“
We work for you.
CYBER COVERAGE
After 38 years of practice, I had never made a claim. Ransomware forced me to contact The Doctors Company. They put me in touch with Beazley Group, who deal specifically with cybersecurity. Their professional experience helped in so many ways. Data was not lost, files were decrypted and life returned to normal. It’s a new age — which requires new insurance. The Doctors Company included cybersecurity coverage, knowing it’s a real risk. It was, and it was covered. Thanks so much! - FDA Services Customer since 2011
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”
HELPING MEMBERS SUCCEED VOL. 31, NO. 7 • November/December 2019
All Star Cast 4
On the Cover
5
Staff Roster
7
President's Message
8
2019-2020 President‘s Profile
12 Membership Benefits 14 Compleat Dentistry 16 Restorative Dentistry 18 FDA Volunteer Helping Hands 20 FLA-MOM 2020 FAQs 22 Building Value in the Dental
46 Bringing Balance to HR
75 Member Resources at
Management is Everyone's
77 7 Reasons to Attend
53 6 Social Media
78 news@fda
Best Practice Tips
Commercial Real Estate
The ACTUAL Law
58 It's Time to Renew Your
87 Diagnostic Discussion
92 Selectively Equilibrating the
License 2•28•2020
102 Career Center
Blockbuster Benefits 62 Information About Dental
28 FDA's 6 District Dental
Assistants, Records, Codes,
Associations
Insurance and More!
34 Florida Dental Schools Thrive
64 New! Dentists May Delegate
38 Get Involved!
108 Off the Cusp
66 Closing or Relocating
is Held Hostage
Hard Occlusal Guard
96 Recommendations for Dental
27 Donated Dental Services
Spotlight on Science
56 HIPAA and Email:
Your FDA Foundation
44 Ransomware: When Your Data
ADA FDC 2020
54 The Downside of DIY
25 Give, Lead, Volunteer:
A Script for Success
Your Fingertips!
Responsibility
Team
A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION
Professionals About HPV
Vaccine Promotion
98 Confession: I Love to do
Single-tooth Dentistry
Remedial Restorative Functions Your Practice?
71 Support FDA Funding Priorities
for the 2020 Legislative Session
73 7 Ways the FDA Advocates
for You!
Cover photo by Judy Stone, FDA Leadership Affairs Manager
TODAY'S FDA ONLINE: floridadental.org
Hinman
Your
BACKSTAGE
ALL ACCESS
On the Cover:
FLORIDA DENTAL ASSOCIATION NOVEMBER/DECEMBER 2019 VOL. 31, NO. 7
EDITOR Dr. John Paul, Lakeland, editor
Dr. Julie Bailey General dentist Proud FDA member for 14 years
STAFF Jill Runyan, director of communications Jessica Lauria, communications and media coordinator Lynne Knight, marketing coordinator
BOARD OF TRUSTEES
Dr. Richard JP Bastien General dentist Proud FDA member for 13 years
Dr. Alan Dransfield General dentist Proud FDA member for 3 years
Dr. Rudy Liddell, Brandon, president Dr. Andy Brown, Orange Park, president-elect Dr. Dave Boden, Port St. Lucie, first vice president Dr. Gerald Bird, Cocoa, second vice president Dr. Beatriz Terry, Miami, secretary Dr. Jolene Paramore, Panama City, immediate past president Drew Eason, CAE, Tallahassee, executive director Dr. Dan Gesek, Jacksonville • Dr. Karen Glerum, Boynton Beach Dr. Jeannette Pena Hall, Miami • Dr. Bernard Kahn, Maitland Dr. Irene Marron-Tarrazzi, Miami Dade • Dr. Eddie Martin, Pensacola Dr. Rick Mullens, Jacksonville • Dr. Jeffrey Ottley, Milton • Dr. Paul Palo, Winter Haven Dr. Howard Pranikoff, Ormond Beach • Dr. Mike Starr, Wellington Dr. Stephen Zuknick, Brandon • Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Rodrigo Romano, Miami, treasurer • Dr. John Paul, Lakeland, editor
PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303 . FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2019 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication. POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303.
EDITORIAL AND ADVERTISING POLICIES Dr. Astrid Gonzalez Pediatric dentist Proud FDA member for 3 years
Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.
EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste 200, Tallahassee, Fla. 32303. FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.561.0504; email address, fda@floridadental.org; website address, floridadental.org.
Dr. Lawrence Weaver General dentist Proud FDA member for 25 years
ADVERTISING INFORMATION For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113. For career center advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.
Today’s FDA is is a member publication ofof the Today’s FDA a member publication the American Association ofof Dental Editors and the Florida Magazine Association. American Association Dental Editors and the Florida Magazine Association.
4
TODAY'S FDA
NOVEMBER/DECEMBER 2019
FLORIDADENTAL.ORG
CONTACT THE FDA OFFICE 800.877.9922 OR 850.681.3629 545 John Knox Road, Ste. 200 • Tallahassee, FL 32303
EXECUTIVE OFFICE DREW EASON, Executive Director deason@floridadental.org 850.350.7109 GREG GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111 CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202 JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 LIANNE BELL, Leadership Concierge lbell@floridadental.org 850.350.7114
ACCOUNTING BREANA GIBLIN, Director of Accounting bgiblin@floridadental.org 850.350.7137 LEONA BOUTWELL Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 ALLEN JOHNSON, Accounting Manager allen.johnson@fdaservices.com 850.350.7140 MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 STEPHANIE TAYLOR Membership Dues Coordinator staylor@floridadental.org 850.350.7119 LESYA WILBUR, Commissions Coordinator lesya.wilbur@fdaservices.com 850.350.7142
COMMUNICATIONS AND MARKETING JILL RUNYAN, Director of Communications jrunyan@floridadental.org 850.350.7113 LYNNE KNIGHT, Marketing Coordinator lknight@floridadental.org 850.350.7112 JESSICA LAURIA Communications and Media Coordinator jlauria@floridadental.org 850.350.7115
FLORIDA DENTAL ASSOCIATION FOUNDATION (FDAF)
FLORIDA DENTAL CONVENTION (FDC) CRISSY TALLMAN Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103 DEIRDRE RHODES, FDC Exhibits Coordinator drhodes@floridadental.org 850.350.7108 ANDREW SCHERER, FDC Meeting Assistant ascherer@floridadental.org 850.350.7162 EMILY SHIRLEY, FDC Program Coordinator eshirley@floridadental.org 850.350.7106
GOVERNMENTAL AFFAIRS JOE ANNE HART Chief Legislative Officer jahart@floridadental.org 850.350.7205 ALEXANDRA ABBOUD Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204 JAMIE SHEEHAN Governmental Affairs Legislative Assistant jsheehan@floridadental.org 850.350.7203
INFORMATION SYSTEMS LARRY DARNELL Director of Information Systems ldarnell@floridadental.org 850.350.7102 RACHEL STYS Systems Administrator rstys@floridadental.org 850.350.7153
MEMBER RELATIONS KERRY GÓMEZ-RÍOS Director of Member Relations krios@floridadental.org 850.350.7121 MEGAN BAKAN Member Access Coordinator mbakan@floridadental.org 850.350.7100 JOSHUA BRASWELL Membership Coordinator jbraswell@floridadental.org 850.350.7110
800.877.7597 or 850.681.2996 545 John Knox Road, Ste. 201 Tallahassee, FL 32303 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat
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R. JAI GILLUM Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117
The last four digits of the telephone number are the extension for that staff member.
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FDA SERVICES
To contact an FDA Board member, use the first letter of their first name, then their last name, followed by @bot.floridadental.org. For example, Dr. John Paul: jpaul@bot.floridadental.org.
TODAY'S FDA NOVEMBER/DECEMBER 2019
5
ADA/FDC Annual Meeting
YOUR FDA BENEFITS ... DON'T MISS OUT! This issue of Today’s FDA focuses on membership and all the benefits of being a member of the Florida Dental Association (FDA). When I graduated from dental school in 1982, my first job was working for a “clinic,” what would be today known as a dental service organization (DSO). In those days, this practice model was in its infancy, and was generally frowned upon by the establishment. I remember wanting to join the FDA but couldn’t find anyone to sponsor me. It wasn’t until I opened a practice in 1986 that I decided to further pursue membership. Even then, throughout the interview process, I was wary of admitting that I had worked for a DSO and found myself apologizing whenever it came up. Why do I tell this story? Because as a young dentist, I wanted nothing more than to be a part of organized dentistry. It was the most important thing to me after I opened my practice. As I look back on why it was so important, I must admit that the number one reason was for the social interaction with my colleagues, second was the continuing education that attending the meetings provided and finally, it was expected. I remember my first Hillsborough County meeting: I checked in, and with a guest sticker on my jacket, I entered a large room looking for a familiar face — any familiar face. Truth was, none of my classmates decided to open practices in Hillsborough County and I felt pretty alone amongst roughly 120 dentists. Then, Terry Buckenheimer must have sensed I was feeling overwhelmed and reached out and introduced himself to me and then took me around and introduced me to other members. This was a great way to break the ice. FLORIDADENTAL.ORG
leadership
After that, I don’t think I missed a meeting for the next four years! I’d like to challenge all members to reach out to unfamiliar faces at your local meetings and introduce yourself, then escort the new or potential new member around and introduce them to your friends and colleagues. This is so powerful and will more likely motivate them to return and participate. Legislative session starts Jan. 14, 2020 and is scheduled to run through March 13, 2020. Interim committee meetings take place in the fall with two weeks scheduled in November and a week in December. This is when the Legislative Contact Dentist (LCD) program kicks into full swing. For those who don’t know what the LCD program is, these visits are scheduled by our Governmental Affairs team during committee week. Unlike the madness that is Dentists’ Day on the Hill (DDOH), the LCD visits are much more productive, as you get quality time in front of legislators and can discuss the FDA’s legislative agenda with them. We’re always looking for individuals who are willing to take a day out of their practice to travel to Tallahassee and serve as an LCD.
PRESIDENT’S MESSAGE RUDY LIDDELL, DMD FDA PRESIDENT
Dr. Liddell can be reached at rliddell@bot.floridadental.org.
Speaking of DDOH, that event is scheduled for Feb. 4, 2020. There will be an opportunity for leadership development training at FDA headquarters on Feb. 3. If you are interested, please contact your district executive director. There will be some “scholarship” funds available to help offset travel to and from Tallahassee.
TODAY'S FDA NOVEMBER/DECEMBER 2019
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president's profile
Dr. Rudy Liddell . . .
1.
2.
Your 2019-2020 President
Dr. Liddell works in a practice with four other dentists including Drs. Zuknick, Branca, Oldham and Waite, who share the same four walls for private office space and a certain sense of camaraderie and self deprecating humor. The comments below reflect that humor.
3.
“
Dr. Liddell has always worked hard and prepares himself appropriately for everything he does. Whether it’s his deliberations as chairman of the ADA Council on Dental Practice or something as simple as email etiquette, Rudy always puts in 100% effort.
— Dr. Steve Zuknick
4.
“ 5.
At the age of 9, Dr. Liddell became my dentist at Brandon Dental Care. At the age of 29, I came to work along side him at Brandon Dental Care. Rudy Liddell has supported me throughout my journey toward a career in dentistry. I’m honored to call him a colleague, but I’m more proud to call him my friend. Organized dentistry is very fortunate to have people like Dr. Liddell as a part of their leadership.
6.
”
— Dr. Dan Branca
“
”
Dr. Liddell is an experienced leader and a great dentist, too. He is pragmatic and helpful to his patients. Although, his humor is unsophisticated. LOL.
7. FLORIDADENTAL.ORG
— Dr. Craig Oldham
” SEE PAGE 10
TODAY'S FDA NOVEMBER/DECEMBER 2019
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president's profile
Presidential Favorites
Hobbies: cycling, golf
Food: a nice, juicy NY strip steak Memory: birth of my children Guilty Pleasure: a nice glass of bourbon or scotch Sports Team: college: Gators, pro: Tampa Bay Lightning Leisure Activity: hanging out on the beach with friends/family Vacation Destination: Napa, CA Book: “Atlas Shrugged” Flower: gardenia Dessert: peanut butter pie Candy: Dove dark chocolate Drink: beer, specifically IPAs Movie: “Pulp Fiction” Music: 70s music Artist: Led Zeppelin Pet: Golden Retriever, Shadow
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TODAY'S FDA
NOVEMBER/DECEMBER 2019
FROM PAGE 9
Tell us where you were born and raised, and about your family. I was born in Pittsburgh, Pa. as the oldest of two children. My dad worked in the electrical contracting business and my mom was able to stay home to raise me and my brother. Probably my greatest claim to fame in my high school days was my swimming prowess. I graduated from Nova High School and took fourth in the 500-yard freestyle, three seconds off the allAmerican time for that year. I met my wife, Sherri, while working in a dental office in Clearwater. I had just graduated dental school and was working part time. Sherri was in dental hygiene school working the identical schedule. We were married in 1985. Sherri was my hygienist when I first opened my solo practice back in 1986 in Brandon. Michael was born in 1989, attended college at Concordia University of Wisconsin and graduated with a combination accounting degree/master’s in finance in 2011. He currently works for Citicorp and is married to Ashley, who works for Raymond James. Brian was born in 1993, attended the Honors College of Florida Atlantic University where he received a bachelor’s degree in biology. He currently works in customer service for Crescent Healthcare in Gainesville and is married to Savannah, who is a fourth-year medical student.
Education/councils/committees/ leadership position/volunteer work I attended the United States Military Academy for two years, transferring to the University of South Florida to finish my engineering degree. From there, I received my dental degree from the University of Florida College of Dentistry. I have served in all the chairs of the Hillsborough County Executive Council and the West Coast District Dental Association. I served as a delegate to the Florida Dental Association (FDA) from 1998-2012, serving as delegation co-chair from 2004-
FLORIDADENTAL.ORG
2012. I served on the FDA Political Action Committee board from 2004-2014 and the Council on Financial Affairs from 2009-2015, chairing the council from 2012-2015. I served as alternate trustee and trustee to the FDA from 2010-2015. I’ve been involved in all five of the Florida Mission of Mercy events.
Photos:
What are your goals for the FDA?
3. Michael’s wedding on Bradenton Beach
According to the “hack-a-thon” that the Board of Trustees (BOT) had in Jacksonville this past August, there seems to be some concerns about the current governance structure of our association. I would like to open some dialogue and see if the BOT really has the stomach to make some structural changes within the organization.
FLORIDADENTAL.ORG
1. Dr. Liddell and his wife, Sherri 2. Dr. Liddell's sons, Brian and Michael, at Brian’s wedding 4. Brandon Dental Care partners 5. 2019 FLA-MOM in Orlando. 6. WCDDA past presidents in July 2019 7. Dr. Liddell, Gov. Ron DeSantis, Dr. Jolene Paramore and CFO Jimmy Patronis
TODAY'S FDA NOVEMBER/DECEMBER 2019
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member views
Membership Benefits... How They Work for You! Dr. Brenna Kever
Dr. Laurie Gordon-Brown
General Dentist, in practice three years, FDA member for two years (AEGD resident in Alabama the year prior)
General Dentist, private practice 28 years, dental professor past 10 years, FDA member for 39 years
What was your career like before becoming a member?
What was your career like before becoming a member?
I have always been a member of the ADA tripartite but there have been times I let my membership lapse for a couple of weeks. During those times I tried to access journal articles I’d had access to with an active membership. After being prompted to pay $30+ on other websites, I promptly reactivated my membership.
I became a member of the American Student Dental Association (ASDA) while in dental school and immediately joined after my residency, so I’ve always been a member.
What have you been able to achieve since becoming a member? While being a member of the FDA, I have been
able to attend many CE courses, receive and access up-to-date information in the field, participate in the Florida Mission of Mercy and other local community events, and have a community of trusted dentists/specialists. What advice would you give someone who is considering membership? With all the changes constantly happening
in our profession, I feel protected by the FDA’s efforts on our behalf. They provide the information and updates I NEED to know in a concise way, provide an abundance of free CE, provide an excellent network of fellow dentists/specialists, and keep me up to date on the changes which could impact my practice or license if I was not attentive. Last but not least, time and time again the FDA has shut down bad legislation that would have caused devastation for our practices and patients. The membership fee is a small price to pay for the peace of mind knowing my livelihood is protected.
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TODAY'S FDA
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What have you been able to achieve since becoming a member? I have developed lifelong friendships and valu-
able contacts as well as a feeling of belonging and volunteerism. To elaborate, I was asked to participate in leadership early on in my career and become the first woman president of my dental society, an editor to our regional newsletter, involved in the FDA House of Delegates, active in Dentists’ Day on the Hill, a legislative contact dentist for several state representatives and senators, mentor and leader for students at my teaching position now that I am full-time faculty, council member, etc. I was active in lobbying for dental issues in Tallahassee and we got some bills passed. I saved money from the ADA insurance plans and retirement plans. What advice would you give someone who is considering membership? Do it, you can’t afford not to.
FLORIDADENTAL.ORG
Dr. Andrea Mier Parsons
Dr. Venita Sposetti
General Dentist, in practice and FDA member for 7 years
General Dentist, in practice 39 years, FDA member about 33 years
What was your career like before becoming a member?
What was your career like before becoming a member?
I have been an FDA member since I began my career because I understood and recognized the importance of organized dentistry.
I can’t say too much about this because I joined the FDA in the first few years that I began working as a dentist.
What have you been able to achieve since becoming a member? I have built a solid career working for a group
practice, am currently the president of the Lee County Dental Society and regularly participate in community events stressing the importance of proper oral health. What advice would you give someone who is considering membership? Being in dentistry is bigger than just
focusing on your sole practice. It’s being part of the dental community, having the resource of the FDA for support and guidance when needed, and participating in preserving the sanctity of our profession.
Dr. Orlando Dominguez Orthodontist, in practice and FDA member for 41 years.
What have you been able to achieve since becoming a member? In addition to the advocacy work of the FDA,
the Florida Dental Convention over the years has been a great high-quality source of continuing education as well as a place to catch up with colleagues across the state. What advice would you give someone who is considering membership? The FDA is an advocacy organization for
dentists in Florida. This group works tirelessly to represent the interests of dentist in this state and all Florida dentists benefit from their efforts. We are fortunate as a profession to have such a strong and effective advocacy organization. An essential part of the strength of the FDA is the broad representation of ideas and talents from the membership.
Dr. Alan Dransfield General Dentist, in practice for 7 years, FDA member 3 years.
What was your career like before becoming a member?
Before becoming an FDA member, I was a dental student and an ASDA member.
of practice in a great profession.
What was your career like before becoming a member? Before moving back to Florida, I had served in the U.S. Navy Dental Corps. So, I was a federal member of the ADA without any state or local affiliation. However, I have been a member of the FDA since separating from the military.
What advice would you give someone who is considering membership? My advice to all prospective members is:
What have you been able to achieve since becoming a member? The power of being a member of the FDA is
What have you been able to achieve since becoming a member? As a member, I have been able to enjoy 41 years
Protect your profession, your educational investment (in time and money) and your career — stay involved (be a member), have your opinions and beliefs count (be a member), enrich your life (be a member), advance your education and secure your future (stay a member).
being part of a larger voice on major issues that affect our profession in our state, such as dental therapists. I was able to participate in actively voicing my opinion at the state Capitol and to the legislators who were in committee on this issue with the tools the FDA gave me to do so. What advice would you give someone who is considering membership? Sign up!
FLORIDADENTAL.ORG
TODAY'S FDA NOVEMBER/DECEMBER 2019
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compleat dentistry
IF YOU’RE CONSIDERING BECOMING A MEMBER “As dentists, we are colleagues and we don’t compete against each other. The closest thing we have to competition is Lexus and Nike, who are competing against us for our patients’ discretionary spending.”
DR. EDWARD HOPWOOD
Dr. Hopwood is a restorative dentist in Clearwater and can be reached at edwardhopwood@gmail.com.
Compleat dentistry is a slower-paced, deliberate style of dentistry, espoused by Pankey, Dawson and so many others, in which the dentist knows the patient well, knows the work, knows their own abilities and limitations, and uses this knowledge to take care of the patients who trust them with their care. The world will change, but the principles of compleat dentistry will remain the foundation of an exceptional practice. The spelling is a homage to Isaak Walton, whose book, “The Compleat Angler,” was about so much more than fishing.
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TODAY'S FDA
And with those words, Dr. Nolan Allen, then president of the Florida Dental Association (FDA), changed my perspective forever. When I heard that speech, I’d just moved back to Florida after finishing four years competing with my classmates for points and class rank in order to graduate from dental school. But now, the leader of the state dental society made it blatantly obvious that I was no longer competing. Because I now had the degree, I became a colleague. When we quit competing with other dentists, we’re free to find our own niche within the profession and then set about practicing in our own way. We’re free to gather up a group of patients who appreciate our approach and our style. We find our “tribe” (as Seth Godin calls it) of people who like the way we do things and want to work with us. One wonderful thing about our profession is we can set up a practice that follows our style. Nowhere is it more evident that we are colleagues than at the local, constituent dental society meetings. When I first went to our local meeting, I was honored to sit with the great local dentists I had always admired. It reinforced Nolan’s words when they were
NOVEMBER/DECEMBER 2019
so welcoming to me and my desire to practice in my hometown. Some of them would call me when they were going to a good continuing education (CE) course they thought I would like, and they would invite me along. Even if I didn’t have the money, I would charge it to a credit card and tag along. I learned so much from the courses and I learned so much from my colleagues. They were always ready to offer advice when I was confused about something dental-related; often, it was comforting to realize they faced the same challenges. Dental CE is a wild place — there is such a wide bell curve from excellent clinicians and organizations teaching fundamentally sound CE at a very high level all the way down to charlatans hocking products they are paid to represent. I found it so helpful to ask my colleagues which courses they recommend. Avoiding the charlatans has saved me more money than I will ever spend in membership dues. I recently went to our first meeting of the new year for our local dental society and I was happy to see that nothing had changed. Even though my mentors had largely retired, there is still a great group of colleagues forming relationships and spending time together. For any young dentist starting out, this kind of group is essential for navigating the dental world. That world can seem overwhelming at first, especially when a young dentist is in an associateship FLORIDADENTAL.ORG
position that is not consistent with their long-term plan. Most good practices are sold through handshakes before a broker gets involved. The local dental society meeting is so often where those first handshakes occur. But if we each are practicing in our own, unique way, then we also need an organization that represents the profession. That organization needs to give one voice to our profession and the more of us that it represents, the more powerful the voice will be. Traditionally, the American Dental Association (ADA) and the FDA have been the national and state voice of dentistry — and there is no better organization to represent us as colleagues. It’s important to have a united voice for dentistry and to have leaders like we have at the FDA and ADA who can think things through and speak prudently when they are representing the profession. The leaders in these organizations think carefully before they speak. They speak not just their own opinion, but on behalf of the profession. In the political realm, where words are easily twisted, it’s imperative to have thoughtful leaders representing us all. This representation is crucial to preserving the profession, and I am proud to support our leaders. Which is not to say that I always agree with the leaders of the FDA or the ADA, but I do agree that they are doing their best to represent my colleagues and my profession. Dentistry has faced many threats through the years and if we are happy to be able to practice in the current environment, then it’s the leaders of organized dentistry who we can thank for this privilege. Current threats include mail order orthodontics, insurance companies dictating fees they don’t cover, politicians threatening to “solve” poorly understood problems and corporations that would like to turn us all into cogs in their corporate machines. We need to count on our leaders to represent us when dealing with these threats. I believe that they are up to the task. I recognize that it’s important for us to have a unified voice for the profession, and because I am honored to be a dentist, I’ve always supported organized dentistry and will continue to do so. I hope that you will do the same.
FLORIDADENTAL.ORG
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When we quit competing with other dentists, we’re free to find our own niche within the profession and then set about practicing in our own way.
”
TODAY'S FDA NOVEMBER/DECEMBER 2019
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restorative dentistry
WHAT COMPLETE DENTISTRY HAS DONE FOR ME: A CAUTIONARY TALE I’ve learned that complete or comprehensive restorative dentistry is just one tool in your practice toolbox. When you only have a hammer, everything becomes a nail — and you could end up ruining everything.
DR. PAUL PALO
Dr. Palo is a general dentist in Winter Haven and can be reached at ppalodmd@gmail.com.
Over the years, I’ve had several younger dentists ask me about going to one of the major institutes here in our state. My question to each of them is, “Why do you think you’d like to go there?” Their response usually is, “Because I want to learn to do full-mouth reconstructions.” While somewhat noble, but very misdirected, this is only the tip of the iceberg of what you’ll learn at these institutes. My sage advice to them is if you truly want this as a practice philosophy, take a good, long look at where — not how — you practice. Are there enough patients in your area who will value and respect this level of care, skill and judgement? I once thought there were, and it was hammered into me from the “masters” that “everyone wants complete treatment, they just don’t know how to ask for it,” or, “It’s never been presented to them.” I found that this is a myopic view of patients. For 18 years, I offered this as my main treatment modality, and I had very little success in convincing patients this was the way to go with their oral health. For so many years I beat myself up for thinking that I just wasn’t good enough at communicating the “philosophy.” I took countless courses in both St.
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Petersburg and Miami not just on honing my technical and diagnostic skills, but also the soft skills of observation and active listening. I invested many, many thousands of dollars on training and consultants to help me learn how to change a patient’s perspective — all for naught. You see, the masters were only partially right. Everyone wants to have ideal oral health ... to a point. That point is where the rubber meets the road, so to speak. When it came down to the patient understanding that in order to achieve ideal oral health, they would have a considerable financial investment, the acceptance waned completely. I had an epiphany of sorts about six years ago. It came from a long conversation with a friend who owns a successful car dealership in town. I asked him why he didn’t carry their company’s luxury line of cars. His response was eye opening. It seems his parent company had done extensive, detailed market analysis in our town and determined that there wasn’t enough market share available to make it worth his investment. For him, it would take several million dollars to build a separate dealership and even more to floorplan the inventory. In a community where an F-150 Super Duty with a towing package and custom lift kit is the vehicle of choice, it wasn’t a matter of cost. It simply was a matter of his customers’ value systems. He wasn’t going to change his customers’ values to get FLORIDADENTAL.ORG
them to buy an Infiniti, so don’t even try. He understood that you must give the customer what they want, not what you think they need. Is oral health the same as a car purchase? Perhaps not, but a customer’s (patient’s) values are still their own and nothing we, as business owners, say to them is going to change how they choose to spend their hard-earned money. So, my considerable investment in skills, facilities and time was all done to sell my patients a Lexus when, in fact, they wanted a Ford. I had to rethink my philosophy and give the patient what they wanted. It had little to do with cost, since few couldn’t afford to finance their complete dentistry. They just didn’t value it enough to invest in it, and there was nothing I nor my skilled team said or did that would ever change their value systems. When you truly “know your patient” as L.D. Pankey said and listen to them when they tell you they only want what their insurance plan covers, that’s their value system speaking. I would have as much a chance of trying to convince a lifelong hunter that the second amendment should be abolished as changing my patient’s values on ideal oral health. This finally brought me some peace and allowed me to refocus my efforts toward giving my patients what they wanted — dentistry within the confines of their dental benefit plans. Is it ideal? Absolutely not, but it provides a service that they need and in return pays the bills. And yes, I still offer each patient comprehensive care if that is what they desire. Are there areas in this state or across the country where a comprehensive restorative practice will succeed? Of course, but will it succeed everywhere? Absolutely not. I do highly value the post-graduate education I received at these institutes. However, do I feel I got a good return on investment? No, sadly, not at all. I still perform a comprehensive evaluation just like I was taught in and after school. I still offer my patients the choice of comprehensive care. What I don’t do anymore is beat myself up when patients choose to do less than what I would consider ideal for myself. I also don’t make business plans based on every patient coming into my office seeking comprehensive care. I’ve found that I can blend the real world and the ivory tower and enjoy practicing dentistry so much more.
“
I had to rethink my philosophy and give the patient what they wanted. It had little to do with cost, since few couldn’t afford to finance their complete dentistry.
”
For those younger dentists or newer graduates who are considering which direction to take your practice, look long and hard as to where you will practice just as strongly as to how you will practice. FLORIDADENTAL.ORG
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Print member card or save to phone
MEMBER CARD
ADA NUMBER
123456789
MEMBER NAME
Dr. Rudy Liddell
MEMBER STATUS
2020 TRIPARTITE MEMBER
foundry
STATE AND LOCAL SOCIETY
FLORIDA DENTAL ASSOCIATION WEST COAST DISTRICT DENTAL ASSOCIATION
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West Coast District Dental Association 850.681.3629 floridadental.org
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JACKSONVILLE 2020 FLA-MOM
Building in Value the Dental Team
Dr. Rafaella Correa-Pinto General and Cosmetic Dentist in Fort Lauderdale
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dental team I have attended the Florida Dental Convention (FDC) several times since graduating dental school in 2008. I always looked forward to attending the local district meetings and the annual FDC to learn something that will not only enhance the quality of my work, but also the patient experience — not to mention earning those much-needed continuing education (CE) credits. It’s always great to run into familiar faces and get updated on the latest innovations in dentistry. I was thrilled this year when Dr. Andrew Forrest told me he would be taking the entire team at 1500 Dental to FDC. I’m sure many practices are hesitant to take their entire team to conventions since the cost is much higher compared to attending solo; however, taking that leap can create value and culture that will give you a return on investment. It is, however, imperative to implement what was learned as soon as everyone returns to the office and while it’s fresh in your mind. FDC2019 was an unforgettable experience not only for me, but also for the team and practice. The doctors took courses that would help them grow, while the business team and assistants each took courses that would benefit their area of work. Each team member was asked to take notes and summarize what they learned over the weekend. We spent time reviewing and implementing what we learned together into our everyday practice as soon as we returned home. I truly feel that our team came back from FDC united and motivated. Building value in the team by educating them and making them feel like they are an integral part of the practice allows us dentists to be successful in the practice of dentistry. As much as patients can love their dentist, it takes an entire team to create the ideal patient experience and to keep patients for a lifetime. So why not learn together so we can grow together — and have fun while doing so! Until the next meeting! Dr. Correa-Pinto is a general and cosmetic dentist in Fort Lauderdale and can be reached at rafaella2008@yahoo.com. Photo: Dr. Rafaella Correa-Pinto and her staff at FDC2019.
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donated dental services
FDA MEMBER HELPS DONATED DENTAL SERVICES PATIENT ACHIEVE A PAIN-FREE SMILE DENTAL LIFELINE NETWORK • DONATED DENTAL SERVICES
Joseph, an elderly veteran living in Jacksonville, enjoys spending time with his children, grandchildren and great grandchildren. While serving in the Army during the late 1960s, he injured his back and knee. Upon returning to civilian life, he worked as an auto mechanic for 45 years until his health took a turn for the worse. He developed high blood pressure, type II diabetes and degenerative disk disease, and he was no longer able to work. Unfortunately, Joseph’s dental health also was poor, and he didn’t have the financial ability to pay for dental treatment. He had three remaining teeth, causing pain while eating and limiting his diet. Joseph found Dental Lifeline Network (DLN) and the Florida Donated Dental Services (DDS) program on the internet and was linked to two generous volunteers. Florida Dental Association (FDA) member Dr. Kevin Snyder, a volunteer since 2018, was able to help Joseph in his first case through the DDS program. He extracted Joseph’s remaining teeth, fitted a full upper denture and placed an implant-retained lower denture with the help of Dynamic Dental Solutions Dental lab. “I could tell that we were really making a positive impact on [Joseph’s] quality of life,” said Dr. Snyder. “He served many years in the military and it was time that someone served him in return.”
FLORIDADENTAL.ORG
DDS Patient Joseph with Dr. Kevin Snyder
Since 1997, Florida DDS volunteer dentists and labs have provided more than $9 million in treatment to more than 1,948 people with special needs. DLN • Florida thanks the FDA and the FDA Foundation for their long-time support of DDS. “Donated Dental Services has brought a culture of service and gratitude to my practice,” said Dr. Snyder. “My team can see first-hand the joy that a new smile can bring to someone.” Will you see one patient this year? Visit willyouseeone.org to sign up online or contact Florida DDS Coordinator Megan Manor at 850.577.1466 or mmanor@dentallifeline.org.
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Your
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GET INVOLVED! GET MORE FROM YOUR MEMBERTIMED TO FIT YOUR SCHEDULE WITH THE HELP AND SUPPORT YOU NEED AT EVERY STEP
QUICK
• share your views: write a letter or an article for Today’s FDA • recruit a new member • speak in support of fluoridation in your community • attend Dentists’ Day on the Hill • volunteer at the Florida Mission of Mercy (FLA-MOM)
SHORT TERM
• share your expertise on an FDA task force or workgroup • organize a fundraiser for a political candidate • speak at an FDA continuing education course • respond to FDA legislative alerts • help the Local Arrangements Committee for the ADA FDC Annual Meeting in October 2020 in Orlando
LONGER TERM ... • serve as a member of the FDA House of Delegates (HOD) or Board of Trustees (BOT) • serve as a member of the FDA Services or FDA Foundation Board of Directors • become a Legislative Contact Dentist • become a Project: Dentists Care provider • sign up for Donated Dental Services • serve as an officer at your district dental association
MORE VOLUNTEER OPPORTUNITIES! FDA COUNCILS & COMMITTEES
The FDA is led by volunteer members! When you get involved and volunteer, you help the FDA advance its mission, “Helping Members Succeed.” You will gain experience in leadership and benefit from networking opportunities.
COUNCIL ON DENTAL BENEFITS & CARE
AUDIT COMMITTEE
promotes quality dental benefit plans based on direct assignment, direct reimbursement and dental savings account concepts
responsible for the planning and review of the FDA’s and related entities’ CPA audit, tax returns, internal accounting controls and accounting procedures and policies; reviews and provides recommendations of audit and tax proposal engagement agreements for presentation to the BOT
COUNCIL ON DENTAL EDUCATION & LICENSURE analyzes and monitors accreditation standards; monitors licensure issues; monitors proposals for new dental schools
COUNCIL ON ETHICS, BYLAWS & JUDICIAL AFFAIRS maintains and enforces the ADA/FDA Code of Ethics
COUNCIL ON FINANCIAL AFFAIRS develops an annual budget of the FDA; reviews proposed budgets for closely affiliated entities; monitors budgetary performance; reviews budget for BOT review and final HOD approval; reviews investment performance and provides recommendations regarding the FDA’s and related entities’ investment policies and practices to treasurers/ boards on investment allocation
COUNCIL ON MEMBERSHIP responsible for FDA membership recruitment and retention programs
COUNCIL ON THE NEW DENTIST represents the voice of dentists who have graduated 10 or fewer years ago
AWARDS COMMITTEE reviews the online submissions for awards nominees and determines final recipients
CONVENTIONS & CONTINUING EDUCATION COMMITTEE develops programs that will enhance camaraderie and the dentist’s ability to provide quality dental care to the public with sufficient scientific programs to successfully fulfill up to 18 hours of continuing education credits to apply toward biennium requirements for relicensure
FLORIDA MISSION OF MERCY COMMITTEE assists the FDA Foundation with all aspects of planning the annual FLA-MOM event, including fundraising, recruiting volunteers, organizing meals and refreshments for volunteers, coordinating patient registration and managing various clinical departments (radiology, oral surgery, restorative, endodontics, etc.)
GOVERNMENTAL ACTION COMMITTEE reviews, analyzes, develops and supports/opposes legislative issues and regulatory issues that could have a negative or positive impact on organized dentistry
LEADERSHIP DEVELOPMENT COMMITTEE improves leadership and communication of councils in the assimilation of all levels of the tripartite
FDA POLITICAL ACTION COMMITTEE serves as the political arm of the FDA, which is administered by a Board of Directors with dentist representation from each dental district. Volunteers can serve on the board and evaluate candidates seeking the support of FDAPAC. Locally, volunteers help hand-deliver checks to supported candidates.
For more information, contact FDA Membership Concierge Christine Trotto at 850.350.7136 or ctrotto@floridadental.org and for more details on FDA councils and committees, go to floridadental.org/about-us/leadership/councils-and-committees.
The Dentist Supply Company
Re: Dental supply savings for your practice Dear FDA Members, There is no denying that the business challenges for dentists across the nation continue to grow as the dental marketplace becomes more complex and competitive. Like many of our peers, we became members of organized dentistry because we believe that our profession should be shaped by those who practice it. And we value being part of a community that supports and advocates for each other. Together, we have a louder voice and more negotiating power. So, we’re writing to share great news, both as peers and as volunteer leaders in organized dentistry: a better way to shop for dental supplies is here. The Dentists Supply Company (TDSC) was launched in California in 2017 as a new business dedicated to leveraging association members’ buying power to deliver dental supply savings. With our shared strength, TDSC negotiates pricing with major manufacturers and distributors, which helps stabilize prices and drive down supply costs for practices of every size. Through an online shopping site, TDSC. com, many member dentists have already started to save more than they pay in annual tripartite dues. This early success has caught the attention of your peers and other leaders in dentistry. Now, TDSC is responding to the demand by partnering with the Florida Dental Association to bring the same level of savings to association members in Florida. As a member, you will be able to benefit from exceptional savings and free shipping on the expansive online catalog of supplies from authorized sources. You can start shopping TDSC.com in December. We encourage you to gather your current invoices today and submit them at TDSC.com/pricecompare to let the TDSC team do the work of comparing prices for you. Your custom price comparison will show product-by-product savings and streamline your shopping. Please know that these supply savings are a free benefit of your association membership. Thank you for supporting our community and your peers as we work to change the business side of dentistry for the better. Sincerely,
Walt Weber, DDS Chair of the TDSC Board of Directors
Rudy Liddell, DMD President, Florida Dental Association
Henry Schein
Your
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info bytes
RANSOMWARE:WHEN YOUR DATA IS HELD HOSTAGE When someone holds your data hostage, even Liam Neeson can’t help you free your data. It’s all over the news — companies, colleges and even cities are being hit with something called ransomware. It’s something no one wants to see, but it’s a real threat to your dental practice. You need to know what it is, how you get it, what to do when you do get it and how to protect your practice’s most valued asset: your data. LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS
Mr. Darnell can be reached at ldarnell@floridadental.org.
What is it? According to the U.S. Cyber Infrastructure Security Agency, “Ransomware is a type of malicious software, or malware, designed to deny access to a computer system or data until a ransom is paid. Ransomware typically spreads through phishing emails or by unknowingly visiting an infected website.” It applies an encryption routine on your files (encrypting is normally a security measure to prevent unauthorized access to your files) and the originator has the specialized key that is used for decrypting (like unscrambling it). It’s like letting someone else install locks at your house and they have the only key. In short, it’s a set of computer instructions purposely crafted with intention. The intent is to extort money in exchange for possibly decrypting your files. There’s often a timer set on the decryption availability to further goad you into making a rash decision. The ransom is never cheap and usually involves payment in bitcoin, which all of us know how to purchase, right?
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How do you get it? You’re often exposed by way of an email that has a malicious attachment. Open the attachment and the process of deploying the malware begins. You also can get ransomware by visiting an infected website or just by clicking an infected advertisement on a normal website. Lately, ransomware may come to you through a managed IT services company. Suppose you have an outside company for IT support. If they are a carrier of ransomware, they can pass on that infection to you and others. That’s a disastrous, worst-case scenario because there is little you could do to keep that from happening; it’s a trusted relationship that has done this to you. Nearly 400 dentists in Wisconsin are dealing with this right now.
How do you know you have it? Usually, the ransomware will announce itself. It encrypts your files and when someone tries to open an encrypted file, the ransomware notice is shown to the user. At this point, you have ransomware. Maybe not all your files have been encrypted yet, so it’s important to do something when you first become aware of the infection.
What do you do if you have ransomware? You must isolate the source of the infection. In medical terms, it’s like finding patient zero. The originator of the infection often is determined because the owner of the new encrypted files is set to this user. FLORIDADENTAL.ORG
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There is no way to ensure that paying the ransom will resolve your problem, and it may make you a bigger target in the long run.
At this point, you must shut down patient zero’s computer and consider all access points that patient zero had connections to (mapped drives, etc.) The next steps to restoring your computer(s) depends on what preparations you’ve made. Is there a backup of all your files, and is it recent and capable of being restored? Could the backup files also have been a victim of the same ransomware? You hear news stories talk about the FBI being involved. In most cases, the FBI can do very little to assist you after the fact. That leaves you responsible for this issue.
Should you ever pay the ransom? While paying the ransom seems to be the goal of those who have done this to you, hopefully you have taken steps before the infection that will keep you from having to make that choice. Many large companies, colleges and even cities have made the choice to pay the ransom. There is no way to ensure that paying the ransom will resolve your problem, and it may make you a bigger target in the long run.
What steps can you take now to prevent getting ransomware or at least to neutralize its impact? n Backup: Have a procedure for regular backups of your critical data. The Florida Dental Association uses both an on-premise and a cloud solution to back up critical data. If you use someone to do this for you, test the restore process monthly. FLORIDADENTAL.ORG
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n Educate: Educate yourself and your staff to make good choices about email links, websites and ads that are clicked on. Have your computer systems up to date with all patches and updates and use a modern anti-virus/anti-malware software program. n Expect: You pretty much can expect that it will either happen to your practice or you personally. It’s no longer a matter of if, but when. You must take steps now with the understanding that it will happen. n Prepare: Prepare yourself for when it does happen. We’ve survived three versions of that ourselves — all a result of innocent-looking attachments that people thought were legitimate. Nobody was doing anything they weren’t supposed to do. Each instance has taught us about being prepared. Ransomware is not going away. In fact, I expect it to begin to affect more people in the next year. In this world of the internet of things, there are too many ways for people to take advantage of us and if we are not aware and diligent, we may end up paying in the end. P.S. It also would be helpful to check out the cyberguard insurance that FDA Services (FDAS) offers, which even covers cyber extortion for ransomware. For more information, contact FDAS at 800.877.7597.
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human relations
BRINGING
BALANCE TO HR MANAGEMENT IS
EVERYONE’S
RESPONSIBILITY For most companies, employee costs in the form of salaries and benefits are their most significant expense. That is, until they encounter a major cost frequently not considered until confronted: the cost of litigating and defending employment lawsuits. Litigation is a fact of life and there is no way to completely prevent it, but exposure to liability can be managed. Managing the company’s human resources (HR) is critical in managing exposure. Employees touch all aspects of a practice
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and can both aid and hinder its success. Failure to take management of this valuable resource seriously can lead to unexpected and unpleasant consequences. Some employers have well-staffed HR departments, while one- or two-person shops handle all HR issues themselves. Frequently, many employers that have established HR departments design them in such a way that the department is isolated from other departments, either physically or in the FLORIDADENTAL.ORG
minds of their managers and employees. This can result in many “front-line” managers and employees feeling that HR doesn’t have anything to do with them and isn’t their issue or problem; HR is just there to process paperwork. An HR department’s ability to help the company manage liability in relation to compliance with ever-changing laws and employment lawsuits is only as effective as its relationship with the managers and employees performing the day-to-day operations. HR can only assist with or solve a problem that it knows about. If a suit relating to a failure to comply with an applicable law or alleging discrimination is filed, the key people involved in and impacted by the case are the front-line managers and employees. The people involved in the day-to-day operations will likely be the individuals with the most personal knowledge of the events complained of. Moreover, it will likely be the managers’ actions and decisions that will be examined and tested during the lawsuit. In the case of small employers, where the owners also are the managers and the HR department, all employment decisions are made by one or two people — there are no checks and balances. In many of these situations, the decision makers are likely too close to the person involved or the incident that has occurred. HR is just one of a multitude of issues that these decision makers must deal with at any given time, and they often find themselves searching for a quick solution to a complex problem. Or, they are unaware of changes in the law that may impact them. Small employers should consider having a consultant, group or association with whom they can speak to get an independent opinion on situations that arise, actions being considered, to handle HR issues and generally to keep them apprised of changes in the laws.
DEBORAH S. MINNIS
Ms. Minnis practices labor and employment law at Ausley McMullen, and she also represents various local government bodies. She can be reached at dminnis@ausley.com. This article is for informational purposes only and is not intended to be a substitute for professional legal advice. If you have a specific concern or need legal advice regarding your dental practice, you should contact a qualified attorney.
Every decision, statement and action relating to employment is like dropping a pebble in a pond — the ripples from those decisions can continue to travel long after the decisions are made. HR is everyone’s responsibility. If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@floridadental.org or 850.350.7202.
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Every decision, statement and action relating to employment is like dropping a pebble in a pond — the ripples from those decisions can continue to travel long after the decisions are made.
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NEW! SIGN UP FOR AUTO-RENEW BY JAN. 1 & RECEIVE THE CE BROKER CONCIERGE PLAN FREE FOR 2020! To thank you for using auto-renew and to help you renew your dental license, we are offering the CE Broker Concierge Plan for free in 2020. This upgrade tracks your compliance, finds the best CE courses and reports completed hours for you. To receive the Concierge Plan for 2020, sign up for auto-renew by Jan. 1, 2020.
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6 P O T 6 SOCIAL MEDIA BEST PRACTICE TIPS 1 Create content intentionally.
Develop a quarterly or monthly content calendar to ensure that content is created thoughtfully to support your goals, represent your brand, resonate with your audiences and be tailored for each platform.
2 Initiate team effort.
Establish roles and responsibilities among your team for content development, monitoring social media platforms and engaging with comments. Establish an internal social response protocol with a sample FAQ, including draft responses for anticipated comments and questions.
3 Establish house rules.
Set up house rules for your social media channels, like Coca-Cola does (facebook.com/CocaColaUnitedStates). Remove posts that go against those rules, such as comments that contain hate speech or profanity.
4 Don’t be afraid to take the conversation offline.
When managing comments on social media, especially those that are more negative in nature, consider taking the conversation offline so the public doesn’t see all the back and forth.
5 Engage with reviews.
Engage with reviews for positive, neutral and negative comments. The good reviews are a powerful resource for obtaining new customers. The negative reviews offer an opportunity to invite the reviewer to contact you directly to discuss further and then address the concern as a compassionate professional, while ensuring that the dialogue does not come off as defensive or combative. Just as with comments, reviews that violate privacy or house rules should be removed.
6 Set up reporting.
Track and analyze what’s working and what’s not to prioritize resources, establish benchmarks and build on your successes.
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real estate
THE DOWNSIDE OF DIY COMMERCIAL REAL ESTATE
MIKE JORGENSON
CARR Healthcare Realty CARR Healthcare is the nation’s leading provider of commercial real estate services for health care tenants and buyers. Every year, thousands of health care practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with startups, lease renewals, expansions, relocations, additional offices, purchases and practice transitions. Health care practices choose CARR to save them a substantial amount of time and money, while ensuring their interests are always first. Visit CARR.US to find an expert agent representing health care practices in your area.
Are you one of the rare health care providers or administrators who understands how much is at stake in commercial real estate negotiations? If so, then you probably know that commercial real estate is the highest negotiable expense for your health care practice. Consequently, most health care providers fall into the statistic that tells us that 80% of health care practices still take a do-it-yourself (DIY) approach to these crucial negotiations and site selection process.
2. During your valuable time off that would normally be spent with your family, relaxing, taking care of personal errands or making memories with those you love.
The following will break down several reasons why doing commercial real estate without representation will likely cost you a significant amount of time and money.
Money
Time The average commercial real estate transaction takes dozens of hours to complete. When you calculate the hours of research, driving the market, communicating with listing agents, touring properties, negotiating letters of intent, negotiating lease contract terms, printing/signing/mailing documents and the dozens of other miscellaneous tasks you encounter in almost every commercial real estate deal, you can easily spend 30-40 hours or more on a single transaction. That equates to an entire week of work! Given the fact you have a full-time job already, you have two options for where you will find those hours: 1. During normal business hours (when you could otherwise be generating revenue).
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Neither option is a good one, especially when you consider how much money you could be making per hour if you invested that time into your practice. Since time is a commodity you can’t get back, it’s important to invest where it can yield you the highest return.
The average health care practice loses tens of thousands of dollars in this DIY approach. In most commercial real estate transactions, you’ll also be working with a listing agent. That agent has a fiduciary responsibility (legal obligation) to the landlord to ensure they get the best possible deal and that their interests are protected and paramount over any other party in the transaction. This also is the person who collects a commission on the transaction. The commission amount is set aside before the property is even listed, and it will either be paid to the listing agent only or it will be split between the listing agent and the agent you hire to represent your needs. Often, if there is no buyer/tenant agent, the listing gets paid an amount that equals a “double commission.” If you take the DIY approach, someone else is making the money for doing the job you did yourself. The craziest part is, the person making money is opposing you in the transaction! FLORIDADENTAL.ORG
And, you just helped that person collect twice as much as they would have if you would have hired an expert agent to represent your needs and protect your interests! This could be because you don’t actually understand everyone’s role within a deal. After all, when you called the name on the sign, they told you they wanted to help you get into the space! The problem is that to them, you are just a customer. The landlord is their only client in the deal. That might not sound like a big difference, but it has a HUGE impact on the outcome of the terms that each party receives. They have a legal obligation (called a fiduciary) to ensure the landlord gets the best possible deal within your transaction. They have no such obligation to you, since you are not their client. Without representation that looks out for your best interests, you’re almost guaranteed to leave a significant amount of money on the table during negotiations.
Experience Some tenants and buyers balk at the idea of hiring an agent to represent them in a commercial real estate transaction through an agency agreement. Those people typically don’t understand that agency is a term created by governmental bodies to protect the consumer (you). If you don’t have an agent involved to exclusively represent you in your transaction, then there is no real estate expert who has a fiduciary responsibility to protect your interests. Most landlords have an agent and other experts they regularly consult with who work diligently to ensure the landlord receives the best deal possible.
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Think about that for a moment. The landlord, who has done hundreds of real estate transactions and whose entire livelihood is based on real estate, hires an agent so they can leverage that agent’s experience. Why would a health care buyer or tenant who will only transact a few times over the course of their career try to do it alone?
Knowledge This is the most important part of representation. We live in a world where “knowledge” is at our fingertips. The problem is, the knowledge that’s available often is a cheap knockoff of the real thing. Have you ever had a patient confidently give you their diagnosis of what is happening to them because they looked it up on WebMD? When you explain to them their actual diagnosis, they say, “Are you sure?” They’re trying to compare your thousands of hours of experience with their 15 minutes of Googling symptoms. There is a monumental difference in your experience versus theirs. Be careful getting too frustrated, though, because many doctors and practice administrators do the same thing when it comes to commercial real estate. Those doctors and administrators will hop on a commercial real estate website for 15 minutes, and now they are suddenly a commercial real estate expert. What they fail to acknowledge is that anyone can find properties or call or email a listing agent to get a property brochure. The part where expert guidance is needed is found during the negotiations (and there is more to a negotiation than simply the lease rate or purchase price).
This concept also is important in deciding how you select your agent. Many doctors fail to realize the complexities of commercial real estate and imprudently hire a residential real estate friend or patient. That’s like having a toothache and going to the veterinarian for help. Sure, they may have some dental experience (on felines), but it’s hardly the same thing. Ok, I need an agent. How do I go about picking the right one? Here is a quick guide to ensure you are covered. Good: Having a commercial real estate agent represent you in your real estate transaction. Better: Having a commercial real estate agent who only represents buyers and tenants represent you in your real estate transaction. This prevents any potential conflict of interest and ensures you will see every potential property available to you. Best: Having a commercial real estate agent who only represents health care buyers and tenants represent you in your real estate transaction. This not only ensures you of their unwavering loyalty to you against any possible landlord, but also ensures you have someone who understands your real estate needs and how to structure a deal that best suits your unique situation as a health care provider. When it comes to DIY real estate negotiations, you don’t save any money. Instead, you stand to lose a fortune. Hiring an agent will, at a minimum, save you a substantial amount of time. Hiring the right agent can ensure you get into the best possible situation and has the potential to save you tens to hundreds of thousands of dollars in your next transaction.
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HIPAA and Email: The ACTUAL Law
ROBERT MCDERMOTT, PRESIDENT/CEO, iCORECONNECT
technology, improving patient care and practice productivity.
Sending and receiving electronic protected health information (ePHI) through email can be a safe and effective way to share patient records and sensitive information with other providers, insurers and patients. It only gets tricky when providers don’t understand the details of the ACTUAL HIPAA law. Once you know, you can effectively embrace
Let’s look at eye-opening background information on HIPAA-violation enforcement. Every day, at least one health care data breach is reported to the Department of Health and Human Services (HHS).1 The HHS Office for Civil Rights (OCR) is responsible for enforcing the Privacy and Security Rules. The OCR audits practices and enforces civil and criminal corrective actions, which may
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lead to fines, jail time and even practice closure. In 2018, the OCR wrapped up a record year of HIPAA enforcement. “Our record year underscores the need for covered entities to be proactive about data security if they want to avoid being on the wrong end of an enforcement action,” stated OCR Director Roger Severino.2 The good news is that it’s easy to stay on the right side of the law. You can make sure you follow the actual HIPAA law FLORIDADENTAL.ORG
Here’s a closer look at what these six requirements mean: 1. Authenticate Recipients. This refers to the doctor receiving your emails. Your secure email exchange should automatically verify that the doctor to whom you are sending ePHI is a registered provider. The federal government approves the DIRECT protocol for provider verification. Look for a secure email provider whose platform is built on the DIRECT protocol. 2. Control Access. Only authorized users should access the content of emails. Your secure email system should have mechanisms in place for automatic user logoff and encryption (scrambling the message content so hackers can’t access ePHI). 3. Transmit Securely. This is where encryption is critical. The higher your level of encryption, the more secure your ePHI. For example, if your secure email exchange has a 2048-bit encryption level, it will take quadrillions of years to break that encryption using today’s technology.3 4. Unaltered Records. All your patient information must be safely stored in such a way that it can’t be altered or lost. The smartest backup systems store your ePHI at multiple secure data centers — not in your office, home or briefcase. HIPAA-compliant, cloud-based backups keep your ePHI on HIPAA servers located around the country. In the rare event that one location is compromised, the other backup locations have you covered. 5. Audit Every Message. The OCR can audit any practice at any time, and anyone can submit an anonymous HIPAA complaint against your practice. If you get audited, you will be required to produce a detailed audit trail of all emails containing ePHI. It’s unusual to find email services who will make this accommodation, so be sure your vendor will definitively state they can produce and deliver an official HIPAA audit trail on short notice. This is critical. 6. Lock Away for 6 Years. This law goes hand-in-hand with Nos. 4 and 5 above. Your records need to be securely stored so PHI cannot be altered or lost for a minimum of six years. There are HIPAA-compliant email services that meet all six requirements. Just remember the ACTUAL law and you’ll be on your way to safe, secure and timesaving improvements for your practice.
requirements by remembering the sixletter word ACTUAL. m m m m m m
Authenticate Recipients Control Access Transmit Securely Unaltered Records Audit Every Message Lock ePHI for Six Years
FLORIDADENTAL.ORG
iCoreConnect’s HIPAA-compliant email service, iCoreExchange, is endorsed by FDA Services. iCoreExchange meets or exceeds every HIPAA requirement for emailing ePHI. For more information, go to icoreconnect.com/fda.
References: 1. hipaajournal.com/march-2019-healthcare-data-breach-report/ 2. hhs.gov/about/news/2019/02/07/ocr-concludes-all-time-record-year-for-hipaaenforcement-with-3-million-cottage-health-settlement.html 3. digicert.com/TimeTravel/math.htm
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We work for you. FDAS: Health Solution Center
FDA SERVICES HEALTH SOLUTION CENTER OPEN ENROLLMENT BEGINS NOV. 1, 2019.
The FDA Services Health Solution Center is a valuable member resource that will help you build the most efficient and cost-effective health plan for your office or family. Your insurance advisors can walk you through the process of creating a plan that fits your unique needs and doesn’t break the bank.
Fill out a quote form at fdaservices.com/health to get started!
CONSIDER A BENEFIT ALLOWANCE PROGRAM (BAP) Instead of providing health insurance to your full-time employees and paying a percentage or all of the premiums, you pay a set dollar allowance for employee benefits. You then work with your benefit agent to customize an employee benefits package based on your office needs. Employees get to choose the plans they need and pay the cost for plans that exceed the allowance.
CALL US AT 800.877.7597 TO DISCUSS YOUR COVERAGE. insurance@fdaservices.com • fdaservices.com
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INFORMATION ABOUT DENTAL ASSISTANTS, RECORDS, CODES, INSURANCE AND MORE! 1
Call the FDA and we can unpack the Florida Board of Dentistry (BOD) rules and find the answer for you.
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Can my dental assistant or dental hygienist perform a certain procedure? Do I have to be in the office? What type of training does he/she have to have?
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How long do I have to keep my dental records?
The BOD rules require you to keep all patient records for four years from the last time the patient was treated. However, many malpractice carriers suggest you keep all records for seven years for statute of limitation purposes. Also, call the FDA if you have questions about what must be included in the dental record per Florida law and what we also suggest should be included as a best practice to protect yourself in the future.
I have a disgruntled patient who is unhappy with their treatment. What should I do?
There are a couple of options here. If you are an FDA member, we offer peer review to help mediate a solution between you and the patient. We also can discuss the correct way to dismiss a patient from the practice and what responsibilities you have for emergency care.
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I’m relocating/opening a new office/retiring. What do I need to do with my patient records?
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I want to apply for a permit to provide anesthesia services in my office. How can I do this?
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There is a specific BOD rule that requires notice in the newspaper. Yes, this is an antiquated way of doing things, but it’s still the law in Florida! Call the FDA for the specific requirements. And on the topic of patient records, you cannot withhold records due to nonpayment for treatment. You can charge for releasing the records, but again, the BOD rule is specific on how much.
This is a loaded question and you will need to call the FDA so we can find the specific answer in the BOD rules. What type of permit: general anesthesia, conscious sedation or pediatric conscious sedation? Will you be using a physician anesthesiologist? Will you be using a practitioner who is itinerate/mobile to administer sedation? Will you be sedating the patient yourself or will you be bringing someone into your office? How many offices do you have and will you sedate patients at all of them?
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THE FDA IS YOUR RESOURCE! CALL US! WE’LL FIND THE ANSWER!
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What happened at the last BOD meeting?
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Help! My office has been hacked and all my patient files are being held for ransom!
The BOD meets in-person quarterly and the councils and committees meet at various times during the year via conference call. The FDA represents you at all these meetings. We then make sure to update our members on all areas that impact your profession. For example, at the last meeting, the BOD approved an update to the Sterilization Rule (go to bit.ly/2lBUmsg) and the board is currently revising the Anesthesia Rules, so make sure to watch your inbox for the latest updates.
Yes, this is an actual call the FDA received. FDA Services can help! We offer coverage for this type of situation and if you are already a FDAS client, your malpractice policy may have coverage already included. You should also contact your local law enforcement agency.
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What code do I use to bill for a certain procedure?
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I am having problems with “X” dental insurance plan. How can I get this claim paid?
The CDT code book is updated every year, and many times there are changes in the ways you code for certain procedures. Call the FDA and we can research the issue and update you on what changes took place.
The FDA has a dedicated staff member to focus resources on third-party payers in Florida and their impact on members. FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire works closely with the various insurance plans, Medicaid managed-care plans, the Agency for Health Care Administration, Department of Health (DOH), BOD and other state and federal agencies, and addresses issues relating to third-party payers. We can address your concerns in the complex arena of third-party payers and can gather data on problems and create momentum for finding solutions.
10 What is the FDA doing about all the do-it-yourself (DIY) dentistry companies and products?
I n recent years, DIY dental practices have become more prevalent. DIY treatments range from oil pulling to whitening with charcoal to clear aligners. Products such as at-home aligners also are called direct-to-consumer (DTC) products. Patients may seek DIY or DTC services for dental treatments like teeth straightening because they feel they can’t fit office visits into their schedule or think that it will cost less than in-person treatment. Many FDA member dentists have contacted the FDA because they are seeing patients being harmed by these DIY practices. The FDA wants to ensure the public is being protected, as visiting a dentist can catch issues beforehand and ensure DIY treatment doesn’t cause more problems than it cures. As such, the FDA strongly discourages the practice of DIY and DTC dental laboratory services because of the potential for irreversible harm to patients.
The FDA is working closely with the BOD to define what constitutes a patient of record under Florida law and to update its rules to incorporate and define supervision levels of scans and impressions taken digitally. The FDA strongly encourage its members, all dentists and their patients to report instances of individuals being harmed by DIY and/or DTC dental laboratory services to: The Florida BOD: bit.ly/2jAcrR7 or call 850.245.4474 The Unlicensed Activity Bureau at the DOH: bit.ly/1L5hYIl The Food and Drug Administration: bit.ly/1KGErtT
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New! dentists may delegate remedial restorative functions What restorative functions are delegable? � All functions delegated shall be performed under direct supervision. � The delegating and supervising dentist shall remain fully responsible for all delegated tasks and for ensuring that the dental assistant or dental hygienist meets the training requirements of this rule. � After a dentist has prepared a tooth, a dentist may delegate to a dental assistant or hygienist the task of placing, packing and contouring amalgam and composite restorations, and the fitting and contouring of stainless steel crowns (tasks). � Does not include permanently cementing stainless steel crowns. � The tasks shall only be performed using a slow-speed handpiece and hand instruments.
for dental assistants What are the prerequisites? � To be eligible to be admitted into the mandatory training course required by rule, a dental assistant (candidate) shall meet the following conditions: � Be at least 18 years of age. � Be a high school graduate or have a High School Equivalency Certificate. � Have a current Basic Life Support for Healthcare Provider certificate. � Be a graduate of a dental assisting program that is accredited by a dental accrediting entity recognized by the United
States Department of Education (DOE) or shall have received formal training in expanded duties. � Never had a dental assisting license suspended or revoked in any jurisdiction. � Within 24 months prior to being admitted to the mandatory training course, the candidate must have documented proof of 2,400 hours of clinical work experience in either a dental office or as an educator of dental assisting. � The training program shall ensure that the candidate meets all the qualifications before accepting the candidate into the training program.
What training is required? � The training course shall be offered by a dental or dental hygiene school or program that is accredited by a dental accrediting entity recognized by the United States DOE.
� At a minimum, the training shall include and contain the following: � 105 clock hours, including a minimum of 10 hours dedicated to
�
� � �
preclinical didactic hours (may be offered online). • At the completion of the preclinical didactic hours, the course shall require the passing of an initial written examination prior to the clinical portion of the training. A passing score shall require a score of 75% or above. A clinical portion consisting of a minimum of 70 hours dedicated to simulated lab, minimum of 25 hours dedicated to live patients. A clinical and lab session for Amalgam Restorations Class I, II, and V, which shall include live patients. A clinical and lab session for Composite Restorations Class I, II, III, and V, which shall include live patients. A clinical and lab session to size, fit and contour, but not permanently cement, stainless steel crowns, which shall include live patients.
� The training program shall verify competency by requiring an exit or final written examination and clinical examination that includes live patients. � The written portion of the examination shall include a section covering the Laws and Rules of Dentistry in Florida. � A passing score shall require a 75% or above on both the written and clinical examination, and the examinations shall not be weighted to achieve an overall score of 75% or better. � The clock hours dedicated to the exit or final written and clinical examination shall not count towards the required minimum 105 total clock hours required by the course.
� Upon the successful completion of the training course, a certificate of successful completion of the Restorative Function Course shall be issued. The delegating dentist shall ensure that a copy of this certificate is immediately available at the location where tasks are delegated, and the certificate shall be produced by the dentist when requested by the Board of Dentistry (BOD) office or any authorized inspector.
Effective June 26, 2019, a dentist may delegate remedial restorative functions to a dental assistant or to a dental hygienist who has completed the mandatory training offered by an accredited dental or dental hygiene program.
What are the responsibilities of the delegating dentist? � Shall not supervise more than four dental hygienists or dental assistants in combination who are simultaneously performing the tasks. � Shall ensure that the patient’s dental chart is annotated to reflect the initials of the dental assistant who performed the tasks. � Shall ensure that the patient’s dental chart reflects that the final restoration was verified by the delegating dentist and the result of the verification also shall be documented.
for Dental Hygienists What are the prerequisites? � To be eligible to be admitted into the mandatory training course required by rule, a dental hygienist (candidate) shall meet the following conditions: � Be at least 18 years of age. � Be a high school graduate or have a High School Equivalency Certificate. � Have a current Basic Life Support for Healthcare Provider certificate. � Have an active unrestricted dental hygiene license from any U.S. state or territory. � Never had a dental hygiene license suspended or revoked in any jurisdiction.
� Within 24 months prior to being admitted to the mandatory training course, the candidate must have documented proof of 2,400 hours of clinical work experience in either: • a dental office • as an educator of dental hygiene • is a graduate of a dental hygiene program, accredited by a dental accrediting entity recognized by the United States DOE, within 24 months prior to being admitted to the mandatory training course. • The training program shall ensure that the candidate meets all the qualifications before accepting the candidate into the training program.
What training is required? � The training course shall be offered by a dental or dental hygiene school or program that is accredited by a dental accrediting entity recognized by the United States DOE.
� At a minimum, the training shall include and contain the following: � 85 clock hours, including a minimum of five hours dedicated to preclinical didactic hours (may be done online), and a clinical portion consisting of a minimum 55 hours dedicated to simulated lab and a minimum of 25 hours dedicated to live patients. • At the completion of the preclinical didactic hours, the course shall require the passing of an initial written examination prior to the clinical portion of the training. A passing score shall require a score of 75% or above. � A clinical and lab session for Amalgam Restorations Class I, II, and V, which shall include live patients. � A clinical and lab session for Composite Restorations Class I, II, III, and V, which shall include live patients. � A clinical and lab session to size, fit and contour, but not permanently cement, stainless steel crowns, which shall include live patients.
� The training program shall verify competency by requiring an exit or final written examination and clinical examination that includes live patients. � The written portion of the examination shall include a section covering the Laws and Rules of Dentistry in Florida. � A passing score shall require a 75% or above on both the written and clinical examination, and the examinations shall not be weighted to achieve an overall score of 75% or better. � The clock hours dedicated to the exit or final written and clinical examination shall not count towards the required minimum 85 total clock hours required by the course.
� Upon the successful completion of the training course, a certificate of successful completion of the Restorative Function Course shall be issued. The delegating dentist shall ensure that a copy of this certificate is immediately available at the location where tasks are delegated, and the certificate shall be produced by the dentist when requested by the BOD office or any authorized inspector.
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INFORMATION ABOUT THE FLORIDA BOARD OF DENTISTRY
CLOSING OR RELOCATING YOUR PRACTICE?
DR. DON ILKKA FDA LIASON TO THE FLORIDA BOARD OF DENTISTRY
Did you know that if you close your practice or relocate, you must put a notice in the newspaper? Yes, it’s an antiquated practice, but the Florida Board of Dentistry rules require that within one month of a dentist’s termination of practice or relocation of practice outside the local telephone directory service area of his/her current practice, a notice shall be published in the newspaper of greatest general circulation in the county where the dentist practiced. The notice must tell patients you either closed your practice or relocated and where they can obtain copies of their records. The notice must appear in the newspaper at least once a week for four consecutive weeks. The one caveat to this is if you are relcoating your practice in the same local telephone directory service area as your former practice. In that case, the notice must include the date of your relocation and your new office’s address. CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS
If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@ floridadental.org or 850.350.7202, or FDA Liaison to the Florida Board of Dentistry Dr. Don Ilkka at donjilkkadds@aol.com or 352.787.4748.
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Radiography Training Online
PSC
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Our practice specialists can help you achieve your goals • Competitive terms on: – Practice sales and acquisitions – Office improvement and expansion • Loans up to $5 million2 • Flexible repayment options • Business debt consolidation3 To learn more, call 800.428.2847 to talk to a practice specialist, or visit bankofamerica.com/practicesolutions.
All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions apply. The term, amount, interest rate and repayment schedule for your loan and any product features, including interest rate lock, may vary depending on your creditworthiness and on the type, amount and collateral for your loan. Commercial Real Estate products are subject to product availability and subject to change. Actual loan terms, loan to value requirements, and documentation requirements are subject to product criteria and credit approval. For owner-occupied commercial real estate loans (OOCRE), a loan term of up to 15 years and owner occupancy of 51% or more are required. Small Business Administration (SBA) financing is subject to approval through the SBA 504 and SBA 7(a) programs. Subject to credit approval. Some restrictions may apply. 3 Bank of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. All promotional and marketing materials are Bank of America Practice Solutions property, as such, cannot be changed, altered or modified, orally or in writing. All questions regarding these materials should be directed or referred to a Bank of America Practice Solutions Sales Associate. Sponsorship of endorser’s products and services is not an expressed opinion or approval by the Bank. Bank of America and the Bank of America logo are registered trademarks of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2019 Bank of America Corporation AD-06-19-0426 | ARKJGMF3 | 07/2019 1
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YOUR HEALTH • ROOTED IN DENTISTRY
2020 DENTISTS’ DAY ON THE HILL
tuesday • FEB. 4, 2020
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Monday Feb. 3, 2020 6 p.m. Aloft Hotel Tallahassee
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Register at floridadental.org/ddoh SPONSORED BY
legislative corner
SUPPORT FDA FUNDING PRIORITIES FOR THE 2020 LEGISLATIVE SESSION During the 2019 Legislative Session, the Florida Dental Association (FDA) successfully passed legislation that was signed into law to establish the Dental Student Loan Repayment Program and the Donated Dental Services Program. Although the policy was approved to establish these programs, the Legislature did not allocate funding needed to implement these programs. The Department of Health, which is the entity these programs will be administered by or contracted through, projected that the state could implement these programs at approximately $773,000. During the 2020 Legislative Session, the FDA will pursue funding to help ensure that these programs will be implemented to help increase access to dental care around the state.
JOE ANNE HART FDA CHIEF LEGISLATIVE OFFICER
For additional information on legislative issues, you can reach Joe Anne Hart at jahart@floridadental.org or 850.350.7205.
WE NEED YOUR HELP!
You can help get support from the Legislature by going to the FDA’s Legislative Action Center at bit.ly/34asFaY and respond to the Legislative Alert. Legislators are currently holding interim committee meetings in Tallahassee before session starts on Jan. 14, 2020. It is important that this funding priority is on their radar prior to the development of the budget recommendations.
381.4019 DENTAL STUDENT LOAN REPAYMENT PROGRAM. The Dental Student Loan Repayment Program is established to promote access to dental care by supporting qualified dentists who treat medically underserved populations in dental health professional shortage areas or medically underserved areas.
381.40195 DONATED DENTAL SERVICES PROGRAM. (3) The department shall establish the Donated Dental Services Program for the purpose of providing comprehensive dental care through a network of volunteer dentists and other dental providers to needy, disabled, elderly, and medically compromised individuals who cannot afford necessary treatment but are ineligible for public assistance. An eligible individual may receive treatment in a volunteer dentist’s or participating dental provider’s private office or at any other suitable location. An eligible individual is not required to pay any fee or cost associated with the treatment he or she receives.
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7 P O T WAYS THE FDA ADVOCATES FOR YOU! 1 Protects organized dentistry
The Florida Dental Association (FDA) represents its members effectively at the state level with a united voice on legislative and regulatory issues before the Legislature and the Florida Board of Dentistry (BOD).
2 Ensures patients’ safety
The FDA supports Florida’s standards for dental licensure to ensure that everyone is receiving quality dental care.
3 Supports initiatives that help increase access to dental care for all Floridians The FDA is tireless in its efforts to support legislative initiatives that help increase access to dental care across the state of Florida.
4 Supports dental-friendly candidates
The FDA Political Action Committee is the political arm of the association and supports candidates during election cycles who are supportive of organized dentistry.
5 Develops relationships with key elected officials
The FDA’s leaders are constantly working to develop and foster relationships with key elected officials who are directly involved in passing state laws affecting the dental profession.
6 Monitors and attends all Board of Dentistry meetings
The FDA is active in monitoring the BOD’s actions, as well as making sure an FDA representative is always present at each BOD meeting and prepared to present the FDA’s position on issues when necessary.
7 Provides opportunities for FDA grassroots member and dental student involvement
The FDA encourages all members and dental students to advocate on behalf of their profession by participating in the annual Dentists’ Day on the Hill and targeted Legislative Contact Dentist Capitol Visits in Tallahassee.
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website resources
Member Resources at Your Fingertips! Advocacy in Action n n n n
Legislative Action Center Century Club Florida’s Action for Dental Health Fluoridation
floridadental.org/advocacy
Continuing Education n NEW Mandatory CE q Two-hour Opioid Prescribing Course q One-hour Human Trafficking Course n FREE CE q Diagnostic Discussion n Online Radiography Training Program
floridadental.org/online-ce
FDA Foundation n n n n n
Donate Disaster Assistance Florida Mission of Mercy Programs Access to Care Resource Guide
floridadental.org/foundation
Hurricane Resources n Hurricane Proof: Practice Readiness Guide n FDA Foundation Disaster Relief Grant Program n Additional Hurricane resources
floridadental.org/hurricane
Legal Resources n Legal FAQs n The Basics of "Medicare Opt-out" for Florida Dentists n Step by Step: BOD Licensure Discipline Process Handbook n Informed Consent Documents q Designation of Health Care Surrogate q Durable Limited Power of Attorney to Provide Medical Consent n You Want Me to Sign What? A Florida Dentist's Handbook on Managed-care Contracts n The Dos and Don'ts of Dental Advertising n Section 1557 of the Affordable Care Act for Florida Dentists (including free, downloadable LEP card) n Starting a Dental Practice in Florida? q Resource guide q New dentist practice checklist n Required posters for the workplace n Danger Zones in Employment Agreements n Contract Analysis n Peer Review
floridadental.org/legalresources
Member Resources n n n n n n n n
FAQs Career Center Crown Savings FDA Services Member Directory Member Marketing Toolkit Now You Know Publications q Today’s FDA online q News Bites q Beyond the Bite blog q Books on the Shelf/Book Reviews n X-ray Fact Sheet
floridadental.org/member-resources
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Card Connect
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updates for members *PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.
Correction: The Sept/Oct issue of Today’s FDA had the incorrect date of death for one of our members. Dr. Tomas Ballesteros died on July 10, 2019 not July 19. We apologize for this error and send our condolences to his family and friends.
Getting You Biennium-ready! All Florida-licensed dentists must renew their license by midnight on Feb. 28, 2020. Visit floridadental.org to view the Florida Dental Association’s (FDA) available online continuing education (CE) courses. Or, purchase the course recordings from the 2019 Florida Dental Convention (FDC), which can be selfreported to CE Broker for CE credit. Go to bit.ly/33gkWZ5 to purchase course recordings. You will report all CE credit and renew your license at CEBroker.com. As an FDA member, you and your team can take advantage of discounted rates for CE Broker accounts! Learn more about the benefit of each account at cebroker. com/plans. With this member-only benefit, you can create a Professional Account for only $24 or Concierge Account for only $90 per year. Go to bit. ly/33iJO2u to access the FDA member discount code to CE Broker.
Set Up Auto-renew! Have your membership automatically renew each year! Sign up now at floridadental.org/dues and select the AUTO-
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RENEW option at checkout. Sign up for auto-renew by Jan. 1 and receive the CE Broker Concierge plan free for 2020!
Registration for the 2020 FLA-MOM is Now Open! The 2020 Florida Mission of Mercy (FLAMOM) will take place on April 24-25 in Jacksonville. Since 2014, FLA-MOM has treated nearly 10,000 patients and provided more than 61,000 procedures, for a total value of care of $9.43 million. We need your help to continue our efforts in 2020 in the northeast Florida region! Go to flamom.org to register to volunteer today!
Support the FDA Foundation with Your Online Holiday Shopping Simply visit AmazonSmile at smile.amazon.com and select the FDA Foundation as your charitable organization. When you shop, 0.5% of your purchase price will be donated to the FDA Foundation. There are no additional fees, and AmazonSmile offers the same great options and pricing as traditional Amazon.
New Single-sheet Format for U.S. Official Order Form for Schedule I and II Controlled Substances If you are registered with the Drug Enforcement Administration (DEA), you should receive a notice that it’s amending its regulations to implement a new single-sheet format for DEA Form
NOVEMBER/DECEMBER 2019
222, used by DEA registrants to order Schedules I and II controlled substances. This official form is required for every distribution, purchase, or transfer of a Schedule I or II controlled substance. The rule took effect on Oct. 30, but provides for a two-year transition period, during which the existing triplicate version of the forms may continue to be used. The rule also includes several minor procedural changes. You can read the final rule at bit.ly/2JQkEQT. If you have any questions, please contact FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire at cstoutamire@floridadental.org or 850.350.7202.
Email from DEA on Suspicious Orders Report System You may have received an email from the DEA about a new requirement to report to a recently launched centralized database called the Suspicious Orders Report System (SORS). Good news! If you only write prescriptions for and dispense controlled substances, you do not have to report anything to SORS. You would only need to report if you distribute controlled substances to other DEA registrants.
Dental Plan Repricing Targets Out-of-network Dentists Some dental plans may hire repricing companies to negotiate lower fees with non-contracted dentists. These companies offer quicker payment in return for FLORIDADENTAL.ORG
a discounted fee. If you get a notice with an offer like this, you aren’t obligated to accept. If you are interested in giving the discount to get paid faster, you don’t have to accept their first offer. The repricing company may be willing to negotiate the discount with you. The repricing company has a certain amount of time, usually 10-12 days, to get you to accept the discount. If they don’t hear from you in that time, the claim reverts to the original dental plan and is processed as a normal out-of-network submission. If you tell the repricing company that you are not interested, the repricing company notifies the dental plan sooner and the plan can process the out-of-network submission faster, so you may want to respond even if you don’t want to accept the discounted fee. Plans often hire more than one repricing company to handle a specific claim. You should determine if the offer is for a specific claim or for all future claims from that payer. If you have any questions, please contact FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire at cstoutamire@ floridadental.org or 850.350.7202.
Welcome New FDA Members These dentists recently joined the FDA. Their membership allows them to develop a strong network of fellow professionals who understand the dayto-day triumphs and tribulations of practicing dentistry.
Atlantic Coast District Dental Association Dr. Nehal Ali, Weston Dr. Arleen Aportela, Boca Raton Dr. Karoline Asbell, Boca Raton Dr. Michael Au, Margate Dr. Scott Azari, Palm Beach Gardens Dr. Erica Barba, Coconut Creek Dr. Kathryn Boehly, Delray Beach Dr. Aurelio Bula, Coral Springs Dr. Anne Castera, Pembroke Pines Dr. Eun Choi, Davie Dr. Andrew Cooper, Royal Palm Beach Dr. Jim Ervil, West Palm Beach Dr. Leslie Fernandez, Fort Lauderdale Dr. Robert Follweiler, Stuart Dr. Rashondia Gaines, Davie Dr. Kelly Gonzalez, Fort Lauderdale Dr. Megan Hanvivatpong, Boca Raton Dr. Christina Johnson, Margate Dr. Ronald Katz, Delray Beach
Dr. Sarah Lipkin, West Palm beach Dr. Raquel Magarelli, Sunrise Dr. Disha Mankame, Plantation Dr. William Mathurin, Cape Coral Dr. Lauren Mitchell, Boca Raton Dr. Dhruv Patel, Wellington Dr. Janely Pinero-Fredrick, Jupiter Dr. Patricia Rodriguez, Miami Dr. Rosa Sanchez, Pompano Beach Dr. Christopher Schloss, Fort Lauderdale Dr. Christopher Sepe, Delray Beach Dr. Dennis Sierra, Boca Raton Dr. Kim Stapleton, Lighthouse Point Dr. Jennifer Sylvian, West Palm Beach Dr. Robert Victome, Lake Worth
Central Florida District Dental Association Dr. Muhammad Alsafadi, Gainesville Dr. Richard Baker, Gainesville Dr. Farrah Beg, Orlando Dr. Keren Castellucci, Maitland Dr. Stephanie Dexter, Orlando Dr. Carlotta Fantin-Yusta, Ocala Dr. Tara Fenn, Orlando Dr. Yaciel Ferrera, Merritt Island Dr. Nadia Fleetwood, Orlando Dr. Stephen Greene, Oviedo SEE PAGE 80
Wheerewoinrld is th Today’s FDA? Are you planning to take your copy of Today’s FDA on your next trip? Perhaps you’ll visit the Eiffel Tower, Australia, the Statue of Liberty ... anywhere, really! Have someone snap a photo of you with your copy and send it to Today’s FDA Editor Dr. John Paul at tfdaeditor@floridadental.org and you could be featured in the next issue of the journal! FLORIDADENTAL.ORG
Dr. Dave Boden took his copy of Today’s FDA all the way to Europe.
TODAY'S FDA NOVEMBER/DECEMBER 2019
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South Florida District Dental Association
updates for members FROM PAGE 79
Dr. Paula Grisales Cano, Apopka Dr. Abeer Hakam, Gainesville Dr. Dileep Kondur, Gainesville Dr. Mani Mirpourian, Gainesville Dr. Diana Moriatis, Port Orange Dr. Bozena Munguba, Leesburg Dr. Tenille Phang, Apopka Dr. Edward Pirie, Windermere Dr. Daniel Popper, Gainesville Dr. Tigura Reddy, Clermont Dr. Alexander Samuel, Orlando Dr. Maritza Seoane, Oviedo Dr. Christine Straka, Gainesville Dr. Nainesh Tailor, Orlando Dr. Schuyler Tang, Gainesville Dr. Rodolfo Tejada, Orlando Dr. Jennifer Van, Orlando Dr. Sarah Vu, Winter Park
Northeast District Dental Association Dr. Aaron Evens, Yulee Dr. John Kulaga, St. Augustine Dr. Ava Lee, Jacksonville Dr. Elssy Lopez, Jacksonville Dr. Serge Mechrek, Jacksonville Dr. Shatha Mechrek, Jacksonville Dr. Ammar Shano, Orange Park Dr. Peter Shih, St. Johns Dr. Bradley Sleeth, Orange Park
Northwest District Dental Association Dr. Anuja Aryal, Pace Dr. Robert Koski, Niceville Dr. Julio Sixto, Tallahassee Dr. Corinne Tabert, Destin
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Dr. Mary Adames, Sunny Isles Beach Dr. David Amador, Plantation Dr. Daniel Berenstein, Hollywood Dr. Christopher Bob, South Miami Dr. Jenevieve Bunassar, Miami Dr. Shana Capra, Delray Beach Dr. Carlos Cardenas, Miami Dr. Alicia Carrazana, Coral Gables Dr. Anthony Carter, Hollywood Dr. Manuel Casas, Miami Dr. Sana Changezi, Doral Dr. Jincy Daniel, New Port Richey Dr. Carlos Escobar, Hollywood Dr. Yelisbet Fernandez, Coral Gables Dr. Maria Franco, Miami Dr. Madeleine Gonzalez, Hialeah Dr. Stephanie Gonzalez, Miami Dr. Guillermo Jauregui Rodriguez, Miami Dr. Navid Lajevardi, Miami Dr. Circe Lassegue, Miami Dr. Eve Libby, Surfside Dr. Karina Lobaina, Miami Dr. Amy Martinez, Miami Dr. Paula Miranda Bucio, Miami Lakes Dr. Marshall Moini, Plantation Dr. Rolando Molina, Miami Dr. Giselle Neukirchner, Miami Dr. Nhora Ortega, Miami Dr. Fransheska Ovalles, Doral Dr. Esteban Parada, Miami Dr. Fernando Pino Rivera, Miami Dr. Gabriel Quinones-Betancourt, Miami Dr. Carissa Ramos Cruz, Miramar Dr. Alice Reich, Plantation Dr. Jorge Robaina, Miami Dr. Regina Saenz, Hialeah Dr. Jenifer Santos, Homestead Dr. Lindsay Scott, Coconut Creek Dr. Erich Soto Del Valle, Miami Dr. Danny Spinosi Bermejo, Miami
NOVEMBER/DECEMBER 2019
Dr. Angela Tejeda, Miami Dr. Ivonne Vasquez, Hollywood Dr. Alberto Vazquez Sanchez, Miami Dr. Joyce Yin, Miami
West Coast District Dental Association Dr. Aneesha Amarnath, Naples Dr. Zeina Armouche, Tampa Dr. Mark Burne, North Port Dr. Maria-Marcia Carvalho, Oak Park Dr. Hari Chebrolu, Hernando Dr. Johana Cobo, Bradenton Dr. Lourdes Cortes, Tampa Dr. Sura Dabbagh, Wesley Chapel Dr. Dima Ghandour, Naples Dr. Samantha Graffeo Gardner, Naples Dr. Nadia Groves, Tampa Dr. Robertzon Guloy, St. Petersburg Dr. Janel Hanna, Sarasota Dr. Tranchau Hoang, Palm Harbor Dr. Nicholas Hoepfner, Tampa Dr. James Houston, Sarasota Dr. Helen Hoveida, Plant City Dr. Hind Hussein, Lakewood Ranch Dr. Mona Khalaj, Tampa Dr. Abdul Khan, Hudson Dr. Paul Kolodziej, Trinity Dr. Thao Latham, Bonita Springs Dr. Jason Latham, Fort Myers Dr. Melissa Leach, Fort Myers Dr. Alex Lopez, Naples Dr. Helen May, Fort Myers Dr. Jonathan McCartney, North Port Dr. Denise McCaskill, Tampa Dr. Nesreen Nimer, Weeki Wachee Dr. Cynthia Odukomaiya, Tampa Dr. Belinda Phan, East Lansing Dr. Bradley Phillips, Port Charlotte Dr. Barbara Popek, Clearwater Dr. Pragya Sharma, Sarasota Dr. Neal Singh, Palm Harbor Dr. Nicole Swanson, Sarasota Dr. David Tarnowski, Pinellas Park Dr. Stephanie Zastrow, Bradenton FLORIDADENTAL.ORG
In Memoriam The FDA honors the memory and passing of an FDA past president: Dr. Albert (Al) Bauknecht, of Jacksonville, passed away on Aug. 16, 2019, surrounded by his family. Dr. Bauknecht is a past president of the FDA and served from 2002-2003. Dr. Albert Bauknecht was a very special man. He exuded warmth and friendship. He was always cordial and courtly and had a way of putting other people at ease. Unless you already knew him, Al was not that person who commanded your attention upon ente ring a room. However, he always wore a smile and had a kind word for everyone. When it came time to get down to work, it quickly became apparent that Dr. Bauknecht could keep up with the thoroughbreds. He was
a modest man, but he had an innate intelligence that he put to work in service to others and his profession. As FDA president, Dr. Bauknecht had a collaborative leadership style. He would work to build consensus but wasn’t afraid to bear the responsibility of making final decisions. Al would take time to listen to others but when he had an opinion on an issue, he wasn’t afraid to voice that opinion. Somehow, he could be both gentle and firm simultaneously. He was devoted to his profession, but the true love of his life was his wife, Margaret Lee. To see how Al and Margaret Lee behaved in each other’s company was to see a display of love and affection that few people achieve. Al was the epitome of an ethical, thoughtful professional. He set an example to all who knew him, and to know him was to respect him. With his passing, a gentle light has been forever dimmed.
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DRS. MARAM BAWAZIR*, NEEL BHATTACHARYYA, DONALD M. COHEN AND NADIM M. ISLAM
A 21-year-old Caucasian female presented with a chief complaint of a painless, gradually enlarging, firm swelling on the lower anterior jaw of certain unknown duration. The patient’s medical and family history was non-contributory. Radiographic examination using cone-beam computed tomography (CBCT) imaging revealed a well-defined multilocular radiolucency involving the anterior mandibular area extending from tooth Nos. 20 to 27 and crossing the midline (Fig.1A-C). The patient’s medical history was otherwise non-contributory. An incisional biopsy was performed under local anesthesia by a trained oral surgeon. The biopsy was received at the University of Florida College of Dentistry Oral Pathology Biopsy Service in Gainesville for microscopic examination. The biopsy specimen included multiple sections of soft gelatinous tissue, which appeared translucent and opaque, and was about 1.3 x 1.2 x 0.9 cm in aggregate (Fig. 2). Microscopic examination revealed aggregates of pale, loose and delicate connective tissue interspersed by delicate capillaries. Foci exhibiting myxoid connective tissue interspersed by fibrils of ropey and delicate loose collagen bundles, intermixed by immature fibroblasts exhibiting spindle shape and wavy nuclei were noted (Fig. 3).
Fig. 1: CBCT imaging: (A) Sagittal view showing angular compartments with septae along the periphery of the lesion. (B) The coronal view shows the mesiodistal extension of the lesion with cortical expansion and sharp fine trabeculations near the margins. (C) An axial view showing the buccocortical expansion and thinning of the cortical plate marked with arrows.
Fig. 2: Photograph displaying the gelatinous and lobular nature of the submission at the gross examination.
Question: Based on the clinical, radiographic and histologic findings, what is the most likely diagnosis? A. Ameloblastoma B. Glandular odontogenic cyst C. Central giant cell granuloma D. Odontogenic keratocyst E. Odontogenic myxoma
SEE PAGE 88 FLORIDADENTAL.ORG
Fig. 3: Photomicrograph showing loosely arranged stellateshaped cells distributed randomly within a loose, delicate myxofibrous stroma (20x magnification). TODAY'S FDA NOVEMBER/DECEMBER 2019
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diagnostics FROM PAGE 87
Diagnostic Discussion A. Ameloblastoma Incorrect. An excellent choice and one worthy of considering in the differential diagnosis! The ameloblastoma is a vital differential to consider whenever a patient presents with a multilocular, massive, destructive and expansile radiolucency of the jaws. Ameloblastoma is the most clinically significant tumor of odontogenic origin. Although ameloblastoma can affect all age groups, it’s more common among adults after the age of 30. Our patient was 21 years old, which is considerably younger than the average patient. It’s also common for ameloblastomas to be associated with an impacted tooth. Moreover, 80% of all ameloblastomas occur in the mandibular posterior region and ramus area, but in our case, the lesion was in the anterior mandible. These lesions are slow-growing, locally destructive, and can cause root resorption and displacement of teeth as seen in the present case. The presence of clinically evident, painless, buccal or lingual expansion, characteristically seen in ameloblastomas was noted, but distinctive microscopic features were absent. Histopathologically in ameloblastomas, the presence of variably sized islands of odontogenic epithelium that resemble the enamel organ with peripheral palisading of the basal cell layer and reverse polarity and peripheral vacuolization is seen, but was absent in our case.
B. Glandular odontogenic cyst Incorrect. A great choice since glandular odontogenic cysts (GOC) tend to occur in the anterior mandible and can appear as expansive destructive lesions. GOC is a cyst; hence, the histologic examination importantly displays a prominent cystic lining epithelium, which was not seen in our specimen. The GOC is a rare, recently described developmental odontogenic cyst. It may be seen over a wide age range with a peak of occurrence in fifth to seventh decades. No gender predilection has been reported. GOCs usually present as a slow-growing, asymptomatic swelling generally affecting the anterior mandible (80%), but either jaw may be involved. It presents as a unilocular/multilocular radiolucency and may be destructive.
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The lining epithelium resembles salivary gland tissue and contains numerous mucous cells, forms multiple cystic spaces and often demonstrates focal areas of ciliated pseudostratified columnar epithelium, thereby, simulating salivary ductal epithelium. None of the clinical or radiographic features of GOC are unique or pathognomonic. The most important feature of this newly described entity is aggressive behavior. It may cause perforation of the cortical plate and has 30% recurrence rate. The possibility of these lesions exhibiting transformation to an intra-bony or central mucoepidermoid carcinoma has been presented in the literature. Small unilocular lesions can be managed conservatively. Marginal resection or peripheral ostectomy are highly recommended for the larger multilocular lesions. The high recurrence rate is conceivably mediated by the multilocular nature, and the tendency of the thin epithelial lining to separate from the underlying connective tissue capsule; thus, making the removal difficult at the time of surgery. Most cases that recur are treated conservatively by enucleation and curettage. Long-term clinical and radiological surveillance is the mainstay of patient follow-up.
C. Central giant cell granuloma (CGCG) Incorrect — an excellent guess except for the histology! Central giant cell granuloma (CGCG) is not considered to be a true neoplasm, but a result of a local reparative reaction. Some lesions demonstrate aggressive behavior like that of a true neoplasm. Just as in the present case, these lesions most often are seen in females under 30 years of age. About 70% of cases occur in the mandible where they are common in the anterior parts and frequently cross the midline, which was almost a near-perfect match with the present case. Radiographically, CGCG may present as unilocular or multilocular radiolucency. Multilocular lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. In most cases, the lesion presents as a painless, slow-growing swelling of the jaw. A helpful feature in identifying CGCG is the presence of a bluish-brown hue, which is perceived on viewing the overlying mucosa in most cases, especially when the lesion tends to perforate the cortical bone. In contrast, this patient did not present with these features. The most notable microscopic feature of the CGCG is the presence of few to abundant multinucleated giant cells in a background of highly cellular fibrous stroma that is composed mainly of
FLORIDADENTAL.ORG
ovoid to spindle-shaped mesenchymal cells. Hemorrhagic areas, hemosiderin, and a highly vascular stroma with few sporadic mitotic figures also are histological features seen in CGCG. These microscopic features were not seen in this patient’s biopsy. Surgical curettage is the most commonly applied therapy in CGCG. Other alternative treatment modalities such as corticosteroid injections, or salmon calcitonin, and usage of interferon-alpha also have been widely reported with varying degrees of success.
D. Odontogenic keratocyst Incorrect — good thought! An odontogenic keratocyst (OKC) is a developmental odontogenic cyst with specific histopathologic features, which differs significantly from the present case. The most crucial distinction is the presence of distinctive cystic lining epithelium. OKCs also exhibit distinct clinical behavior. Several authors believe that these cysts should be classified as benign cystic neoplasms due to their aggressive biologic behavior and different growth mechanism. OKCs arise from the proliferation of post-functional epithelial dental lamina. Majority of OKCs are seen in the second to third decades of life, with at least 25-40% of the cases being associated with an unerupted or impacted tooth, mostly a mandibular third molar. Unlike our case, the ramus and posterior body of the mandible are involved in 60-80% of the cases. However, they can occur in the anterior mandible where they often mimic the radiographic features of the radicular or lateral periodontal cyst. Crucially, OKC tends to grow in an anterior-posterior direction without causing noticeable bone expansion within the medullary cavity of the bone. Even when they are quite large, they rarely show the degree of expansion seen in this case. OKCs also rarely cause root resorption with only a subtle displacement of teeth even though they may tend to grow to a considerable size. Larger lesions of the mandible typically appear multilocular or with a “soap-bubble” appearance. The diagnosis of OKC is based on the histopathologic features alone since the radiographic features may mimic many other entities, such as dentigerous cyst and ameloblastoma. OKCs typically show a thin, friable wall with keratinized epithelial lining. Characteristically, the basal epithelial layer exhibits a palisaded layer of cuboidal or columnar epithelial cells with hyperchromatic nuclei. These microscopic features were not present in our case (Fig. 3). OKCs have a high recurrence rate close to 30-60%. The recurrence is attributed to incomplete removal of the satellite microscopic cysts in the connective tissue wall of the OKC or the friable lining that tends to fragment and remain within the bone during/postenucleation attempt. FLORIDADENTAL.ORG
E. Odontognic myxoma Correct! Odontogenic myxoma (OM) is a rare, benign, aggressive intraosseous tumor that arises from the odontogenic ectomesenchyme. OM represents less than 10% of all odontogenic tumors. It’s most common among younger adults, affecting females slightly more than males. The tumor frequently affects the mandible more than maxilla with no specific site of preference and may be associated with an unerupted tooth. Clinical presentation may vary from a small asymptomatic lesion discovered on routine radiographic examination to largely expansile lesions. The painless nature of the growth often results in delayed diagnoses until it reaches considerable size. OM may present radiographically as unilocular or multilocular radiolucency with scalloped margins and can cause tooth displacement or root resorption as in the present case. The characteristic radiographic feature is the presence of thin, wispy trabeculae of residual bone sometimes arranged perpendicular to one another and a “soap-bubble” appearance. This radiographic feature also can be seen in ameloblastoma. Gross examination shows a gelatinous loose mass with no form or shape, as seen in Fig. 2. Microscopically, the tumor is composed of haphazardly arranged stellate, spindle-shaped and round cells distributed within an abundant, loose myxoid stroma that contains only a few collagen fibrils. Moreover, small islands of inactive-appearing odontogenic epithelial rests may be scattered throughout the myxoid or mucoid ground substance, but their presence is not crucial for diagnosis. In cases where there is a more significant collagen component, the tumor is recognized as fibromyxomas or myxofibromas. Importantly, odontogenic tissue such as normal follicular tissue or enlarged dental follicles as well as the developing dental papilla, which has the immature mesenchymal tissue is commonly mistaken histopathologically for OM. This misconception can be resolved by evaluating the radiographic features. There is no standardized protocol for diagnosis and management. Small OM is generally treated conservatively by enucleation or curettage. However, careful periodic reevaluation is necessary for at least five years. For larger lesions, more extensive resection with 1 cm clear margins from the radiographic delineation is required. Radiotherapy is never the treatment of choice since this lesion is radioresistant. OM has an approximate recurrence rate of around 25% that is supported by various studies. Some authors suggest that this
SEE PAGE 90 TODAY'S FDA NOVEMBER/DECEMBER 2019
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diagnostics
FROM PAGE 89
Diagnostic Discussion is contributed by UFCD professors, Drs. Indraneel Bhattacharyya, Don Cohen and Nadim Islam who provide insight and feedback on common, important, new and challenging oral diseases.
is attributed to the non-encapsulated nature of the tumor and its high tendency to infiltrate the surrounding bone. However, this high recurrence rate also may be a result of incomplete excision and may not necessarily be attributed to the biological behavior of this tumor.
References:
The dental professors operate a large,
Adeel M, Rajput MSA, Arain AA, Baloch M, Khan M. Ameloblastoma: Management and Outcome. Cureus. 2018;10(10):18.
DR. BHATTACHARYYA multi-state biopsy service. The column’s
case studies originate from the more than 12,000 specimens the service receives every year from all over the United States.
De Lange J, van den Akker HP, van den Berg H. Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2007;104(5):603-615. Effiom OA, Ogundana OM, Akinshipo AO, Akintoye SO. Ameloblastoma: current etiopathological concepts and management. Oral Dis. 2018;24(3):307-316. Francisco ALN, Chulam TC, Silva FO, et al. Clinicopathologic analysis of 14 cases of odontogenic myxoma and review of the literature. J Clin Exp Dent. 2017;9(4):e560-e563. Kaplan, I., G. Gal, Y. Anavi, R. Manor & S. Calderon (2005) Glandular odontogenic cyst: treatment and recurrence. J Oral Maxillofac Surg, 63, 435-41. Kauke M, Safi AF, Kreppel M, et al. Size distribution and clinicoradiological signs of aggressiveness in odontogenic myxoma-three-dimensional analysis and systematic review. Dentomaxillofacial Radiol. 2018;47(2):3-5. Neville, B.W., Damm, D.D., Allen, C.M. and Chi, A.C. (2016) Oral & Maxillofacial Pathology. 4th Edition, WB Saunders, Elsevier. Pazdera J, Kolar Z, Zboril V, Tvrdy P, Pink R. Odontogenic keratocysts/keratocystic odontogenic tumours: Biological characteristics, clinical manifestation and treatment. Biomed Pap. 2014;158(2):170-174.
Clinicians are invited to submit cases from their own practices. Cases may be used in the “Diagnostic Discussion,” with credit given to the submitter. DR. COHEN
Drs. Bhattacharyya, Cohen and Islam, can be reached at oralpath@dental.ufl.edu. Conflict of Interest Disclosure: None reported for Drs. Bhattacharyya, Cohen and Islam.
The Florida Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental DR. ISLAM Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/ goto/cerp. *Second-year resident in oral and maxillofacial pathology at the University of Florida College of Dentistry.
Shah, A. A., A. Sangle, S. Bussari & A. V. Koshy. 2016. Glandular odontogenic cyst: A diagnostic dilemma. In Indian J Dent, 38-43.
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SELECTIVELY EQUILIBRATING THE HARD OCCLUSAL GUARD JOHN R. ANTONELLI, DDS, MS
The hard occlusal guard is believed to play an important role in treating temporomandibular disorders, especially when myofascial pain is pronounced.1-6 Also, occlusal guards are useful for treating nocturnal bruxism and clenching in adults and children, and the ravages of occlusal-incisal attrition with which it often coexists.6,7 A properly constructed appliance: (1) enables condyles to seat in their most anterior-superior positions (centric relation [CR]) in the glenoid fossae); (2) provides canine guidance; (3) provides simultaneous and even incisal and posterior point contacts with the opposing functional cusps; and, (4) eliminates all posterior contact in excursive movements. The guard should have a smooth occlusal surface that will not provide any occlusal indentations into which opposing teeth can lock and effect heavy lateral or thrusting forces. Dawson refers to appliances so designed as “permissive.”8 The smooth occlusal surface of the permissive guard eliminates sensory feedback from interfering tooth contacts, which allows elevator muscles to move the mandible so that the condyles can slide posteriorly and up the slopes of the eminentiae for completed seating in CR. With healthy condyles that can accept occlusal loading, a permissive occlusal guard that enables the condyles to seat during clenching should eliminate lateral pterygoid muscle resistance to the masseter and temporalis muscles and afford relief from myofascial pain. For this reason, permissive occlusal guards are also known as “muscle deprogrammers.” Occlusal guards should be made of highly polished, heat-polymerized acrylic resin. Maxillary guards might be better tolerated, more stable, avoid crowding of the tongue and achieve occlusal contact with opposing teeth regardless of the patient’s
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Fig. 1: Mandibular and maxillary guards seem to be equally effective in reseating the condyles in CR and treating muscle pain disorders. In this anterior open bite case, anterior guidance is limited to the canines.
maxillomandibular relationship. It could be difficult to achieve proper anterior contact and incisal guidance with a mandibular guard in patients with Class II and III maxillomandibular relationships (Fig. 1).
Intraoral Equilibration of the Processed Occlusal Guard The efficacy of therapy with an occlusal guard — i.e., how effectively it functions to relax the elevator muscles (masseter, temporalis, medial pterygoid and superior belly of the lateral pterygoid) — depends on how accurately it is equilibrated and on the level of patient cooperation. Many dental students and some practitioners are uncertain about how to equilibrate (eliminate harmful occlusal interferences) an occlusal guard after initial seating in the patient’s mouth. The following suggestions should help to selectively, rather than haphazardly, eliminate harmful occlusal interferences on the guard and, subsequently, to bump up the success rate with use of this appliance: 1. With the maxillary occlusal guard seated and fitted comfortably in the patient’s mouth (i.e., adequately retentive without rocking; lip and tongue movements are not unseating the FLORIDADENTAL.ORG
guard), recline the patient to simulate the sleeping posture. Gravitational forces will likely encourage a slight posterior repositioning of the mandible. Use bimanual manipulation to ensure placement of the condyles in their anterior-superior position. Rehearse the patient by instructing him/her to slide the mandible into protrusive, and right and left laterotrusive excursions. This should help to ensure accurate registration of occlusal contacts on the flat occlusal surfaces of the guard. After the patient is sufficiently rehearsed and can reproduce the necessary mandibular excursions correctly, ask the dental assistant to grasp thin, red/blue articulating ribbon with a Miller forceps and place the ribbon intraorally over occluding surfaces of all opposing teeth. Register all mandibular CR functional cusp tip and incisal edge contacts with the blue side of the ribbon facing acrylic. If contacts are detected mostly on one side of the arch, then flatten areas of heavy or premature occlusal contacts until solid, blue CR contacts are registered bilaterally on the posterior surfaces of the guard (Fig. 2). A pear-shaped laboratory acrylic finishing bur (the Komet H77E-029 [Komet USA LLC, Rock Hill, SC]) is recommended to eliminate CR prematurities and deflective contacts produced by all mandibular excursions until each CR functional cusp has uniform, equal-intensity contacts against the smooth guard surface and each contact is registered by a relatively even diameter blue mark.
Fig. 2: Bilateral, even diameter, blue CR contacts may be seen on the smooth surfaces of the occlusal guard.
Fig. 3: Protrusive interfering contacts extend anterior/forward of the blue CR dots. A laterotrusive (working) contact extends laterally from the blue CR contact.
2. Identify anterior protrusive sliding contacts with the red side of the articulating ribbon. With the same red side, identify and eliminate posterior interfering contacts that occur during protrusion — these protrusive markings extend anteriorly from the blue CR dots. As interfering posterior protrusive contacts are eliminated, make every effort to preserve all blue CR dots (Fig. 3). Observe the anterior sliding contacts on the guard made by mandibular canines and incisors during protrusive movement — these contacts should be preserved (Fig. 4). 3. Ask the patient to move the mandible laterally and register left and right canine guidance with the red side of the ribbon. The acrylic prominences built into the guard in the canine areas should be angulated approximately 30-45 degrees to the occlusal plane; they should allow the mandibular canines to disclude posterior teeth during these laterotrusive movements. Next, place the red side of the ribbon over right and left posterior areas of the appliance and ask the patient to move the mandible laterally once again; movements must be smooth as all posterior teeth should disclude because of the canine FLORIDADENTAL.ORG
Fig. 4: Note the anterior protrusive sliding contacts (P) made by mandibular canines. In this case, some malposed mandibular anterior teeth did not contact the guard during protrusive excursion; therefore, not all sliding contacts were recorded.
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incisors and place protrusive guidance only on the mandibular canines. This should ensure that anterior teeth would not be traumatized by any particular jaw movement, especially when only one mandibular incisor bears the entire force of the protrusive excursion. 4. Equilibration of the occlusal guard should avoid spot grinding that produces indentations or “pot holes,” which provide resistance to opposing cusps that could trigger an increase in muscle activity. Planar grinding is preferred to eliminate any occlusal indentations in the guard. Adjust broad anterior contacts (see Fig. 6) until they are lighter than posterior contacts (see Fig. 4).
Fig. 5: Note the laterotrusive (LT) and anterior protrusive sliding contacts (P) made by mandibular canines. Arrows point to two laterotrusive contacts (located in the premolar area, lateral to the blue CR contacts), which should be selectively eliminated.
5. Upon completing all adjustments in the guard with the patient reclined, raise the patient to the upright head position. Reevaluate all occlusal contacts to account for any reshifting of the mandibular arc of closure that could produce anterior contacts that are heavier than those in the posterior regions. At this point, Okeson9 recommends specifically instructing the patient to tap lightly on the posterior teeth. Readjust any anterior contacts that are heavier than the posterior contacts. Check again to ensure that all working and non-working interferences have been eliminated (Fig. 7). 6. Add autopolymerizing acrylic resin to the occluding surfaces of the appliance to replace/augment any areas where occlusal contacts are absent or deficient; direct the patient to occlude while the resin is in the initial (rubbery) stage of polymerization. Rinse the appliance with water before reseating it in the patient’s mouth. Do not polish areas on the guard where contacts were adjusted — polishing could result in the loss of contacts. The minor roughness produced by the fluted laboratory carbide bur will not harm opposing enamel, nor will it generate any discomfort for the patient. The following design features should be incorporated in an occlusal guard:
Fig. 6: Both anterior sliding contacts (see arrows), forward of the blue CR dots, are excessively wide. Selectively adjust their widths narrower (as in Fig. 4) without eliminating them altogether and without eliminating the blue CR dots.
1. All opposing mandibular functional (buccal) cusp tips should contact simultaneously and evenly on the guard in CR. In CR, as many incisal edges as possible should contact the guard.
prominences in the guard (Fig. 5). Eliminate any posterior laterotrusive (working) and mediotrusive (non-working) red contacts on both sides of the guard (Fig. 3); preserve all blue CR contacts (Fig. 6). The only remaining laterotrusive contact markings that should be preserved on the guard are those made by mandibular canines. In addition, it is desirable to eliminate all eccentric contacts made by mandibular
2. The guard should ensure immediate disclusion of all posterior teeth in all excursive movements; the only laterotrusive contacts that should be present are those of canines contacting evenly during canine-guided movements (Fig. 8). Mandibular canines and as many mandibular incisors as possible should contact during protrusive movement for incisal guidance.
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3. The occlusal guard should have a shallow anterior ramp to ensure incisal guidance. 4. The occlusal guard should be stable (i.e., not move) during CR closure and all eccentric movements.
Discussion Arturo Manns et al. studied electromyographic (EMG) activity when the masseter muscles clenched.10 They quantified muscle activity when patients clenched on natural teeth and then compared to muscle activity when the same patients clenched on occlusal guards. They observed increased muscle activity when patients clenched on an occlusal guard. When the design of the guard was altered to permit contact on only six anterior teeth, muscle activity decreased by 40%. When premolars and incisors were permitted to contact, they noted a 20% decrease in maximum bite force. Maximum muscle activity was recorded when only the molars were permitted to contact. A properly constructed occlusal guard manages bite forces by loading the temporomandibular joints with all teeth touching simultaneously. The study determined that muscle activity and joint health are dependent on posterior tooth contacts and anterior guidance functioning to prevent posterior tooth contacts during excursive movements of the mandible. Reducing posterior tooth contact will reduce muscle activity. Earlier, Manns et al. studied how excursive contacts affect muscle activity.11 They compared EMG activity in patients exhibiting canine guidance with those displaying group function. They discovered that during laterotrusive and mediotrusive movements, both the masseter and temporalis muscles work half as much in canine guidance as in group function. The authors attributed this to a decrease in contacts among posterior teeth during canine guidance. (The decrease in EMG activity among the elevator muscles resulted from the elimination of posterior contacts and not the contact of canines.4) This constitutes an overwhelming case for designing canine guidance in occlusal guards for patients with myofascial pain. When the design features listed previously are incorporated in the occlusal guard, the temporalis and masseter muscles release their contractions (i.e., become more relaxed) and, therefore, are unable to exert the magnitude of harmful force as when posterior interferences are present.4 Soft occlusal guards are not recommended, as they tend to produce an increase in masseter muscle activity during maximum clenching. On the other hand, properly equilibrated hard occlusal guards decrease EMG activity in both masseter and temporalis muscles.
Fig. 7: Left. Two non-working interfering contacts (extending from the blue CR dots to the midline); Right. Two working contacts (extending laterally from the blue CR dots). Eliminate working and non-working interferences when detected.
Fig. 8: Selective grinding should preserve anterior protrusive sliding contacts (as many as possible), laterotrusive (canineguided) contacts, and light functional cusp CR contacts. Eliminate all posterior laterotrusive, mediotrusive and protrusive sliding contacts.
References 1. Hak-Kong Yip K. “Rehabilitating a patient with bruxism-associated tooth tissue loss: A literature review and case report. Gen Dent 2003;51(1):70-73. 2. Al Quran FAM, Lyons MF. “The immediate effect of hard and soft splints on the EMG activity of the masseter and temporalis muscles. J Oral Rehabil 1999;26:559-563. 3. Okeson JP. “The effect of hard and soft occlusal splints on nocturnal bruxism.” JADA 1987;114:788-791. 4. Williamson EH, Lundquist DO. “Anterior guidance: Its effect on electromyographic activity of the temporal and masseter muscles.” J Prosthet Dent 1983;49(6):816-823. 5. Attanasio R. “Bruxism and Intraoral Orthotics.” Texas Dent J 2000;117(7):82-87. 6. Solberg WK, Clark GT and Rugh JD. “Nocturnal electromyographic evaluation of bruxism patients undergoing short term splint therapy.” J Oral Rehab 1975;2:215-223. 7. Hachmann A, Martins EA, Araujo FB and Nunes R. “Efficacy of the nocturnal bite plate in the control of bruxism for 3-5-year-old children.” J Clin Pediat Dent 1999;24(1):9-15. 8. Dawson PE. Occlusal Splints. In: Functional Occlusion from TMJ to Smile Design, St. Louis, MO: Elsevier Mosby.; 2007:380-382 9. Okeson JP. Occlusal Appliance Therapy. In: Management of Temporomandibular Disorders and Occlusion, St. Louis, MO: Elsevier Mosby.; 7th ed. 2013;375-398. 10. Manns A, Miralles R, Valdivia J and Bull R. “Influence of variation in anteroposterior occlusal contacts on electromyographic activity.” J Prosthet Dent 1989;61(5):617-623. 11. Manns A, Chan C and Miralles R. “Influence of group function and canine guidance on electromyographic activity of elevator muscles.” J Prosthet Dent 1987;57(4):494-501
abstract
RECOMMENDATIONS FOR DENTAL PROFESSIONALS ABOUT HPV VACCINE PROMOTION ABDULAZIZ HAKEEM BDS,1 AND FRANK A. CATALANOTTO, DMD2
Introduction Oropharyngeal cancers (OPCs) have been linked to strains of high-risk human papillomavirus infections (HPV) (Auluck et al., 2010). The purpose of this abstract is to review recent updates on the spread of HPV and the increase of oral cancer, as well as the potential roles of dental professionals in the prevention of HPV and oral cancers.
Methods This abstract review covers a wide range of subjects from HPV infection, oral cancer prevalence and risk factors, to recent recommendations about dental professionals’ role in prevention. We searched databases for sources from 20102019. For these articles, inclusion and exclusion criteria were applied, which resulted in the selection of 42 papers
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relevant to the issue. Inclusion criteria were articles related to oral cancer prevalence (epidemiology), HPV, the role of dental professionals, risky sexual practices, HPV vaccine, barriers and recommendations. For exclusion criteria, articles that were completed outside the United States and Canada, in languages other than English or were only partially available were avoided. Additionally, technical articles and articles that precede more recent ones on the same topic were eliminated.
Discussions One of the things discussed in this literature review was the changing prevalence of oral cancer in the U.S. (according to Feller, Wood, Khammissa and Lemmer, 2010). This cancer usually occurred in lingual and palatine tonsils in younger men. The Centers for Disease Control and Prevention (CDC) reported prevalence according to gender and overall race rate (18,225 per 100,000 persons), female (3,412 per 100,000 persons) and male (14,814 per 100,000 persons), FLORIDADENTAL.ORG
where age prevalence is 62 years in women and 61 years in men (Division of Cancer Prevention and Control, 2018). Another topic which was discussed is the link between OPCs and HPV (Tam et al., 2018). The incidence rate was 4.38 cases per 1,000 person-months, which exhibits a lower occurrence in the oral cavity compared to genitalia and cervices in healthy candidates. Prevention: Vaccination would lead to decreased prevalence. The role of dental professionals in counseling can lead to the increase of secondary acceptance. Barriers as follows: Patients between the ages of 13-17 were vaccinated more often than those ages 9-12. Younger males from racial minorities received less attention regarding HPV vaccination. One barrier is that this is a sensitive topic for patients. Providers influence the HPV vaccination decision; however, they often perceived parents to be hesitant, due to a low comfort level when discussing risky sexual behaviors. There are mixed results on the providers’ roles in HPV vaccination; providers are less likely to talk about vaccination during an acute visit. They need a different set of skills to facilitate this role. One of the most frequent barriers is a financial burden. There is a negative perception of vaccines, which is contributed to by the lack of participation of providers in this topic with their patients.
Recommendations Based on this assessment, the function of dentists in preventing HPV infection and an increase in rates of oral cancer should be stronger and more proactive. Based on literature reviewed and including the documents, our recommendation is: Gilkey & McRee, 2016; Griner et al., 2019; Malo etal., 2016; McCave, 2010; Vazquez-Otero et al., 2018; Walker et coll., 2019. It is essential to increase understanding of the problem from exact sources because it may assist to eliminate incorrect information and promote a good approach to the HPV vaccine. Understanding of several variables, such as the era of patients and the layout of a hospital, which influence many characteristics, such as privacy requirements, as patients are unable to communicate data in public. Important emphasis on dentistry communication skills is a main factor, as many dental experts reported being uneasy speaking about dangerous patient sexual behaviour. The private convictions of patients are another significant factor, as a favorable perspective of the HPV vaccine can strongly impact the choice to receive the vaccine. FLORIDADENTAL.ORG
The HPV vaccine and dangerous sexual conduct must be discussed comfortably by providers. They also need to provide adequate and clear data in the complicated communications of the HPV vaccine. Finally, cancer prevention should be heavily underlined, awareness raised and CDC suggestions adhered to, as they may change the future of enhanced HPV OPC incidence.
References Auluck, A., Hislop, G., Bajdik, C., Poh, C., Zhang, L., & Rosin, M. (2010). Trends in oropharyngeal and oral cavity cancer incidence of human papillomavirus (HPV)-related and HPV-unrelated sites in a multicultural population: the British Columbia experience. Cancer, 116(11), 2635-2644. doi:10.1002/cncr.25087 Feller, L., Wood, N. H., Khammissa, R. A., & Lemmer, J. (2010). Human papillomavirus-mediated carcinogenesis and HPV-associated oral and oropharyngeal squamous cell carcinoma. Part 2: Human papillomavirus associated oral and oropharyngeal squamous cell carcinoma. Head Face Med, 6, 15. doi:10.1186/1746-160x-6-15 Gilkey, M. B., & McRee, A. L. (2016). Provider communication about HPV vaccination: A systematic review. Hum Vaccin Immunother, 12(6), 14541468. doi:10.1080/21645515.2015.1129090 Griner, S. B., Thompson, E. L., Vamos, C. A., Chaturvedi, A. K., VazquezOtero, C., Merrell, L. K., Daley, E. M. (2019). Dental opinion leaders’ perspectives on barriers and facilitators to HPV-related prevention. Hum Vaccin Immunother, 1-7. doi:10.1080/21645515.2019.1565261 Malo, T. L., Ali, K. N., Sutton, S. K., Perkins, R. B., Giuliano, A. R., & Vadaparampil, S. T. (2016). The content and context of physicians’ communication with males about human papillomavirus vaccination. Hum Vaccin Immunother, 12(6), 1511-1518. doi:10.1080/21645515.2015.1132963 McCave, E. L. (2010). Influential factors in HPV vaccination uptake among providers in four states. J Community Health, 35(6), 645-652. doi:10.1007/s10900-010-9255-4 Tam, S., Fu, S., Xu, L., Krause, K. J., Lairson, D. R., Miao, H., Dahlstrom, K. R. (2018). The epidemiology of oral human papillomavirus infection in healthy populations: A systematic review and meta-analysis. Oral Oncol, 82, 91-99. doi:10.1016/j.oraloncology.2018.04.005 Vázquez-Otero, C., Vamos, C. A., Thompson, E. L., Merrell, L. K., Griner, S. B., Kline, N. S., Daley, E. M. (2018). Assessing dentists’ human papillomaviruserelated health literacy for oropharyngeal cancer prevention. Journal of the American Dental Association (JADA), 149(1), 9-17. doi:10.1016/j. adaj.2017.08.021 Walker, K. K., Jackson, R. D., Sommariva, S., Neelamegam, M., & Desch, J. (2019). USA dental health providers’ role in HPV vaccine communication and HPV-OPC protection: a systematic review. Hum Vaccin Immunother. doi:10.1080/21645515.2018.1558690
1. University of Florida Department of Epidemiology College of Public Health and Health Professions and College of Medicine. Dr. Hakeem can be reached at AHakeem@dental.ufl.edu. 2. University of Florida College of Dentistry Department of Community Dentistry and Behavioral Science. Dr. Catalanotto can be reached at FCatalanotto@dental.ufl.edu.
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single-tooth dentistry
CONFESSION: I LOVE TO DO SINGLE-TOOTH DENTISTRY I love to do single tooth dentistry. There, I said it! Now that I’m bearing my soul to you, I also should confess that I love to do posterior composites. I get excited when I have a new patient exam and the patient needs operative. And when I see a couple of fillings on the schedule, I get tingly inside.
DR. JOHN GAMMICHIA
Dr. Gammichia is a general dentist in Apopka and can be reached at jgammichia@aol.com.
Sure, I do all the big stuff, too. I’m part of a Spear Study Club with some fantastic dentists. I love this group of people who make me a better dentist every time we meet. We talk about a philosophy of dentistry that I really believe in, but only get to execute four or five times a year. Rarely do we get to talk about the “bread and butter” of dentistry — the single tooth. Yes, the CAD/CAM technology is exciting. Yes, digital dentistry can be revolutionary, but enough already. It’s in your face all the time. It’s on the cover of every magazine. It’s the lead lecture at all the meetings. Even the mail is full of digital this and digital that. The dentists who have this technology have their own clubs and forums and organizations. The digital dentistry revolution is like a locomotive coming at me. And I feel that I have a choice, either jump on this train or get run over. Now don’t get me wrong, I think this stuff is quite exciting and I am not downplaying how good it is. It’s just not for me right now. You know what is just as exciting to me? “Old school dentistry,” and, I get to do it every day. I don’t want to feel like I’m on an island because I’m not progressing at the speed of light. I don’t want to feel less because I love where I’m at right now. Am I alone in this? I don’t think so. Maybe dentists who do family general dentistry are kind of a silent majority. We just go to work, do great dentistry, have great relationships with our patients, go home and repeat. To some this sounds boring, to me it sounds amazing. Let me show you how doing tons of fillings can be exciting, amazing and fulfilling. First, I want to break down the barriers — I know what you are thinking: “Fillings are boring” and “I can’t make a living doing a bunch of fillings.” Well, the way I do fillings is not boring and I can attest to you, being conservative in your treatment plans can afford you a pretty good living.
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I numbed him up and we began the amalgam removal. Now that the amalgam is gone and the teeth are cleaned up, it doesn’t look that bad.
Fig. 1
3:09 p.m.
So, let me tell you a story of Mr. David. Mr. David is 79 and he had a couple of broken-down teeth. He is a missionary and, of course, money is an object. He came to me for a second opinion; another dentist told him he needed two crowns and it would be close to $3,000. (Don’t get me started on the issue of over-treatment in our profession.)
Fig. 3
3:22 p.m.
I used the tools and the techniques that we’ve perfected over the last couple of decades and just fill them up.
This is where I love owning my practice. I don’t need to answer to anyone. Yes, #12 needs an onlay or crown, but he is 79 years old and doesn’t have the money for “ideal.” I can improvise. I told him that I can restore his teeth with a couple of composite fillings, and he will be good as new in less than an hour. He said, “Let’s do it.” Now I want to get on my soapbox for a second. If all you know how to do is crowns and a big filling is not part of your repertoire, in my opinion, you’re doing a tremendous disservice to your patients. A big filling must be part of what you offer. I do this all the time and they last — I have 10-20-year post-ops that will prove it to you.
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Fig. 5
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FROM PAGE 99
I know another obstacle is that you might think that doing this kind of work could take too long. I took these photos with my iPhone and on the top of the photos is the time the photo was taken. After looking at the times, it seems that from the first photo to the last, it took me 33 minutes to do this. Yes, just a little more than a half an hour! I know if you don’t do this often then it might take you a bit longer. But the more you do it, the faster you become. Remember the barriers we talked about — that fillings are boring? Au contraire, mon frère. These fillings are anything but boring. Pretty exciting, don’t you think? And the money thing? I charged him for a three-surface posterior resin and a four-surface posterior composite. So, let’s do the math. I am assuming that most of us charge about the same for a couple of large restorations, within $50-75. We might charge somewhere in the neighborhood of $550-750, depending on our expertise, for two beautiful, conservative composite restorations in a little more than half an hour. That is a pretty good hourly production. The bonus is there’s almost no overhead. No fancy machines, no lab costs.
single-tooth dentistry With composites there is no follow-up appointments, no cementation appointments ... just raving fans. Speaking of a raving fan, Mr. David thinks our office was kind, understanding and took care of his problem relatively inexpensively and with excellence. This guy is going to be singing our praises all over this small town. Then the next thing you know, you have a thriving family practice full of patients who love you and tell all their friends. It’s simple. Like I said, single-tooth dentistry can be exciting. I love making “bread and butter” more like “filet and lobster.” You don’t need fancy equipment. You don’t need a group of dentists to discuss the different modes of treatment. You don’t need to lose sleep the night before the treatment starts. You already have everything you need. Oh, and remember that train mentioned earlier? Don’t worry about not jumping on this one, there will be another train coming around in the next 20 minutes or so.
American Sensor Tech ADS Chris Brown
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career center The FDA’s online Career Center allows you to conveniently browse, place, modify and pay for your ads online, 24 hours a day. Our intent is to provide our advertisers with increased flexibility and enhanced options to personalize and draw attention to your online classified ads! Post an ad on the FDA Career Center and it will be published in our journal, Today’s FDA, at no additional cost! Today’s FDA is bimonthly; therefore the basic text of all active ads will be extracted from the Career Center on roughly the 10th of every other month (e.g., Jan. 10 for the Jan/Feb issue, March 10 for the March/April issue, etc). Please note: Ads for the Nov/Dec issue must be received no later than Nov. 1. Please visit the FDA’s Career Center at careers.floridadental.org. Dentist. Provides and supervises the complete dental care of facility detainees/inmates. Evaluates and seeks improvement in the facility dental health program, dental services provided, patient care required/administered, dental operative conditions and equipment in use. Functions as a consultant to the facility staff physician. Primary Duties and Responsibilities: Initiates and maintains compliance with company policies for accreditation. Performs routine cleaning, drilling, filling, and extraction of teeth in accordance with National Commission for Correctional Health Care Standards for dental care. Educates patients on maintaining proper oral health. Teaches patients about diet, flossing, use of fluoride, and other aspects of dental care. Prescribes medications as necessary. Formulates and create treatment plans on an individual basis after a thorough exam. Completes an initial dental screening on all new commitments within seven (7) days. Evaluates those patients needing or applying for dental care and makes whatever recommendations deemed clinically appropriate. Takes impressions for dental plates. Sends prostheses to outside dental labs. Documents all services rendered in the patient dental health record. Monitors need for dental supplies and equipment. Provides in-service training for health staff members on appropriate issues, such as dental hygiene, dental care, dental emergencies, and techniques. Supervises the work of professional, technical and administrative staff. Provides input into performance evaluation. Performs other duties as assigned. Minimum Requirements. Degree in dentistry from an accredited dental school required. Licensed to practice as a registered dentist in the state of Florida. Professional license must remain on file at all times at the facility where services are rendered. Equal Opportunity Employer. NOTES: Additional Salary Information: Competitive Salary, Full Benefits Package, Malpractice Insurance Coverage. mdobos@geogroup.com. Oral Surgeon – Melbourne. You’ve invested the time to become a great oral surgeon. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an oral surgeon supported by Pacific Dental Services®, you can rely on a great number of referrals, as you will be providing owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an oral surgeon to have a career that will serve you for a lifetime. As a PDS®-supported oral surgeon, you will have a balanced lifestyle, fantastic income opportunities and you’ll work for offices that care about people, patients and their communities. You won’t have to spend your time navigating practice administration and instead, you’ll focus on your patients and your well-being. The Future: As an oral surgeon supported by PDS, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue to provide clinical excellence in the future. Apply Today. Apply now or contact
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a recruiter anytime, we’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2oymjTJ. Oral Surgeon – Orlando. You’ve invested the time to become a great oral surgeon. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an oral surgeon supported by Pacific Dental Services®, you can rely on a great number of referrals, as you will be providing owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an oral surgeon to have a career that will serve you for a lifetime. As a PDS®-supported oral surgeon, you will have a balanced lifestyle, fantastic income opportunities and you’ll work for offices that care about people, patients and their communities. You won’t have to spend your time navigating practice administration and instead, you’ll focus on your patients and your well-being. The Future: As an oral surgeon supported by PDS, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue to provide clinical excellence in the future. Apply Today. Apply now or contact a recruiter anytime, we’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2Jy2nrx. General Dentist - Gainesville, Florida (Full/Part Time). If you’re looking to make your professional mark on a community and help continue to lead a well-established and successful dental practice, this is your chance. Build valuable relationships with your patients and be involved with the greater community of Gainesville, FL while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success. You’ll enjoy the following: Base salary with performance incentives to earn more. Sign-on bonus of $5,000. Full time and part time benefits package. Family friendly days/hours. Full-service center to support you in your mission for providing great care: Marketing, Revenue Cycle, IT, Human Resources, Accounting, Call Center and Leadership Teams. Equal Opportunity Employer/Drug Free Workplace. www.puredentalbrands.com. #WeHaveWhatMakesYouSmile #LoveWhereYouWork. Candidate must be licensed to practice in the State of Florida with no board reprimands or issues
NOVEMBER/DECEMBER 2019
and have a valid DEA license and be up to date on all required CE. Prefer experienced General Dentist with additional skills in molar endodontics, oral surgery and placement/restoration of implants. NOTES: Employer will assist with relocation costs. Additional Salary Information: Opportunities to earn more based on production. bradcabibi@puredentalbrands.com. Dental Assistant – Naples. Overview: Responsibilities: Perform functions in accordance with the applicable state’s Dental Auxiliaries Table of Permitted Duties. Actively participate in the Perfect Patient Experience by striving to keep your patients focused on optimal treatment while attending to their individual needs and concerns. Escort patients to/from the front desk and introduce them to other team members as appropriate. Maintain a clean, sterile, and cheerful environment. Record patient charting and all of the dentist’s notes in the digital patient chart as directed by the dentist. Maintain strict compliance with State, Federal, and other regulations, (e.g., OSHA, WC, Dental Board, HIPAA, ADA, DOL, HR policies and practices). Qualifications: Necessary industry certifications and education. Possess outstanding time management, communication, and technical skills. Can-do attitude, a proactive nature, a strong sense of ownership and integrity and a desire to continue to learn and grow. Demonstrate knowledge of dental terminology, instruments and equipment. Benefits: Medical, dental and vision insurance; Continuing Education (CE Units); Paid time off; Tuition Reimbursement; Child care assistance; 401K; Paid time to volunteer in your local community. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2Wxr2l3. General Dentist – Royal Palm Beach. Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 - $390,000. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2NtuysJ.
FLORIDADENTAL.ORG
Dental Assistant- Certified. POSITION SUMMARY: The certified Dental Assistant is responsible for assisting dental providers in the delivery of care including but not limited to pediatric dental procedures, assisting in the operating room dental procedures, oral surgery, orthodontics, periodontics, and endodontics. Provide routine care and support to the patients and families. Maintain exam rooms, equipment, and supplies to ensure safe delivery of care to patients. KEY ACCOUNTABILITIES: Assists with patient triage and documentation by completing electronic dental record entries. Assists dentists with procedures by preparing supplies and equipment for the patient visit. Obtains effective dental x-rays following proper patient placement, policies, and procedures. Ability to polish crowns, place sealants in children, and work with nitrous oxide. Cleans and sterilizes dental equipment and instruments. Maintains the patient care areas by disposing of waste and stocking supplies. Monitors, cleans, and arranges for repair as needed of dental equipment/furniture. Provide dental education to patients and families. Upholds and models the mission, vision, and values of JHACH. Protects patients, family members, and employees by adhering to infection control policies and procedures. QUALIFICATIONS: Certification from a Florida Board of Dentistry or Commission of Dental Accreditation (CODA) approved Dental Assistant program or a DANB Certified Dental Assistant (CDA) certification (grandfathered in prior to May 2009) required. State Certified in Dental Radiation Technology by Florida Department of Health (FDOH). Current state licensure required. Completion of training course of no less than two days in duration as described in the American Dental Association’s “Guidelines for Teaching and Comprehensive Control of Pain and Anxiety in Dentistry” or equivalent; or scheduled to complete this course within 6 months of the date of hire. Minimum 3 years’ experience as a Dental Assistant, experience in a pediatric dental practice preferred or with pediatric patients. Excellent verbal communication skills, knowledge of HIPAA privacy rules. Current CPR certification required. Bi-lingual in Spanish preferred at the conversational level. PHYSICAL DEMANDS: Ability to move freely (standing, stooping, walking, bending, pushing and pulling) and lift up to a maximum of twentyfive (25) pounds without assistance. Category 1: Job classification is exposed to blood borne pathogens (blood or bodily fluids) while performing job duties. WORK ENVIRONMENT: Frequent exposure to sharp objects and instruments. Occasional exposure to moving mechanical parts, fumes, or airborne particles, toxic, or caustic chemicals, and risk of electrical shock. Occasional high noise level in the work environment. Occasional contact with aggressive and/or combative patients. Works in climate-controlled office setting with daily movement throughout the building and hospital campus. Use of computer throughout the work day. Possible exposure to communicable diseases, hazardous materials, and pharmacological agents. Apply here: bit.ly/2N4j5kw. Registered Dental Hygienist – Oviedo. Overview: Are you ready to take your career as a hygienist further than you ever thought possible? Do you get excited about working closely with dentists and dental staff to provide the best care that will keep your patients healthy and happy? If the answer is yes, then joining our practice as a hygienist is for you. This collaborative and well-supported office will help you grow your skills as a hygienist while providing a rewarding and exciting career. About the opportunity: If you care about your career as much as you care about your patients, join our practice, an office supported by Pacific Dental Services®, and build relationships that will keep patients coming back for years to come. As a hygienist, you are a vital part of patient care. As such, you deserve to work for a practice that cares about their employees as much as they care about their patients. You will receive ongoing technical training, have access to the latest technology, and have a balanced lifestyle that leaves you feeling ready to greet each new opportunity with a smile. Add on competitive compensation and benefits, including healthcare, dental and vision insurance, paid time off, retirement savings plans, child care assistance, and the fact that PDS® is one of the fastest growing companies in the US, and you’ll wonder why you didn’t find us sooner! About you: As a registered dental hygienist with our team, you need to have a current state license. You will have a desire to always be learning and want to stay on top of the latest technology. You should also have outstanding time management and communication skills. To excel, you’ll bring a can-do attitude, a strong desire to treat and educate your patients, and a strong sense of ownership and integrity. Apply Today. Ready to get started? We are too! Apply
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today! Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2N4JvTd. General Dentist – Fort Myers. Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 - $390,000. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/335cz2v. General Dentist – Lakeland. Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 - $390,000. Apply Today. Apply now or contact a recruiter anytime. We’d love to chat, get to know you and share more about us. Testimonial: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/327esKt. Miami, FL Area Oral Surgery Practice for Sale! This dental practice in northwest Miami, Florida is on the market and it is hot! This specialty oral surgery and implant practice is well-established in the community. Located in an upscale office building with over 1,700 square feet. The current doctor has practiced in the community for over three decades. As such, they are willing to stay on for a number of years to ensure a smooth transition. To learn more about this outstanding practice in the Sunshine state, read below: 4 fully equipped operatories; Collections nearly $690,000; Adjusted EBITDA nearly $120,000; Current doctor willing to stay on for smooth transition; Great growth opportunity with extended hours, offering more services in house and additional marketing efforts; To receive a copy of the prospectus and learn more about this practice opportunity in Miami-Dade County, please reach out to Kaile with Professional Transition Strategies. Email anytime: kaile@professionaltransition.com or by phone: 719.694.8320. Registered Dental Hygienist – Mount Dora. Overview: Are you ready to take your career as a hygienist further than you ever thought possible? Do you get excited about working closely with dentists and dental staff to provide the best care that will keep your patients healthy and happy? If the answer is yes, then joining our practice as a hygienist is for you. This collaborative and wellsupported office will help you grow your skills as a hygienist while providing a rewarding and exciting career. About the opportunity: If you care about your career as much as you care about your
patients, join our practice, an office supported by Pacific Dental Services®, and build relationships that will keep patients coming back for years to come. As a hygienist, you are a vital part of patient care. As such, you deserve to work for a practice that cares about their employees as much as they care about their patients. You will receive ongoing technical training, have access to the latest technology, and have a balanced lifestyle that leaves you feeling ready to greet each new opportunity with a smile. Add on competitive compensation and benefits, including healthcare, dental and vision insurance, paid time off, retirement savings plans, child care assistance, and the fact that PDS® is one of the fastest growing companies in the US, and you’ll wonder why you didn’t find us sooner! About you: As a registered dental hygienist with our team, you need to have a current state license. You will have a desire to always be learning and want to stay on top of the latest technology. You should also have outstanding time management and communication skills. To excel, you’ll bring a can-do attitude, a strong desire to treat and educate your patients, and a strong sense of ownership and integrity. Apply Today. Ready to get started? We are too! Apply today! Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2r3feLZ. General Dentist. At Christie Dental, we are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. We currently have a wonderful full-time opportunity available in beautiful Crystal River, FL. Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/Fee for Service dental group practice with 12 locations serving communities across central Florida. If you’re someone who is passionate about providing quality care and driven by opportunities for leadership and continued learning – Christie Dental may be the perfect fit for you to grow your career. The General Dentist that joins our team will be responsible for performing dental examinations and treatment in a collaborative, patient centric practice environment. Continuing education and leadership development opportunities are available and encouraged for this role. Excellent communication skills are required to maintain our group’s mission of providing the highest quality of patient service and asserting our position as a provider of choice in the communities we serve. pschwartz@amdpi.com. Treatment Coordinator – Melbourne. Overview. Do you love working with patients to make sure they can get the treatment they need within their financial means? Are you great at helping patients understand their options and why the treatment is important to their health and well-being? Are you looking for a challenge and the chance to be part of a true team environment where you can constantly learn and grow? If so, now is the time to join us as a benefits coordinator. Responsibilities: Gain a financial commitment from the patient; Understanding of general dental operations and patient flow issues; Utilize tools, skills, and talents to assist patients in making the best possible decision for their unique wants and needs, remembering that the most important choice the patient will make is getting started with treatment; Coordinate fees and insurance benefits for patients visiting general practitioners; Utilize available financial options to give patients choices for how they can pay; Professionally overcome the common patient objections/rejections; Maintain accurate patient financial paperwork and adherence to the office manager’s financial arrangement parameters; Properly use patient account software and maintain accuracy in records related to patient financials. Obtain necessary insurance approvals in a timely manner; Partner with the Specialty BC, when appropriate, to complete patient care; Help in exceeding patient expectations in order to achieve the Perfect Patient Experience®. Qualifications: High school diploma or general education degree (GED) and one or more years of previous experience as a treatment coordinator in a dental practice is preferred; Ability to understand insurance plans is preferred; Knowledge of Microsoft and QSI software applications is preferred. Benefits: Medical, dental and vision insurance; Paid time off; Tuition Reimbursement; Child care assistance; 401K; Paid time to volunteer in your local com-
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career center FROM PAGE 103 munity. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/36gxnGh. Dental Assistant – Melbourne. Overview. Responsibilities: Perform functions in accordance with the applicable state’s Dental Auxiliaries Table of Permitted Duties; Actively participate in the Perfect Patient Experience by striving to keep your patients focused on optimal treatment while attending to their individual needs and concerns; Escort patients to/from the front desk and introduce them to other team members as appropriate. Maintain a clean, sterile, and cheerful environment; Record patient charting and all of the dentist’s notes in the digital patient chart as directed by the dentist; Maintain strict compliance with State, Federal, and other regulations, (e.g., OSHA, WC, Dental Board, HIPAA, ADA, DOL, HR policies and practices). Qualifications: Necessary industry certifications and education; Possess outstanding time management, communication, and technical skills; Can-do attitude, a proactive nature, a strong sense of ownership and integrity and a desire to continue to learn and grow; Demonstrate knowledge of dental terminology, instruments and equipment. Benefits: Medical, dental and vision insurance; Continuing Education (CE Units); Paid time off; Tuition Reimbursement; Child care assistance; 401K; Paid time to volunteer in your local community. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2JB5HCk. Dental Assistant – Port Charlotte. Responsibilities: Perform functions in accordance with the applicable state’s Dental Auxiliaries Table of Permitted Duties; Actively participate in the Perfect Patient Experience by striving to keep your patients focused on optimal treatment while attending to their individual needs and concerns; Escort patients to/from the front desk and introduce them to other team members as appropriate. Maintain a clean, sterile, and cheerful environment; Record patient charting and all of the dentist’s notes in the digital patient chart as directed by the dentist; Maintain strict compliance with State, Federal, and other regulations, (e.g., OSHA, WC, Dental Board, HIPAA, ADA, DOL, HR policies and practices). Qualifications: Necessary industry certifications and education; Possess outstanding time management, communication, and technical skills; Can-do attitude, a proactive nature, a strong sense of ownership and integrity and a desire to continue to learn and grow; Demonstrate knowledge of dental terminology, instruments and equipment. Benefits: Medical, dental and vision insurance; Continuing Education (CE Units); Paid time off; Tuition Reimbursement; Child care assistance; 401K; Paid time to volunteer in your local community. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/34nyqm1. Dental Volunteers. LOCAL DENTISTS, SPECIALISTS, HYGIENISTS, DENTAL ASSISTANTS…HELP!!!! Dental Volunteers needed to care for our under-served Tampa Bay Veterans! The SmileFaith Veterans Dental Clinic located in New Port Richey is a 501c3 nonprofit designed to put smiles on our Veterans’ faces! This unique, charitable program is not affiliated with the Veterans Administration (VA), but is intended to bridge the gap for our under-served Veterans. DID YOU KNOW THAT ONLY ABOUT 5% OF VETERANS HAVE ACCESS TO VA DENTAL BENEFITS? All of our dentists, specialists, assistants, hygienists and various, AWESOME volunteers generously give their time and talents as a tangible way of saying, “THANK YOU FOR YOUR SERVICE!” Dental professionals are cordially invited to visit our beautiful, state-of-the-art facility, schedule a time to serve our
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Veterans and contribute funds to help us purchase supplies and keep the lights on! Call or email Tricia for more information or to schedule a time to care for our under-served Veterans! (813) 2703594 or tricia@smilefaith.com. SmileFaith Veterans Dental Clinic 5400 School Road New Port Richey, FL 34652 www.SmileFaithVeteransDentalClinic.org. CEU’s available for charitable service (SmileFaith is a registered CE BROKER); Donated dental supplies, consumables, equipment and cash donations are tax deductible; Volunteer dentists are covered through the “Good Samaritan Act”, and all patients sign liability waivers plus consent forms for each treatment. General Dentists and Dental Hygienists must have licenses to practice in the State of Florida. Dental Assistants must have Expanded Functions, CDA or RDA certifications. NOTES: 255 openings. General Dentist. NEW DENTAL PRACTICE OPPORTUNITY – New Port Richey, FL. TITLE: General Dentist. REQUIREMENTS: You must have a desire to build your own, exciting dental practice in a growing area of Tampa Bay and have a passion to give back to our under-served Veterans. RESPONSIBILITIES: Oversee every aspect of your practice including marketing, patient care, staff management, financials, etc. WHAT YOU GET: Fully operational state-of-the-art dental facility with nicely equipped operatories, panoramic and hand-held x-ray systems, lobby and reception areas, consultation room, doctor’s office, sterilization unit and an oral surgery suite. You will also receive expert business consultation services, marketing assistance, specialty training with CEU’s and access to a modern analog/digital onsite dental lab. PRACTICE COST: LET’S TALK! This is a wonderful opportunity for a dentist to build a growing practice from the ground up. Everything needed to succeed is at your fingertips! Email Cover Letter & Resume to: info@smilefaith.org. Graduate from an accredited School of Dentistry with a DMD or DDS degree. Applicant must also be licensed to practice Dentistry in the State of Florida. NOTES: Additional Salary Information: To Be Determined. Oral Surgeon – Fort Lauderdale. You’ve invested the time to become a great oral surgeon. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an oral surgeon supported by Pacific Dental Services®, you can rely on a great number of referrals, as you will be providing owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an oral surgeon to have a career that will serve you for a lifetime. As a PDS®-supported oral surgeon, you will have a balanced lifestyle, fantastic income opportunities and you’ll work for offices that care about people, patients and their communities. You won’t have to spend your time navigating practice administration and instead, you’ll focus on your patients and your well-being. The Future: As an oral surgeon supported by PDS, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue to provide clinical excellence in the future. Apply Today. Apply now or contact a recruiter anytime, we’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2JF0fhL. General Dentist – Miami Shores. Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000
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- $390,000. Apply Today. Apply now or contact a recruiter anytime. We’d love to chat, get to know you and share more about us. Testimonial: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/34glIp1. Full-Time General Dentist Needed. Busy dental group is looking for a seasoned (minimum 7 years’ experience) Florida dentist for a full-time position. Guaranteed minimum salary of $200,000$250,000 1st year. State of the art facilities with digital (Dexis) x-rays, intra-oral cameras, laser, etc. Medical, and mal-practice paid for you. No lab bill, 30% of collections. We offer a 401K match and a doctor equity program (no cost to you). No nights/no weekends. We are expanding and will have positions open in Plant City, Brooksville, and Riverview. Interested docs can email me your resume: vmonti@happydentistry.com or check out our website at: www.happydentistry.com. No brokers or temp services need apply. Minimum 7 years’ experience. Proficient in Crown & Bridge. Proficient in extractions (not impacted). Florida Dental License (clear). NOTES: Additional Salary Information: Vacation, 401K, Equity program, Medical and mal-practice paid 30% of collections. General Dentist. Dr. Mohammed Mujeeb is seeking a full-time General Dentist. His group practice consists of eight general practices throughout the Melbourne area. newimagedentistry.net/ location/new-image-dentistry-suntree-ppc. Our group philosophy is simple. Our want to pioneer a new culture in dentistry starts with bringing good people into our group. It is not enough to simply put our like-minds in the same room. We are committed to providing the ultimate freedom, individuality, to those who want to do the right thing for the patient, and for each other. We provide a strong group of individuals for focus and support. We use proven methods in administration that we have learned over a decade’s time, paired with growth initiatives that will guide us to where we are going, to pioneer a future in dentistry that we all want to be a part of. Let’s Put the Patient First Together. We want to put the patient first, together, with you. We realize that this cannot happen unless a doctor and their clinical team is first taken care of. NADG offers to take care of all the essential business administration tasks, and even offers clear paths to a healthier financial outcome for our doctors. Choose to Practice Group Dentistry, not Corporate Dentistry. Earn a competitive salary; Retain true clinical autonomy; Ownership opportunities with equity; Full benefits for full-time work; CE & Mastery programs; Malpractice insurance. How We Support You: Marketing; Finance; Insurance; Billing; Information Technology; Patient Service Center; Human Resources. A Path to Partnership for Associate Dentists. NADG is offering the Path to Partnership for high-performance associate doctors. We leverage our financial expertise to help you reach a sustainable and profitable career. The path begins when you start a career with us and ends when you are given ownership in our group as a partner. Please contact Belinda Wade directly at (850) 353-1460 or wadeb@ nadentalgroup.com. General Dentist. A busy, successful, family private practice in Palm Bay, FL is searching for a full-time Associate. This is an excellent opportunity to join a state of the art, patient-focused practice. Fee for service & PPO driven. Great staff and great patient base. Experienced DDS, DMD. Licensed in Florida. Please forward CV to gamdent@aol.com or Denise@capesidedental.com or Call 321-733-4711 Samuel Artley for confidential consideration. Florida License & 2 plus years’ experience- and/or GPR. General Dentist-Associate. Our office is seeking a well-rounded, highly motivated, enthusiastic general dentist to join our caring team. We are offering a full-time (four days a week) position as an associate with the potential for future partnership for the right individual. Potential candidates should possess great communication and people skills, a strong desire to continue to lean, a willingness to work as part of a collaborative team. We provide all phases of comprehensive dentistry in a modern, state of the art office which includes: digital radiography, CT scan, and digital scanner, as well as digital paperless records. Please email CV to mshultz@familydentistree.com. Current Florida Dental License; DEA License; 1-2 years’ experience preferred/ 1 year AEGD or GPR
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residency. NOTES: Additional Salary Information: Compensation to include an initial guaranteed 3-month daily rate ($500/day) transitioning into a salary that is based on a percentage of the individual associate’s collections Medical insurance Malpractice insurance CE allowances. Pediatric Dentist -Tampa, FL. Available Summer 2020. Position availability -- Summer 2020. Private Pediatric dental practice - Two owners, with 3 office locations in the Tampa area. Newly renovated office has 15 chairs and is 5 days a week. Smaller office has 7 chairs and is 2 days per week. 3rd office is new and is growing rapidly, with all new equipment and chairs. The ideal candidate we are seeking is full time, 4-5 days per week and will work at 2 different office locations. PPO insurance and fee-for-service patients in all practices, no government plans or HMO plans. High-income potential, guaranteed $225K+ in the first year with our compensation structure and patient volume. All offices have digital radiographs and digital charting. In office IV-sedation provided on a regular basis with a certified Pediatric Anesthesiologist group. Fully trained and certified pediatric dental staff in place. Orthodontic treatment is provided in all locations by our in-house orthodontist. Full autonomy over treatment plans. Must have a current Florida dental license, previous experience in private practice is preferred but not necessary. Must be a certified pediatric dentist. Candidate should have excellent communication skills and enjoy a fast pace, fun work environment. We are now interviewing qualified candidates, if interested please email current CV to: sugarbugdude@gmail. com. We look forward to speaking with you. Kind Regards, CV to -- sugarbugdude@gmail.com. Requirements: Must have a current Florida dental license. Previous experience in private or corporate offices is preferred. Must be a pediatric dental specialist. General Dentist’s, limited to children only, need not apply. Excellent communication and people skills are a priority. NOTES: Additional Salary Information: High income potential. Salary and contract details will be discussed only with qualified candidates. General Dentist. We are looking for an extremely motivated and talented General Dentist to join our growing dental team! We work with patients of all ages. We are a privately-owned practice. Please send your resumes to: lakesidefamilydentalcare@yahoo.com Oral Surgeon - Naples. Overview: You’ve invested the time to become a great oral surgeon. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an oral surgeon supported by Pacific Dental Services®, you can rely on a great number of referrals, as you will be providing owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an oral surgeon to have a career that will serve you for a lifetime. As a PDS®-supported oral surgeon, you will have a balanced lifestyle, fantastic income opportunities and you’ll work for offices that care about people, patients and their communities. You won’t have to spend your time navigating practice administration and instead, you’ll focus on your patients and your well-being. The Future: As an oral surgeon supported by PDS, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue to provide clinical excellence in the future. Apply Today. Apply now or contact a recruiter anytime, we’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2WE8CPV. Oral Surgeon - Tampa. Overview: You’ve invested the time to become a great oral surgeon. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an oral surgeon supported by Pacific Dental Services®, you can rely on a great number of referrals, as you will be providing owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they
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deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an oral surgeon to have a career that will serve you for a lifetime. As a PDS®-supported oral surgeon, you will have a balanced lifestyle, fantastic income opportunities and you’ll work for offices that care about people, patients and their communities. You won’t have to spend your time navigating practice administration and instead, you’ll focus on your patients and your well-being. The Future: As an oral surgeon supported by PDS, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue to provide clinical excellence in the future. Apply Today. Apply now or contact a recruiter anytime, we’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2PHzZah. Oral Surgeon - Miami. Overview: You’ve invested the time to become a great oral surgeon. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an oral surgeon supported by Pacific Dental Services®, you can rely on a great number of referrals, as you will be providing owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an oral surgeon to have a career that will serve you for a lifetime. As a PDS®-supported oral surgeon, you will have a balanced lifestyle, fantastic income opportunities and you’ll work for offices that care about people, patients and their communities. You won’t have to spend your time navigating practice administration and instead, you’ll focus on your patients and your well-being. The Future: As an oral surgeon supported by PDS, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue to provide clinical excellence in the future. Apply Today. Apply now or contact a recruiter anytime, we’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2CdfGcR. Associate Dentist – Oakland Park. Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country's leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 - $390,000. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2NOephJ.
Opportunity & Competitive Compensation Package. Trinity FL (North Clearwater Area). Are you an experienced Associate who is ready to join a well-established private dental practice that seeks your general dentistry talents? We are looking for a full time, Monday – Friday, highly productive dentist who is proficient in all aspects of general dentistry. We seek an Associate who also possesses a positive and cooperative nature, keen sense of business, self-directed motivation, exceptionally smart, eager to learn, and an easy-going personality. About Our Practice: At New Port Richey Dental; soon to be Trinity Dental Excellence, we boast a team of dental professionals dedicated to creating and maintaining healthy, beautiful smiles. We will be moving into a brand-new office building that is currently under construction in Trinity FL. In a safe, comforting environment, we provide meticulous, uncompromising, state-of-the-art dentistry to each and every patient. We are a private PPO/FFS dental office. We do not accept HMO/ Medicaid. We have a wonderful team dedicated to the success of our patients, dentist, and our office. I cannot speak highly enough of the front business team, the two assistants and our hygienist. We are looking for someone to join our already strong team. Perks of being a dentist at our Practice: Paid CE, 3 weeks paid time off. Guaranteed salary of $150,000 plus 28% of collections. Targeted compensation of $150,000 - $300,000 in year 1 with room to grow in years 2-5. POSITIVE WORK CULTURE of learning, growth, and positivity. HIGH CLINICAL CARE STANDARDS where proper patient treatment is the #1 priority. CLINICAL FREEDOM to expand your procedure expertise as you grow or to use your expanded skills. Essential Job Responsibilities: Diagnose and treat oral health conditions in accordance with the Office Treatment & Diagnosis Policy in the H/R Manual; Examine patients, review medical history, develop and present a preventive and restorative treatment plan; Prescribe medications appropriately; Address clinical issues promptly and accurately; Provide treatment for fillings, broken teeth, replacement of teeth, root canals, extractions and other treatments as necessary; Perform daily Post Op calls to any patients that received surgery or root canals; Available by phone for after hour emergencies; Ensure compliance with OSHA and dental board procedures. Required Job Qualifications: Must have 1-2 years of general dentistry experience; Ability to work evening hours 2 days/week; we offer patient centered business hours; Degree from an accredited U.S. Dental School; Must have and maintain a current dental license in FL; Must have and maintain malpractice insurance; Possess strong communication skills with the ability to build positive and trusted relationships with both staff and patients; Dedicated to provide consistent quality dental care and service to patients; Strong desire to grow and learn new skills and responsibilities; Enjoy working with all generations of patients. seangassett@gmail.com. Dental Assistant – Royal Palm Beach. Overview: Responsibilities: Perform functions in accordance with the applicable state's Dental Auxiliaries Table of Permitted Duties; Actively participate in the Perfect Patient Experience by striving to keep your patients focused on optimal treatment while attending to their individual needs and concerns; Escort patients to/from the front desk and introduce them to other team members as appropriate. Maintain a clean, sterile, and cheerful environment; Record pa-tient charting and all of the dentist's notes in the digital patient chart as directed by the dentist; Main-tain strict compliance with State, Federal, and other regulations, (e.g., OSHA, WC, Dental Board, HIPAA, ADA, DOL, HR policies and practices). Qualifications: Necessary industry certifications and edu-cation; Possess outstanding time management, communication, and technical skills; Can-do attitude, a proactive nature, a strong sense of ownership and integrity and a desire to continue to learn and grow; Demonstrate knowledge of dental terminology, instruments and equipment. Benefits: Medical, dental and vision insurance; Continuing Education (CE Units); Paid time off; Tuition Reimbursement; Child care assistance; 401K; Paid time to volunteer in your local community. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for em-ployment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2CjH211.
GENERAL DENTIST - PRIVATE FFS/PPO, Trinity Florida. Associate Dentist, Immediate Full-Time Opening. PRIVATELY OWNED, Well-established, Growing Dental Practice. Progressive Career
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off the cusp
GRATITUDE IS IN THE
JOHN PAUL, DMD, FDA EDITOR
ATTITUDE
Dr. Paul can be reached at jpaul@bot.floridadental.org.
Last week, our priest spoke about gratitude. He asked what the parish was grateful for and then proceeded to walk around the room asking individuals. About 300 people looked at their shoes and thought they would be most grateful for the power of invisibility. My 11-year-old’s hand immediately shot into the air and stayed there until he finally made it to our pew and posed the question to her. She answered, “That I get to take the trash to the street with my Mom!” and it was the priest’s turn to stare at the floor and seek composure. He’s new and he doesn’t know my daughter. One day she is in New York wearing designer clothes on a runway and the next day she’s taking out the trash. She truly is grateful for both. The trips to model nice clothes in nice places are fun and the responsibility of walking a can as large as she is next to a busy street with her Mom is equally important. She feels trusted and valued in both, and I’m grateful that she doesn’t assign her values the way society might. Any time of the year is right, but in November, America sets aside a day to add up those things in the plus column and try to ignore all the rest. I’m grateful to practice a profession that seems tailor made for me. I don’t have to go to work, I get to go to work. I’m also grateful that two of my hobbies, reading and writing, lead to this side gig where I get to work with many people who don’t just want to help me succeed, they want to help you succeed, too.
My staff — and yes, I refer to them as a staff ... Moses had a staff and when he threw it on the ground, it turned into a snake. If it was good enough for him, I suppose it’s good enough for me. That’s an apt metaphor. My staff is happy to support me, but if I treat them poorly, they are likely to bite me. (If I were referring to a disease, the word would be staph. Spelling is important.) — My staff wondered what made me happy in the morning. My reply surprised them. I said, “When I pull into the parking lot and everyone is here, that makes me happy. I am satisfied we are ready to do good together.” I say it often and I’ll say it again. Dentists are weird and wonderful people. Weird because you work in a space about the size of a tennis ball that is dark, smelly and poses all manner of danger. You chose to work there, you begged to work there, some of you wrote $300, 000 checks for the privilege. For that, we get to relieve pain and suffering, make broken things whole, give back lost smiles and more often than we know, save a life. You have a lot in the plus column and if you ever have a day when you think the board is stacked against you, remember what you really do and know tomorrow will offer another chance to do it again.
JOHN PAUL, DMD, EDITOR, TODAY'S FDA
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FDAS CHECKS IN TO GET YOU THE BEST DEALS & COVERAGE. FDAS is committed to making sure our dentists get the best deals and accurate coverage before renewal each year, so we implemented our annual renewal call program! Other insurance agencies may let your insurance renewals pass by with no mention, leaving you wondering if you still have the most accurate and affordable coverage. By checking in with our members each year, we can review any possible new discounts or coverage changes and continuously tailor your insurance portfolio to meet your unique practice and personal needs. We look forward to checking in with you this year!
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