Today's FDA Sept/Oct 2023

EDITOR

Dr. Hugh Wunderlich, CDE Palm Harbor

BOARD OF TRUSTEES

PRESIDENT

Dr. Beatriz Terry

FIRST VICE PRESIDENT

Dr. John Paul Lakeland

IMMEDIATE PAST PRESIDENT

Dr. Gerald Bird Cocoa

TREASURER

Dr. Rodrigo Romano Miami

TRUSTEES

Dr. Tom Brown Orange Park

Dr. John Coroba Lake Mary

Dr. Karen Glerum Boynton Beach

Dr. Reese Harrison Lynn Haven

Dr. Eddie Martin Pensacola

Dr. Enrique Muller Aventura

Dr. Jeffrey Ottley

SECOND VICE PRESIDENT Dr. Dan Gesek Jacksonville

SPEAKER OF THE HOUSE

Dr. Don lIkka Leesburg

EXECUTIVE DIRECTOR Drew Eason, CAE Tallahassee

Dr. Christopher Bulnes Tampa

Dr. Bethany Douglas Jacksonville

Dr. Fred Grassin Spring Hill

Dr. Bertram Hughes Gainesville

Dr. Richard Mufson Miami

Dr. John Pasqual Delray Beach

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, to email Dr. Hugh Wunderlich, his email would be hwunderlich@bot.floridadental.org.

To call a specific staff member below, dial 850.350. followed by their extension.

EXECUTIVE OFFICE

FLORIDA DENTAL CONVENTION AND CONTINUING EDUCATION

Crissy Tallman • director of conventions and continuing education ctallman@floridadental.org Ext. 7105

Alyssa Bynum • FDC meeting assistant abynum@floridadental.org Ext. 7162

Brooke Martin • FDC marketing specialist bmartin@floridadental.org Ext. 7103

Isabelle McCreless • FDC program coordinator imccreless@floridadental.org Ext. 7106

Lisa O’Donnell • FDC program coordinator lodonnell@floridadental.org Ext. 7120

Deirdre Rhodes • FDC exhibits coordinator drhodes@floridadental.org Ext. 7108

GOVERNMENTAL AFFAIRS

Joe Anne Hart • chief legislative officer jahart@floridadental.org Ext. 7205

Alexandra Abboud • governmental affairs liaison aabboud@floridadental.org Ext. 7204

Jamie Graves • legislative assistant jgraves@floridadental.org Ext. 7203

INFORMATION SYSTEMS

Larry Darnell • director of information systems ldarnell@floridadental.org Ext. 7102

Charles Vilardebo • computer support technician cvilardebo@floridadental.org Ext. 7153

MEMBER RELATIONS

Kerry Gómez-Ríos • director of member relations krios@floridadental.org Ext. 7121

Megan Bakan • member access coordinator mbakan@floridadental.org Ext. 7100

Bettie Swilley • membership coordinator bswilley@floridadental.org Ext. 7110

FDA SERVICES | 545 John Knox Road, Ste. 201 • Tallahassee, FL 32303 • 800.877.7597 or 850.681.2996

Scott Ruthstrom • chief operating officer

Ext. 7154

Tessa Pope • commercial account advisor tessa.pope@fdaservices.com Ext. 7158

Liz Rich • commercial account advisor liz.rich@fdaservices.com Ext. 7171

Karina Scoliere • commercial account advisor karina.scoliere@fdaservices.com Ext. 7151

YOUR RISK EXPERTS

Dan Zottoli, SBCS, DIF, LTCP director of sales • Atlantic Coast 561.791.7744 • cell: 561.601.5363 dan.zottoli@fdaservices.com

Rick D’Angelo, CIC director of sales • West Coast 813.475.6948 • cell: 813.267.2572 rick.dangelo@fdaservices.com

Joseph Perretti, SBCS director of sales • South Florida cell: 305.721.9196 joe.perretti@fdaservices.com

Mike Trout director of sales • North Florida cell: 904.254.8927 mike.trout@fdaservices.com

Dennis Head, CIC director of sales • Central Florida 877.843.0921 • cell: 407.927.5472 dennis.head@fdaservices.com

Cybersecurity in the Dental Office

By FDA President Beatriz E. Terry, DDS, MS

In today’s digital age, the significance of cybersecurity cannot be overstated, especially in professional sectors like our dental practices. Dental clinics, like other businesses, handle sensitive information, including patient records, medical history, financial data and personal details.

The vulnerability of this data to cyberthreats necessitates a robust cybersecurity strategy to safeguard both patient information and the dental office’s reputation.

This issue of Today’s FDA covers cybersecurity threats and how to handle them. In addition, we have expert advice on what protections and insurance we might get to protect us from potential future attacks.

My practice is digital and paperless, and we continually change and use strong and unique passwords to prevent attacks. In addition, when opening emails, we are

cautious about what we click on, as potential phishing schemes are everywhere. Like many of you, I did not grow up in the digital age and had to learn to incorporate digital into my practice. My “IT guy” has set up ways to back up important data regularly and securely. In other words, we are overly cautious. We have all heard the stories of businesses, including dental practices, being cyberattacked and their information held for ransom. A lot of money and heartache is usually required to retrieve this sensitive information.

Florida Dental Association Services (FDAS) offers insurance products to protect your practice from a cyberattack and, if one should occur, the insurance

should protect the attack from being less threatening than without proper coverage.

Dentists must remain vigilant against evolving cyberthreats and adopt proactive measures to safeguard their patients’ data. By fostering a culture of cybersecurity awareness and investing in reliable security measures, dental practices can fortify their defenses and continue to provide quality care with the utmost confidence in their digital security. This way, we can prevent loss of business income, maintain patient trust and keep the information confidential.

Cybersecurity becomes paramount as dental practices transition into a more digitally-driven era. Protecting sensitive patient information and maintaining a practice’s reputation rely on strong cybersecurity practices.

FDA President Dr. Terry can be reached at bterry@bot.floridadental.org

FDC2023 COURSE RECORDINGS

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Dentists must remain vigilant against evolving cyberthreats and adopt proactive measures to safeguard their patients’ data.

Reporting The Full Fee

By FDA Chief Legal Officer Casey Stoutamire

Did you know that reporting the full fee in the dental claim form for each service reported to a third-party payer is always appropriate? A full fee is a fee for a service set by the dentist, which reflects the costs of providing the procedure and the value of the dentist’s professional judgment. A contractual relationship does not change the dentist’s full fee. Therefore, the American Dental Association and Florida Dental Association (FDA) recommend that it is always appropriate to report the full fee.

FDA Chief Legal Officer Casey Stoutamire can be reached at cstoutamire@floridadental.org.

What is a Dental Compact and Why Does It Have Nothing to Do With Makeup?

By FDA Chief Legislative Officer Joe Anne Hart

While this article focuses on summarizing discussions about compacts, it will not give you the latest makeup tips and tricks for achieving a more natural look. Instead, you will learn about the latest movement to expand portability within the health care industry, allowing more providers to practice across state lines.

Before the pandemic, several groups supported compacts to address workforce shortage issues. These com-

seven states have to pass legislation into law to initiate the dental compact. Once this happens, dentists and dental hygienists who are licensed in a state that is a part of the compact can practice in another participating state by obtaining a compact privilege. The model legislation is clear that all states will keep their autonomy regarding their scope of practice, which means that dentists and dental hygienists will be subject to the scope of practice for that state (regardless of the scope of practice where they hold their original license). For a comprehensive review of what is being proposed and considered, visit the “Dentists and Dental Hygienists Compact” website at ddhcompact.org/, which includes a very detailed “frequently asked questions” (ddhcompact.org/faq/)

pacts ranged in scope and industry and included groups like teachers, mental health counselors and nurses. Finding the right solution to recruit and retain employees in any industry has become one of the biggest challenges employers face in each state. Applicants prioritize worklife balance, flexibility, competitive benefits and workplace culture during the hiring process. The ultimate question is, will compacts be a solution to addressing these issues in the long run?

Since the pandemic, there has been an effort by several groups to provide an additional pathway for dentists and dental hygienists to have mobility to practice in states where they are not licensed through a dental compact. The Council on State Governments has been working with the Department of Defense, the American Dental Association and the American Dental Hygienists’ Association to create model legislation to support a dental compact. In order for a dental compact to be enacted, at least

document as well as a section-by-section summary of the model legislation which can be viewed at bit.ly/3qvCKjK.

Three states (Iowa, Tennessee and Washington) have passed dental compact legislation. Several other states are considering legislation to implement a dental compact, but none have made it to the finish line yet. Dental compact legislation has not been considered in Florida, however that does not mean there isn’t any interest in pursuing this type of legislation. The Florida Dental Association (FDA) is reviewing the components of the model legislation in relation to Florida’s dental licensure laws. As the Legislature prepares for the 2024 Session and its desire to attract more health care providers to the state, the likelihood is that everything will be on the table for consideration.

FDA Chief Legislative Officer Joe Anne Hart can be reached at jahart@floridadental.org.

In order for a dental compact to be enacted, at least seven states have to pass legislation into law to initiate the dental compact.

The Vital Importance of Cyber Liability Insurance for Dental Offices

By FDA Services Chief Operating Officer Scott Ruthstrom

In our modern world, where technological advancements have infiltrated even the simplest of tools, dental offices are confronted with distinctive vulnerabilities concerning cyberthreats.

From malicious hackers to disruptive ransomware, the dental industry has become a battlefield for cybersecurity. To equip dental offices against these digital adversaries, they must adopt a potent defense: cyber liability insur-

ance. This article delves into the rationale behind the necessity of this insurance, addressing concerns such as lost business income and patient apprehension.

Loss of Business Income: Disruption in Operations

Imagine you arrive at your dental practice, ready to navigate the day’s challenges, only to discover your com-

hackers

ransomware,

dental industry has turned into a battlefield for cybersecurity.

Cyber liability insurance represents an indispensable safeguard for dental offices.

puter systems have been compromised, plunging your schedule into disarray and leaving patients in limbo, not to mention the financial repercussions for your business. Cyber liability insurance can facilitate a swift recovery — it encompasses the reimbursement of lost revenue and the expenses of system restoration, allowing you to concentrate on your primary expertise: oral health care.

Patient Trust and Confidential Information: A Fragile Bond

Patients place their trust in dental offices with their most sensitive data, but what transpires when this trust is violated? A cyber breach has the potential to shatter patients’ confidence, casting doubts about your ability to safeguard their information. This is where cyber liability insurance emerges as it covers the expenses associated with notifications, credit monitoring and even public relations endeavors, aiding in the gradual reestablishment of trust one patient interaction at a time.

Cost of Cyber Ransom: Navigating Demanding Intrusions

Ransomware incidents are occurring more and more frequently in dental practices. Cybercriminals encrypt your dental office’s data and demand a ransom; it’s akin to an intruder breaking into your practice and holding essential tools hostage until a payment has been made. Yet, cyber liability insurance provides financial resources to handle negotiations, legal fees and the laborious data recovery process.

Cyber liability insurance represents an indispensable safeguard for dental offices. Given the potential ramifications of lost income, compromised patient trust and the looming threat of cyber extortion, this insurance becomes an imperative companion, shielding practices from digital threats.

FDA Services (FDAS) Chief Operating Officer Scott Ruthstrom can be reached at scott.ruthstrom@fdaservices.com

From malicious

to disruptive

the

Emotional Intelligence Can Help Dentists Retain a Strong Team

By Southwest Institute for Emotional Intelligence Founder Bobi Seredich

Emotional intelligence (EI) is understanding and managing emotions constructively. Dentists who operate with high EI can significantly impact their teams by effectively fostering healthy, happy and productive work environments.

Daniel Goleman, the famous researcher who brought EI to the leadership forefront in the 1990s, stated:

“IQ, cognitive abilities are basically hardwired. They don’t really change that much through life. On the other hand, emotional intelligence (EQ or EI) is learned and learnable and you can upgrade it at any point in life.”

What Leading With EI Looks Like

If we break down Goleman’s summary of EI, there are five key components:

1. Self-awareness

2. Self-regulation

3. Motivation

4. Empathy

5. Social skills

Let’s dive deeper into each component to identify characteristics shown in dentists with strong EI.

● Self-awareness: confident, realistic about their selfassessment and can laugh at themselves.

● Self-regulation: redirects disruptive impulses in moods, thinks before acting, is trustworthy and has integrity.

● Motivation: works for reasons beyond money, power or status and is optimistic even in the face of failure.

● Empathy: understands the emotional makeup of others and builds strong relationships.

● Social skills: networks easily, builds rapport with people and relates with others.

The Positive Results of EI-Driven Dentists  Dentists who excel in EI often produce high-impact results, including:

● Faster team productivity.

● Higher team engagement.

● Stronger trust and transparency with colleagues.

● Healthier conflict resolution.

● Better ability to handle work pressures.

In my leadership coaching and training experience, I see all types of dentists with unique challenges. Outstanding leadership starts with you and your authentic self-awareness.

Becoming a great dentist evolves — this is hard in practice and needs to be a part of your proactive growth to leadership excellence. It’s important to grow as a dentist and continue practicing EI because it significantly affects leadership and team performance.

Grow Your EI Skills

Do you want to strengthen your EI skills and team culture? To learn more about EI, join us at LEAD 2024 in Orlando, where Bobi Seredich, founder and president of The Southwest Institute for Emotional Intelligence, will present a half-day workshop on Jan. 19, 2024.

About the Author

Bobi Seredich is a recognized speaker, author, trainer and successful entrepreneur specializing in leadership development. She has spent more than 20 years of her career creating, directing, writing and presenting leadership programs for top companies in the U.S. and worldwide.

Seredich is the founder of the Southwest Institute for Emotional Intelligence and President of EQ Inspirations.

“The most dangerous leadership myth is that leaders are born — that there is a genetic factor to leadership. That’s nonsense; in fact, the opposite is true. Leaders are made rather than born.”

— Warren Bennis

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FDA Earns Membership Awards

The Florida Dental Association (FDA) was recently recognized for its accomplishments in membership recruitment and retention by the American Dental Association (ADA) at the ADA’s “Reimagining Our Tomorrow” conference.

The FDA received two awards — one for converting the highest percentage of nonmembers to membership and the other for the greatest percentage of reduced dues payers to full dues membership. The FDA was also celebrated for having 80% or greater of national signing day applications signed by the class of 2022 at LECOM School of Dental Medicine, the University of Florida College of Dentistry and Nova Southeastern University.

● Offer patients a unique and informed member experience.

● Experience an end-to-end membership plan solution that streamlines all aspects of plan administration.

Staying Connected?

Ensure your email, cell phone, practice and home addresses on file with us are up to date. Simply visit ada.org/myada and use your ADA number as your username or call the FDA at 850.681.3629.

The FDA-Endorsed Dental Membership Plan Solution

The Bento platform endorsed by the FDA empowers dental practices to offer customized dental membership plans for free. With Bento, dentists can maximize the efficiency of their practice while providing the best possible care for their patients. Create the perfect membership plans tailored to your patients’ needs and see why Bento is the top choice for dental professionals!

Bento’s Dental Membership Plan Solution empowers dentists to:

● Customize membership plans to address patient needs.

● Launch plans for free in minutes.

● Market plan easily with expert support from Bento’s team.

● Build patient loyalty and generate recurring revenue.

Learn more at bento.net/in-office-plan or schedule a free demo today at bit.ly/3PbR0X1! Check out an informative guide at bit.ly/3P8U5qY0, about the considerations for offering a great membership plan!

Already Retired or Retiring Soon?

If you are no longer practicing or have plans to retire soon, please contact our membership team at membership@floridadental.org or 850.681.3629 to complete your retired affidavit through a quick and easy DocuSign form. Most retired members pay little or no dues to maintain their membership and keep access to all their benefits and services.

Dr. Bert Hughes Receives Acceptance Into Prestigious Harvard Program

FDA member Dr. Bert Hughes recently received acceptance into Harvard University’s Global Health Care Leaders Program (GHLP) — a multi-modular global program that aims to bring together the most important topics defining the future of the health care industry for leaders who will lead the

FDA President-elect Dr. Jeff Ottley accepted Florida’s awards.

charge. With the health care industry as dynamic and complex as it is, GHLP aims to deliver hands on experiences with the best practices, strategic frameworks and insights to help unlock opportunities and drive growth and innovation within the healh care field. Congratulations, Dr. Hughes!

ERISA Plans: What Dentists Should Know

The Employee Retirement Income Security Act of 1974

— commonly called ERISA — is a federal law that regulates employee benefit plans, including those for dental care. Some carriers administering ERISA plans argue that since ERISA is a federal law, it supersedes or “preempts” state insurance laws that protect patients. For example, if there is a specific dental insurance problem that a state legislature passes a law to fix, like assignment of benefits, the self-funded plans claim ERISA preemption to avoid compliance with that law. Nationwide, approximately 46% of subscribers are covered by self-funded dental plans. Those plans fall under ERISA, and ERISA has historically proven to be very difficult to amend. The ADA needs your help to show state officials the magnitude of the problem and to keep the momentum established under the recent court case. Creating public awareness of the problem is the first step to reforming this federal law. To read the full article, go to bit.ly/3Ey0jf2.

New Guideline Details Dental Pain Management Strategies for Pediatric Patients

The American Dental Association (ADA) has recently endorsed one guideline that recommends acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen — as initial treatments for managing shortterm dental pain in children under the age of 12. It was determined by a panel that whether alone or in combination, they can effectively manage the pain after a tooth extraction or during a toothache. Recommendations for adolescents and adults are currently in development. The new acute pediatric pain management guideline can be found at ada.org/painmanagement.

The FDA honors the memory and passing of the following members:

Henry Breitmoser

Jacksonville

Died: 08/23/2023

Age: 81

Robert Fields

Fleming Island

Died: 07/31/2023

Age: 66

Howard Pranikoff

Ormond Beach

Died: 8/29/2023

Age: 81

where in the world

Where in the World is Today’s FDA?

Thank you, Dr. Sam Desai, for taking Today’s FDA to the Gaylord Opryland Resort & Convention Center in Nashville, Tennessee!

Do you have vacation plans this Fall? On your next trip, take a copy of Today’s FDA with you, take a photo and send it to jrunyan@floridadental.org to see it featured in an upcoming issue.

Where will Today’s FDA venture next?

Dr. Pranikoff served on the FDA Board of Trustees from 2013-2021 and received the J. Leon Schwartz Lifetime Achievement Award in 2022.

Learn more by visiting our virtual Member Center at floridadental.org

Welcome New FDA Members

The following dentists recently joined the FDA. Their memberships allow them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry.

Atlantic Coast District

Dental Association

Dr. Jose Carcamo, Lighthouse Point

Dr. Mohammad Abdollahzadehfard, Plantation

Dr. Kristina Carnogursky, Fort Lauderdale

Dr. Adriana Castaneda Carpio, Boynton Beach

Dr. Ivan Cedeno Mendez, Wellington

Dr. Ember Courtney-lima, Vero Beach

Dr. Milena Darcadia, Parkland

Dr. Michael Farrell, Boynton Beach

Dr. Miriannys Fiffe Gonzalez, West Palm Beach

Dr. Morgan Goldstein, Port St. Lucie

Dr. Mileidy Gonzalez Negreira, West Palm Beach

Dr. Lakshay Goyal, Fort Lauderdale

Dr. Janny Guerra Rodriguez, Boynton Beach

Dr. Maria Gutierrez, West Palm Beach

Dr. Timothy House, Wilton Manors

Dr. Artur Jakubowski, Pompano Beach

Dr. Calvin Kaler, Palm Beach Gardens

Dr. Alexis Mady, Palm Beach Gardens

Dr. Ross Miller, Boca Raton

Dr. Amy Mohamed, Fort Lauderdale

Dr. Nicholas Perez, Lake Worth

Dr. Roberto Ramirez, Royal Palm Beach

Dr. Daniel Rovirosa, Coral Springs

Dr. Sydney Schmitz, Jupiter

Dr. Marie-lourdes Senatus, Coral Springs

Dr. Serina Shepard, Sunrise

Dr. Ryan Smith, Fort Lauderdale

Dr. Aylen Socarras, Wellington

Dr. Negin Taghizadeh Asl, Westlake

Dr. Carlos Yanes Gonzalez, Boynton Beach

Dr. Savannah Young, Riviera Beach

Central Florida District

Dental Association

Dr. Ameen Alameen, West Melbourne

Dr. Meyzgan Amin, Oviedo

Dr. Marian Bekheit, Pembroke Pines

Dr. Verna Biniamin, Lady Lake

Dr. Louise Carlos, Kissimmee

Dr. Laura Choque Huachua, Gainesville

Dr. Joseph Fernandes, Orlando

Dr. Karla Garcia, Winter Park

Dr. Ariani Garrido, Orlando

Dr. Robert Gherman, Maitland

Dr. Sebastian Giambini, Ocala

Dr. Jeremy Gies, Orlando

Dr. Shirley Guerra, Port Orange

Dr. Shelby Hall, St. Augustine

Dr. Robert Heck, Gainesville

Dr. Mena Ibrahim, Orlando

Dr. Ahmed Ibrahim, Orlando

Dr. Matthew Joseph, Melbourne

Dr. Hannah Kazaal, Gainesville

Dr. David Kelly, Merritt Island

Dr. Cameron Kocan, Palm Coast

Dr. Caroline Krueger, Apopka

Dr. Avery Lane, Gainesville

Dr. Jesse LeBrecht, Merritt Island

Dr. Edgardo Leiva, Indian Harbour Beach

Dr. Nadine Malik, Titusville

Dr. Nicky Masoodi, Winter Park

Dr. Reshav Mehtani, Orlando

Dr. Nikita Meyer, Orlando

Dr. Azeem Mohiuddeen, Gainesville

Dr. David Myara, Ormond Beach

Dr. Swati Patel, Geneva

Dr. Shilan Patel, Eustis

Dr. Anastacia Piceli Zanoni Morales, Winter Garden

Dr. Saara Rasool, Orlando

Dr. Andre Reis, Gainesville

Dr. Laura Sawires, Apopka

Dr. Sandra Shaker, Port Orange

Dr. Visalakshi Shivaraman, Gainesville

Dr. Tyler Smayda, Gainesville

Dr. Sumit Soni, Oviedo

Dr. Pedro Sperandio Lopes Morales, Winter Garden

Dr. Ben Wasson, Orlando

Dr. Kayla Wilkerson, Orlando

Dr. Tony Yassa, Port Orange

Northeast District

Dental Association

Dr. Marcel Acris, Jacksonville

Dr. Haider Aldally, Fleming Island

Dr. Syed-Omair Ali, Jacksonville

Dr. Sarah Danser, Jacksonville Beach

Dr. Marissa Hamilton, Jacksonville

Dr. Dillon Hernandez, Jacksonville

Dr. Madeline Howe, Jacksonville Beach

Dr. Christopher Miller, Pompano Beach

Dr. Danny Nguyen, Jacksonville

Dr. Rajeev Patel, Jacksonville

Dr. Elayne Wang, St. Johns

Dr. Nicklaus Wilson, Jacksonville

Dr. Tourner Wright, Fernandina Beach

Dr. Troy Wubker, Windermere

Northwest District

Dental Association

Dr. Leonard Anderson V, Pensacola

Dr. Kyle Cross, Altamonte Springs

Dr. Peter Farag, Pensacola

Dr. Alexandra Ferguson, Miramar Beach

Dr. George Jones, Tallahassee

Dr. Margaret Marino, Tallahassee

Dr. Zachary Mutter, St. Louis

Dr. David Quach, Lynn Haven, FL

Dr. Liset Rodriguez Barrero, St. Augustine

Dr. Lauren Snow, Niceville

Dr. Nigist Tadesse, Freeport

Dr. William Tyre, Havana

Dr. Katherine Wei, Tallahassee

Dr. Daniel White, Shalimar

Dr. Chanyce Williams, Tallahassee

South Florida District

Dental Association

Dr. Diana Alberich, Miramar

Dr. David Alishayev, Miami Beach

Dr. Anais Alonso Torres, Miami

Dr. Maribel Alvarez, Hialeah

Dr. Jenny Alvarez, Miami

Dr. Elizabeth Alvarez Cardentey, Miami

Dr. Dailyn Amador Stuart, Miami

Dr. Andy Ashtiani, Miami Beach

Dr. Francys Ballesteros de Orduna, Miami

Dr. Magda Barrera, Aventura

Dr. Lauren Barreras, Miami

Dr. Yenia Basulto Guerrero, Hialeah

Dr. Patricia Cantens, Miami

Dr. Mary Capasso, Miami

Dr. Sofia Castellon, Miami

Dr. Carlos Castillo Plasencia, Homestead

Dr. Mateo Castro, Hallandale

Dr. Lauren Corcho Nodarse, Sunny Isles Beach

Dr. Haynielis Crespo Soto, Miami

Dr. Sigal Dahan, Miami Beach

Dr. Maylin Davila Perez, Orlando

Dr. Maria De Moya, Miramar

Dr. Maidy Echevarria, Pembroke Pines

Dr. Ali Farhat, Weston

Dr. Alessandra Forlano Valdivieso, Hialeah

Dr. Patricia Gamez Oconnor, Miami

Dr. Ana Garcia, Miami

Dr. Dairys Garcia Sanchez, Miami

Dr. Lilibeth Gomez Flores, Miami

Dr. Andres Gonzalez, Coral Gables

Dr. Gabriela Gutierrez Moreno, Miami

Dr. Rose Harooni, Miami Beach

Dr. David Homayoun Guerrero, Tampa

Dr. Liza Kanter, Pinecrest

Dr. Taylor Light, Miami

Dr. Julio Lima, Hialeah

Dr. Maria Lopez Castro, Davie

Dr. Lorraine Maloney, Davie

Dr. Axel Mancia, Doral

Dr. Claudia Martinez, Miami

Dr. Elsa Martinez Hernandez, Hialeah

Dr. Yanela Martinez Suarez, Homestead

Dr. Andrea Merlano, Miramar

Dr. Cristoffer Montenegro Larios, Miami

Dr. Mariamne Morales, Hialeah

Dr. Lisandra Nodarse Consuegra, Hialeah

Dr. Greyt Novo Garcia, Hollywood

Dr. Rosa Osteicoechea Romero, Doral

Dr. Adriana Padron, Miami

Dr. Taha Peerzada, Sunny Isles Beach

Dr. Junie Polanco Garcia, Hollywood

Dr. Oleg Prokopenko, Sunny Isles Beach

Dr. Marta Puentes Marrero, Miami

Dr. Shelley Robinson, Miami

Dr. Cesar Rodriguez Susana, Orlando

Dr. Javier Ruiz Benitez, Miami

Dr. Elizabeth Sanchez, Miami

Dr. Flora Sarmiento, Brownsville, TX

Dr. Sharon Sheero, Aventura

Dr. Tanweer Syed, Hollywood

Dr. Ashley Torres Abreu, Orlando

Dr. Susana Trecu Bencomo, Orlando

Dr. Kevin Truong, Pembroke Pines

Dr. Elianne Vazquez, Miami

Dr. Leisy Veliz Borges, Tampa

Dr. Catherine Ventura-Monzon, Miami

Dr. Rebeca Zaragoza, Miami

West Coast Dental Association

Dr. Noor Abid, Wesley Chapel

Dr. Abanojoseph Abied, Wesley Chapel

Dr. Yasmeen Abugharbiyeh, Valrico

Dr. Michelle Afonso, Tampa

Dr. Alin Alias, Naples

Dr. Chaoukat Alsakati, Port Charlotte,

Dr. Jhon Andraous, Palm Harbor

Dr. Gabriela Barrera Pinon, Tampa

Dr. Christina Basily, Tampa

Dr. Mina Bassaly, Oldsmar

Dr. Claudia Battistini, Odessa

Dr. Macie Berry, Naples

Dr. Hanna Bostwick, Tampa

Dr. Cassandra Brower, Sarasota

Dr. Grace Call, Fort Myers

Dr. Daniel Camejo, Naples

Dr. Yunet Chao Perez, Elizabeth, NJ

Dr. Rene Consuegra Diaz, Naples

Dr. Christine Demeter, Sarasota

Dr. Vivek Dewan, Sarasota

Dr. Rachel Dwyer, St. Petersburg

Dr. Katherine Eisberg, Bonita Springs

Dr. Kevin Ellorin, Wesley Chapel

Dr. Johana Flores Valdes, Naples

Dr. Kyle Fries, Naples

Dr. Dayanne Ghorayeb, Tampa

Dr. Devon Giddens, St. Petersburg

Dr. Phillip Glassberg, Massapequa, NY

Dr. Avery Greene, Bradenton

Dr. Fernando Haddock, Naples

Dr. Ivanna Hazim Schiffino, Tampa

Dr. Sandra Henein, Fort Myers

Dr. Grant Hodges, Parrish

Dr. Waleed Ibrahim, Seffner

Dr. Karleigh Johns, Sarasota

Dr. Taylor Johnson, St. Petersburg

Dr. Jenna Johnson, Cape Coral

Dr. Nicole Lauritsen, Sarasota

Dr. Thi Le, Spring Hill

Dr. Cameron Long, Fort Myers

Dr. Orisel Lopez Martinez, Harrison, NJ

Dr. Parker MacPhail, Sarasota

Dr. Juan Martinez, Naples

Dr. Lisett Mata Alvarez, Cape Coral

Dr. Evan McElroy, Fort Myers

Dr. Roshni Minhas, Tampa

Dr. Emily Nabut, St. Petersburg

Dr. Mohamed Nada, Tampa

Dr. Rida Ngo, Pinellas Park

Dr. Michelle Nguyen, Pinellas Park

Dr. Andy Pan, Tampa

Dr. Jinal Patel, Cape Coral

Dr. Shina Patel, Haines City

Dr. Nicole Power, Tampa

Dr. Matthew Raso, Tampa

Dr. Brock Reichardt, Venice

Dr. Othman Rezki, Spring Hill

Dr. Diana Rivera-Ramos, Punta Gorda

Dr. Collin Ryan, Sarasota

Dr. Indira Sanchez Concepcion, Fort Myers

Dr. Nikoll Sanchez Garrido, Tampa

Dr. Matthew Sawaged, Sarasota

Dr. Kelly Shimada, St. Petersburg

Dr. Kyle Shtern, Tampa

Dr. Fatima Shuayb, Brooksville

Dr. Josmar Suarez, Estero

Dr. Sacha Tobaly, Sarasota

Dr. Tai Van, Venice

Dr. Justin Vice, Tampa

Dr. Andrius Vilkialis, Indian Rocks Beach

Dr. Michael Waldron, Largo

Dr. Carolinne Woodhouse, Odessa

Dr. Aubrie Zuiderveen, Fort Myers

FDA Services has teamed up with Coalition to offer cyber insurance coverage of up to $1 million through their platform. This coverage can help protect your dental practice from the financial impact of a cyber attack.

With FDA Services and Coalition, you can have peace of mind knowing that you have a comprehensive cyber insurance policy that covers the most common and costly cyber losses.

Dental Office Avoids Ransom Payment But Incurs Business Interruption Costs

By Catherine Lyle, Coalition

CASE STUDY

A nationwide dental company was confronted with a ransomware event impacting more than 50 offices across the U.S. Within 24 hours, they reported it to Coalition Claims1 and engaged with breach counsel and one of our panel vendors for incident response.2

Because they maintained viable data backups at each location, the dental company was able to quickly start restoring data at the impacted offices and avoid paying the ransom to cyber criminals. Though the incident response was relatively uncomplicated from a technical standpoint, the number of offices and involved parties at each location made the process more challenging.

During the restoration process, the company experienced an unrelated distributed denial-of-service (DDoS) attack. Since the incident response firm had already deployed endpoint monitoring, they quickly remediated the DDoS attack to ensure it caused no further damage to the dental company.

Given the complicated restoration process, the company experienced business interruption across the impacted locations for five days. Their business interruption coverage kicked in after their self-insured retention of $25,000, which included data restoration costs and totaled $430,624.

To comply with HIPAA regulations, the dental office reported the incident to the Department of Health and Human Services and the state attorney general. They also sent notifications to a handful of impacted patients.

Florida Dental Association Services

Crown Savings partner Coalition brings together active monitoring, incident response and comprehensive cyber insurance designed to help mitigate your organization’s cyber risk. To learn more, visit coalitioninc.com.

Reprinted with permission from Coalition.

Catherine Lyle can be reached at brokers@coalitioninc.com.

References

1. The claim scenarios described here are intended to show the types of situations that may result in claims. These scenarios should not be compared to any other claim. Whether or to what extent a particular loss is covered depends on the facts and circumstances of the loss, the terms and conditions of the policy as issued and applicable law.

2. Breach response included the engagement of an incident response firm; the insured selected one of our preferred panel vendors.

office avoids ransom payment but incurs business interruption costs

Florida Board of Dentistry Meets in Ft. Lauderdale

As a reminder, the BOD approved the revisions to Rule 64B5-17.002 at its May meeting on what must be included in the dental record. This was to clarify what must be included in the dental record after an administrative law judge ruled that it was ambiguous. The discipline case that led to this rule revision dealt with a male dentist treating female dentists at his office after hours and not recording that treatment in the patients’ records.

At its August meeting, the Board revised the language again to clarify what needs to be included in the record if the dentist “saw” the patient via teledentistry. The proposed rule now reads:

The next BOD meeting scheduled for 7:30 a.m.

of Dentistry (BOD) met in Ft. Lauderdale on Friday, Aug. 11 at 7:30 a.m.

The Florida Dental Association (FDA) was represented by BOD Liaison Dr. Steve Hochfelder and Chief Legal Officer Casey Stoutamire. Drs. Jerry Bird, Edy Guerro, Jim Haddix and FDA President Beatriz Terry were also in

attendance, as were dental students from the Nova Southeastern University College of Dental Medicine.

BOD members present included: Dr. Claudio Miro, chair; Dr. Nick White, vice-chair; Drs. Brad Cherry and Jose Mellado; hygiene members, Ms. Karyn Hill and Ms. Angela Johnson; and consumer member Mr. Fabio Andrade. Drs. Christine Bojaxhi, Tom McCawley and TJ Tejera and consumer member Ben Mirza were absent.

64B5-17.002 Written Dental Records; Minimum Content; Retention.

A dentist shall maintain patient dental records in a legible manner and with sufficient detail to clearly demonstrate why the course of treatment was undertaken.

(1) Dental Record: The dental record shall contain sufficient information to record each patient/ dentist in person or teledentistry encounter, identify the patient, support the diagnosis, identify and justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; X-rays (if taken); examination results; test results; records of drugs prescribed, dispensed, or

FDA Chief Legal Officer Casey Stoutamire

administered; reports of consultation or referrals; identification of all treatments and procedures preformed and when they were performed, and copies of records or reports or other documentation obtained from health care practitioners at the request of the dentist and relied upon by the dentist in determining the appropriate treatment of the patient.

Mr. Ed Tellechea, Board counsel, asked the BOD what rules it would like to include in its annual regulatory plan. These are rules that the Board feels need to be modified. The FDA asked the Board to update its rules on remediable tasks to hygienists and assistants to clarify what

those auxiliary staff can do regarding the placement of implants and under what supervision level. The rules were promulgated at a time when implants were not as prevalent as they are today and the FDA encouraged the Board to make sure all dentists understand what is and is not remediable when it comes to implants. The FDA will be working with the Board on this issue.

The Board recognized Ms. Jessica Sapp and thanked her for her service as executive director. The FDA wishes Ms. Sapp well in her new position at the Department of Health. The Board then introduced Ms. Allison Dudley as its new executive director, and we look forward to working with her.

There were three disciplinary cases and one petition for modification of a final order that included, among other things, failing to meet the minimum standard of care by a general dentist providing root canal therapy, the placement of a temporary bridge and a very difficult root canal procedure by an endodontist.

It is much better to be a spectator than a participant in BOD disciplinary cases.

FDA Chief Legal Officer Casey Stoutamire can be reached at cstoutamire@floridadental.org.

Sobering Email Security Stats You Need to Know

In today’s digital age, the significance of cybersecurity cannot be overstated, especially in professional sectors like dental practices. Dental clinics, like other businesses, handle sensitive information, including patient records, medical history, financial data and personal details.

If you’re following information technology (IT) or cybersecurity news or groups on social media, it may be no surprise that email is the number one target for cyberattacks. Or perhaps you’ve been on the receiving end of a phishing attack and, given the statistics, the odds are pretty good.

It’s also why you should pay close attention to your email security and find ways to limit your risk. Education starts with understanding the threat and how the security measures you employ can help protect you, your patients and your practice.

Here are some general stats regarding the volume of data breaches and cyberattacks in health care:

● Health care and finance remain the two most targeted industries for cyberattacks.

● Despite that threat, health care organizations allocate approximately 6% of their budgets toward cybersecurity.

● The most significant health care data breach of 2023, thus far, impacted more than 4.2 million people.

Cyber liability insurance represents an indispensable safeguard for dental offices.

Now, let’s look at some of the attack methods:

● 59% of health care professionals identify email as the most vulnerable entry point.

● 88% of health care workers have opened a phishing email.

● Phishing is a leading cause of health care attacks and breaches.

● Breaches caused by phishing often take nearly 300 days to identify.

● Despite the effectiveness of security training, only a third of health care organizations conduct phishing tests and a quarter provide no training to avoid phishing attacks.

● In the last few years, health care email frauds have grown (by 493% in 2020) and continue to be a significant threat.

● Ransomware attacks against health care organizations have doubled in the last five years, with smaller clinics and dental offices growing in value. Experts believe this may be underestimating the threat as well.

● Nearly two-thirds of breaches come from employee negligence rather than an outside threat.

And then let’s consider the costs:

● On average, health care data breaches cost an average of $408 per health record.

● The cost of an average breach in health care is up to $10.1 million.

● The “average cost” rarely includes the cost of security upgrades, remediation, regulatory fines, insurance hikes, lawsuits and reputation.

Why is Email A Target for Cyberattacks?

The short answer is that, for many, it’s the most vulnerable part of your tech stack. The more detailed explanation includes factors as to why:

● More people, more opportunity: Whether it’s the number of email accounts in your organization or people checking a single administrative account, more people increase the likelihood of human error.

● Public email servers: Reliance on public (nonsecure) email servers means security measures are likely not as stringent as they should be.

● Email volume: Volume means malicious emails can slip through, especially when they’re more advanced. Because you’re moving fast, you may be more prone to send patient emails with protected health information “just this once.”

● Hacker savvy: Hackers are getting better at spoofing and mimicking legitimate partners, vendors and others with whom you have an established relationship. Especially if you send emails with any patient names, date of birth, medical info, etc., you’re giving a hacker opportunity to disrupt or destroy a practice and/or patient.

● Weak security: If you’re getting a lot of spam or unsolicited emails, it may indicate that your email security is not strong enough.

From malicious hackers to disruptive ransomware, the dental industry has become a battlefield for cybersecurity.

Types of Email Security

In Memoriam

In Memoriam

Let’s talk about how to be proactive to prevent this from being something you experience.

The FDA honors the memory and passing of the following members:

The FDA honors the memory and passing of the following members:

Nelson Castellano

Nelson Castellano

Tampa

Tampa

Died: 2/12/2023

Died: 2/12/2023

Age: 83

Age: 83

Michael Chanatry Jacksonville

Michael Chanatry

Jacksonville

Died: 2/12/2023

Died: 2/12/2023

Age: 72

Age: 72

Silas Daniel Seminole

Robert Ettleman

Robert Ettleman

Tampa

Tampa

Died: 1/23/2023

Died: 1/23/2023

Age: 69

Age: 69

Wendell Hall Tampa

Gilbert Principe

Gilbert Principe

● Spam Filters: Obviously, one of the best solutions to preventing spam and phishing attempts is never to receive them in the first place. Use an email service that prevents unknown senders from initiating communication unless you reach out first.

GET FREE COURSE TUITION AT FDC2023!

GET FREE COURSE TUITION AT FDC2023!

Wendell Hall Tampa Died: 2/12/2023

Died: 2/12/2023

Age: 88

Age: 88

Silas Daniel Seminole

Died: 1/10/2023

Died: 1/10/2023

Age: 74

Age: 74

Charles Infante Plantation

Longwood Died: 1/12/2023

Longwood

Died: 1/12/2023

Age: 80

Age: 80

Edward Stokes

Edward Stokes

Died: 1/11/2023

Died: 1/11/2023

Age: 76

Age: 76

● Encryption: One of the most significant risks to email and the data contained is when it’s in transit between inboxes. Encryption essentially scrambles the information and any files until it reaches the intended recipient. Encryption is crucial in health care as HIPAA compliance requires encryption. However, encryption alone does not meet all federal HIPAA rules for electronic transmission of protected health information.

Volunteer to be an FDC Speaker Host.

● Antivirus Software: Antivirus software can help identify dangerous emails, scan them for threats and prevent delivery.

Volunteer to be an FDC Speaker Host.

Charles Infante

Plantation

Died: 2/15/2023

Died: 2/15/2023

Age: 92

Age: 92

● HIPAA compliance and security: HIPAA requires that you control access to all email, including verifying recipients. Further, you must ensure encrypted transmissions, with no data alterations, and create an auditable trail backed up for at least five years. Those requirements and the security mentioned above are a baseline. And yet, your average email application can’t meet those standards.

As with most security plans, layering your defenses is the best move, but the first and most important part of your defense is educating yourself and your staff on the threat, potential vulnerabilities and security measures they can and should employ beyond what’s in place.

Volunteers provide an invaluable service to the Florida Dental Convention. Speaker Hosts will be responsible for introducing the speaker, making announcements in front of the course, passing out and collecting surveys, and contacting convention staff if AV assistance is needed.

Volunteers provide an invaluable service to the Florida Dental Convention. Speaker Hosts will be responsible for introducing the speaker, making announcements in front of the course, passing out and collecting surveys, and contacting convention staff if AV assistance is needed.

Volunteering has its perks!

Volunteering has its perks!

Tobacco Free Florida

• All Speaker Hosts receive a $20 lunch voucher for Exhibit Hall concessions.

• All Speaker Hosts receive a $20 lunch voucher for Exhibit Hall concessions.

• Lecture Speaker Hosts receive free course tuition for the hosted course.

• Lecture Speaker Hosts receive free course tuition for the hosted course.

Volunteer today at education.floridadentalconvention.com

Volunteer today at education.floridadentalconvention.com

QUESTIONS?

QUESTIONS?

Florida Dental Association Crown Savings partner iCoreExchange is an encrypted HIPAA-compliant email designed with more than compliance in mind. It’s so secure that no iCoreExchange email has ever been hacked, phished or held for ransom. If you’re ready to take email security seriously and help mitigate your risk, book an iCoreExchange demo today at iCoreConnect. com/FL10 or call 888.810.7706.

Contact Mackenzie Johnson at mjohnson@floridadental.org or 850.350.7162.

Contact Mackenzie Johnson at mjohnson@floridadental.org or 850.350.7162.

FDA: Well-being program

The Florida Dental Association presents

The NEW Communities of Interest provide opportunities for member involvement and engagement through an online platform.

Share ideas, ask questions, provide feedback and network with your peers in private online communities that focus on:

Dental Education and Licensure

Dental Benefits and Care

Membership and Leadership

New Dentists

Regis ter n ow by sc a nn i ng t h is QR code an d g et s tar te d to d ay !

The Ten Commandments of Cybersecurity

By FDA Director of Information Systems Larry Darnell, MBA, CAE

Thou Shalt Believe it Can Happen to You!

Most people believe it will never happen to them. Ransomware attacks are occurring with greater frequency. The health care sector is particularly under threat. Private health information is 50 times more valuable than credit card data on the dark web. Last year, the American Dental Association was impacted. Just recently, Tallahassee Memorial HealthCare hospital in Tallahassee was restricted for three weeks.

Thou Shalt Use Strong and Unique Passwords for Each Account.

Compromised passwords are one of the greatest threats to your cybersecurity. A common practice is using the same password for everything. One of your passwords

gets compromised, and now the bad guys have access to all your other accounts. Your passwords are being bombarded daily with programs designed to crack them Don’t believe me? Go to haveibeenpwned.com, type in one of your email addresses, and look at how many times your account has been breached. It will make you want to change all of your passwords.

Thou Shalt Enable Multi-factor Authentication Whenever Possible.

Multi-factor authentication (MFA) is no longer a suggestion but a must. MFA works with your password to have a code sent to you or some other form of authentication (face, touch, authenticator app, etc.) before anyone gains access to your account, email, etc. I know it seems annoying and excessive, but without it, you are making yourself an easy target for cybercrime.

Thou Shalt be Careful What You Click On!

Ninety percent of cybercrime is still started via a phishing email. The email has links or a button and because it seems urgent, vital and important, you click on it and do whatever it says. Phishing emails have cost companies billions, forced some to close and destroyed lives. Take time to think before you click that link!

Remember to Back Up Important Data Regularly and Securely.

Backups are still one of the best ways to beat cybercrime and save you from paying the ransom to regain your data. It does not fix everything, but it at least provides a way for your business to get back up and running quicker.

Honor Your Software by Keeping it Up-to-date.

Updates for software are being pushed out daily for your phone, tablet, computers and other technological devices. Why? Because bugs or exploits have been identified. You are putting yourself at risk by not updating. Using old or outdated technology adds to the threat and can leave your systems vulnerable to attack. The “Internet of Things” is full of devices that can be exploited. Updates can help.

Thou Shalt Only Download and Install Apps From Trusted Sources.

Have you ever stopped to read any of those agreements that come with apps you install or software you put on your computer? No. You click “ok” and move on. Then you have little idea what risk you are taking so you best trust the source you are getting those apps from. Even the Apple Store is susceptible to apps that misuse your data. Ensure you know what access you are giving before doing it.

Thou Shalt Use Caution Accessing Public Wi-Fi Networks.

Free Wi-Fi is everywhere. All you have to do is connect, plugin, click a box and boom, you are on the Internet. You

might be opening up shop for your data to be stolen by doing so. Even charging your phone is a risk now. Take precautions. Use virtual private network software that protects data on your device.

Thou Shalt Not Share Your Personal or Sensitive Information Online.

The hackers sometimes do not even need to hack you. We are handing them all the information they need via social media. On vacation? Facebook knows. So does everyone else. Do you play those silly games that ask you questions? Doing so can provide information that hackers can use when trying to guess your security questions. If you would not tell a stranger who shows up at your house, why tell the world that information?

Thou Shalt be Aware of Your Weakest Link.

Your best defense is only as strong as your weakest link. If I have a secret, I have one daughter I can tell to keep it and another daughter if I want everyone to know what it is. If you can’t identify the weakest link, then it very well may be you. Education and training can go a long way to helping others know the risks and avoid costing you and your business greatly.

FDA Director of Information Systems Larry Darnell can be reached at ldarnell@floridadental.org.

Even the Apple Store is susceptible to apps that misuse your data. Ensure you know what you are giving things access to before doing it.

Let Freedom Ring:  How Abyde Liberates Practices from the Stress of HIPAA & OSHA Compliance

By Abyde President & Co-Founder Matt DiBlasi

Adopting Abyde software and liberating health care practices from the burden of the Health Insurance Portability and Accountability Act (HIPAA) and Occupational Safety and Health Administration (OSHA) compliance offers more than just relief — it brings a refreshing sense of freedom and empowerment.

Maintaining compliance with HIPAA and OSHA regulations is an essential responsibility for health care providers. HIPAA safeguards patient privacy by setting standards for the security and confidentiality of protected health information. On the other hand, OSHA ensures a safe working environment for health care professionals by enforcing regulations related to workplace hazards and employee safety.

We know - that was a mouthful! The sheer complexity of these regulations, coupled with ever-evolving requirements and the risk of severe penalties for non-compliance, can overwhelm health care organizations. Compliance tasks, such as conducting risk assessments, creating policies and procedures, employee training and documenting compliance efforts, require significant time and resources. This burden distracts health care providers from their core mission of patient care.

Enhanced Focus on Patient Care

Health care providers can redirect their energy toward providing quality patient care by reducing the time and effort spent on compliance-related tasks. The freedom to prioritize patient needs fosters an environment that enhances overall health care outcomes and patient satisfaction.

With Abyde, health care professionals can devote their expertise and attention to what truly matters: the well-being of their patients.

Cost Savings

The traditional compliance process often requires extensive resources, including staff hours, training and documentation. Abyde optimizes these processes, providing freedom from the financial burden of compliance. By streamlining compliance efforts and automating tasks, organizations can experience significant cost savings. These financial resources can then be allocated towards improving patient care, investing in advanced technologies or expanding health care services.

Peace of Mind

Compliance with HIPAA and OSHA regulations protects patients and safeguards health care organizations’ reputations and integrity. Abyde ensures that health care providers stay up-to-date with the latest regulatory changes and always maintain compliance. The software’s continuous monitoring and automatic updates provide peace of mind, knowing compliance requirements are being proactively addressed. Health care professionals can focus on their work with the confidence that they are operating within the bounds of the law and adhering to the highest standards of privacy and safety. Ensuring your practice abides by HIPAA and OSHA regulations doesn’t have to be stressful. Abyde makes it stress-free!

Streamlined Efficiency

Abyde brings efficiency and organization to the compliance process. A user-friendly interface and intuitive tools make it easy for health care providers to navigate the complexities of HIPAA and OSHA regulations. Automation capabilities save time by generating custom documentation, reminders for training and conducting risk assessments. This streamlined approach allows health care organizations to allocate resources more effectively, improving operational efficiency and smoother workflows.

Abyde liberates health care organizations from the burdensome weight of HIPAA and OSHA compliance, providing a stress-free experience marked by efficiency, cost savings, peace of mind and an enhanced focus on patient care. With intuitive tools, automated processes and continuous monitoring, Abyde allows health care professionals to thrive in an environment where compliance is seamlessly integrated, leaving them free to do what they do best — provide exceptional patient care. Embrace Abyde’s freedom, and embark on a new era of simplified compliance and empowered health care provision.

Abyde is a Florida Dental Association (FDA) Crown Savings Endorsed Partner and the Abyde software solution is the easiest way for any sized dental practice to implement and sustain comprehensive HIPAA and OSHA compliance programs. FDA members save 20% on Abyde services that help their practices meet government-mandated standards through the implementation of risk management programs, training for doctors and staff, customized policy generation and more. Visit fdaservices.com/ abyde or call 800.594.0883.

Compliance with HIPAA and OSHA regulations protects patients and safeguards health care organizations’ reputations and integrity.

WHOSE INTERESTS

does your malpractice insurer have at heart?

Yet another of Florida’s dental liability insurers has transitioned from focusing on dentists to focusing on Wall Street. This leaves you with an important question to ask: Do you want an insurer that’s driven by investors? Or do you want an insurer that’s driven to serve you—one that’s already paid $140 million in awards to its members when they retire from practice?

Join us and discover why delivering the best imaginable service and unrivaled rewards is at the core of who we are.

FDA Career Center

The American Dental Association, Florida Dental Association and your local dental association all work together to provide members with every level of service and support. This three-tier system forms a cohesive partnership to ensure the success of individual members and their practices, as well as the dental profession.

CAREER CENTER BENEFITS

29,000 in the Network 800+ 384,000+ 200+

Searchable Resumes

Average Montly Visits Job Views Per Month

Average View Per Jobs

Looking for Your Next Recruitment Solution?

Is your organization seeking high-quality, professional individuals to be a part of your team? Expand your exposure through the FDA Career Center today!

Connect with our network of elite professionals through our state-of-the-art recruiting platform. Designed to specifically match you with qualified industry candidates, no other commercial job board can deliver quality professionals looking to take the next step in their careers.

• Quick and easy job posting

• Broad health care field exposure to high quality candidates

• Online reports providing job activity statistics

• Simple, affordable pricing options

careers.floridadental.org/employers

Contact Naylor Employer Support to get started: employersupport@naylor.com

The FDA Career Center is also a great resource for job seekers. Visit today!

Plan to join us June 20-22 for the 2024 Florida Dental Convention.

As always, FDC2024 will feature free registration for FDA members.

The 2023 Florida Dental Convention (FDC), “Launching Dentistry Forward,” was held June 20-22 at the Gaylord Palms Resort & Convention Center in Orlando.

FDC2023 was an unforgettable event where more than 7,800 dental professionals, including 1,360 Florida Dental Association (FDA) members, from across Florida and the country came together to sharpen skills, discover new techniques and connect with peers.

This year featured more than 130 courses ranging from lectures to hands-on workshops and mini-residencies for the entire dental team, including: The Dawson Academy’s Function Occlusion course, Botox, 3D printing, clear aligner therapy, crown lengthening, implant advancements, sleep disorders, platelet rich fibrin therapy and more. Attendees were able to earn up to 22 hours of continuing education (CE) credit at FDC2023. The Exhibit Hall buzzed daily with attendees learning about the latest technologies and buying products from more than 300 leading dental vendors.

“Come for the CE, Stay for the Fun” continued to be the FDC motto with family-friendly social events. On Thursday, attendees had the opportunity to mingle with exhibitors during the cocktail reception in the Exhibit Hall, followed by a night of fun with their peers at the new LIVE! at FDC event featuring the Blonde Ambition Band. On Friday, FDA members honored their colleagues at the annual Awards Luncheon, including Dentist of the Year, Dr. Cesar Sabates, and J. Leon Schwartz Lifetime Service Award recipient, Dr. Kim Jernigan. Friday evening, attendees blasted off to outer space for stellar fun at the Out of This World Party, featuring fun for the entire family. It was a can’t-miss event!

Plan to join us June 20-22 for the 2024 Florida Dental Convention. As always, FDC2024 will feature free registration for FDA members, exceptional education courses and a bustling Exhibit Hall all under one roof at the Gaylord Palms in Orlando. The course/speaker listing will be available in October 2023 and registration will open March 2024 at floridadentalconvention.com. We can’t wait to see you there!

FEATURED SPEAKERS

> Debra Engelhardt-Nash

> Kevin Henry, MA

> Mark Kleive, DDS

> Sara Jockin, DDS

> Laci Phillips-Newland

> Mario Romero, DDS

> Sully Sullivan, DDS

> Kevin Suzuki, DMD, MS

HOT TOPICS

> AI in Dentistry

> Bone Augmentation

> Dental Implants

> Dental Photography

> Forensic Dentistry

> Full Arch Restoration

> Patient Communication

> Smile Design & 3D Printing

Robotically Assisted Implant Surgery in Clinical Practice and Dental Education

By Thomas G. Wiedemann, MD, PhD, DDS

The term “robot” was first used in 1921 in a play called “Rossum’s Universal Robots” by the Czech writer Karel Capek. The expression derives from the Czech word “robota,” which means “forced labor.”

In 1941, science fiction writer Isaac Asimov first used the word “robotics” to describe the technology of robots. When “Star Wars” was released in 1977, George Lucas introduced the strongest image of a human future with robots, which inspired a generation of researchers.

But can robots and humans work together in the real world? Many of us worry that robots are replacing human workers in every facet of our jobs.

Which other real-life field could be a better example of how robots and humans can achieve this goal than medicine? In the mid-1980s, NASA developed a robot t

for deep space exploration to perform remote surgical procedures for soldiers in space or on the battlefield. In 2000, the DaVinci robot was introduced for laparoscopic use and, in 2009, for transoral procedures. There is barely any discipline in medicine that does not currently benefit from robotic surgery. Robotics is no longer the therapy of tomorrow; it is the therapy of today.

However, dentistry has been late, only joining in 2017 with the Food and Drug Administration’s approval of YOMI, the world’s first computerized navigation robotic system for dental implants. The latest statistics suggest that around 30,000 implants have been placed using robotic assistance since commercialization. The robot consists of multiple components, which include a planning laptop and a monitor, but the key elements are the tracker arm and the robotic guidance arm. This robot arm is not autonomous, which means it only responds to forces supplied by the surgeon or provides real time

feedback by virtue of constraining motions. A typical question often asked by dentists is, “How does a robot know where the patient is in real-time?” The tracker arm essentially maps the patient from the virtual world into the real world and vice versa.

The execution of robotic implant surgery is a four-step process: scan, plan, place and restore the implant. The entire process starts with applying a splint and a fiducial array, which the patient will wear when a CBCT scan is obtained. This scan is then imported into the robotic software, and thereby the patient is brought from the physical world into the virtual world. The implant planning is performed directly on the robot. Any implant system can be chosen from a comprehensive implant library. The patient is then tethered to the robot, which results in a constant overlay of both physical and virtual reality. At every step, calibration checks are taken to ensure that every landmark identified matches the 3D

Robotic-assisted implant surgery has passed its infancy and is part of an evolution.

This cutting-edge technology was also introduced to educate dental students.

Fig. 1: Implant placement with robotic-assisted implant surgery (RAIS): The implant surgeon always has unimpeded intraoral verification while the robot provides real-time visualization on the robotic monitor throughout the entire procedure.

workspace. In general, the robot uses a series of mathematical algorithms to maintain its spatial awareness, one of the key elements that provide for the accuracy and precision of the surgery. RAIS allows the surgeon to guide the handpiece directly to match the preplanned surgical implant position, thereby combining the advantages of the physical constraints of computer-aided guidance and the flexibility of dynamic navigation. As the drill reaches the planned depth, the robotic arm stops and does not allow further drilling. RAIS can ultimately be described as computer-driven motion restriction by reducing inaccuracies and preventing iatrogenic-induced errors. However, the surgeon can modify or adjust the implant positioning plan at any time during the surgical procedure. RAIS allows same-day guided surgery with no wait for surgical guides and provides extreme concentricity of the implant osteotomy with no drill chatter, resulting in excellent primary stability of implants. RAIS is nowadays a choice we have, an opportunity to elevate our practices and provide leadership in a new level of care.

This cutting-edge technology was also introduced to educate dental students. The Department of Oral and Maxillofacial Surgery at New York University (NYU) College of Dentistry has engaged with dental students through various approaches. After weeks of intense training, on May 4, 2022, three dental students at NYU College of Dentistry became the first in the U.S. to perform dental implant surgery using this state-of-the-art robotic technology independently. This unique event went viral and has been picked up and reposted across multiple platforms since. Implementing robotic technology is now transforming dental education.

Summary

Robotic-assisted implant surgery has passed its infancy and is part of an evolution. It delivers unprecedented surgical accountability and minimizes human error with multiple layers of security, but it is not a substitute for sound judgment, experience and proper decisionmaking.

However, regarding student education, precision, safety and outcome of implant placement using RAIS, we have reached the borders of the current technology. It would take some out-of-the-box development to push these four factors drastically higher.

References:

1. Ahmad, P.; Alam, M.K.; Aldajani, A.; Alahmari, A.; Alanazi, A.; Stoddart, M.; Sghaireen, M.G. Dental Robotics: A Disruptive Technology. Sensors 2021, 21, 3308.

2. Bolding SL, Reebye UN: Accuracy of haptic robotic guidance of dental implant surgery for completely edentulous arches J Prosthet Dent, 2021.

3. Hatamifar A, Pelton J, Wilkins G, Glickman R, Wiedemann T., Talib HS. Evolution or Revolution: Is Robotics the New Age Digital Shift in Dental Education? J Dent Oral Sci. 2023;5(1):1-3. DOI: https://doi.org/10.37191/Mapsci-2582-3736-5(1)-147

4. Pallardy C.: The latest in Dental Robotics, AGD Impact, April 2023

5. NYU College of Dentistry Performs First Dental Student-Led Robot-Assisted Dental Implant Surgery. New York University, 5 May 2022, nyu.edu/about/newspublications/news/2022/may/ dental-student-led-robot-assistedsurgery.html.

Dr. Thomas G. Wiedemann is a clinical associate professor and assistant director for the Advanced Clinical Fellowship Program in Oral Surgery at New York University’s College of Dentistry. He is a fellow of the European Board of Oral and Maxillofacial Surgery, Head and Neck Surgery and is a diplomate of the International Congress of Oral Implantologists. Dr. Wiedemann will present his course, “Guided Versus Robotically Assisted Implant Placement: The Future is Haptic,” at the Florida Dental Convention in Orlando on Friday, June 21 at 9 a.m. He can be reached at tgw1@nyu.edu.

THE DEADLINE TO RENEW YOUR DENTAL LICENSE IS FEBRUARY 28, 2024

28 HOURS OF GENERAL COURSE CREDIT

Only 3 hours of the 28 hours of general credit can be practice management course credit

2 HOURS OF PRESCRIBING CONTROLLED SUBSTANCE CREDITS

All dentists, regardless of DEA licensing, must complete this course requirement. This 2-hour course is included in the 28 hours of general course credit needed to renew.

2 HOURS OF MEDICAL ERRORS CREDITS

YOU MUST HAVE 30 HOURS OF CE CREDIT TO RENEW YOUR DENTAL LICENSE.

This course is required for all dentists and must be completed each license renewal.

2 HOURS OF DOMESTIC VIOLENCE CREDITS

This course is due every third biennium. Check your CE Broker account to confirm the last time you took this course.

2 HOURS OF HIV/AIDS CREDITS

This course is only required during your first license renewal cycle.

UPDATED CPR CERTIFICATE

You must have a current CPR certification to renew. This course must be live or a “blended course” with the hands-on components in-person and test online. The CPR certification course hours do not count toward the 30 hours required to renew.

LOOKING FOR ADDITIONAL CE CREDIT? READY

The FDA o ers free online CE opportunities! You can earn up to 6 hours of CE credit at the convenience of your home or o ce. Visit floridadental.org/online-CE to learn more about these courses exclusively available for free for FDA member dentists.

TO REVIEW?

Visit cebroker.com to view the CE credits you currently have or report any remaining credits you need to renew.

Then, visit floridahealthsource.gov to begin the license renewal process.

Medication Access and Training Expansion Act:  Answers to the New Mysterious

8-Hour Requirement for DEA License Renewal

By Richard A. Mufson, DDS

“We need another 8 hours of CE?”

“What the [expletive]?”

“How come?” and “For what???”

“Is SFDDA providing any CE for this?”

“Is organized dentistry doing anything about this?”

These are but a few of the questions our members have been asking recently.

Here Are Some Answers:

The Medication Access and Training Expansion (MATE) Act is not a Florida state-mandated continuing education (CE) requirement. It is the result of a new federal law for which we can all thank our “inside-the-Beltway” Washington, D.C. legislators in Congress.

And, as a federal law, the new CE requirement is conceptually and legally worlds apart from our more familiar state-mandated CE courses typically offered by local dental organizations for complying with biennial state licensure.

The MATE Act was included as part of the Omnibus Spending Bill, which passed the U.S. Congress at the end of 2022. It was enacted as a onetime eight-hour training requirement

on substance use and abuse disorders for all Drug Enforcement Administration (DEA)-registered practitioners as a requisite for the initial application or renewal of one’s DEA license.

What has organized dentistry done for me lately, especially on issues like this? Funny you should ask.

The American Dental Association (ADA) and American Association of Oral and Maxillofacial Surgeons (AAOMS) jumped on this issue. They sought answers to important questions and further clarity surrounding the new law.

AAOMS President Dr. Paul Schwartz, in a Feb. 24 email letter to Dr. Yngvild K. Olsen, M.P.H., director of the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), expressed thanks on one hand for allowing AAOMS and other concerned organizations to participate in a Feb. 13 MATE “Listening Session” offered by SAMHSA, but on the other hand raised significant concerns and questions regarding the implementation and compliance with the new law, among which included:

1. A lack of specific clarity in training that would satisfy the expectations of the MATE Act. Given that SAMHSA does not have the authority to determine course content or delivery that would meet the bar for compliance, it would remain unknown as to whether varying types or forms of training would be accepted by the DEA.

Examples would include whether training must be “live” or can be “on demand,” or whether it must be completed in a single session or divided among several, or whether it must include “all criteria” referred to in the ACT, namely those outside the scope of the practicing dentistry – such as pharmacological management of pain, screening, intervention and referral, or whether focusing on one or some requirements within our scope would suffice.

2. The overly prescriptive nature of the law and variability in rulemaking across many state jurisdictions may also pose the risk that many practitioners may opt out of renewing their DEA licenses and thus create a potentially wide gap in access to care. Further, the seemingly “onesize-fits-all” approach to fulfill requirements spelled out in the law may leave dentists/oral and maxillofacial surgeons, for whom treating substance use and abuse is not within their training or scope of practice, unable to prescribe controlled substances, including much-needed pain medication after surgery.

3. Insufficient time for implementation in which there would be the anticipated need for course development, locating and enlisting

qualified educators, marketing and, adding on to this, the need for clarity in requirements strongly suggested the June 21 deadline was unrealistic for implementation.

The ADA also came forth with significant contributions in advocacy on this issue, including success in having Congress amend specific provisions in the MATE ACT, which included: (1) Removal of the requirement from the original bill, which meant that dentists would need to complete specialized training in safely prescribing buprenorphine, a drug used in the treatment of opioid addiction; (2) Allowing dentists to apply CE for state licensure toward their federally-required training, in addition to courses taken through ADA CERP providers, and (3) Upon recognizing that dentists receive coursework and training in pharmacology and prescribing of controlled substances as an inherent part of dental school education and post-doctoral graduate and residency programs, the following provision was added: “New dentists who are less than five years out of dental school” may use their dental school [and graduate/residency] coursework toward their federally-required training requirement.”

The eight-hour training under this new federal law is a “one-time-only” requirement upon initiating or renewing one’s DEA registration application.

CELEBRATE NEW SKILLS WITH DENTAL RADIOGRAPHY CERTIFICATION

Take the first step on the path to dental radiography certification. Train online, at your own pace. Study anywhere! The Florida Dental Association (FDA) Online Radiography Training Program provides you the formal training you need, with the professional development you want. Enrich your career path while contributing a vital service to your patients and dental team. It’s the most convenient and economical way to get the radiography training required by Florida law. It’s affordably priced, too — just $285 per student* for FDA members!

*Non-members pay $385.

So, what much of this news comes down to, without many of us having fully appreciated, is that the requirement may have already been fulfilled if one is a recent dental graduate. Or, for those among us who have taken one or more of our local dental society-offered courses on “Prescribing of Controlled Substances,” we likely may have already fulfilled part, most or even all of the eighthour requirement.

Another point of interest: The one-time requirement is limited to “checking a box” on the DEA initial or renewal application, attesting to the fact that the required coursework was completed.

As a final summary of multi-faceted answers to the new requirement, a June 26 update published by AAOMS on the MATE Act includes the following: The eight-hour training under this new federal law is a “one-time-only” requirement upon initiating or renewing one’s DEA registration application. Beginning June 27, 2023, practitioners will be required to check a box on their on-line DEA registration form attesting to completion of the eight-hour training.

WELCOME TO THE FDAS BOARD

DR. JOSÉ PERALTA

• Past training counts toward the eight hours if received before Dec. 29, 2022, by one of the approved organizations: ADA, AAOMS and any other organization accredited by ACCME or CCEPR, among others listed in DEA and SAMHSA literature and websites. Practitioners who have “graduated in good standing from a medical, dental, physician assistant or advanced nursing practitioner training school within five years of June 27, 2023” will be considered to have completed a comprehensive curriculum that includes — and therefore satisfies — the eight-hour requirement.

• Coursework may also be in varying formats, including classroom, seminars at professional meetings or virtual offerings. DEA also recommends retaining some form of verification of course completion. Training does not have to occur in a single eight-hour session but may be in several sessions totaling at least eight hours.

• Courses may be related to the management of patients with opioid or other substance abuse disorders, but not necessarily the treatment of these patients (again, as it is outside of our scope of practice).

For those requiring one or more additional courses, you may visit the CE section of AAOMS or ADA websites for other accepted courses available. Members are also strongly encouraged to contact the DEA with questions regarding qualifying courses or other matters. You may also email questions to the Diversion Control Division Policy Section at odlp@dea.gov or call 571.362.3260.

Reprinted with permission from the South Florida District Dental Association (SFDDA) Summer 2023 Newsletter.

Dr. Richard A. Mufson is the editor of the SFDDA Newsletter and may be contacted at 305. 935.7501 or MufsonOralSurg@aol.com.

Clinical Dental Director of Florida Dental Care Alliance

Women in Dentistry Leadership Series

Transform your perspective. Transform your life.

Powerful and passionate women’s voices that will make us all rethink how we balance our lives professionally and personally.

Christine Cashen, Presenter Staying Inspired When You’re So Darn Tired

Business humorist and author Christine Cashen will reveal the secret to achieving your goals using the resources and capabilities you already possess to make a positive impact in both your workplace and your life.

Hazel Glasper, DDS, Presenter Anne Duffy, Moderator Being Your Own Change Agent: Success on Your Terms

Join Hazel Glasper, DDS, and Anne Duffy as they delve into the secrets of focusing on your passions and dedicating the necessary energy and mindset to create the fulfilling and abundant life we all yearn for.

By the American Dental Association

SmileCon®, the American Dental Association’s (ADA) annual meeting taking place Oct. 5–7 in Orlando at the Orange County Convention Center, will feature hundreds of continuing education (CE) courses from more than 120 dental thought leaders bringing the latest and greatest in dental education.

With courses centered on specific themes, including the business of dentistry, science and technology, art and design, and the common good, attendees can explore the areas that interest them the most. SmileCon’s hands-on activities are another CE highlight, allowing dentists to roll up their sleeves and take their skills to the next level. Depending on the registration pass purchased, these hands-on courses may include an additional charge.

Some hands-on activity hot topics include “Diagnosis, Planning and Treatment Using New 3-D Technology” (5111) facilitated by Drs. John C. Flucke, Marty Jablow and Paul Feuerstein; “CBCT Imaging Essentials 1: Introduction

to CBCT Acquisition Principles, Software Tools and Scan Navigation” (6214) with Dr. Setareh Lavasani, MS, Diplomate ABOMR, FGDIA; or “Laying it Down: Create Beautiful Anterior Composite Restorations” (7204) with Dr. Troy Schmedding.

“SmileCon is a new take on the traditional dental meeting and delivers the latest science, innovations and trends in a highly concentrated experience. We have curated a collection of dental education stars, big names and new voices to deliver CE in a high-energy, relatable and engaging manner. No other meeting has so many high-end speakers in one place, at one time,” said Dr. Nanette C. Tertel, CE chair. Get ready for three exciting, education-packed days dedicated and tailored to you, the dental professional.

The Women in Dentistry Leadership Series (WIDLS), sponsored by Crest + Oral-B, will share women’s viewpoints about the subjects that matter most to them professionally and personally. This year’s panel of powerful and passionate women will transform your perspective and life.

Christine Cashen, business humorist and author, will reveal the secret to achieving your goals using the resources and capabilities you already possess to make a positive impact in both your workplace and your life in her course “Staying Inspired When You’re So Darn Tired” (6145).

Join Dr. Hazel Glasper and Anne Duffy for “Being Your Own Change Agent: Success on Your Terms” (6147) as they delve into the secrets of focusing on your passions and dedicating the necessary energy and mindset to create the fulfilling and abundant life we all yearn.

There will also be two networking events for attendees to meet and connect with the WIDLS speakers following both sessions on Friday, Oct. 6.

Attendees can also get peer-to-peer learning and time with several speakers during hosted lunch C.H.A.T.s over the three-day meeting. Lunch C.H.A.T.s are an additional cost and have limited seats available.

The pillars of SmileCon are Meet, Play, Learn and Smile, and while CE is important, making time to connect with colleagues and reconnect with the team is just as vital! So, here are four top additional reasons to attend:

1. New immersive learning experiences, such as the Oral Pathology Escape Room in the Oral Medicine Hub or seeing and touching the future of Augmented Intelligence in the Tech Hub.

2. Opportunities to expand your superpowers are limitless, whether it’s reuniting with your industry peeps in Dental Central, giving back to the community during the Give Kids A Smile® Pack & Give Back Event or cheering on future colleagues at the dental student team trivia competition during Dental Olympics.

3. Have some SERIOUS fun at the Grin & Gobblin’ Fest, celebrate the profession in the opening session and Saturday keynote, and catch-up with your industry friends during the closing party in Dental Central.

4. You and your team work tirelessly to create smiles, and YOU should be rewarded with time of your own to SMILE!

Learn more about the CE program and register today at SmileCon.org.

While CE is important, making time to connect with colleagues and reconnect with the team is just as vital!

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Since 1996, our team of experts have provided successful transition services exclusively to dentists. Choice prides itself on its reputation for integrity, service and results for both traditional practice sales and commission-free sales to DSOs.

Practice Consolidation Is Cresting

It’s

Time to Understand the Value of Your Practice

Silent Partners Buy Part of Your Practice

Dozens of Invisible Dental Support Organization (IDSO) silent partners are paying record values for partial interests in Endodontic practices advised by LPS. Endo-only IDSOs compete fiercely with the multi-specialty and Specialty Surgical Trifecta IDSOs, driving up values. You should understand all of your options.

IDSOs purchase 51% to 90% of practices for cash now at low tax rates. Doctors retain ownership and have significant upside in the equity value. Some LPS clients have achieved 3x to 7x equity returns in only three to five years.

Long-Term Wealth Building Partnership

Doctors continue to lead their practice with their brand, team and strategy for years or decades. Practices benefit from the resources of a larger, silent partner, but are not micromanaged or homogenized.

IDSO partnership is not a short-term transition strategy, but rather a long-term wealth building partnership. Some happy LPS Endodontic clients are under 35!

Six or More Choices in Partnership

LPS clients have 6 to 10+ qualified bidders. LPS completed over $500 million of transactions for dentists of all types, in the last 12 months. LPS’ size enables our clients to achieve record values that the little advisors cannot match. Multiple Endodontic clients have achieved values of over 3x collections.

Your Value in Today’s Consolidation Frenzy

Great practices with at least $1.4 million in collections have many options today. You should understand the value of your practice in an LPS-advised process. Doctors who deal directly with IDSOs often leave millions on the table and do not get to consider ALL of their options.

Contact us to schedule a confidential, no obligation discussion to learn the value of your practice; you might be surprised at today’s values!

Diagnostic Quiz

By Drs. Njood Hawari, Neel Bhattacharyya and Nadim M. Islam

A 12-year-old male was referred to Dr. David Beltran, a periodontist at Beltran Periodontics Clinic, in Kissimmee, for diagnosis and treatment of a lesion on the maxillary gingiva associated with a chief complaint of bleeding upon brushing. A painless red gingival lesion in the anterior maxillary gingiva was noticed by the patient’s parents approximately one month ago (Fig. 1). Importantly, they reported that the patient had recently completed (about two months ago) orthodontic therapy with placement of brackets and archwire. The orthodontic therapy was done for about 14 months.

Intraoral examination revealed a well-circumscribed, bright red, pedunculated gingival overgrowth with a spongiotic papillary surface on the facial margin and attached gingiva of teeth #10 and #11. No intra-osseous involvement was found via radiography.

Dr. Beltran performed an excisional biopsy of the lesion measuring about 0.8 mm x 0.6 mm x 0.3 mm (Fig. 2) and submitted the tissue to the University of Florida Oral Pathology Laboratory Biopsy Service for microscopic examination.

Question:

Based on the clinical presentation and history, what is the most likely diagnosis?

A.) Lymphangioma

B.) Verruca Vulgaris

C.) Peripheral Giant Cell Granuloma

D.) Peripheral Ossifying Fibroma

E.) Localized juvenile spongiotic gingival hyperplasia

Fig. 2. Area after excision.

Fig. 1. Bright red, pedunculated raised somewhat papillary surfaced lesion on attached gingiva between teeth #10 and #11.

A. Lymphangioma

Incorrect. Good guess! This is a good consideration in the differential diagnosis since oral lymphangiomas can occur on the gingiva. However, lymphangiomas typically present as translucent raised lesions with a slight yellowish, whitish or even bluish hue due to the presence of lymphatic fluid. Oral lymphangiomas are benign, hamartomatous tumor-like growths of lymphatic vessels. They can have a variety of clinical presentations and are soft and compressible. They also tend to rapidly enlarge in size, which did not happen in this case. They have a smooth or slightly granular surface texture and are primarily fluctuant due to the presence of lymph. These lesions frequently lack distinct borders, unlike the present, well-circumscribed lesion. Oral lymphangiomas may occur anywhere in the oral mucosa, but the most common location is the tongue, especially the anterior two-thirds. Importantly, lymphangiomas arise early in a patient’s life, typically at birth (60% to 70%) or up to two years of age, contrasting this presentation.

B. Verruca Vulgaris

Incorrect. A great guess! Verruca vulgaris is common in children, so it is a suitable consideration. In addition, verruca vulgaris is typically raised with finger-like projections and is white, unlike this case, where the lesion was somewhat “flat,” spongiotic and bright red. These represent a benign proliferation of heavily keratinized stratified squamous epithelium, presumably induced by human papillomavirus. The predilection sites include the vermilion border of the lower lip, labial mucosa or anterior tongue, unlike the location of this gingival lesion. These lesions are usually solitary, and their size is typically constant for months or years unless the lesion is irritated. Verruca are challenging to distinguish from papilloma’s both clinically and microscopically. It’s treated by conservative surgical excision. Verruca does not exhibit malignant transformation, and two-thirds spontaneously resolve within two years, especially in children.

C. Peripheral Giant Cell Granuloma

Incorrect. Peripheral giant cell granuloma (PGCG) is a common tumor-like growth of the gingiva; hence, this is a good entity to include in the differential diagnosis of

gingival lesions. However, unlike this case, PGCG demonstrates a peak incidence in the fifth to sixth decades of life. PGCG tends to be bluish-purple or darker red instead of the bright red coloration. Also, PGCG is raised, forms a “bump” on the gingiva and is usually not flattened, as seen here. These are most likely reactive lesions caused by local irritation or injury and do not represent a tumor. PGCG also arises in the papillary interdental gingiva. Approximately 60% of cases occur in females. PGCG may cause “cupping” resorption of the underlying alveolar bone, unlike our case, where no radiographic alterations were observed.

D.) Peripheral Ossifying Fibroma

Incorrect, but great presume! Peripheral ossifying fibroma (POF) is the prototypical example of a “bump on the gum” lesion. These occur exclusively on tooth-bearing gingiva and are nodular, pedunculated or sessile-raised masses with an ulcerated surface. Importantly, POF is often present for many weeks or months before the diagnosis is made, as opposed to the lesion seen here, which came up in a few days to weeks. In addition, POF primarily affects young adult females. These tend to bleed easily and might exhibit ulceration or surface changes. Previously, the terms peripheral odontogenic fibroma and POF were used interchangeably, but peripheral odontogenic fibroma is now considered a distinct and separate entity. Local surgical excision with histopathologic evaluation is the preferred treatment for POF, and it should be excised down to the periosteum since recurrence is more likely if the remnants of the lesion remain. The neighboring teeth should be carefully scaled to remove any potential irritants. POF is thought to arise from the periodontal ligament or gingival connective tissue. A recurrence rate of 8% to 16% has been documented.

E. Localized Juvenile Spongiotic Gingival Hyperplasia

Correct. Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a rare condition characterized by a well-circumscribed, papillary and exophytic soft red tissue lesion on the gingival border and attached gingiva. Even though the condition is found to be idiopathic, it

has been proposed that the isolated patch of exteriorized junctional or sulcular epithelium may be secondarily affected by local factors such as mouth breathing or local irritation. LJSGH is an infrequent lesion that clinicians may encounter. The most common presentation of LJSGH is a small, bright red, velvety-colored raised lesion with papillary alterations that often bleed easily upon manipulation. Only a few reports have studied LJSGH because it was only recently recognized as a clinical standalone entity and, most of the time, misdiagnosed as plaque-related gingivitis. Most reported instances were excised cautiously, with a recurrence rate ranging from 6% to 16.7%. Although many cases are misinterpreted as puberty gingivitis because of the overlapping appearance of gingival erythema, indicating a local inflammatory process, LJSGH’s important key factor of differentiation is that it lacks a response to improvement of oral hygiene and, therefore, has no plaque-related etiology. LJSGH is commonly seen in young individuals with a median age of 12 years involving the anterior maxillary facial gingiva, primarily associated with orthodontic therapy similar to our patient’s history. Histopathologic examination demonstrates papillary growth of keratinized epithelium and supporting fibrous connective tissue (Fig. 3A). The epithelium exhibits multiple finger-like projections with significant hyperplasia, extensive spongiosis, edema and leukocytic exocytosis (Fig. 3B).

References:

1. Bhayya H, Pavani D, Avinash Tejasvi ML, Geetha P. Oral lymphangioma: A rare case report. Contemp Clin Dent. 2015 Oct-Dec;6(4):584-7. Sunil S, Gopakumar D, Sreenivasan BS. Oral lymphangioma - Case reports and review of the literature. Contemp Clin Dent. 2012 Jan;3(1):116-8.

2. Chang JY, Kessler HP, Wright JM. Localized juvenile spongiotic gingival hyperplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Sep;106(3):411-8.

3. Siamantas I, Kalogirou EM, Tosios KI, Fourmousis I, Sklavounou A. Spongiotic Gingival Hyperplasia Synchronously Involving Multiple Sites: Case Report and Review of the Literature. Head Neck Pathol. 2018 Dec;12(4):517-521.

Diagnostic Discussion is contributed by University of Florida College of Dentistry professors, Drs. Indraneel Bhattacharyya and Nadim Islam who provide insight and feedback on common, important, new and challenging oral diseases.

The dental professors operate a large, multi-state biopsy service. The column’s case studies originate from the more than 16,000 specimens the service receives every year from all over the United States.

Clinicians are invited to submit cases from their own practices. Cases may be used in the “Diagnostic Discussion,” with credit given to the submitter.

Drs. Bhattacharyya and Islam and can be reached at oralpath@dental.ufl.edu.

Conflict of Interest Disclosure: None reported for Drs. Bhattacharyya and Islam.

The Florida Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental 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.

Dr. Bhattacharyya

Dr. Islam

Fig. 3. (A) On low power, papillary architecture of hyperplastic epithelium is observed (Hematoxylin and eosin). (B) High-power photomicrograph shows significant spongiosis, inflammatory exocytosis and edema.

FDA’s 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!

General Dentist, Jacksonville. Nestled in the picturesque coastal landscape of Northeast Florida, Jacksonville beckons with its unique blend of Souther charm, vibrant urban energy, and stunning natural beauty. As Florida’s largest city by both area and population, Jacksonville offers a dynamic setting where pristine beaches, lush parks, and a thriving cultural scene come together harmoniously. This flourishing metropolis presents an exceptional opportunity for a skilled and passionate dentist to become an integral part of the community while enjoying the best of what the region has to offer. If you are a skilled and compassionate General Dentist looking to make a positive impact on the oral health of a vibrant community, look no further! We are seeking a talented dentist to join our dedicated team at our Ortega Boulevard Dental practice located in beautiful Jacksonville, Florida! What You’ll Do: Perform comprehensive dental examinations, diagnose dental conditions, and develop personalized treatment plans for patients of all ages. Administer general and preventive dental procedures, including fillings, extractions, crowns, bridges, and more. Collaborate with our team of experienced dental professionals to ensure optimal patient care and treatment outcomes. Educate patients on proper oral hygiene practices and preventive measures to maintain excellent oral health. Stay up-to-date

with the latest advancements in dental technology and techniques to provide the best possible care. Why Choose Us: Competitive compensation package that includes a Sign-On Bonus! Supportive and collaborative team environment that fosters professional growth. Access to cutting-edge dental technology and tools to enhance your practice. Beautiful Jacksonville, Florida location, offering a mix of relaxation and outdoor activities. Strong patient base and established reputation in the community. If you are a dedicated General Dentist looking to make a positive impact and enjoy the beauty of Jacksonville, we’d love to hear from you! DMD or DDS degree from an accredited dental school. Active Florida state dental license in good standing. Proven experience as a General Dentist, with a focus on patient-centered care. Strong communication skills and the ability to build rapport with patients. Commitment to continuous learning, and staying updated on industry trends. Visit careers.floridadental.org/ jobs/19049800/.

General Practice Belleview/

The Villages For Sale including Real Estate, Belleview.

Practice Available Immediately. 11 year Fee For Service General Dental Practice just north of The Villages. Belleview is a rapidly growing family community in a central location with easy access to I-75 drawing patients from Ocala and many

other 55+ neighborhoods full of cash paying patients wanting a private dentist. 950 sq. foot building built in 2008 sits on an acre of land with room for an addition or another building. 2 operatories are fully equipped and a third is plumbed. Modern technology includes digital sensors and Patterson Fuse cloudbased software. All equipment is included. 250 patients are scheduled for recall with over 1000 patients of record. This would be a perfect satellite for a GP or specialist or for a new grad to hone their skills before expanding. $300k includes practice, equipment, building, and 2 commercial lots. Visit careers.floridadental.org/jobs/18722455/

General Dentist, Ormond Beach. Offering an excellent General Dentistry Associateship position that can lead to partnership and/or ownership. Long standing modern family practice with over 40 years at current location. Amazing staff that have been at the practice for years. We have a cone beam CT, CAD CAM milling, iTero scanner, soft tissue laser and more. Looking for someone who enjoys engaging the patients and practicing high quality dentistry. For details please contact Dr. Drake at drake@drdrake.com. Active DDS/DMD and valid Florida dental license. Visit careers.floridadental.org/ jobs/18693589/.

Visit the FDA’s Career Center at careers.floridadental.org.

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 5th of every other month (e.g., Jan. 5 for the Jan/Feb issue, March 5 for the March/April issue. etc.).

Please note: Ads for the Nov/Dec issue must be placed no later than Nov. 1.

Pediatric Dentist, Naples. Pediatric Dentist, Healthcare Network, Naples. This position will provide comprehensive Pediatric Dental care to patients in a primary health care delivery system. The Pediatric Dentist assumes the responsibility of providing the best care possible for all of patients. Provide preventive and restorative treatments for problems affecting the mouth and teeth. High moral character, ethics, and conduct are mandatory. Responsibilities and Standards. Perform oral examinations of hard and soft tissue while working with patients to maintain and restore quality health to everything within the mouth. Examine teeth and diagnose patients’ dental conditions by using tools such as x-rays, dental instruments, and other diagnostic procedures. Clean, restore, extract, and replace teeth, using rotary and hand instruments, dental appliances, medications, and/or surgical equipment. Evaluate the current health and condition of the patient’s teeth to determine diagnosis of dental condition, if any. Completes treatment planned procedures that are agreed upon by patient and parent/guardian, such as restoring teeth affected by decay and treating gum disease. Perform pediatric dentistry services, including the diagnosis and treatment of diseases, injuries, and malformations of teeth, gums, and related oral structures.

Consults with the patient, parent and/ or guardian and advises them of their dental status, prescribes the treatment needed, provides risks, benefits and alternatives. Perform oral cancer examinations, take and interpret radiographs. Provide dental services at any and/or all HCN dental facilities as necessary to meet department needs. Supervise and evaluate dental students and residents during their rotations at HCN’s dental facilities. Performs other related duties as indicated or when requested by a supervisor including moderate conscious sedation procedures and/or taking healthy or medically compromised children to perform restorative procedures under general anesthesia. Job Specifications.

Experience: Education/Training Level: Graduation from an accredited school of dentistry (DMD or DDS); Must maintain required CE credits to maintain licensure; Experience with nitrous oxide, oral sedation, IV sedation and/or general anesthesia preferred. Licenses & Certifications: Possession of a current Florida license to practice dentistry; Board Certification in Pediatric Dentistry; Current CPR Certification in Basic Life Support, PALS Certification; DEA License; FL Certification in Moderate Sedation preferred. Communication Skills: Strong verbal and written communication skills; Bi-lingual in Spanish/ English and/or Creole/English preferred. Technology

Seeking

Train your dental assistants to expose radiographs using the FDA’s MyDentalRadiography online course that combines self-paced learning with clinical proof of competency. Call Lywanda Tucker at 850.350.7143 for details or visit mydentalradiography.com/FDA to create a supervising dentist account and complete the necessary tutorial on how the program works.

Skills: Understanding of and ability to use Electronic Dental Record; Experience with Denticon system preferred please visit careers.floridadental.org/ jobs/18561218/.

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IS YOUR ONLINE DATA SECURE?

By Hugh Wunderlich, DDS, CDE, FDA Editor

Do you have a password login?

Is your backup service run by a Klabautermann?

Are you the LifeLock guy-Todd DavisSS# 457-55-5462

Did you besmirch Edward Snowden?

Does your password include an octothorpe, ampersand, solidus or squiggly bracket?

Is it taped to your monitor on a 3X5 card?

In 2001 did you ever play chess with a HAL-9000 computer?

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FDA Editor Dr. Hugh Wunderlich can be reached at hwunderlich@bot.floridadental.org.

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