteban Garza, Dallas Dr. Thomas Gerald, Amarillo Ms. Elizabeth Gold, Houston Mr. Hector Gomez, Houston Ms. Whitney Gomez, San Antonio Mr. Iven Gonzalez, Houston Mr. Will Goodwin, San Antonio Dr. Jeffery Greene, Temple Mr. Virgil Gutierrez, San Antonio Ms. Huma Hamid, Houston Mr. Andrew Hanna, San Antonio Dr. Mimi Harmon, Dallas Ms. Tori Harrison, San Antonio Dr. Duc Ho, Katy Ms. Hanh Hoang, Houston Dr. David Hodges, DeKalb Dr. Susan Hollar, Arlington Mr. Diego Hurtado, Dallas Ms. Emilia Isaza, San Antonio Ms. Lorraine Jacob, Houston Mr. Taylor Jardine, San Antonio Dr. Neerav Jayaswal, Denton Mr. Tim Jessop, San Antonio Ms. Anita Jhangiani, Houston Mr. Arthur Johnson Dallas Ms. Danielle Jones, Dallas Mr. Chris Kahlden, Dallas Mr. Tony Kasallis, Houston Dr. Kevin Kean, Corpus Christi Ms. Precious King, Houston Dr. Hristina Kiprovska-Gavrilova, Austin Dr. Aric Klein, Houston Dr. Amy Klein, Houston Ms. Jaimie Kocian, San Antonio Mr. Joseph Koyne, Dallas Mr. Chad Lagaly, Houston Mr. Ricky Larson, Lewisville Mr. Daniel Lawrence, Houston Mr. Andy Le, Carrollton Ms. Jenny Lee, Houston Ms. Maria Linan, Dallas Mr. Chad Lindt, Pearland Ms. Angela Lopez, San Antonio Ms. Amanda Lopez, Dallas Mr. Scott Ludlow, McKinney Mr. Anthony Maggio, San Antonio Mr. Mark Malley, Grand Prairie Ms. Andrea Mambretti, San Antonio Ms. Helen Martinez, Houston Ms. Vickie Martinez, Houston Ms. Reena Mathew, San Antonio Mr. Marshall May, San Antonio Dr. Darlene McConathy, Angleton Mr. Jonathan McEwan, Spring 15

Ms. Alexis McKendall, San Antonio Dr. Judith Medina-Rivera, Cedar Park Ms. Christina Meiners, San Antonio Mr. Andres Mendoza, San Antonio Ms. Karina Mendoza, San Antonio Dr. Rafael Mercado, San Antonio Ms. Jessica Milburn, Dallas Dr. Adam Mileski, Dallas Mr. James Miller, Houston Ms. Rebecca Montalvo, San Antonio Mr. Aron Montgomery, San Antonio Mr. Ryan Montgomery, San Antonio Mr. Shamim Moslemi, Houston Ms. Sara Mouzi, Houston Ms. Monica Muller-Delgado, Houston Mr. Justin Mund, Houston Mr. Sergio Munoz, San Antonio Ms. Marina Narowetz, Roanoke Mr. Bernuy Neker, San Antonio Ms. Audrey Nghrem, Mansfield Ms. Phuong Ngo, Houston Mr. Kevin Nguyen, Terrell Dr. Nhung Nguyen, Houston Mr. Kip Nielson, San Antonio Ms. Elizabeth Oâ&#x20AC;&#x2122;Donnell, San Antonio Dr. Jill Ombrello, Lancaster Mr. Thomas Orme, San Antonio Ms. Lisette Ortega, Dallas Mr. Jason Packard, San Antonio Dr. Lynette Page, Dallas Dr. Jennifer Parker, Mansfield Mr. Bill Patel, San Antonio Ms. Depal Patel, San Antonio Ms. Jaanki Patel, Sugarland Mr. Neel Patel, San Antonio Ms. Hailey Patton, San Antonio Ms. Holly Pavlick, Houston Mr. Dwight Peccora, Houston Ms. Thanh Pham, Houston Ms Tonya Pickett, Houston Ms. Katy Poramapornpilas, Houston Mr. Adriel Ramirez, Houston Ms. Monica Ramos, San Antonio Ms. Krystal Reyes, Dallas Ms. Jihoon Rha, Houston Mr. Jordan Risinger, Houston Ms. Jennifer Rodrigues, Dallas Mr. Richard Rouse, Houston Mr. Daniel San Martin, Houston Mr. Kenneth Sandberg, Marvel Dr. Valerie Santiago-Doyle, Pearland Dr. Alison Scott, Houston Ms. Leslie Scruggs, League City Ms. Kristen Seagren, San Antonio Ms. Shivani Shah, San Antonio Mr. Brandon Shamblin, San Antonio Ms. Nandar Shar, Plano Ms. Kayla Sherrer, San Anotnio

Mr. Adam Shisler, Houston Ms. Maheen Siddiqi, Dallas Mr. Jeremy Simpson, San Antonio Mr. Sridhar Sista, Missouri City Mr. Jacob Smith, San Antonio Dr. Ronald Smith, Humble Dr. James Spiger, Austin Ms. Livia Stancu, San Antonio Mr. Garrett Stigall, Dallas Dr. Kara Sumbera, Conroe Ms. Naven Taiym, San Antonio Mr. Stephen Tapp, Houston Ms. Connie Taylor, Dallas Ms. Rosemary Thomas, Houston Dr. Sheela Thomas, Rockwall Dr. Derek Tillman, Houston Dr. Susan Tran, Irving Ms. Tiffany Tredway-Ransom, Houston Ms. Kim Turnbow, New Braunfels Ms. Poonam Vallabhbhai, Houston David Van Zandt, Houston Mr. Andrew Verrett, San Antonio Mr. Andres Villasenor, Houston Dr. Glenn Vo, Irving Dr. Cameron Wallace, Farmers Branch Dr. Timothy Warren, Fort Worth Dr. William Whittle, Fort Worth Dr. Phillip Wilson, Crandall Dr. Logan Wood, Victoria Mr. Aaron Wood, San Antonio Mr. Martin Youngs, Houston Ms. Estera Zanca, Dallas Ms. Yuliya Zebrowski, San Antonio Mr. Joseph Zimmerman, San Antonio Dr. Michael Zingalis, Belton

If you are interested in joining the Texas Academy of General Dentistry, or know someone who is, please fill out the application located on the back of the TexasGP and return it to the TAGD office or call Amy Knitt, Membership Director, at 512-244-0577 or toll free 877-464-8243

Texas Academy of General Dentistry 409 West Main Street Round Rock, TX 78664 ADDRESS SERVICE REQUESTED

Texas AGD Membership Application

3. Send in your application and dues

1. Choose your interests

q 2009 Academy Dues - State & National q Student Dues Or New Dentist Special Dues Rates - State & National q 2005 Graduate q 2006 Graduate q 2007 Graduate q 2008 Graduate or Resident

$494 $16

Local Component Dues

$_________

Today’s Date______/______/__________

Check any areas of interest that you would like to know more about or participate in: q Educational Programs q Fellowship/Mastership Award q Jack T. Clark Foundation q Volunteer Opportunities q Financial Planning Program q Other:_____________________

$425 $324 $221 $127

Dues vary by component area, see chart below

2. Tell us about you Name__________________________________________________

Address_________________________________________________ q Brazos Valley $25 City, State, Zip___________________________________________ Phone______-_______-________ Fax______-_______-________ E-mail_________________________________________________ Date of Birth ______/______/________ q

Male q

Female

License #_____________________ Year of Graduation*__________ Dental School______________________________ New Dentist?*

q q Central Texas $35 q q Dallas $45 q q East Texas $20 q q El Paso $10 q q Fort Worth $40 q q Heart of Texas $15 q Lubbock $35

Panhandle Rio Grande Valley River District San Antonio South East Texas Houston q2008 Grad q2007 Grad q2006 Grad

$0 $35 $15 $35 $10 $50 $25 $35 $45

*If you graduated less than five years ago your dues are less (see special rates on the right)

Total Amount Due $_________ q Check Enclosed (Payable to Texas AGD) q Solo q Associateship q Group q Discover q Master Card q Visa q Federal Services (specify)______________________________ Card #____________________________Expiration Date__________ q Specialist (specify)___________________________________ Signature________________________________________________ Sponsor Name (optional)___________________________________

Type of Practice - Check all that apply

Mail or fax your completed form to: Texas Academy of General Dentistry • 409 West Main Street • Round Rock, TX 78664 • Fax 512-244-0476