OFFICIAL PUBLICATION OF THE TEXAS ACADEMY OF GENER AL DENTISTRY
SPRING 2016, VOLUME 42, ISSUE 2
6 June 17–18, 2016
Austin, Texas
Q& A: The Inside Scoop
Faith in Pr actice
Robots in Dentistry
Dr. Alan Jeroff
Dr. Melissa Lent
Dr. Andrew Lazaris
PRESIDENT’S MESSAGE James S. Bone, MS, DDS, MAGD
“Desire is the key to motivation, but it’s determination and commitment to an unrelenting pursuit of your goal, a commitment to excellence that will enable you to attain the success you seek.” – Mario Andretti Every day I am amazed by the accomplishments of the TAGD and its members. I am constantly notified of our successes. Our members are… • Appointed to the Texas State Board of Dental Examiners (TSBDE) • Appointed to national leadership positions • Publishing textbooks • Leading mission work • Mentoring students
I am copied on any advocacy work being done on your behalf and on the countless hours these individuals devote to monitoring
regulatory and legislative activities, determining political strategies, advocating with their legislators and at the state board to ensure that the general dentist and his or her rights to practice dentistry in Texas are protected. As part of my duties on the National AGD Dental Education Council, I review applications for Fellowship, Mastership, and Lifelong Learning and Service Recognition. Texas consistently has one of the highest numbers of awardees in these areas. I continually receive reports about TAGD members who have passed the Fellowship exam, and about how our MasterTrack program continues to thrive. I do not see our award numbers waning anytime soon. So for all those who continue to move forward on these award paths, I congratulate you. For those of you who are interested in Fellowship, Mastership, or LLSR, I would encourage you on your journey and ask you to let us know how we can help. Abraham Lincoln once said, “If I had eight hours to chop down a tree, I’d spend six sharpening my axe.” I frequently have to remind myself that the only way I am going to get any better is by returning to the basics again and again. Each time I revisit a concept, I seem to pick up a new piece of knowledge, technique, or “pearl” I somehow had missed the time before. And even if not that, I find that I am reminded of something I have forgotten or even worse, just lazily pushed aside. Fortunately, we all can, and should, return to the basics. The AGD was founded on the basics of education and helping the general dentist succeed. Your Texas AGD is always striving to offer great continuing education opportunities. For those wishing to improve on their surgical skills, the New Dentist Conference is focusing on surgery. For those looking to brush up on implants, practice management, or a variety of other areas, the Lone Star Dental Conference has a number of great offerings. Even closer to home you will find a ton of great programs being presented by your local component. So let’s all take some time to “sharpen the saw!” TAGD is doing important things for our members and for general dentistry. I encourage everyone to make a small contribution to the profession and encourage others to join in and take part as well. As more people ride the wagon and fewer are pulling it, the wagon will eventually stop. If we had every last general dentist pulling, it would be easy to pull the wagon anywhere we want to go. I want to thank each of you for being a member and serving dentistry. If we don’t take care of ourselves, who will? Determined, Committed & Pulling, James S. Bone, MS, DDS, MAGD
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. Texas GP is published quarterly by the Texas Academy of General Dentistry, 1016 La Posada Dr. Suite 200, Austin TX 78752. Address changes should be sent to the TAGD. TexasGP 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. Printed in U.S.A. Copyright 2015, Texas Academy of General Dentistry, Austin, TX. No portion of TexasGP may be reproduced in any form without prior written permission from the TAGD. The opinions expressed by TexasGP are not necessarily endorsed by the TAGD.The publication of an advertisement in TexasGP does not indicate endorsement for products and services. TAGD/AGD approval for continuing education courses or course sponsors will be clearly stated.
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BOARD OF DIRECTORS PRESIDENT James Bone, DDS, MAGD Kerrville IMMEDIATE PAST PRESIDENT Kevin Gureckis, DMD, MAGD, ABGD Boerne PRESIDENT ELECT Marc Worob, DDS, FAGD Austin SECRETARY/TREASURER Jeffrey Geno, DDS, MAGD League City EDITOR Andrew Lazaris, DDS, FAGD Plano
DIRECTORS Randall Farmer, DDS, FAGD Houston Bryan Moore, DDS Dallas Mary Mellard, DDS, MAGD San Antonio Shane Ricci, DDS, FAGD Plano J. Dempsey Speer, DDS, FAGD Corpus Christi Tor Gotun, DDS, MAGD Austin NATIONAL TRUSTEE Douglas Bogan, DDS, FAGD Houston
TABLE OF CONTENTS The 5 Ways Social Media Helps Generate ROI For Your Dental Practice
Pg. 4
Advocacy Pulse – On the Frontline
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TAGD FellowTrack Student Perspectives
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Q&A: The Inside Scoop with Dr. Alan Jeroff
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2016 New Dentist Conference
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MasterTrack Case Study: Dreams Don’t Grow Old
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Welcome New Members
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Faith in Practice
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Technology Spotlight
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Calendar of Events
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REGIONAL DIRECTOR David Tillman, DDS, MAGD Fort Worth
COMPONENT PRESIDENTS BRAZOS VALLEY AGD Craig Scasta, DDS, FAGD Bryan
HOUSTON AGD Randall Farmer, DDS, FAGD Houston
CENTRAL TEXAS AGD Jason Carlyon, DDS Austin
PANHANDLE AGD Tom Karr, DDS, MAGD Amarillo
DALLAS AGD Phil Estes, DDS, FAGD Frisco
SAN ANTONIO AGD Kristen McBride, DDS, FAGD San Antonio
EL PASO AGD Patrick Mitchell, DDS, FAGD El Paso
SOUTH TEXAS AGD Benjamin Vela, DDS Corpus Christi
FORT WORTH AGD Marie Holliday, DMD Fort Worth
WEST TEXAS AGD Thomas Campagna, DMD, MAGD Midland
TEXAS ACADEMY OF GENER AL DENTISTRY STAFF EXECUTIVE DIRECTOR Francine Johannesen EDUCATION DIRECTOR Lindsey Robbins EDUCATION ASSISTANT Aleisha Stills DIRECTOR OF FINANCE Nadia Baig CONFERENCE & EVENTS SPECIALIST Regina Saranglao
COMMUNICATIONS MANAGER Leah Thompson COMMUNICATIONS COORDINATOR Joy Garza MEMBERSHIP SPECIALIST Megan McBride
CONTACT TAGD 1016 La Posada Drive, Suite 200 Austin, Texas 78752 www.TAGD.org T
512-371-7144
F
512-371-7178
EDITOR’S MESSAGE By Andrew Lazaris, DDS, FAGD
Like many of you, I am fascinated with technology and how rapidly the pace of innovation accelerates every year. In my 17 years of private practice, I have gone from paper charts and films to patients scheduling their own appointments online, CAD/CAM dentistry, and CT scans. One area in medicine where there is no dental equivalent is the field of child life specialists. These health care professionals work with children and families in hospitals and other settings to help and support children and families to cope with their medical challenges and fears. This field is a whole new area where technology can fill that void. I want to thank Mark Williams, President of RxRobots, for taking the time to give us a peek at the future (on page 18) and how these robots (MEDi™) are now entering dentistry as our partners to educate patients and relieve anxiety in patients. Also, thanks to Dr. Olin, who is lucky enough to have MEDi™ in his office, for his valuable input as well. For the movie buffs out there, there are three standouts to me that I would recommend. For the closest to what MEDi™ will be in the near future – Robot & Frank. From my favorite science fiction writer of all time, Isaac Asimov – Bicentennial Man. And finally, for a bleak, but possible view of what may happen when robots pass the Turing test – Ex Machina. Spring 2016 | 3
The 5 Ways Social Media Helps Gener ate ROI For Your Dental Pr actice By Jack Hadley
As I speak at dental events across the country, some of the most common questions I hear are, “How does social media help me make more money and what’s social media marketing’s return on my investment?” Our team spends an enormous amount of time tracking the financial returns on dental practices’ social media marketing efforts. We’ve found that Return On Investment (ROI) clearly falls into the following five categories:
1. GREATER WEBSITE TRAFFIC From the moment Google’s executive chairman and former CEO, Eric Schmidt, admitted that Google’s biggest mistake was failing to anticipate the rise of the social networking phenomenon (“… not a mistake we’re going to make again”), everything about the relationship between social media and Search Engine Optimization (SEO) began to change. Today, “social signals” are becoming an important component of search results. Publishing share-worthy content on social platforms with links back to your website provides valuable information to Google when those links are clicked. In addition, Google reviews (a critical component of social media) also generate more exposure and traffic to your website. SEO expert at MOZ, Casey Meraz recently explained, “It’s cool to rank in the top three results, but our click test studies have shown that many users will bypass the first or second result and click on the third if the number of positive reviews is greater. You need to have a solid review strategy in place in 2016. If you’re running a great business and don’t have a program for online reviews, then you need to get your act together.” Well said, Casey. 2. IMPROVED RETENTION If your practice has 2,000 active patients and a 10–15 percent attrition rate in overall patient retention, that means you must replace 200–300 patients each year just to stay even. Yes, some people move, die, change insurance, etc. But a number of those patients move on because they don’t feel a strong, personal bond with you and your team. It’s more profitable to retain a patient than to replace one. Reducing attrition by even 1–2 percent through effective, relationship-based marketing can mean thousands in savings each year. 3. INCREASED CASE ACCEPTANCE You’ve heard the term, “million dollar file cabinet” with reference to all the previously recommended treatment that patients 4 | Spring 2016
haven’t scheduled. Social media helps your practice make a dent in that file cabinet through education and stories that spread about the amazing services you offer. Don’t assume your patients know what you do! They often don’t—or it’s not of greatest priority. Educating patients is a key benefit of consistent social media marketing. 4. MORE REFERRALS & NEW PATIENTS Social media marketing is primarily internal marketing. Online word-of-mouth increases referrals and generates top-of-mind awareness. And the cool thing is, these are quality new patients who aren’t typically one-timers—they’re keepers who appreciate you more and spend more money over their patient lifetime.
prospective new patients builds and strengthens relationships. People like doing business with people they know and like. They get to know you through social media and often decide they want to be your patient long before they first walk into your practice. Social media marketing is relationship marketing. Effective social media marketing helps your practice convey the message, “Yes, I’m busy… but never too busy for you.” What are you doing in your practice to connect the dots between social media and ROI?
5. ADDED PRACTICE EQUITY A deep-seated digital marketing presence reaches beyond SEO. It can be an important contributor to practice valuation. Aaron Schulman of 5th Avenue Acquisitions & Venture Capitalists, helps dentists sell and acquire practices. He recently wrote, “Having an active social media existence will make your dental office inviting to potential buyers and will show that your marketing is current and front-of-mind to potential and current patients.” AND, LEST WE FORGET… Albert Einstein is credited for saying, “Not everything that counts can be counted, and not everything that can be counted counts.” Yes, ROI is extremely important to all of our businesses. But as a savvy business owner, remember to listen to your gut too. Doesn’t it just make sense that having stronger relationships with your patients, team members, and community will help you run a more profitable, thriving practice? Of course it does.
ABOUT JACK Jack Hadley teaches digital marketing to MBA students at Brigham Young University’s Marriott School of Management in Provo, Utah. He is also a founding partner at My Social Practice. Jack is an award-winning copywriter and former ad agency creative director.
In a dental practice, finding common ground and sharing common experiences through social media with patients and Spring 2016 | 5
ADVOCACY PULSE – ON THE FRONTLINE By Joey Cazares, DDS, FAGD | TAGD Advocacy Council Member
It’s About Relationships The Texas Academy of General Dentistry’s (TAGD) history has long been noted for “Lifelong Learning.” Although the Academy of General Dentistry (AGD) continually produces excellent CE opportunities with recognitions such as a Fellowship and Mastership, there has been an important addition to the focus of our academy advocacy is now front and center.
As times change, the AGD and specifically the TAGD has taken the role of advocacy very seriously. TAGD’s Advocacy Council is now a year-long council that is keeping track of the pulse of the profession. This council is constantly on top of the most current issues, bringing them up for discussion so that TAGD is knowledgeable, relevant and is a true advocate for the profession, its members and the patients we serve. I have had the distinct opportunity to work closely with the Advocacy Council and Mr. David Mintz, our advocacy consultant, for several years now. I have presented testimony on behalf of TAGD several times, including this last legislative session on four different issues. Our biggest issue was the mid-level provider issue. Against us were entities that spent close to $3 million. Due to the work of TAGD and TDA, the mid-level provider bill did not pass. However, I see this issue continuing in other states, and may return to Texas in future sessions. What was the key component of our success in getting TAGD’s message across? A pro-active Advocacy Council, an excellent consultant and the relationships of the grass-roots dentists with our State Representatives and Senators. Relationships with public figures can be the most important component of all. It takes time to nurture that relationship, one built on trust, respect and knowledge of the issues concerning our profession. Developing the relationship over time is key - giving them time to really know who you are, your ethics, your principles and most importantly, your commitment to do the right thing. I have availed myself to helping my local legislators by asking the simple question - what can I do to help you do a better job in the legislature? I have been active on campaign committees, held fund-raisers, met with key directors of agencies involved in healthcare at the request of my state representative, and been a phone call away to help their staff answer questions on bills that concern our profession. All in all, we have become trusted friends. Many times the Chief of Staff is the person working the intricacies of a bill who may need a question answered during the bill process. You may be the one who knows that key information needed. Bottom line - it’s about relationships. Get to know your local legislators. Do not wait until the 11th hour - reach out now and stay involved year-round. If you do not find it in yourself to get involved in that way, keep our advocacy at TAGD strong by donating to the TAGD Advocacy Fund. Together, we can keep our profession going in the right direction.
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For Members Only:
Advocacy and Legislative Updates To stay current on legislative updates check the Gatekeeper section in the TAGD monthly newsletter or visit www.TAGD.org/gatekeeper to get caught up!
Advocacy Council Members Chair - Brooke Loftis Elmore, DDS, FAGD Advocacy Consultant - David Mintz Joey Cazares, DDS, FAGD Fred Philips, DDS Susan Putthoff, DDS Dave Roberts, DDS Jennifer Bone, DDS, MAGD Shane Ricci, DDS, FAGD Donna Miller, DDS, MAGD James Bone, DDS, MAGD
“...reach out now and stay involved year-round.”
At Texas Academy of General Dentistry TAGD FELLOWTR ACK It’s All About Your Success! STUDENT PERSPECTIVES
Varun Joseph
FellowTrack - San Antonio UT Health Science Center School of Dentistry San Antonio Class of 2017 Earlier this year, I had the pleasure of attending a San Antonio AGD board meeting. It was an experience that opened my eyes to the tremendous amount of work that general dentists do for the local community, the profession and general public at large. We met at a local restaurant and as soon as I arrived I was treated as a future colleague by some of the most respected doctors in the San Antonio community. They welcomed me with open arms and were very patient about explaining what they do for a guest who has never been to a board meeting. The first thing I noticed was everyone’s passion for dentistry and serving their community. They knew about each other’s families and it was an atmosphere of friends getting together to talk about something they loved - their profession. We talked about the finances of the local component and then went on to talk about events that were being planned. Topics included an event at the local zoo with another local dental organization, and continuing education for both new and established doctors. We discussed the components nominee for Texas Dentist of the Year™ and New Dentist of the Year then voted for the best candidates. Next we talked in detail about the FellowTrack program that’s been ongoing in the dental school for junior and senior dental students. I was very impressed with the attention the board paid to the FellowTrack program as it doesn’t affect them at all. But every single person on the board was very attentive as FellowTrack updates were presented. Almost all of them asked questions about how to improve the program for students. As one of the board members said, “They are our future colleagues and we want to make sure they have a great experience.”
Sar ah Stuart
FellowTrack - Houston UT Health Science Center School of Dentistry at Houston Class of 2018 The AGD has given me more practical knowledge about running a business from successful dentists than any class dental school has offered. Every month I can count on the Houston FellowTrack meetings to renew my excitement for dentistry and increase my confidence in patient management. At our last meeting, Dr. Geno talked about patient communication and selling treatment plans. He stressed the importance of putting dental care in terms that the patient values, particularly how treatment options can affect patient lifestyle. Asking patients about the types of foods they want to continue to enjoy (fajitas and brisket or mashed potatoes) can help them to make more informed choices about their dental care. Another important principle highlighted was the Spanish Creole custom of “lagniapee”- which roughly translates to “a little extra for you my friend.” Patients need to know you are doing something special for them want to feel valued by their dentist. They already expect fantastic work, but what separates one great dentist from the BEST are the little things. From cards on Mother’s Day to pumpkin decorations at Halloween, having an interactive atmosphere in one’s practice makes the patient feel like part of the family. What makes AGD such a wonderful organization is its unique opportunities to gain the wisdom of experienced practitioners opportunities that frequently aren’t provided in school. I believe whole-heartedly that attending these meetings will make me a better dentist.
Attending this board meeting helped me to understand the importance of organized dentistry and how dentists who are involved in their community can also help the profession and pave the way for future clinicians like me. These doctors might not be discussing issues of national importance that members of Congress might discuss, but they are doing something that they love. And as Mother Teresa said, “We can do no great things, but only small things with great love.”
To get more information about the FellowTrack programs at your dental school, please contact Lindsey Robbins, Education Director, at 512.371.7144 or email.
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Q& A:
Dr. Alan jeroff The inside Scoop The New Dentist Conference chair, Dr. Susan Putthoff, gives you an inside look at your upcoming NDC speaker – building the suspense for another great conference June 17-18th.
One of your passions is flying – do you see any similarities between performing dental surgery and piloting a plane? Yes. Like flying, there are no shortcuts. Everything is by the book because when things don’t go right, we have to fall back to our basic training. It is always good practice to follow procedures, follow checklists and have a plan of action – “A Flight Plan.” For example, whenever I fly from Point A to Point B, we always have a flight plan that we know should end with a safe landing. We do a weather briefing ahead of time. We don’t just take off and hope for the best. In surgery, you never start a case before
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your brain has visited it ahead of time. It is very much procedure oriented and by the book. When we do surgery we have to decide at the beginning is this a forceps extraction or a surgical extraction? In aviation, I set it up as if every landing would be a missed approach. If I see the airport, I’ll go ahead and land! Always prepare for surgical, just in case. Have everything ready to go in case things don’t work out. You want everything to be predictable. How did you get into flying? Other than for your hobby, why else do you fly? Back in the early 80’s, my best friend,
who worked for a local TV station as a news editor, invited me to go up to the airport and do a familiarization flight. I did, stuck with it and went on to get my commercial and instrument rating. I’m an air ambulance pilot for a Medevac organization that allows me to fly cancer patients from their home to the city where the cancer treatment is being done and back in the same day. Many of these patients live on Vancouver Island and need to take a ferry as part of their journey so it is more convenient. It combines my love of flying with helping someone in need. These people already have one strike against them and to deal
with cancer is another strike - why not make life a little bit easier for them? Did anything in particular spark your interest in oral surgery?
to avoid shortcuts and do it right the first time. This talk I hope will give the dentists a good foundation with some new techniques that save time and keep them out of trouble.
I didn’t get a lot of oral surgery experience at dental school, so I took a program several years ago at the University of the Pacific.
Are your techniques something that can be implemented Monday morning or is additional practice instrumentation needed?
I was able to combine my love of flying and dentistry by flying down to San Francisco every Thursday night for a class on Friday. That I flew in was a shock to the surgeon mentoring me. At the time, there were only two of us in the program so we were able to just take turns assisting one another. It was all hands-on.
Yes, these are tips and techniques can be put into practice first thing Monday morning! I will discuss how to take out wisdom teeth, how to use local anesthesia and how to calculate the proper dose for patients.
Now I teach in an urgent care clinic. You never know what is coming through the door. We do whatever comes in. It’s like MASH dentistry where you are doing emergency procedures on the fly to relieve pain. These patients don’t usually have a family dentist. By the time they see us, their tooth often can’t be saved. Do you feel the techniques you’ll be presenting at the New Dentist Conference are innovative or improvements on what most will learn from their dental school training? It is all about doing the job right the first time. If we don’t have time to do it right the first time, when are we going to have time? If we rush through a crown prep and do a poor impression that the lab can’t read, then what? This now comes at the inconvenience of the patient if you have to reschedule and they have to come back in. It is important
No one wants drama in their practice. It just boils down to treating the right patients and knowing our limitations. Information before hand is part of the diagnosis. Information after is an excuse. The rule of thumb is inform then perform. It’s best to tell patients that it will be a surgical extraction right from the start and if it turns out to be a simple extraction - so be it. What are good things to tell a patient when a simple tooth extraction turns out to be a lot more complicated? Hopefully you will learn new techniques that will save you time and make your surgeries less stressful. What sources (articles, lecturers, etc) do you use or go to in order to stay up-to-date with managing patients who are medically compromised? Conferences and Study Clubs. I like to hear what the top dentists in the country and world are saying. What is
the latest treatment for the medically compromised, like patients on blood thinners? I want to hear what the experts are saying from the dental schools and what the specialists from the schools are saying. I want to make sure I’m in line with the most current teachings. What is the benefit of attending a conference and experiencing it face-to-face? Conferences are more interactive. It is important for dentists to go to lectures and conferences where they are taught something by a mentor. It’s best to look at it as an investment. You want to go to a course where someone actually teaches you. Not just looking at beautiful success cases of dentists. We learn by doing it over and over and over again. We do better each successive time. The best basic training is done by repetition. What else can we anticipate from you at the New Dentist Conference? Learn how to extract a tooth with no anesthesia, no forceps, no suture and no pain. Everything is clinical! Tips and techniques that will make your surgery more enjoyable, less stressful and more rewarding/satisfying. Bring lots of paper and pencils!
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Catch Dr. Alan Jeroff and Dr. Wendell Edgin at the upcoming 2016 New Dentist Conference this June! Register today!
“SIT BACK, BUCKLE UP AND HANG ON!”
– Dr. Alan Jeroff
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June 17-18, 2016 • Austin Omni SouthPark • Austin, Texas Friday, June 17th
Education Session Full Day Lecture • 8:00am-4:30pm • Subject Code 310
Contemporary Oral Surgery for the General Dentist Presented by Dr. Alan Jeroff Have you ever had a routine dental extraction that turned ugly? Dr. Alan Jeroff will walk you step by step through proven and effective ways to remove teeth while causing minimal trauma to the underlying bone. If you want to expand your oral surgery experience to further understand and manage dento-alveolar surgical procedures, look no further. This course will offer you an opportunity to better handle your extraction cases, manage complications and know what to avoid.
Social Events
Lunch with Leaders in Dentistry 11:30am-1:00pm Preparing for your long term career in general dentistry is just as important as pre-op care for surgery. Join in round table discussions and learn from Fellows and Masters.
“It is inspiring to be surrounded by dentists who are commited to lifelong learning.” -Ensy Atarod, DDS
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Post-Op Party with Peers! 6:00pm-9:00pm After a long day in surgery – RELAX and ENJOY a little post-op party with your peers while fine tuning your mad surgery skills at a private arcade! According to research, doctors who spent at least three hours a week playing video games made fewer mistakes in surgery and performed the task faster than their counterparts who did not play video games. Eat, Drink, Game and Network with your peers, Fellows, and Masters with Torchy’s Tacos and Deep Eddy’s cocktails! Additional guest tickets can be purchased for $45.00 each. (21+ only)
OMS - Oh My...Surgery! Oral & Maxillofacial Surgery, Trauma & Biopsies From Pre-Op to Post-Op - Plan your Patient Care
Saturday, June 18th
Education Session Half Day Lecture • 8:00am-1:30pm • Subject Code 310
Oral & Maxillofacial Trauma and Biopsies Presented by Dr. Col. (Ret) Wendell E. Edgin Advances in the resuscitation and treatment of patients with maxillofacial injuries have evolved! Dr. Col. (Ret) Wendell E. Edgin will cover the most common major maxillofacial injuries and describe current treatment protocols. He will discuss how correct and timely management of dentoalveolar trauma can control litigation and be tooth-saving. Then through clinical cases, he will review the indications and surgical techniques commonly used to biopsy lesions in the oral and maxillofacial region.
Save 30%. Early Bird Pricing Expires May 27, 2016. Registration now open at: www.TAGD.org/NDC Sponsors and Exhibitors Exhibitors: American Orthodontic Society | Burkhart Dental Supply | Carestream Dental | Dentsply Implants | H&M General Contractors | McLerran & Associates | Med-Tech Construction, Inc. | Periochip Dexcel Pharma | Shofu Dental Corporation | Straumann USA, LLC | Thomas Allen Real Estate Advisors Wallace Specialty Insurance Group | Weave
ROOM BLOCK INFORMATION Austin Omni Southpark 4140 Governors Row Austin TX, 78744 Reserve by phone at 1-800-THE-OMNI (800-843-6664) Block name: TAGD Book Online DEADLINE MAY 16
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CASE STUDY
DREAMS DON’T GROW OLD By Jennifer M. Roe, DDS, FAGD PATIENTBEFORE BEFORE PHOTO PATIENT PHOTO
ABSTRACT The intent of this article is to highlight the imperative need of comprehensive treatment planning, which includes an effective coordination between the restorative doctor and their circle of specialists. It is also to focus on the importance of effective communication between the restorative dentist and patient concerning treatment that will meet or exceed the patient’s expectations. Coordination between the restorative doctor (the “quarterback”) and specialists is critical in utilizing comprehensive treatment planning in order to achieve optimum results for the patient.
INTRODUCTION The role of the general or restorative dentist can sometimes be a lonely road. The general dentist sees many patients in a day with a variety of issues. It can become a survival instinct to try and “put out the fires” and not take the time or effort to truly assess the root cause of the patient’s condition. As a result, the general dentist may not know what the patient’s desires are in restoring themselves to optimal dental health. Too many times, due to lack of knowledge, lack of time, or lack of effort on the dentist’s part, the patient leaves a dental office without a true understanding of what can be done to restore their dental health. When there is a “team-centered approach” to complex dental patients, the road of the restorative dentist becomes less lonely and dentistry becomes much more rewarding for both the patient and the dentists.
CASE REPORT
In December of 2013, a 69 year old female patient reported to the dental office with the chief complaint, “My previous dentist told me I was too old for implants and needed to get another partial. I don’t want another partial! I want to be able to eat raw carrots.” Medical History: Positive for cancer (basal cell carcinoma – neck), fibroid tumors of breast, seasonal allergies, heart murmur, HBP, asthma, GERD, thyroid removal, ADR to codeine (hallucinations), and anxiety. Medications include: Alprazolam, Diovan with HCTZ, Levothyroxine, Premarin, Toprol, Trazodone, Zyrtec, and Nexium. Social History includes occasional use of EtOH. Dental History: Multiple, missing, posterior teeth; failing restorations; and multiple areas of decay. Patient reports pain associated with #29. She reports difficulty chewing due to missing teeth and RPD. The patient’s periodontal status is classified as generalized, moderate; localized moderate/severe chronic periodontitis with generalized, mild, plaque-induced gingivitis. There is a significant recession present at #24 & #25. Diagnosis: The Global Diagnosis for patient is: hyperactive upper lip, at 14mm, see figures 1 & 2; long upper lip, at 27mm, see figure 3; and dento-alveolar extrusion present at #24, 25, 12, 13, & 14, see figure 4. There is attrition present at #6, 7, 8, 9, 24, 25, & 27, see figure 5. The DAE of #12-14 can be attributed to missing, mandibular, posterior teeth on the left side. There is also excessive spacing present between #24-25 & #25-26, see figure 5. There is clinical, recurrent, and x-ray decay throughout mouth. The most significant caries noted is #29, which is an abutment to a 3-unit FPD, see figure 6. Decay is also present on teeth #6, 7, 8, 9, 10, 11, 12, 13, 14, 21, & 22. Endodontically, there is a suspicious, non-symptomatic lesion above #12, and #29 has a PARL , see figure 7.
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CASE REPORT (CONTINUED)
Figure 1
Figure 2
Figure 5
Figure 6
Figure 3
Figure 4
Figure 7
TREATMENT PLANNING This is an interdisciplinary treatment planning case encompassing restorative, orthodontics, periodontics, oral surgery, and endodontics. First, periodontal therapy was recommended, followed by OHI, and caries prevention. Next, the FPD (#29-31) will be removed and a determination made if the tooth is restorable. Caries control will be initiated. The patient will simultaneously be referred to orthodontist, endodontist (treat #29 if restorable, and to evaluate #12), and a periodontal consult for grafting, bone augmentation, sinus lifts, and implant placement.
MATERIALS & METHODS Non-surgical periodontal therapy was performed, followed by OHI, and caries prevention. Next, FPD (#29-31) was removed, and it was determined that #29 was not restorable. Patient was sent to oral surgeon for removal of #29. Over the next month the patient went for an orthodontic consult, endodontic consult, and a periodontal consult. There was then a collective consult between the restorative dentist and the above mentioned specialists. Endodontic Consult: Concerning #12: “We discussed options at length and decided RCT would not be the best move at this point. It is not clear if there is any endodontic issue at this point anyway. The patient knows to return to our office if signs and symptoms increase.� Periodontal Consult: Patient will need UR sinus lift; bone grafts LR, LL, #24-26, along with CTG’s in this area. Periodontist is confident he can create a good long term prognosis in the #24-26 area with augmentation. Sinus lift, bone grafting, and crown lengthening will take place approximately 3 months before anticipated end of orthodontic therapy, see figure 8.
Figure 8
Orthodontic Consult: Start orthodontics with the intention of setting up space for a lower incisor implant (#26A), see figure 9; and to create anterior coupling. This presents a challenge due to the adding of a lower incisor. A diagnostic set-up was done by orthodontist and reviewed by restorative dentist and periodontist. Caries control was initiated which consisted of multiple large fillings in teeth: #6 MILF, DILF; #7 MLF; #8 MF; #9 DL; #10 MLF; #11 M; #21 MODB(Class5); #22 DL. Crowns were removed from #12, 13, & 14 and there was very little tooth structure left. These teeth also exhibited moderate-severe bone loss. After discussing pros and cons of crown lengthening and possible endodontic treatment on one or more of these teeth, the patient, periodontist, and restorative dentist decided that implants in this area would provide the best, long-term prognosis. Temporary crowns were placed. Orthodontic treatment was then initiated and is currently in progress, see figure 10.
Figure 9
Figure 10
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DISCUSSION A diagnostic wax-up using Kois’ DFA mounted models in CR will be done while the patient is in retention. The orthodontist is aware that teeth cannot move once impressions are made for a diagnostic wax-up. A surgical guide will be fabricated from diagnostic wax-up. Sinus lift, bone augmentation, grafting, and extractions will be done approximately 3 months before anticipated completion of orthodontics. The scheduled date for this first surgery is in September 2015. After healing, retention of orthodontics, obtaining CR records, and completion of diagnostic wax-up, the implant surgery will be scheduled. Implants are planned at sites: #3, 4, 5, 12, 13, 14, 19, 20, 26A, 29, & 30. While waiting on diagnostic wax-up, patient will bleach lower anterior teeth. After integration of implants; #6, 7, 8, 9, 10, & 11 will be prepped for anterior crowns; bonding added to #22 & #27 to aid with canine guidance; and re-contouring of lower anteriors performed. Implant crowns will be placed on custom abutments at #3, 4, 5, 12, 13, 14, 19, 20, 26A, 29, & 30. Temporaries will be placed on implants as well as maxillary anterior teeth while crowns are being fabricated in lab. The temporaries will ensure that patient retains proper occlusion. An occlusal splint will then be delivered once all restorative has been completed. Patient will then maintain her treatment with 3-month periodontal therapy appointments which will include fluoride varnish. She will use Prevident daily as well as a Sonicare ultrasonic toothbrush to control plaque and caries. Patient will alternate periodontal appointments with periodontist.
“Judge tenderly, if you must. There is usually a side you have not heard, a story you know nothing about, and a battle waged that you are not having to fight.” -Traci Lea LaRussa “Judging is acting on a limited knowledge. Learn the art of observing without evaluating.” - Pushpa Rana, Just the Way I Feel
CONCLUSION General dentists are in the unique position to see many different dental and medical issues in a single day. It is the job of the “quarterback” to perform a thorough, comprehensive exam, assimilate that information, and present the patient with multiple treatment options depending on their wants, needs, and desires. It is detrimental to patients and the practice of dentistry to judge patients based on pre-conceived ideas. For the past 20 months, with coordination between a restorative doctor, periodontist, oral surgeon, endodontist, and orthodontist, this patient is well on her way to achieving her goal of “being able to eat raw carrots.”
REFERENCES 1. “Global Diagnosis”, J. William Robbins, DDS, MA CORE Dentistry Curriculum 2. Dr. Dan O’Dell – Periodontist (Austin, TX) 3. Dr. Barry Rouch – Orthodontist (Austin, TX) 4. Drs. Michael Swharze & Karl Keiser – Hill Country Endodontics (New Braunfels, TX) 5. Dr. John Cranham – Clinical Director of The Dawson Academy – Lecture presented at MasterTrack September 27-28, 2014
About Jennifer M. Roe, DDS, FAGD Dr. Roe obtained her dental degree from The University of Texas Health Science Center at San Antonio. She is a member of the American Dental Association and the Academy of General Dentistry. Dr. Roe is currently in MasterTrack, and just received her Fellowship from the AGD in June of 2015. She resides in the Heart of the Texas Hill Country with her husband and 3 children (ages 9, 6, and 2). Dr. Roe has a full-time private practice in Wimberley, TX and is honored to be a part of such a great community.
Fast Track to Mastership Interested in receiving 96 hands-on hours this year? The MasterTrack™ program is for YOU! By joining, you’ll have access to high quality, affordable continuing education and one-on-one staff support. MasterTrack™ fulfills all of the subject code participation requirements needed for Mastership in four years. The program brings together service oriented and business savvy decision makers with a dedication to excellence. People just like YOU. Call now to reserve your space! For any questions about the MasterTrack™ program, please contact Lindsey Robbins by email or at 512-371-7144. Already a Master? Check out the Master Study Club – a program created by Masters for Masters! Earn hours towards LLSR and stay connected with your peers. 14 | Spring 2016
Welcome New Members January 1, 2016 - March 15, 2016 The members of the Texas Academy of General Dentistry (TAGD) make up a community of over 2,800 general dentists. We are proud to be the largest constituent of the Academy of General Dentistry (AGD) and we continuously serve our members through high quality continuing education, advocating for general dentists, and overall helping general dentists succeed. We would like to recognize and welcome the members below who have recently joined the TAGD. These members joined between January 1st, 2016 and March 15th, 2016. Centr al Texas AGD
El Paso AGD
Tiffany Paiva, DMD
Heather Diulio, DMD
Austin, TX
El Paso, TX
Paige Priour, DDS Austin, TX
Dallas AGD
Ryan Fort, DDS Magnolia, TX
Bindeshwari Korat, DMD Stafford, TX
Fort Worth AGD
Asim Sundrani, DDS
Jacob Brown, DDS
Cypress, TX
Fort Worth, TX
San Antonio AGD
Sarah Chilmeran, DDS
Brian Gosnell, DDS
McKinney, TX
Corinth, TX
Penelope Drayer, DDS
Karen Neil, DDS
Dallas, TX
Fort Worth, TX
Thomas Grant, DMD
Anilkumar Patel, DDS
Frisco, TX
Weatherford, TX
South Texas AGD
David Hughes, DMD
Hyun Sik Sung, DMD
Dallas, TX
Fort Worth, TX
Tilman Richards, DDS
Shazia Khan, DDS
Kent Hamilton, DDS San Antonio, TX
Faryn Vela, DDS Karnes City, TX
Corpus Christi, TX
Plano, TX
Heart of Texas AGD
West Texas AGD
Anita Madhav, DDS
Chelsea Wilson, DMD
Robert Christensen, DDS
Plano, TX
Waco, TX
Midland, TX
Afunrhe Oghre-Ikanone, DDS
James Fregia, DDS
Dallas, TX
Houston AGD
Martin Pak, DDS
Sophie Doan, DDS
Trevor Harrison, DDS
Carrolton, TX
Houston, TX
San Angelo, TX
Manuel Pazmino Jr., DDS
Cam Ngoc Dong, DDS
Lance Skidmore, DDS
Red Oak, TX
Houston, TX
San Angelo, TX
Odessa, TX
Spring 2016 | 15
FAITH IN PR ACTICE By Melissa Lent, DDS My father, a physician, and I packed our bags and boarded a plane to Guatemala City in January 2014. We traveled with 40 health professionals and translators with Faith in Practice, a nonprofit Christian organization that provides surgical, medical, and dental services to the poor of Guatemala. We had no idea that we were about to experience one of the most incredible weeks of our lives. Since the day I decided to become a dentist, I hoped to serve with my father in this capacity. As a young child, I always wanted to be a doctor like him. I eventually decided to take the dental route, but he remained my role model and inspiration. As soon as I knew of the opportunity to participate in a Faith in Practice mission trip with him, I knew it was an experience I would never forget. The particular Faith in Practice team we joined was a “Village Team,� which means that the group travels to remote villages with minimal access to medical or dental care. When we arrived in our first village, it was immediately apparent how significant the need is in this country. The villagers excitedly awaited our arrival and designated an empty schoolhouse to be our clinical. Prior to this trip, I participated in numerous Mission of Mercy events in Texas, so I was no stranger to practicing dentistry in an alternative clinical environment. Still, I had a hard time imagining how this building with no glass on the windows, no overhead lighting, and no indoor plumbing could be transformed into a functioning medical and dental office. Less than two hours later, this schoolhouse was converted into a primitive yet functioning medical facility. As I learned when patients arrived the next morning, this schoolhouse turned doctor/dental office was nothing short of an answered prayer for the people of the village. When we pulled up to the school the following morning for final set-up, hundreds of men, women, and children greeted us, eager to discuss their ailments and hope for relief. Many of these patients walked for hours to get to the clinic, some carrying elderly relatives or small children. I initially signed up to serve as a dentist with this team, but was asked to translate in the triage area in the mornings and work in the dental clinic in the afternoons. I agreed to serve in whatever capacity I was needed and learned more in triage than I ever imagined I could. Listening to the patients in triage taught me
16 | Spring 2016
that each and every patient comes with a story, a sense of hope, and an overwhelming gratitude that help has arrived. I no longer viewed this clinic as primitive or limited in its capacity, I now saw the clinic as the patients did - a true miracle and gift of hope for the people of the village. Over the course of four days in two different villages, our group of nurses, physicians, dentists, and translators treated nearly two thousand patients, many of whom had never seen a doctor. Each evening, my father and I reflected back on what we had seen that day in clinic. As a physician, he provided the medical care for many of the patients I had met in the triage clinic. To hear about the happiness that the patients experienced after receiving medication for their knee pain or having a tooth extracted was truly inspiring. Upon our return to the states, my dad and I decided that we would return to Guatemala with future Faith in Practice missions. We returned in March 2015 and plan to participate in another Village Team in April 2016, this time with my mother in tow as well! My interest in Faith in Practice stemmed initially as a desire to work with my dad to help patients in need, but the experience has meant so much more to me than that alone. We have witnessed the agony of pain and suffering, but have also experienced the true meaning of hope, faith, and healing.
Technology Spotlight By Andrew Lazaris, DDS, FAGD
Over the years, dentists have tried many different ways to reduce anxiety in patients. Technology has reached a point where it can be an alternative to sedation, restraints or other traditional methods. In dentistry, there are no Child Life professionals available as in medical settings and MEDi™ serves a similar role. Mark Williams, President of RxRobot, Inc. gives us insight into the future of robotics in dentistry.
Please tell us about yourself and your company. RxRobots was founded in 2015 by Dr. Tanya Beran and Mark Williams. How are robots being used in healthcare/dentistry now? RxRobots has created MEDi™, the first humanoid robot programmed with behaviors that are proven using randomized control trials to reduce children’s pain by 50% during medical procedures using cognitive-behavioral interventions. MEDi™ is the first robot for the pediatric robotic patient care (RPC) market and it is designed for use in hospitals and dentist offices. In a clinical setting, MEDi™ provides physical companionship during the medical or dental procedure. MEDi™ provides an alternative to restraints and anesthesia for dealing with children who have needle fear. Outside of the clinic, MEDi™ is a celebrity and ambassador. MEDi™ appeals to donors and is an effective tool for foundations to increase fundraising. Children love to take pictures and videos of MEDi™ to post on social media. MEDi™ is easy enough to operate to be used by volunteers. What are the benefits of having a robot in your dental practice? The benefit to the patient and their family is clear. Patients arrive frightened and anxious, but amazed when a robot that appears to be alive greets them by name. The patient will experience less pain and anxiety during the dental procedure as well. The patients and their families will likely tell their friends and family about the “amazing dental office with the magical robot” which will attract new patients. In addition, the operations of the practice will be improved by transforming children that are reluctant to participate in dental procedures into compliant patients.
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Research has shown that children are more likely to follow the instructions of a robot than an adult. MEDi™ can act as a metronome to keep the procedure on track. MEDi™ not only improves the work environment for the staff, it actually teaches the staff how to properly use cognitive-behavioral interventions with patients and instill confidence in the child. MEDi™ is also being used for outreach. Multiple presentations have been developed for our clients for Children’s Dental Health month and MEDi™ will be presenting to schools and other meetings about the importance of dental care for children. What is your vision of robots in dental practice? MEDi™ is increasingly playing a role as an educator. Waiting room applications have been developed to prepare the child for their dental procedures. MEDi™ acts similar to Child Life Specialists in the hospital. In the future, robots will likely take on more of the administrative responsibilities. These include being a greeter when patients arrive and signing the patients into the patient management system. How autonomous is MEDi™? Experience has shown that the best way to alleviate pain and anxiety and improve operations is for MEDi™’s actions to be optimized for the dental procedure. MEDi™ addresses the child by name and speaks during the procedure, but does not respond directly to the child. MEDi™’s behaviors for each of the dental procedures that have been developed can be customized. RxRobots includes customization services so that each dentist office can incorporate the best practices into MEDi™’s behaviors.
No programming is required. Procedures can be videotaped and then RxRobots will develop a script and then customized behaviors. These behaviors are then downloaded to the customer’s tablet. Once they are played, customers give feedback until the behavior is the way that the office likes. Can users program MEDi™? A software development kit is included that allows users to program MEDi™, although we have not found that our customers are interested in programming the robot once they find out how easy it is to work with our customization services. Mr. Williams, thank you for your time. I look forward to seeing MEDi™ “in person” at the ADA annual meeting.
TEXAS ACADEMY OF GENER AL DENTISTRY
Calendar of Events APRIL 2016 Wednesday, April 6 San Antonio FellowTrack TBD Wednesday, April 6 Dallas FellowTrack Practice Models Panel w/ DAGD Board Wednesday, April 6 Houston AGD Wine and CE Series Occlusion – Does it Really Matter? w/ Dr. Ernie Anderson Wednesday, April 13 San Antonio AGD SAFE Mouth guard & Sports Dentistry w/ Dr. Danette McNew Thursday, April 14 Dallas AGD Wine & CE Series #2 Endodontics for the General Practitioner w/ Dr. Kian Daghighi & Dr. Nick Khalilkhani Thursday, April 14 San Antonio AGD Thursday CE Series#5 Implant placement through maintenance w/ Dr. David Little Thursday, April 14 CenTex AGD Social & CE- Endo for the General Practitioner w/ Shane Devericks Friday, April 15 Panhandle AGD FUSION w/ Dr. Mike Fling Wednesday, April 20 Houston FellowTrack TBD
Wednesday, April 20 Fort Worth AGD Reata Night - Fixing & Removable Prosthetics w/ Darrel Clark, CDT, Rick Burdine, CDT, Emory Burdine, CDT Wednesday, April 20 Houston AGD New Dentist Study Club w/ Suneel Chilukuri, MD Thursday, April 21 Dallas AGD Board Installation Friday, April 22 Houston AGD Low Level Laser Therapy in Modern Dentistry w/ James Carroll & Dr. Tor Gotun Friday, April 22 CenTex AGD Implants w/ Dr. Norman Ickert
MAY 2016 Tuesday, May 10 Houston AGD Installation Dinner Tuesday, May 17 Houston AGD New Dentist Study Club w/ Dr. Josh Austin Saturday, May 21 TAGD Board Meeting Wednesday, May 25 Houston AGD Wine and CE Series Current Techniques in Cosmetic Dentistry & Biomaterials w/ Dr. Joe Ontiveros
THANK YOU TO OUR 2016 TAGD STATEWIDE EDUCATION PARTNERS
Wednesday, May 25 San Antonio AGD SAFE Social
JUNE 2016 Wednesday, June 15 San Antonio AGD SAFE Implant Provisionals & Restoration w/ Dr. Maureen Libby Thursday-Sunday, June 16-19 TAGD MasterTrack Austin, TX Oral Medicine w/ Dr. John Wright Fixed Prosthodontics w/ Dr. Bob Lowe Friday-Saturday, June 17-18 TAGD Master Study Club Austin, TX Friday-Saturday, June 17-18 TAGD New Dentist Conference Contemporary Oral Surgery for General Dentists w/ Dr. Alan Jeroff Oral & Maxillofacial Trauma and Biopsies w/ Dr. Wendell Edgin Austin, TX
For more info or to register call the TAGD office at 512-371-7144 or visit tagd.org/events
SAVE THE DATE
September 23-24, 2016 The Westin Austin at the Domain | Austin, TX
General Dentist Sessions: Dr. Alan Scott Douglas - Implants Dr. Arthur Jeske - Antibiotics and Pain Medication | Local Anesthetics General Staff & Hygiene Sessions: Amy Morgan- New School Marketing | Treatment Acceptance & Patient Communication Nancy Dewhirst - Ergonomics | Emerging Diseases Additional Featured Sessions: Dentalosophy Lunch & Learns Texas Academy Awards Early Bird Registration Opens in May! - www.TAGD.org/LSDC
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TEXAS ACADEMY OF GENERAL DENTISTRY