2019 - Jan/Feb TFDA by Florida Dental Association

2019 Dentists’ Day on - March 2019 - Page Alerting Floridians tothe theHill Risks of DIY11-12, Dentistry Page 52 2

VOL. 31, NO. 1 • JAN/FEB 2019 • LEGISLATIVE ISSUE

2019 DENTISTS' DAY ON THE HILL

Florida's Action for Dental Health The HIPAA Rules That Dentists Should be Most Familiar With

The HIPAA-cratic Oath: Do No Harm to Patient Data

Check Out Page 17 for an FDA History Fact

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

FDA Lobbying Team – Ready to Battle

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HELPING MEMBERS SUCCEED VOL. 31, NO. 1 • JANUARY/FEBRUARY 2019

RISKS 29

Florida Congressional Members

in every issue 3 Staff Roster 5 President's Message 10 Did You Know? 15 Info Bytes 16 news@fda 26 Get Involved! 74 Compleat Dentistry 77 Diagnostic Discussion 80 Career Center 82 Advertising Index 84 Off the Cusp

Florida Board of Dentistry Meets in Lake Mary

Guest Editorial: Is There a Preparedness Problem in Dental Education?

Florida's Governor and Cabinet

Florida Legislature

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

The HIPAA Rules That Dentists Should Be Most Familiar With

The HIPAA-cratic Oath: Do No Harm to Patient Data

Opioid BOD Rule

Alerting Floridians to the Risks of DIY Dentistry

Organized Dentistry is Well Represented in Tallahassee!

FDAPAC, GAC & LCD

2019 Dentists' Day on the Hill

Brooksville: A Small City With a Big Fluordiation Win

52 60

FDC2019 Speaker Preview — The Mindful Dental Professional

Florida's Action for Dental Health

18 Ways the FDA Made a Difference in 2018

FDC2019 Speaker Preview — Approaching Acute Dental Pain Management to Reduce Opioid Prescribing

2019 FDA President: Dr. Jolene Paramore

TODAY'S FDA ONLINE: floridadental.org

FLORIDA DENTAL ASSOCIATION JANUARY/FEBRUARY 2019 VOL. 31, NO. 1

EDITOR Dr. John Paul, Lakeland, editor

STAFF Jill Runyan, director of communications Jessica Lauria, communications and media coordinator Lynne Knight, marketing coordinator

BOARD OF TRUSTEES Dr. Jolene Paramore, Panama City, president Dr. Rudy Liddell, Brandon, president-elect Dr. Andy Brown, Orange Park, first vice president Dr. Dave Boden, Port St. Lucie, second vice president Dr. Gerald Bird, Cocoa, secretary Dr. Michael D. Eggnatz, Weston, immediate past president Drew Eason, CAE, Tallahassee, executive director Dr. Karen Glerum, Boynton Beach • Dr. Jeannette Pena Hall, Miami Dr. Bernard Kahn, Maitland • Dr. George Kolos, Fort Lauderdale Dr. Eddie Martin, Pensacola • Dr. Jeffrey Ottley, Milton Dr. Paul Palo, Winter Haven • Dr. Howard Pranikoff, Ormond Beach Dr. Rick Mullens, Jacksonville • Dr. Beatriz Terry, Miami Dr. Stephen Zuknick, Brandon • Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Spring Hill, Treasurer • Dr. Rodrigo Romano, Miami, Treasurer-elect Dr. John Paul, Lakeland, editor

PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303 . FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2019 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication. POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303.

EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.

EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste 200, Tallahassee, Fla. 32303. FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; email address, fda@floridadental.org; website address, www.floridadental.org.

ADVERTISING INFORMATION For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113. For career center advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.

Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.

TODAY'S FDA

JANUARY/FEBRUARY 2019

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CONTACT THE FDA OFFICE 800.877.9922 OR 850.681.3629 545 John Knox Road, Ste. 200 • Tallahassee, FL 32303

EXECUTIVE OFFICE DREW EASON, Executive Director deason@floridadental.org 850.350.7109

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GREG GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111

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KENLEE BRUGGEMANN, FDC Meeting Assistant kbruggemann@floridadental.org 850.350.7162

JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 LIANNE BELL, Leadership Concierge lbell@floridadental.org 850.350.7114

ACCOUNTING BREANA GIBLIN, Director of Accounting bgiblin@floridadental.org 850.350.7137 LEONA BOUTWELL, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 ALLEN JOHNSON, Accounting Manager allen.johnson@fdaservices.com 850.350.7140 MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 STEPHANIE TAYLOR, Membership Dues Coordinator staylor@floridadental.org 850.350.7119 LESYA WILBUR, Commissions Coordinator lesya.wilbur@fdaservices.com 850.350.7142

COMMUNICATIONS AND MARKETING JILL RUNYAN, Director of Communications jrunyan@floridadental.org 850.350.7113

SCOTT RUTHSTROM, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146

DEIRDRE RHODES, FDC Exhibits Planner drhodes@floridadental.org 850.350.7108

CAROL GASKINS, Commercial Accounts Manager carol.gaskins@fdaservices.com 850.350.7159

JENNIFER TEDDER, FDC Program Coordinator jtedder@floridadental.org 850.350.7106

GOVERNMENTAL AFFAIRS JOE ANNE HART, Chief Legislative Officer jahart@floridadental.org 850.350.7205 ALEXANDRA ABBOUD, Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204

INFORMATION SYSTEMS LARRY DARNELL, Director of Information Systems ldarnell@floridadental.org 850.350.7102 RACHEL STYS, Computer Support Technician rstys@floridadental.org 850.350.7153

MEMBER RELATIONS KERRY GÓMEZ-RÍOS, Director of Member Relations krios@floridadental.org 850.350.7121 DESTINY SIMS, Member Access Coordinator dsims@floridadental.org 850.350.7100 ASHLEY MERRILL, Member Relations Coordinator amerrill@floridadental.org 850.350.7110

JESSICA LAURIA, Communications and Media Coordinator jlauria@floridadental.org 850.350.7115

CHRISTINE TROTTO, Membership Concierge ctrotto@floridadental.org 850.350.7136

FLORIDA DENTAL ASSOCIATION FOUNDATION (FDAF)

ALEX KLINE, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166 MARCIA DUTTON, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145 PORSCHIE BIGGINS, North Florida Membership Commercial Account Advisor pbiggins@fdaservices.com 850-350-7149 MARIA BROOKS, SFDDA Membership Commercial Account Advisor maria.brooks@fdaservices.com 850.350.7144 KELLY DEE, ACDDA Membership Commercial Account Advisor kelly.dee@fdaservices.com 850.350.7157 MANDY MOORE, Commercial Account Advisor mandy.moore@fdaservices.com 850.350.7156 EBONI NELSON, CFDDA Membership Commercial Account Advisor eboni.nelson@fdaservices.com 850.350.7151 MELISSA STAGGERS, WCDDA Membership Commercial Account Advisor melissa.staggers@fdaservices.com 850.350.7154 TESSA DANIELS, Commercial Account Advisor tessa.daniels@fdaservices.com 850.350.7158

CARRIE MILLAR Director of Insurance Operations carrie.millar@fdaservices.com 850.350.7155

YOUR RISK EXPERTS DAN ZOTTOLI, SBCS Director of Sales — Atlantic Coast 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com DENNIS HEAD, CIC Director of Sales — Central Florida 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com MIKE TROUT Director of Sales — North Florida 904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com JOSEPH PERRETTI, SBCS Director of Sales — South Florida 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com RICK D’ANGELO, CIC Director of Sales — West Coast 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

LIZ RICH, Commercial Account Advisor liz.rich@fdaservices.com 850.350.7171

To contact an FDA Board member, use the first letter of their first name, then their last name, followed by @bot.floridadental.org. For example, Dr. John Paul: jpaul@bot.floridadental.org.

R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117

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

The last four digits of the telephone number are the extension for that staff member.

TODAY'S FDA JANUARY/FEBRUARY 2019

leadership

IT’S A HAPPY NEW YEAR, TIME FOR A NEW BEGINNING I’ve had a paid vacation only once prior to Hurricane Michael. For six months before I started dental school, I worked as a chemist in the Pesticide Research Lab at the University of Florida. One of the benefits of working for the state in 1984 was generous vacation and sick leave. I thought getting paid for not working was a wonderful thing. It felt like skipping school. Little did I realize then that it would be 34 years until I had another opportunity for a paid vacation.

On Oct. 10, 2018, Hurricane Michael — the third strongest hurricane to make landfall in the U.S. in recorded history — changed my community and the surrounding 11 counties in Florida forever. I know what those of you who have experienced hurricanes are thinking. The power’s on in a few days, maybe a week. The debris gets picked up in a few weeks, maybe a month. The leaves all grow back in a few months. As a native Floridian, that’s what my numerous previous hurricane experiences were like. Until Michael.

PRESIDENT’S MESSAGE JOLENE PARAMORE, DMD FDA PRESIDENT

Dr. Paramore can be reached at jparamore@ bot.floridadental.org.

The first responders, tree debris operators, insurance adjusters and government disaster officials who have worked other recent hurricanes all say the damage from Hurricane Michael is way worse than Katrina, Ivan or Andrew. There’s hardly a house without a blue tarp or temporary roof in Bay and Gulf counties. Those that don’t have a tarp still have trees on them or are scheduled to be bulldozed. Acres and acres of pine trees (retirement for many locals) are leveled — for 60 miles inland. Once you are in South Georgia and 100 miles from landfall, it’s only every other house. Cotton is scattered so the roadsides look like snow and pecan groves are uprooted with no chance for recovery. Michael was the real deal. More than $12 billion of the real deal. My last “President’s Message” focused on how the Florida Dental Association (FDA) helps members succeed, especially when the shockers and stressors come along that affect our profession. Those who know me, know I’m all about building relationships and networking with people. So,

SEE PAGE 6 WWW.FLORIDADENTAL.ORG

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leadership FROM PAGE 5

with that background, here’s a snippet of that column: As dentists, you are challenged to elevate your game in your practice. At a recent presentation, we also were challenged to do more. Elevate your perspective. Elevate your relationships. Elevate your engagement. Elevate your impact. I’m all in, are you? All it takes is effort. So, let’s do a quick risk assessment. What or who has the greatest potential to shock or stress our profession? The policy makers (legislators). The rule makers (Board of Dentistry). The insurance industry. The government (pick your favorite regulatory entity). How do you as an individual dentist respond to these shockers and stressors? Do they break you? Do you know who to reach out to try to resolve your stressor? Do you have the kind of relationships that get an appointment with those who can help you respond? Then, I focused on threatening professional issues. Now, I strive to apply the same thought process to address the personal upheaval that a disaster like Hurricane Michael causes. In either situation, it’s still all about elevating your perspective, relationships, engagement and impact. And boy, have the teams at the FDA, FDA Services (FDAS), FDA Foundation, Northwest District Dental Association (NWDDA), Bay County Dental Society (BCDS) and many, many FDA members (those unscathed and those wounded) elevated their games to make an impact! Bear with the length, because the dental family has been doing incredible things! The day before the storm, the Foundation broadcasted information to all members in the NWDDA about their disaster relief grants. FDA Foundation Director of Foundation Affairs R. Jai Gillum, Director of Information Systems Larry Darnell and Director of Communications Jill Runyan all went above and beyond to push this information as the storm intensified. The FDA’s headquarters was closed, as parts of Tallahassee didn’t have power for several days and several FDA team members had homes that were damaged. Nonetheless, before all our team was back at work, quick and easy grant applications were

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R. Jai Gillum

Larry Darnell

Jill Runyan

sent via multiple methods. Over the next two weeks, contact numbers and websites for disaster relief, temporary mobile dental clinics, Federal Emergency Management Agency (FEMA), Florida and U.S. Small Business Administration programs and unemployment assistance were posted by Team FDA on social media, emailed and snail-mailed to members and non-members in the storm’s path. So far, 59 grants of $2,000 each have been issued to dentists by the Foundation! We are fortunate to have a Foundation led by President Dr. Bob Payne and Vice President Dr. Natalie Carr-Bustillo that helps members succeed. To support the Foundation’s efforts, please direct your contributions to the Emerald Club. Your leaders thank you in advance! Team FDA prepared lists of dentists in the storm’s path. FDA Editor Dr. John Paul and FDA President-elect Dr. Rudy Liddell spearheaded the Board of Trustees’ (BOT) member outreach calls to all dentists in the hurricane’s path once the storm passed. Similar to last year’s calls to those in Irma’s path, many dentists did not have power, internet, landline phone or cell service. For weeks, BOT members continued their calls to reach out to members to determine their needs. One need was changing an office address with the Florida Board of Dentistry (BOD). If you were lucky enough to find or share space in an undamaged dental office with power after the storm, but your temporary or relocated office address is not listed with the BOD, dental suppliers will not process your orders for necessary supplies like anesthesia. So, you still are unable to see patients. If you have no internet access, it’s hard to quickly change your address (even with internet, their website updates 48 hours after receipt). Waiting on the mail and processing time at the BOD takes another week, at best. That’s where the relationships come in. FDA Director of

WWW.FLORIDADENTAL.ORG

Member Relations Kerry Gómez-Ríos reached out to BOD Executive Director Jennifer Sapp and in one day, a process was established to expedite the address change. That’s truly helping members succeed to provide care to our citizens and start the recovery process! Kerry Gómez-Ríos

Do you know insurance company payments won’t be sent if your temporary location doesn’t match your tax ID address? If you’re fortunate enough to be able to practice in a new location, you won’t get insurance checks. Again, Team FDA to the rescue! FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire has Casey Stoutamire relationships with key insurance company administrators, so once she confirmed the process our members needed to take to resolve this problem, that information was pushed out to help our members begin to recover. Thanks, Casey, for helping members succeed.

Greg Gruber

Judy Stone

Lianne Bell

Angel Estep

Eighteen months ago, the December FDA, FDAS Services and Foundation board meetings were scheduled in Panama City Beach. I planned to showcase my wonderful and beautiful town to other FDA leaders. We were planning to go to an Escape Room for team building and to my favorite local places. But, all the plans I made were blown away — literally — by Michael. Those places I wanted to share were out of commission. Just days after the storm, my friend, Eric Blay of Henry Schein, contacted me to offer the resources of Henry Schein Cares’ Road to Recovery. Eric, a Pensacola native, was a generous supporter of the 2017 Florida Mission of Mercy, which was held in Pensacola, and wanted to help affected dentists rebuild. Henry Schein Cares Inc. Executive Director, Jennifer Kim Field and Director of Global Professional Relations Michele Penrose, provided us with a wonderful opportunity to help host a recovery symposium like the one held last year in Texas after Hurricane Harvey. They graciously agreed to hold the event at the same day and venue as our board meetings in Panama City Beach.

2. SEE PAGE 8

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leadership FROM PAGE 7

Once again, relationships proved to be the key, as we only had a month to plan and coordinate the event. FDA Chief Operating Officer/Chief Financial Officer Greg Gruber, Leadership Affairs Manager Judy Stone, Leadership Concierge Lianne Bell and NWDDA Executive Director Angel Estep worked together to ensure our success. We received commitments to speak at the symposium from 21 experts representing governmental, financial services, accounting, legal, insurance, public adjustments, mental health and veterinary medicine entities in just a few short days — many because of texting or messaging friends on social media since cell coverage was restored, but bundled cable, internet and landline phone service were not. Through Henry Schein and Henry Schein Cares, the FDA, NWDDA and BCDS also partnered with the Florida Medical Association and the Florida Veterinary Medical Association to host the Recovery Empowerment Symposium on Friday, Nov. 30. Health care is a large part of a community’s backbone, and the collaborative efforts to rebuild medical, dental and veterinary medical facilities is key. Nearly 90 people attended with rave reviews on the resources it provided. The symposium was recorded and is available to those who were unable to attend. It also will be used to help others faced with disaster recovery in the future. You can access these videos at floridadental.org/hurricane. NWDDA and FDA BOT member Dr. Reese Harrison’s office roof lost the battle with Michael and his office was one of many with new skylights and extensive damage. The next day, he and his wife, Mara, began feeding citizens of Lynn Haven, a small city with a contiguous southern border with Panama City, from the parking lot of his office. With 15 grills and numerous volunteers, more than 10,000 meals were provided in the days after the storm! As the relief efforts turned into recovery and rebuilding, a nonprofit was created by Reese and Mara: Hope Panhandle. They were featured on “The Today Show” during Thanksgiving week. If you are looking for a way to help a devastated community rebuild, Hope Panhandle is a great choice. They need volunteers with relationships to help them acquire what’s needed for the more than 300

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3. families they serve. You can learn more on their website at hopepanhandle.org. NWDDA member and BCDS President Dr. Daniel Melzer organized emergency dental care for any citizen in need of care in the weeks after the storm. Through relationships with Mission Smiles, Daniel was able to get their mobile dental bus stationed in NWDDA member Dr. Anish Patel’s parking lot in downtown Panama City and recruit local dentists to take shifts on the bus. Social media posts and word of mouth resulted in patients receiving dental care at no charge, thanks to Daniel and his leadership. There are multiple other dentists throughout Florida and across the country who have done great, kind and wonderful things to help those affected by that devil storm, Michael. I only wish I had the space in this column to share more of them. Some won’t be back to work even as you read this message in 2019. As I write this, I haven’t treated patients in my practice for nine weeks. I’m so thankful I have insurance that covers my lost business income and continuing expenses. Please reach out to your FDAS agent and have your business policy checked before you have to use it. If you don’t know who your district agent is, look at page 3 of this journal. Call them for a review. They’re also a part of Team FDA and they believe their job is to help you succeed. And, when disaster strikes, you get something rare. You get a paid vacation. You’ll need it.

WWW.FLORIDADENTAL.ORG

WE ARE RESILIENT. WE WILL REBUILD OUR COMMUNITIES. WE ARE 850 STRONG.

voice? Meet me in Tallahassee on Monday, March 11 at 6 p.m. for the legislative briefing with the FDA Governmental Affairs team. Commit to taking a walk with your district’s dentists on Tuesday, March 12 for Dentists’ Day on the Hill (DDOH) to meet key legislators who will vote on dental therapy legislation in the 2019 Legislative Session. Register online at floridadental.org/ddoh. I’m all in, are you? All it takes is effort.

4. I’ve never been more fearful for the lives of my loved ones as I was on Oct. 10. I’ve never worked harder or been more stressed in my life. I’ve never been more blessed, comforted and loved, either. The grace of God, family, friends, acquaintances and strangers has provided for all our needs. Our community is still in shambles. Yet, despite all the destruction and disruption, hope springs eternal in the Florida Panhandle. We are resilient. We will rebuild our communities. We are 850 Strong. The impact on our community is elevated by our efforts and those of colleagues, neighbors and friends from around the country through our relationships. This applies to all shockers and stressors that might affect our members — professionally or personally. Your Team FDA is here to help members succeed.

Until next time, I remain yours in the bond,

Photos: 1. Before and after photos of Hurricane Michael on a typical Panhandle road. 2. The Henry Schein Recovery Empowerment Symposium was held in Panama City Beach on Nov. 30, 2018. 3. The new normal: mobile post office with porta potty. 4. #850Strong — the Panhandle spirit survives.

We have no say in natural disasters. But, we do have a voice about what happens to our profession. Will you use your

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TODAY'S FDA JANUARY/FEBRUARY 2019

DIDYOU

BOD

INFORMATION ABOUT THE FLORIDA BOARD OF DENTISTRY

DR. DON ILKKA FDA LIASON TO THE FLORIDA BOARD OF DENTISTRY

MS. CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@ floridadental.org or 850.350.7202, or FDA Liaison to the Florida Board of Dentistry Dr. Don Ilkka at donjilkkadds@aol.com or 352.787.4748.

TODAY'S FDA

PROVIDING RECORDS TO A MEDICAL EXAMINER/CORONER Did you know that Florida law requires a dentist to provide records to a medical examiner/coroner in connection with a death investigation? If you knowingly fail or refuse to provide the records when requested by the the medical examiner/coroner, then you could be found guilty of a first-degree misdemeanor. HIPAA is not violated when producing the records under this situation. Florida Statute 406.12 states: “It is the duty of any person in the district where a death occurs, including all municipalities and unincorporated and federal areas, who becomes aware of the death of any person occurring under the circumstances described in s. 406.11 to report such death and circumstances forthwith to the district medical examiner. Any person who knowingly fails or refuses to report such death and circumstances, who refuses to make available prior medical or other information pertinent to the death investigation, or who, without an order from the office of the district medical examiner, willfully touches, removes, or disturbs the body, clothing, or any article upon or near the body, with the intent to alter the evidence or circumstances surrounding the death, shall be guilty of a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.”

JANUARY/FEBRUARY 2019

WWW.FLORIDADENTAL.ORG

BOD meeting

FLORIDA BOARD OF DENTISTRY MEETS IN LAKE MARY

MS. CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@ floridadental.org or 850.350.7202.

The Florida Board of Dentistry (BOD) met in Lake Mary on Friday, Nov. 16, 2018 at 7:30 a.m. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Don Ilkka and Director of Third Party Payer of Professional Affairs Casey Stoutamire. Other FDA members in attendance included Drs. Andy Brown, Joe Calderone and Michael Ragan. Students from the Nova Southeastern University College of Dental Medicine, as well as students from the hygiene programs at Valencia and Seminole state colleges also were in attendance. All the BOD members were present, which included: Dr. T.J. Tejera, chair; Dr. Naved Fatmi, vice chair; Drs. Matt Freedman, Nick Kavouklis, Claudio Miro and Nick White; Ms. Cathy Cabanzon and Ms. Angie Sissine, hygiene members; and, Mr. Fabio Andrade, consumer member. There is one dentist position and one consumer position open on the board that the governor has not yet filled. The BOD recognized Dr. Calderone for his service to the citizens of Florida. Dr. Calderone completed his term on the BOD Oct. 31, 2018. The FDA thanks him for his service! In addition, Dr. Miro was elected chair and Dr. Fatmi will continue as vice chair for the upcoming year. Congratulations to them both and the FDA looks forward to working with them! The BOD heard several requests for variances and waivers to the anesthesia rules. A dentistâ&#x20AC;&#x2122;s request for a variance or waiver of Rule 64B5-14.0032 that requires a dentist to be an anesthesia permit holder if they are going to

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use a physician anesthesiologist in their office to administer sedation was denied. One variance on a request for an anesthesia permit was granted because the BOD found the applicant met the spirit of the rule and his circumstances were unique. He completed the didactic portion at a CODA-approved program, but his sedation cases were not done at an accredited program. However, he showed logs of anesthesia cases he has performed in his private practice in Alaska. He also is routinely performing sedation in his practice, as he has not yet moved to Florida. However, in a similar case, the BOD did not grant the variance for an anesthesia permit. Although he also completed the didactic portion at a CODA-approved program, his sedation cases were not, and he has not performed sedation since 2005. It was advised that he complete his 20 sedation cases through an accredited program and then his permit could be granted. BOD Executive Director Ms. Jennifer Wenhold reported that the BOD is more than $1 million in the red on its budget and the shortfall is projected to be $8 million plus by 2020. The only way to truly make up the budget shortfall is a fee increase, but legislation must be passed to implement this. With a Republican-controlled legislature and a Republican governor, this is not likely. Thus, the BOD approved a motion creating an initial inspection fee for a General Anesthesia Permit, Moderate Sedation Permit and Pediatric Sedation Permit to $2,000. The actual cost of an inspection is about $1,964.52, so this fee will cover the actual cost of the inspection. WWW.FLORIDADENTAL.ORG

It’s only for the initial inspection and will not be for routine inspections or for another office. The fees may be refunded if the applicant is denied the permit without inspection. In addition, the fee for biennial renewal of a dental temporary certificate will now be $300, where there wasn’t a fee before. Finally, the fee for an initial dental residency permit, dental teaching permit and dental temporary certificate shall now be $300, where there also wasn’t a fee before. Ms. Sissine updated the BOD on the status of the restorative function dental auxiliary (RFDA) proposals. The BOD moved the RFDA proposal forward so Mr. David Flynn, the BOD attorney, can start the rulemaking process. The Hygiene Council discussed the proposal on their Nov. 28 call. They bifurcated the rule as they had some suggestions for the rule language as it applies to hygienists. The full BOD met via conference call on Dec. 19 and unanimously approved the proposed RFDA rule for dental assistants. The BOD will discuss the RFDA rule for hygienists at its meeting in February. Mr. Flynn informed the BOD that dentistry was the first regulatory board to fully implement HB 21 and its cor-

WWW.FLORIDADENTAL.ORG

The next BOD meeting is scheduled for Friday, Feb. 15 at 7:30 a.m. EST in Gainesville. responding rules. The BOD rule on the prescription of opioids became effective on Dec. 4. Please see floridadental.org/opioidlaw for more information. In addition, Baptist Health was recognized as an approved provider of the mandatory continuing education (CE) course. There were five disciplinary cases, one informal hearing not involving disputed issues of material facts, one determination of waiver and two voluntary relinquishments that dealt with failing to keep adequate records, failing to meet the minimum standard of care and Medicaid fraud. If you have not yet attended a BOD meeting, it is suggested that you take the opportunity to attend and see the work of the BOD. It is much better to be a spectator than a participant in BOD disciplinary cases.

TODAY'S TODAY'SFDA FDA JANUARY/FEBRUARY 2019

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info bytes

HOW TO SPOT FAKE NEWS The last few years, particularly throughout the 2016 and 2018 election cycles, the term “fake news” has become more prominent. So, what is it? Fake news is simply information that cannot be verified, doesn’t have sources and is possibly untrue. On the internet, fake news falls into three basic categories. First, there are stories that are just not true. Most of this type have purposeful intent. The intent often is to deceive, inflame, make money or confuse the reader. The second type are stories that contain some truth but aren’t fully accurate. This type is the most dangerous because it hard to know the full truth. The third type is simply a label thrown about by those who wish to dismiss information as inaccurate, so they call it “fake news.” It may or may not be inaccurate but putting the fake news label on it seems to make people believe it isn’t true. At times, it’s clear to see that some of these stories are a genre called satire. However, the lines between truth, falsehood and satire have been blurred. In our fast-paced lives, many don’t take the time to consider the source, the motive or the consequences. The real problem is that we often take whatever we see on the internet as the absolute truth. Understand this: Whatever appears on the internet had its origin with some human intervention, so there are likely to be biases, opinions, inaccuracies and ulterior motives. So, what do we do? Here are five things to consider when consuming information on the internet. 1. Consider the source. You know this idea never changes and works for any type of information. Many purveyors of fake news try to mimic actual news stations to lend more credence to their claims. Take a good look at who is providing this information. Check and

WWW.FLORIDADENTAL.ORG

see if multiple, credible news sources confirm the information. 2. Consider the message. Understanding that the intent of online information is to get you to click, take a moment and consider what message the content is trying to communicate to you. Is the message properly sourced? Are there clear biases that come through the message? Is the news factual or is it more of an opinion? 3. Consider the motive. Content on the internet often has an intent behind it. Sometimes it’s obvious, sometimes not. Is the content sponsored (meaning they paid to show it to you)? Why are you seeing this? In the age of targeted marketing, you’re likely getting it because someone has deemed you’re interested in it. What did the person who posted it hope to achieve?

LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS

Mr. Darnell can be reached at ldarnell@floridadental.org.

4. Consider your response. Many people share or repost fake news. Often, we do it in haste or in an emotion-based response. That response speaks for you in ways you may not have intended. And even when you delete it, chances are it’s not gone forever. 5. Consider the consequences. Ah, the consequences. It’s easy to believe these don’t exist. However, I know people who have lost their job, their marriage and their friends over what essentially was fake news. Everyone wants to be “viral” on the internet until it’s for all the wrong reasons. I’d like to end with a couple of parting tips as well. Use your common sense. If it’s too good or too bad to be true, it probably is. Take some time to critically evaluate the information you consume. It’s said 73.6 percent of all statistics are made up … I’m starting to believe that about the news we read, too. TODAY'S FDA JANUARY/FEBRUARY 2019

updates for members *PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.

New Year’s Checklist to Help You Get Started on the Right Foot 1. Renew your Florida Dental Association (FDA) membership investment for 2019 at floridadental.org/dues. Your username is your American Dental Association (ADA) number. 2. Confirm your address is correct on your ADA/FDA profile and add your photo to your Find-a-Dentist profile at ada.org/myada. Your username is your ADA number.

Mark Your Calendar for FDC2019 The 2019 Florida Dental Convention (FDC) will be held on June 27-29 at the Gaylord Palms Resort and Convention Center in Orlando. Discover “The Power of the Complete Team” with more than 120 lecture and hands-on courses, 300+ leading dental exhibitors and nightly social events. As a reminder, FDA members pre-register for FREE! Registration opens March 1. Go to vimeo. com/282896626 to watch the FDC2019 promo video.

Come for the CE, Stay for the MAGIC FDC2019 attendees can take advantage of discounted Walt Disney World® Theme Park ticket pricing. Experience

TODAY'S FDA

unforgettable Walt Disney World® Theme Park offerings, including Toy Story Land at Disney’s Hollywood Studio® and the World of Avatar at Disney’s Animal Kingdom® Theme Park. Go to mydisneygroup.com/fdc2019 to learn more.

Colgate Oral Health Network Offers Free Webinar Colgate Oral Health Network, the FDA’s preferred online continuing education (CE) provider, will be offering a FREE webinar for FDA members on March 19. Go to colgateoralhealthnetwork. com/floridadental to register to attend Dr. Sundeep Rawal’s webinar, “Digitally Driven Implant Dentistry — Innovations from Single Tooth to Full-arch Therapy.”

Annual ALDA Ski & Learn in Big Sky The FDA has partnered with the Alabama Dental Association (ALDA) to co-host the annual ALDA Ski & Learn in Big Sky, Mont., March 13-22, 2019. Featuring 16 hours of CE, this seminar allows you to enjoy one of the largest and most compelling mountain resorts in North America while earning CE for your licensure. Big Sky boasts more than 5,750 acres of skiable terrain with 4,350 vertical ft., 23 chair lifts and 10 surface lifts. Big Sky is truly the “Biggest Skiing in America.” For more information, contact the ALDA at 800.489.2532 or bigsky@aldaonline.org.

JANUARY/FEBRUARY 2019

Dental Sedation Workshop The Florida Board of Dentistry (BOD) and the Division of Medical Quality Assurance’s Bureau of Enforcement are hosting a Dental Sedation Workshop. The purpose of this workshop is to interact with dental inspectors to learn more about the inspection program. The workshop will be held on Feb. 14 from 9 a.m.–4 p.m. at the Hilton UF Conference Center located at 1714 SW 34th St., Gainesville, FL 32607. Five CE hours will be awarded to licensees who sign in and sign out at the workshop. The BOD also invites dentists to attend their board meeting the following day, Feb. 15, at 7:30 a.m. at the same location. Up to four hours of CE can be earned each biennium for attending a meeting where disciplinary cases are heard. The agenda and workshop materials will be posted on the BOD website at floridasdentistry.gov prior to the meeting.

Editor’s Note The “Diagnostic Discussion” in the November/December issue accidentally had the incorrect images with the accompanying captions on page 97. Please see the following page for the correct image and caption pairs. We apologize for this oversight and any confusion it may have caused.

WWW.FLORIDADENTAL.ORG

FDA History The Florida State Dental Society was founded on Oct. 15, 1884 in Jacksonville by Dr. James Chace, of Cedar Key, Fla. Dr. Chace, along with other dentists from Florida, laid plans for a professional dental society that would help create and maintain standards for ethical practices.

Welcome New FDA Members These dentists recently joined the FDA. Their membership allows them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry. Fig. 1: Histology and immunohistochemical stains. (a) Mixed inflammatory infiltrate composed of eosinophils, neutrophils, lymphocytes and plasma cells; (b) Arrow is pointing to a kidney beanshaped (reniform) nuclei; (c) CD-1a showing strong membranous positivity in lesional cells; (d) S-100 demonstrating cytoplasmic and nuclear positivity in lesional cells.

Fig. 2: CBCT imaging of a radiolucent lesion apical to Nos. 11-12. (a) Axial view showing perforation of the lingual cortical plate; (b) 3D reconstruction of the patientâ&#x20AC;&#x2122;s left maxillary arch; (c) Reconstructed panoramic view showing a well-defined radiolucent lesion encircling the apices of Nos. 11-12; (d) Sagittal view demonstrating buccal cusp fracture on No. 12. WWW.FLORIDADENTAL.ORG

Atlantic Coast District Dental Association Andrew Colgan, Vero Beach Ana Harris, Boynton Beach Kevin Jones, Jupiter Maria Mantellini, Davie Daniel Rozen, Parkland Mitchell Troyer, Davie

In Memoriam The FDA honors the memory and passing of the following members: John H. Ross St. Petersburg, FL Died: 10/30/18 Age: 92 Richard E. Tomlin Seminole, FL Died: 11/12/18 Age: 80 James K. Brandt Mount Dora, FL Died: 11/14/18 Age: 84

Central Florida District Dental Association Steven Barrett, Longwood Simon Brodsky, Gainesville Danielle Freburg-Hoffmeister, Gainesville Ricardo Galindo Ramirez, Orlando Joseph Kilman, New Smyrna Beach David McCreary, Daytona Beach Chachy Philip, Kissimmee Christopher Wollenschlaeger, Clermont

Charles J. Younger Spanish Fort, AL Died: 11/25/18 Age: 92 Richard E. Adams Hernando, FL Died: 12/18/18 Age: 87 Salvatore L. Spallone Vero Beach, FL Died: 12/29/18 Age: 76

SEE PAGE 19 TODAY'S FDA JANUARY/FEBRUARY 2019

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updates for members South Florida District Dental Association

FROM PAGE 17

Northeast District Dental Association Laura Ike, Jacksonville Jeffrey Margulis, Ponte Vedra

Northwest District Dental Association Scott Antonio, Pensacola William Baldock, Tallahassee Scott Denton, Crestview Pamala Good, Tallahassee Steve Heinicke, Crestview Nathan Kupperman, Tallahassee Cierra Sapp, Mary Esther

West Coast District Dental Association Dillon Bale, Tampa Christopher Cetta, St. Petersburg Norman Clement, Tampa Marc Dadkhah, Naples Teresa Dolan, Longboat Key Francisco Gari, Tampa Shadan Hafsa, Brandon Sherief Hussein, Tampa Christina LePochat, Seffner Lauren Maass, Odessa Susana Martinez, Bradenton Claudia Moricz, Osprey Annelise Perez, Fort Myers Youssef Riad, Oldsmar Alejandra Rivera, Lakeland Gregory Ross, Clearwater Earl Santos, Clearwater David Smith, Englewood Eleftherios Zervoudakis, Dunedin

Tomas Bello, Miami Candida Casado, Pembroke Pines Niurvis Gomez, Miami Ivette Gomez-Bello, Miami Jhezanuel Goncalves, Miami Jessica Hayate, Miami Elias Moron, Pembroke Pines Maria Nazco Batista, Dade City German Ochoa, Pembroke Pines Alexis Otero, Doral Osvaldo Puig, Miami Nathalie Rivero, Davie Gustavo Wiscovitch Maldonado, Miami Stephen Wright, Hollywood

THE FDA WELL-BEING COMMITTEE OFFERS YOU CONFIDENTIAL, PROFESSIONAL ASSISTANCE Alcoholism and drug addiction can touch any of us. ADA statistics have shown that almost 20 percent of all dentists will have problems with drugs or alcohol sometime during their careers! The FDA Well-Being Committee is a group of dental professionals with personal experience with these problems who can give complete confidential assistance to members of the profession, their staff and spouses.

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guest editorial

IS THERE A PREPAREDNESS PROBLEM IN DENTAL EDUCATION?

DAN B. HENRY, DDS, FACD, FICD, FPFA

Dr. Henry is a past president the FDA, the American Academy of Gold Foil Operators and the Florida Academy of Dental Practice Administration. He can be reached at golddoc46@gmail. com. Editor’s note: Views and conclusions expressed in all editorials, commentaries, columns or articles are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association. For full editorial policies, see page 2. All editorials may be edited due to style and space limitations. Letters to the editor must be on topic and typically a maximum of 500 words. Submissions must not create a personal attack on any individual. All letters are subject to editorial control. The editorial board reserves the right to limit the number of submissions by an individual.

TODAY'S FDA

Graduating dental students are confronting new and difficult challenges. How to deal with student loan debt, unscrupulous individuals, misguided practice models and government regulations are not part of the current dental educational model. Add generational changes in lifestyles, including unintended consequences of misplaced priorities, and you can see the problems festering. Because of an ever-increasing hostile practice environment, where small missteps can lead to career-ending events, there simply must be a better way to prepare our future graduates for these new challenges. According to an American Dental Association (ADA) survey, the average student debt for graduating dental students in 2017 was $287,331. Some dental schools have students with debt approaching $400,000, plus an average of $38,000 for undergraduate studies. Thus, you have students graduating into the dental workforce with an average of $325,331 in debt. New data shows that servicing just $30,000 in student loan debt can cut as much as $325,000 from your retirement balance over a working career. Who knows what significantly larger debt will do? The impact on the country’s economy will become greater as this continues. For example, one study showed that overall, student loan debt is growing nationally by $2,726 every second! Furthermore, it prevents many college graduates from buying a car, home or even covering their

JANUARY/FEBRUARY 2019

rent and taking part in the economy. Moving back in with parents is becoming popular and necessary. It’s looking more like a four-year college degree might not be cost-effective for those who want a degree just to get a better job. If you are forced to borrow the money to pay for that undergraduate degree, a college degree might not be the best choice, unless you are going into a medical, dental, law or an advanced degree program. A large part of the problem can be blamed on the federal government for making college loans available to anyone who wishes to have one. This is like the housing bubble that led to the financial disaster from which the country is still recovering. Studies show that there is a high percentage of students who take out loans and then drop out of college without graduating. Some are encouraged to get the loans even though they are not college material. Evidently, no one wants to hurt the psyche of Generation Y by telling the truth. Everyone gets a trophy! Additionally, college and university tuition has followed the money, substantially raising the cost of a four-year degree. The average tuition increase at private universities over the past 20 years has increased by 157 percent. Out-of-state universities have increased by 194 percent and in-state colleges and universities have increased by 237 percent. Compare the total consumer price index increase of 52 percent for the same period and you can see the problem.

WWW.FLORIDADENTAL.ORG

So, what responsibility do dental schools have in this scenario? I’d suggest that dental schools have a responsibility to prepare their students for an environment where skills across the full gambit of running a successful ethical dental practice are needed. Dental students can no longer be content with learning enough to pass an inadequate state dental licensure examination and expect to have a successful career in dentistry. It’s becoming more imperative that dental students need skills beyond basic operative dentistry right out of school. Without foundational skillsets for practicing dentistry and living in a complex world, they are at the mercy of unscrupulous actors who can use their limited experience and understanding to profit themselves. Therefore, the question is: Is there a preparedness problem in dental education? The obvious issue is that dental students cannot learn all they need to know to successfully practice dentistry in today’s environment within a four-year program. They need to have added instruction in business, management, life skills, psychology and ethics beyond a couple of lectures. In addition, they need to have the basic human development that comes from a good liberal arts foundation. Dental students should be grounded in a life-centered curriculum, which allows for the development of the skills needed to practice dentistry and live an ethically centered lifestyle based on an understanding of balanced responsibilities to one’s patients, family, community, profession and self. It’s understood that these “extra” requirements are intended to be learned prior to attending dental school. However, due to pre-dental requirements and a disagreement or misguided understanding of what’s important, a lot of the learning experiences that should occur are simply ignored. If, however, dental schools had control of the student’s curriculum for longer than the traditional four years, this could be remedied. Because of what is happening within education today, innovative ideas within non-traditional frameworks will be a familiar theme in education — particularly in dental education well into the future. One solution follows. Dental schools could take advantage of the full eight years most students spend in college and dental school together. By restructuring and placing emphasis in different areas within the first two years of college, a revised pre-dental curriculum can be created. Students could then be accepted into dental

“

Because of an ever-increasing hostile practice environment, where small missteps can lead to career-ending events, there simply must be a better way to prepare our future graduates for these new challenges.

”

SEE PAGE 25 WWW.FLORIDADENTAL.ORG

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school at the completion of the sophomore year of college. This would give six years for a joint dental school and upper level college curriculum that would lead to both BS and DDS/ DMD degrees. Incoming class sizes could be increased to compensate for those who decide to drop out or who have been shown not to be suitable to continue to the DDS/DMD degree after achieving their BS degree. There are multiple benefits of moving dental school into the last two years of college. Most important, there would be enough time to expand the curriculum to include business, management, liberal arts, humanities, psychology and ethics classes. A well-educated person with a solid foundation of core values should make a more responsible dentist. Also, upper level science classes, such as organic chemistry, could be tailored for dental students. This would give the dental student more meaningful information and would cut time spent duplicating basic science instructions during current dental school curriculums. This program design would give the dental school more time to control the student’s curriculum and better evaluate an individual student’s needs to successfully complete the DDS/DMD degree. It also would shift the burden of proof away from grades to a total evaluation of the individual’s intellect and character for predicting future ethical success in dentistry. Within a program such as this, the first three years would be pre-clinical, with the last three years devoted primarily to clinical training. The student also could have clinical exposure during the first three years by aiding fifth-year students in the clinic and starting to have patient interaction in other ways. The fourth and fifth years would be completed in a traditional dental school clinic setting. The student would learn the art and science of general restorative dentistry and would be required to pass competency evaluations in all disciplines by the end of the fifth year. The sixth and final year of the curriculum would be spent away from dental school in a community clinic. The student would be under supervision of credentialed, ethical, privatepracticing dentists. The clinics would be set up in underserved or rural areas, allowing the indigent and working poor access to quality dental care at no cost or reduced fee-for-service. WWW.FLORIDADENTAL.ORG

The clinics would have one or more full-time dental school instructors to supervise treatment, teach and run the clinic. The government could participate through federal or state dental programs. Revenues earned from fee-for-service and Medicaid patients would remain with the sponsoring dental school. Because this would not be a residency program, but the last year of dental school, the students would not be entitled to stipends. These three conditions — government funding, fees-for-service collections/Medicaid contracts and no-residency stipend — should make the clinics doable from a cost standpoint. Benefits should be obvious — the government would get the most benefit for the use of tax payer dollars, dental schools would have an added funding source and students would have the benefit of a full-year of exposure to ethical, private-practicing clinicians while working in an ethically sheltered environment. Communities would gain an asset for the whole community — jobs and access to quality dental care. In addition, the government would have a new tax revenue source. While working in the community-based clinic during the sixth year, students would have the opportunity to complete a full clinical board case on one of their patients. This would substitute the current clinical examination and be much more relevant than a “test” done on mannequins. Consider this: What is the reason for the licensure examination? It was set up to evaluate a candidate’s competence in treating patients within a state or jurisdiction. In addition, it was a check and balance for the dental school where the student was trained. Completing a full board case on a patient involving an examination, diagnosis, treatment plan and completed treatment of a patient would more accurately reveal a graduate’s abilities and the institution where they were taught. Finally, because of the influence state board examinations have on dental school curriculums and students themselves (teach to and learn to the test), it’s imperative that these exercises demonstrate comprehensive ethical dental care. Simply completing a couple of “procedures” on a live patient or an inanimate object does not! In fact, I suspect that if the examination process were switched to mannequin only, this could conceivably drive dental school curriculums further away from livepatient interactions and leave the dental student with even less experience in operative dentistry on live patients. TODAY'S FDA JANUARY/FEBRUARY 2019

WWW.FLORIDADENTAL.ORG

TODAY'S FDA JANUARY/FEBRUARY 2019

governor and cabinet

2018-2022 FLORIDAâ&#x20AC;&#x2122;S GOVERNOR AND CABINET Governor

Attorney General

Chief Financial Officer

Commissioner of Agriculture

Ron DeSantis (R)

Ashley Moody (R)

Jimmy Patronis (R)

Nikki Fried (D)

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JANUARY/FEBRUARY 2019

WWW.FLORIDADENTAL.ORG

congressional members

FLORIDA CONGRESSIONAL MEMBERS 2018-2022 U.S. Senate

Congressional District 9

Congressional District 19

Sen. Marco Rubio (R) Rick Scott (R)

Rep. Darren Soto (D)

Rep. Francis Rooney (R)

Congressional District 10

Congressional District 20

Rep. Val Demings (D)

Rep. Alcee Hastings (D)

Congressional District 11

Congressional District 21

Rep. Daniel Webster (R)

Rep. Lois Frankel (D)

Congressional District 12

Congressional District 22

Rep. Gus Bilirakis (R)

Rep. Ted Deutch (D)

Congressional District 13

Congressional District 23

Rep. Charlie Crist (D)

Rep. Debbie Wasserman Schultz (D)

Congressional District 14

Congressional District 24

Rep. Kathy Castor (D)

Rep. Frederica Wilson (D)

Congressional District 15

Congressional District 25

Rep. Ross Spano (R)

Rep. Mario Diaz-Balart (R)

Congressional District 16

Congressional District 26

Rep. Vern Buchanan (R)

Rep. Debbie Mucasel-Powell (D)

Congressional District 17

Congressional District 27

Rep. Greg Steube (R)

Rep. Donna Shalala (D)

U.S. Representatives Congressional District 1 Rep. Matt Gaetz (R)

Congressional District 2 Rep. Neal Dunn (R)

Congressional District 3 Rep. Ted Yoho (R)

Congressional District 4 Rep. John Rutherford (R)

Congressional District 5 Rep. Al Lawson (D)

Congressional District 6 Rep. Mike Waltz (R)

Congressional District 7 Rep. Stephanie Murphy (D)

Congressional District 8 Rep. Bill Posey (R) WWW.FLORIDADENTAL.ORG

Congressional District 18 Rep. Brian Mast (R) TODAY'S FDA JANUARY/FEBRUARY 2019

florida legislature

2018-2020 FLORIDA LEGISLATURE Below is a list of senators and representatives who will serve in the 2018-2020 Florida Legislature. Legislators elected to the Senate during this election cycle will serve a four-year term, while the House members will serve a two-year term. Legislators were officially sworn into office during Organizational Session on Tuesday, Nov. 20 in Tallahassee.

Senate District 1 Sen. Doug Broxson (R) Pensacola District 2 Sen. George Gainer (R) Panama City District 3 Sen. Bill Montford (D) Quincy District 4 Sen. Aaron Bean (R) Jacksonville District 5 Sen. Rob Bradley (R) Orange Park District 6 Sen. Audrey Gibson (D) Jacksonville District 7 Sen. Travis Hutson (R) Palm Coast District 8 Sen. Keith Perry (R) Gainesville District 9 Sen. David Simmons (R) Longwood District 10 Sen. Wilton Simpson (R) Spring Hill District 11 Sen. Randolph Bracy (D) Ocoee District 12 Sen. Dennis Baxley (R) Lady Lake District 13 Sen. Linda Stewart (D) Orlando

District 21 Sen. Bill Galvano (R) Bradenton District 22 Sen. Kelli Stargel (R) Lakeland District 23 Sen. Joe Gruters (R) Venice District 24 Sen. Jeff Brandes (R) St. Petersburg District 25 Sen. Gayle Harrell (R) Stuart District 26 Sen. Ben Albritton (R) Wauchula District 27 Sen. Lizbeth Benacquisto (R) Fort Myers District 28 Sen. Kathleen Passidomo (R) Naples District 29 Sen. Kevin Rader (D) Boca Raton District 30 Sen. Bobby Powell (D) West Palm Beach District 31 Sen. Lori Berman (D) Boynton Beach District 32 Sen. Lauren Book (D) Plantation District 33 Sen. Perry Thurston Jr. (D) Fort Lauderdale District 34 Sen. Gary Farmer (D) Fort Lauderdale District 35 Sen. Oscar Braynon II (D) Miami Gardens District 36 Sen. Manny Diaz (R) Coral Gables District 37 Sen. Jose Javier Rodriguez (D) Miami District 38 Sen. Jason Pizzo (D) Miami District 39 Sen. Anitere Flores (R) Miami District 40 Sen. Annette Taddeo (D) Miami

District 14 Sen. Tom Wright (R) New Smyrna Beach District 15 Sen. Victor M. Torres (D) Kissimmee District 16 Sen. Ed Hooper (R) Clearwater District 17 Sen. Debbie Mayfield (R) Melbourne District 18 Sen. Janet Cruz (D) District 19 Sen. Darryl Rouson (D) St. Petersburg District 20 Sen. Tom Lee (R) Brandon

TODAY'S FDA

JANUARY/FEBRUARY 2019

House District 1 Rep. Mike Hill (R) Pensacola District 2 Rep. Alex Andrade (R) Gulf Breeze District 3 Rep. Jayer Williamson (R) Pace District 4 Rep. Mel Ponder (R) Fort Walton Beach District 5 Rep. Brad Drake (R) DeFuniak Springs WWW.FLORIDADENTAL.ORG

District 6 Rep. Jay Trumbull (R) Panama City

District 39 Rep. Josie Tomkow (R) Auburndale

District 7 Rep. Halsey Beshears (R) Monticello

District 40 Rep. Colleen Burton (R) Lakeland

District 8 Rep. Ramon Alexander (D) Tallahassee

District 41 Rep. Sam Killebrew (R) Winter Haven

District 9 Rep. Loranne Ausley (D) Tallahassee

District 42 Rep. Mike La Rosa (R) St. Cloud

District 10 Rep. Chuck Brannan (R) Macclenny

District 43 Rep. John Cortes (D) Kissimmee

District 11 Rep. Cord Byrd (R) Jacksonville

District 44 Rep. Geraldine Thompson (D) Orlando

District 12 Rep. Clay Yarborough (R) Jacksonville

District 45 Rep. Kamia Brown (D) Ocoee

District 13 Rep. Tracie Davis (D) Jacksonville

District 46 Rep. Bruce Antone (D) Orlando

District 14 Rep. Kim Daniels (D) Jacksonville

District 47 Rep. Anna Eskamani (D) Orlando

District 15 Rep. Wyman Duggan (R) Jacksonville

District 48 Rep. Amy Mercado (D) Orlando

District 16 Rep. Jason Fischer (R) Jacksonville

District 49 Rep. Carlos Guillermo Smith (D) Winter Park

District 17 Rep. Cyndi Stevenson (R) St. Augustine

District 50 Rep. Rene Plasencia (R) Titusville

District 18 Rep. Travis Cummings (R) Orange Park

District 51 Rep. Tyler Sirois (R) Merritt Island

District 19 Rep. Bobby Payne (R) Palatka

District 52 Rep. Thad Altman (R) Indialantic

District 20 Rep. Clovis Watson Jr. (D) Gainesville

District 53 Rep. Randy Fine (R) Palm Bay

District 21 Rep. Chuck Clemons (R) Jonesville

District 54 Rep. Erin Grall (R) Vero Beach

District 22 Rep. Charlie Stone (R) Ocala

District 55 Rep. Cary Pigman (R) Sebring

District 23 Rep. Stan McClain (R) Ocala

District 56 Rep. Melony Bell (R) Bartow

District 24 Rep. Paul Renner (R) Palm Coast

District 57 Rep. Mike Beltran (R) Lithia

District 25 Rep. Tom Leek (R) Daytona Beach

District 58 Rep. Lawrence McClure (R) Plant City

District 26 Rep. Elizabeth Fetterhoff (R) Deland

District 59 Rep. Adam Hattersley (D) Riverview

District 27 Rep. David Santiago (R) Deltona

District 60 Rep. Jackie Toledo (R) Tampa

District 28 Rep. David Smith (R) Winter Springs

District 61 Rep. Dianne Hart (D) Tampa

District 29 Rep. Scott Plakon (R) Longwood

District 62 Rep. Susan Valdes (D) Tampa

District 30 Rep. Joy Goff-Marcil (D) Maitland

District 63 Rep. Fentrice Driskell (D) Tampa

District 31 Rep. Jennifer Sullivan (R) Eustis

District 64 Rep. James Grant (R) Tampa

District 32 Rep. Anthony Sabatini (R) Eustis

District 65 Rep. Chris Sprowls (R) Clearwater

District 33 Rep. Brett Hage (R) Oxford

District 66 Rep. Nick DiCeglie (R) Belleair Bluffs

District 34 Rep. Ralph Massullo (R) Beverly Hills

District 67 Rep. Chris Latvala (R) Clearwater

District 35 Rep. Blaise Ingoglia (R) Spring Hill

District 68 Rep. Ben Diamond (D) St. Petersburg

District 36 Rep. Amber Mariano (R) Port Richey

District 69 Rep. Jennifer Webb (D) St. Petersburg

District 37 Rep. Ardian Zika (R) Land Oâ&#x20AC;&#x2122; Lakes District 38 Rep. Danny Burgess (R) Zephyrhills WWW.FLORIDADENTAL.ORG

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Doctor's Choice

florida legislature FROM PAGE 31 District 70 Rep. Wengay Newton (D) St. Petersburg

District 96 Rep. Kristin Jacobs (D) Coconut Creek

District 71 Rep. Will Robinson (R) Bradenton

District 97 Rep. Jared Moskowitz (D) Coral Springs

District 72 Rep. Margaret Good (D) Sarasota

District 98 Rep. Michael Gottlieb (D) Davie

District 73 Rep. Tommy Gregory (R) Sarasota

District 99 Rep. Evan Jenne (D) Hollywood

District 74 Rep. James Buchanan (R) Venice

District 100 Rep. Joe Geller (D) Dania Beach

District 75 Rep. Michael Grant (R) Port Charlotte

District 101 Rep. Shevrin Jones (D) West Park

District 76 Rep. Ray Rodrigues (R) Fort Myers

District 102 Rep. Sharon Pritchett (D) Miami Gardens

District 77 Rep. Dane Eagle (R) Cape Coral

District 103 Rep. Cindy Polo (D) Miramar

District 78 Rep. Heather Fitzenghagen (R) Fort Myers

District 104 Rep. Richard Stark (D) Weston

District 79 Rep. Spencer Roach (R) North Fort Myers

District 105 Rep. Ana Maria Rodriguez (R) Doral

District 80 Rep. Byron Donalds (R) Naples

District 106 Rep. Bob Rommel (R) Naples

District 81 Rep. Tina Polsky (D) Boca Raton

District 107 Rep. Barbara Watson (D) Miami Gardens

District 82 Rep. MaryLynn Magar (R) Hobe Sound

District 108 Rep. Dotie Joseph (D) North Miami

District 83 Rep. Toby Overdorf (R) Palm City

District 109 Rep. James Bush (D) Miami

District 84 Rep. Delores Johnson (D) Fort Pierce

District 110 Rep. Jose Oliva (R) Hialeah

District 85 Rep. Rick Roth (R) Palm Beach Gardens

District 111 Rep. Bryan Avila (R) Hialeah

District 86 Rep. Matt Willhite (D) Royal Palm Beach

District 112 Rep. Nicholas Duran (D) Miami

District 87 Rep. David Silvers (D) West Palm Beach

District 113 Rep. Michael Grieco (D) Coral Gables

District 88 Rep. Al Jacquet (D) West Palm Beach

District 114 Rep. Javier Fernandez (D) Coral Gables

District 89 Rep. Mike Caruso (R) Boca Raton

District 115 Rep. Vance Aloupis (R) Miami

District 90 Rep. Joe Casello (D) Boynton Beach

District 116 Rep. Daniel Perez (R) Miami

District 91 Rep. Emily Slosberg (D) Delray Beach

District 117 Rep. Kionne McGhee (D) Cutler Bay

District 92 Rep. Patricia Williams (D) Lauderdale Lakes

District 118 Rep. Anthony Rodriguez (R) Miami

District 93 Rep. Chip LaMarca (R) Fort Lauderdale

District 119 Rep. Juan Fernandez-Barquin (R) Miami

District 94 Rep. Bobby DuBose (D) Fort Lauderdale

District 120 Rep. Holly Raschein (R) Key Largo

District 95 Rep. Anika Omphroy (D) Lauderdale Lakes

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TODAY'S FDA JANUARY/FEBRUARY 2019

The Doctors Company

lobbying

ORGANIZED DENTISTRY IS WELL REPRESENTED IN TALLAHASSEE! Lobbying team for organized dentistry with Sen. Lori Berman (center), wife of FDA member, Dr. Jeff Ganeles

GAO team: (L to R) Alexandra Abboud, Courtney Thomas and Joe Anne Hart

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Each year, special interest groups send their lobbyists to Tallahassee to lobby the Legislature on their behalf. The Florida Dental Association (FDA) is no exception. The FDAâ&#x20AC;&#x2122;s governmental affairs office includes Chief Legislative Officer Joe Anne Hart and Governmental Affairs Liaison Alexandra Abboud. In addition to the FDAâ&#x20AC;&#x2122;s Governmental Affairs Team, dentists are represented by two contract firms located in Tallahassee. The FDA contracts with Johnson and Blanton, who work closely with the governmental affairs office on legislative and political efforts for organized dentistry. The Florida Society of Oral and Maxillofacial Surgeons (FSOMS) have contracted with GrayRobinson lobbying firm who has represented oral surgeons for more than a decade. It is extremely vital for organizations to have individuals representing their interest who are well-respected in this field. Organized dentistry is well represented in Tallahassee!

Johnson and Blanton team: (L to R) Darrick McGhee, Travis Blanton and Jon Johnson

GrayRobinson team: (L to R) Mike Huey, Jessica Love and Todd Steibly

TODAY'S FDA JANUARY/FEBRUARY 2019

fdapac, gac & lcd

FDAPAC, GAC AND LCD MEMBERS BY DISTRICT To help coordination efforts between the various grassroots members of the Florida Dental Association (FDA), listed below are the FDA Political Action Committee (FDAPAC) representatives, Governmental Action Committee (GAC) representatives and Legislative Contact Dentists (LCD) for each district.

Atlantic Coast

Central Florida

Dr. David Boden, FDAPAC consultant, GAC consultant, LCD

Dr. Gerald Bird, FDAPAC chair, GAC consultant, LCD

Dr. Rick Huot, GAC consultant, LCD

Dr. Dan Crofton, FDAPAC consultant, LCD

Dr. Ethan Pansick, FDAPAC member, LCD

Dr. Don Ilkka, GAC BOD liaison

Dr. Jay Singer, GAC member

Dr. Jason Larkin, GAC member, LCD

Mrs. Jerilyn Bird, FDAPAC member

Dr. Donald Thomas, FDAPAC member Dr. Ralph Attanasi, LCD Dr. William Balanoff, LCD

Dr. Daryl Askeland, LCD

Dr. Susan Berlin, LCD

Dr. Ronald Askeland, LCD

Dr. Christopher Dermody, LCD

Dr. Tomas Ballesteros, LCD

Dr. Joseph Dermody, LCD

Dr. Stephen Beckett, LCD

Dr. Raymond Doremus, LCD

Dr. Hal Coe Jr., LCD

Dr. Robert Eckelson, LCD

Dr. Brian Coleman, LCD

Dr. Shawn Engebretsen, LCD

Dr. Mark Falco, LCD

Dr. Donovan Essen, LCD

Dr. Timothy Glomb, LCD

Dr. Mark Fedele, LCD

Dr. Robert Hawkins, LCD

Dr. Alan Friedel, LCD

Dr. Curtis Hill Jr., LCD

Dr. Jeffrey Ganeles, LCD

Dr. Steven Hochfelder, LCD

Dr. Laurence Grayhills, LCD

Dr. Bert Hughes, LCD

Dr. Alana Humberson, LCD

Dr. Bernard Kahn, LCD

Dr. Brian Jacobus Jr., LCD

Dr. Raymond Kenzik, LCD

Dr. George Kolos, LCD

Dr. Lee Anne Keough, LCD

Dr. Thomas Lane, LCD

Dr. Robert Matteson, LCD

Dr. Robert Bruce McDonald, LCD

Dr. Jackie Miller, LCD

Dr. Douglas Starkey, LCD

Dr. Patrick Mokris, LCD

Dr. Craig Stranigan, LCD

Dr. Oscar Morejon, LCD

Dr. James Strawn, LCD

Dr. Robert Mount, LCD

Dr. Paul Werner, LCD

Dr. Larry Nissen, LCD Dr. Elizabeth Nixon, LCD Dr. Naghman Qureshi, LCD Dr. Sundeep Rawal, LCD

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JANUARY/FEBRUARY 2019

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Dr. Jeff Sevor, LCD

Dr. Joseph Gay, LCD

Dr. Kevin Snyder, LCD

Dr. Harvey Gordon, LCD

Dr. Wade Townsend, LCD

Dr. Laurie Gordon-Brown, LCD

Dr. Anthony Wong, LCD

Dr. Melvin Kessler, LCD Dr. Carlos Sanchez, LCD

Northeast

Dr. Joel Slingbaum, LCD

Dr. Andy Brown, GAC consultant, LCD

West Coast

Dr. Dan Gesek, FDAPAC member, GAC member Dr. CJ Henley, FDAPAC member, LCD

Dr. Doug Jungman, GAC member, LCD

Dr. Rick Stevenson, FDAPAC consultant, LCD

Dr. Zack Kalarickal, FDAPAC consultant, LCD Dr. Greg Langston, FDAPAC member

Dr. Robert Cowie, LCD

Dr. Rudy Liddell, FDAPAC consultant, GAC member, LCD

Dr. Ron Dixon, LCD Dr. Thomas Klechak, LCD

Dr. T.J. Albert, LCD

Dr. Orrin Mitchell, LCD

Dr. Eva Ackley, LCD

Dr. Claude Owens, LCD

Dr. Rodney Ackley, LCD

Dr. George Weeks, LCD

Dr. Nolan Allen, LCD

Dr. Cecil White, LCD

Dr. William Belton Jr., LCD Dr. Victoria Bong-Krueger, LCD

Northwest

Dr. Todd Britten, LCD Dr. Terry Buckenheimer, LCD

Dr. Jeff Ottley, GAC Member, LCD

Dr. Wendy Churchill-Urrico, LCD

Dr. Jolene Paramore, FDAPAC member, GAC chair, LCD

Dr. David Clary, LCD

Dr. Daniel Melzer, FDAPAC member

Dr. Sam Desai, LCD Dr. James Holloway, LCD

Dr. Joseph Barnett, LCD

Dr. Bradley Jergins, LCD

Dr. Richard Bastien, LCD

Dr. Charles Llano, LCD

Dr. Darrh Bryant, LCD

Dr. Janice Luke, LCD

Dr. Walter Colon, LCD

Dr. Mariela Lung, LCD

Dr. Howard Fisher, LCD

Dr. Tim Marshall, LCD

Dr. Chinara Garraway, LCD

Dr. Oscar Menendez, LCD

Dr. Nathan Hall, LCD

Dr. Paul Miller, LCD

Dr. Tricia Hess, LCD

Dr. James Oxer, LCD

Dr. Robert Payne, LCD

Dr. John Paul, LCD

Dr. James Walton, LCD

Dr. Robert Payne, LCD Dr. Carmine Priore, LCD

South Florida

Dr. Michael Reynolds, LCD Dr. Rodrigo Romano, LCD

Dr. Michael Eggnatz, GAC member, LCD

Dr. Rose Rosanelli, LCD

Dr. Irene Marron-Tarrazzi, FDAPAC member, GAC member, LCD

Dr. Carol Stevens, LCD

Dr. Cesar Sabates, GAC consultant, LCD

Dr. Steven Tinsworth, LCD

Dr. Beatriz Terry, FDAPAC member, LCD

Dr. Andrew Varga, LCD

Dr. Tina Thomas, LCD

Dr. Tim Verwest, LCD Dr. Pedro Castro, LCD

Dr. Dewitt Wilkerson, LCD

Dr. Dalia Forero-Amaya, LCD WWW.FLORIDADENTAL.ORG

TODAY'S FDA JANUARY/FEBRUARY 2019

ddoh

2019 DENTISTS’ DAY ON THE HILL HELP TELL LEGISLATORS WHY QUALITY DENTAL CARE MATTERS! Members of the Florida Dental Association (FDA) understand why it’s important that patients seek quality dental care. Extensive education, in-depth training and comprehensive knowledge about the entire body are just a few reasons why it’s of the utmost importance to receive a high standard of dental care. While these reasons may seem obvious to dentists, legislators in Tallahassee may not understand the magnitude of their votes on dental policy and how it may impact the dental profession. It’s vital that FDA dentists, students and their spouses help inform the Legislature on crucial policy issues for the dental profession. That’s why the theme of the 2019 Dentists’ Day on the Hill (DDOH) is “32 Reasons Why Quality Dental Care Matters!” DDOH will take place on Tuesday, March 12, 2019. A legislative briefing is scheduled for the night before at 6 p.m. on Monday, March 11. To register, please visit floridadental.org/ddoh. All registration will be processed online; no paper registration is available. The FDA room block at the Doubletree by Hilton Tallahassee is sold out. Please visit floridadental.org/ddoh for other hotel information. Sponsored by the Alliance of the FDA, the large number of attendees at last year’s DDOH greatly impressed legislators who were debating legislative issues critical for the dental profession during that time. Attendees are responsible for scheduling their own meetings with their legislators. If you would like to find information on your legislator, please visit flsenate.gov for the Senate and myfloridahouse.gov for the House of Representatives. When dentists take time away from their practices and daily lives to travel to the Capitol to participate in advocacy efforts, elected officials sit up and take notice. Participating in these meetings shows legislators you care about legislation impacting your patients as well as your profession. Help explain to legislators why quality dental care matters — sign up for DDOH today!

WWW.FLORIDADENTAL.ORG

TODAY'S FDA JANUARY/FEBRUARY 2019

fluoridation

BROOKSVILLE: A SMALL CITY WITH A BIG FLUORIDATION WIN

Community water fluoridation, the precise adjustment of fluoride that occurs naturally in a community’s water supply to the level recommended for optimal dental health, is a tool that dentists and their dental team know to be extremely effective and safe. It’s an efficient way to prevent one of the most common childhood diseases — dental decay. Fluoridation also benefits middle-aged adults by reducing tooth decay that occurs on tooth enamel surfaces and on root surfaces that become exposed as gums recede. Yet, despite the myriad amount of scientific research and the backing of reputable organizations like the Centers for Disease Control and Prevention and the World Health Organization, fluoridating our water systems is still heavily disputed both nationally and in Florida. In 2018, the city of Brooksville was the most recent community to face a fluoridation fight for its 8,000 citizens. The fluoride fight was nothing new in this area; the city began adding fluoride in the mid-1980s but stopped at some point. In 2013, local dentists, hygienists and other citizens pushed for its return, which was successful.

Dr. Johnny Johnson shows his support for keeping Brooksville’s water fluoridated on election day, Nov. 6, 2018.

TODAY'S FDA

JANUARY/FEBRUARY 2019

On July 16, 2018, the Brooksville City Council voted to place community water fluoridation as a referendum for voters to approve or disapprove on the Nov. 6 ballot. The city and surrounding areas served by the city’s water system were fluoridated, but a push from several city council members and a vocal minority wanted to see fluoride removed. Before a 3-2 vote by the council to take the measure to the residents, many audience members from the Hernando County Health Department, Florida Department of Health (DOH) and private practice testified on the safety and health benefits of

WWW.FLORIDADENTAL.ORG

community water fluoridation. Drs. Eva Ackley, Jose Peralta and Doug Routh; Florida Dental Hygiene Association (FDHA) representative Ms. Karen Hodge; DOH staff Mr. Sean Isaac and Ms. Robin Napier; along with Florida Dental Association (FDA) Governmental Affairs Liaison Alexandra Abboud, testified and asked the council to maintain fluoridation as is and to not send it to the voters. Despite their best efforts, the council maintained that the citizens at large should vote on whether their water systems should continue to be fluoridated. That loss did not deter the oral health community, and neither did the council’s refusal to reverse their decision at their August city council meeting. The fluoridation question was to appear on the ballot as follows:

CITY OF BROOKSVILLE OPINION REFERENDUM — CONTINUING TO ADD FLUORIDE TO THE CITY WATER SYSTEM Should the city of Brooksville continue to add fluoride to the city’s water system? (Yes or No) A 2.coalition was formed made up of the FDA, FDHA, 3. Hernando County Health Department and Oral Health Florida. Dr. Johnny Johnson, a known fluoride advocate and president of the American Fluoridation Society, was the FDA’s spokesperson in the community. For the next several months, the challenge became educating the community of Brooksville to “Vote Yes” to keep fluoride in their water systems. With assistance from the American Dental Association (ADA), the FDA was able to engage in an educational campaign with a simple message: “Protect Your Teeth, Vote Yes, Keep Brooksville Fluoridated.” Yard signs were purchased and placed in front of dental offices, churches and throughout the community. Church fans were created and donated to several major churches in the area for the congregations to use. Flyers

WWW.FLORIDADENTAL.ORG

were printed and passed out to churches and schools to send home with children. Dr. Johnson and Ms. Abboud traveled to Brooksville to spearhead this ground campaign — just one approach to keeping fluoride in the city. Additionally, Drs. Johnson and Peralta participated in several radio interviews and in-person community outreach events to educate the public on the benefits of fluoride. The second approach was reaching citizens online. The FDA created a separate website for Brooksville citizens entitled, “Keep Brooksville Fluoridated.” This site linked back to the FDA’s main fluoridation website, floridafluoridation.org, and included helpful and relevant information for the community. Flyers, facts on fluoride, a short video and information regarding the ballot could all be found in one central area. Additionally, the FDA was a part of an ADA pilot project designed to provide internet support to local fluoridation campaigns. The project targeted Brooksville ZIP codes — when anyone from the specific areas searched online for fluoridation and other key words, they would see an ad from the ADA directing them to the ADA’s Mouth Healthy fluoridation page, mouthhealthy. org/en/az-topics/f/fluoride. This website is geared for the public with videos and simple to understand information regarding fluoridation, versus technical material that may appear on other ADA fluoride pages. On Tuesday, Nov. 6, the citizens of Brooksville voted to continue community water fluoridation by referendum. The fluoride referendum passed with 64.62 percent of the vote and Brooksville will remain fluoridated. The win in Brooksville should be celebrated not only because citizens will continue to receive the single most effective way to reduce dental decay, but also because Brooksville is an exemplary case of the type of success the oral health community can achieve when it comes together. Educational efforts were successful because the private and public sectors worked together to inform the citizens of Brooksville in various strategies. This helped ensure that voters understood the referendum they were voting for when it came time to cast their ballot. To achieve similar successes in future fluoride fights, the work the oral health community did in Brooksville should be used as a model to help achieve wins throughout the state. For more information on fluoridation, visit floridafluoridation.org.

TODAY'S FDA JANUARY/FEBRUARY 2019

FLORIDA’S ACTION FOR DENTAL HEALTH

FDA Foundation - Mission of MerFlorida’s Action for cy Dental Health is a comprehensive effort developed Stats by the Florida Dental Association to improve the oral health and resulting overall health of all Floridians.

EXECUTIVE SUMMARY The Florida Dental Association (FDA) is pleased to announce the launch of Florida’s Action for Dental Health in conjunction with the American Dental Association. The FDA promotes and advocates for oral health because a healthy mouth is essential to a healthy body. All Floridians should have access to quality dental care with programs and services tailored to Florida’s unique demographics — from infants to the elderly. Recently, the FDA partnered with stakeholder groups to develop Florida’s Action for Dental Health objectives and strategies designed to improve the oral health and resulting overall health of all Floridians. Florida’s Action for Dental Health will be implemented over the next several years with collaborative efforts from like-minded groups seeking to achieve these goals.

OBJECTIVES 1. Promote attainable dental care for the uninsured and underserved in Florida. 2. Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive and therapeutic dental care. 3. Expand opportunities for public health dentistry to serve Floridians.

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STRATEGIES 1. Promote attainable dental care for the uninsured and underserved in Florida. Develop partnerships with other entities that serve patients who need a dental home (physicians, hospitals, nursing homes, county health departments, federally qualified health centers, advocacy and stakeholder groups). Connect patients needing care with a dental team in an appropriate facility and support a reimbursement process to cover the cost of care. Increase the effectiveness of the Medicaid dental program in providing preventive care and treatment. Develop and implement an elder care protocol for dental care, focusing on caregiver education. Secure state funding for coordinators to match special needs and medically compromised patients with volunteer dentists through the Dental Lifeline Network (Donated Dental Services). 2. Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive and therapeutic dental care. Increase use of private practices, educational institutions, and state and federally supported dental programs with capacity to treat patients. Develop mechanisms for dental team members to establish dental care programs/facilities in underserved, rural areas of Florida. Establish Community Dental Health Coordinator (CDHC) education programs at dental, dental assisting and dental hygiene schools in Florida and incorporate CDHCs into the dental team.

Provide more preventive care by expanding dental assistant duties allowed under general supervision in all settings. Allow for more efficient delivery of dental care by expanding auxiliary duties to include placement and finishing of restorations (with proper training and certification). Recruit and assist in dental lab techniciansâ&#x20AC;&#x2122; education. Support and expand preventive oral care in pediatriciansâ&#x20AC;&#x2122; offices. Support and expand the volunteer safety net programs, including FDA-supported Project: Dentists Care clinics and Mission of Mercy programs. Establish and expand emergency room diversion programs for definitive treatment. Optimize dental care in nursing homes. Educate emergency room and nursing home facility staff on available resources for definitive treatment and establish referral lists of local dentists. 3. Expand opportunities for public health dentistry to serve Floridians. Establish and adequately fund a dental student loan repayment program. Require oral health education in schools and public assistance programs. Expand funding for county health department dental programs. Increase state supported funding for community water fluoridation. Increase Medicaid dental reimbursement rates and require 85/15 medical loss ratio for dental care in managed care programs. Expand public/private partnerships with federally qualified community health centers using private practice providers. Promote the Health Access Dental License to increase the number of providers in health access settings. SEE PAGE 44

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FROM PAGE 43

FLORIDA’S ACTION FOR DENTAL HEALTH ACKNOWLEDGMENTS The FDA would like to recognize the members of the Workforce Innovation Task Group for the development of Florida’s Action for Dental Health:

The FDA would also like to recognize the members of the Sub-workgroup on Elder Care which contributed to this report:

Dr. Jolene Paramore (Chair)

Dr. Nolan Allen (Chair)

Dr. Jim Antoon

Dr. Terry Buckenheimer

Dr. Ralph Attanasi

Dr. Don Ilkka

Dr. Terry Buckenheimer

Bob Macdonald

Dr. Bill D’Auito

Dr. Cesar Sabates

Dr. Michael Eggnatz

Dr. Richard Stevenson

Dr. Richard Huot Dr. Kim Jernigan Dr. George Kolos Dr. Rodrigo Romano Dr. Barry Setzer Dr. Richard Stevenson

CONTACT: jahart@floridadental.org Joe Anne Hart, Governmental Affairs Office Drew Eason, MA. CAE, Executive Director deason@floridadental.org Tallahassee, FL 32301 118 E. Jefferson St. floridadental.org 850.224.1089

TODAY'S FDA

JANUARY/FEBRUARY 2019

WWW.FLORIDADENTAL.ORG

WAYS THE FDA MADE A IN 2018 defeated legislation to create dental therapists in Florida

received Board of Dentistry (BOD) approval for an online radiography program

secured $200,000 in state funds for community water fluoridation

worked with the BOD to create a restorative function dental auxiliary program for dental assistants

helped Brooksville maintain water fluoridation through voter referendum

simplified the membership renewal process with auto-renew

alerted members to HB 21 and provided guidance on the new laws and rules when prescribing and dispensing controlled substances

provided individual support through calling campaigns to assist with membership renewal, licensure requirements and grant programs

awarded 59 emergency disaster grants and disbursed $118,000 to dentists affected by Hurricane Michael through the FDA Foundation Disaster Assistance Fund

guided members on how to update their ADA Find-a-Dentist profile for the public

provided 1,879 patients with 12,719 procedures valued at $1.77 million with more than 1,300 volunteers at the 2018 Florida Mission of Mercy

provided constant reminders about dental licensure renewal by Feb. 28, 2018

partnered with the Florida Medical Association to offer the mandatory opioid course during the 2018 Florida Dental Convention for a discounted rate to FDA members, as well as offer it as an online webinar

provided a personalized insurance checkup for FDA Services-insured members with Annual Review Call Program

partnered with Colgate Oral Health Network as its preferred online continuing education (CE) provider, which offers more than 250 CE units, 110+ live and on-demand webinars and 50 articles

increased the Workersâ&#x20AC;&#x2122; Compensation Dividend Program savings to 25 percent

assisted members with payment and credentialing issues with third-party payers

added 3M Products to FDASupplies.com

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JANUARY/FEBRUARY 2019

The HIPAA Rules That Dentists The Health Information Portability and Accountability Act (HIPAA) Privacy Rule gives patients certain rights over their health information, including dental and billing records. Initial compliance date: April 14, 2003.

The HIPPA Security Rule requires your office to conduct a written risk assessment and develop safeguards to protect electronic patient information and requires ongoing maintenance of those safeguards, periodic risk assessments, training of your staff and documentation. The purpose of the Security Rule safeguards is to protect the confidentiality (people can’t access the information if they are not authorized to do so), integrity (data is not corrupted or changed without authorization), and availability (authorized individuals may access information whenever it is needed) of electronic patient information. Initial compliance date: April 20, 2005.

The Health Information Technology for Economic and Clinical Health (HITECH) Act is where you will find the authorization for the Breach Notification, which requires dental practices to provide notification of breaches of unsecured patient information to affected individuals, the federal government, and in some cases, the media. Initial compliance date Feb. 22, 2010.

Privacy Rule Security Rule

HITECH Breach Notification Rule

HIPAA RULES

Final Omnibus Rule

The 2013 HIPPA Omnibus Final Rule strengthens all of the above rules by: extending the requirements of the privacy and security rules to covered dental practices’ business associates (more information on this below) and their contractors establishing new limitations on the use of protected health information for marketing and fundraising purposes prohibiting the sale of a patient’s personal health information without individual authorization expanding patients’ rights to request and receive electronic copies of their personal health information broadening patients’ ability to restrict disclosure of their personal health information to health insurance plans

Should Be Most Familiar With These rules only apply to a dental office if it is a covered entity, which means the office transmits an electronic “covered transaction,” such as submitting an electronic claim to a dental plan. A dental practice is also a covered entity if someone else (like a clearinghouse) sends an electronic covered transaction on behalf of the dental practice. For more examples of covered transactions and information about covered entities, please view the Centers for Medicare and Medicaid Services’ Covered Entity Guide at go.cms. gov/29TaShR. Assuming your office is a covered entity (most offices are), you will need to take steps to comply with these rules. These steps include, but are not limited to:

appointing a HIPAA privacy official and a HIPAA security official.

reading and understanding all the requirements.

creating a HIPAA compliance team.

overseeing delegated tasks.

performing a risk assessment.

devising policies and procedures.

training workforce members.

maintaining compliance in an ongoing manner.

HIPAA defines a “business associate” as an outside person or entity that does a service for a covered dental practice that involves patient information, such as a billing service, practice management or electronic health record system vendor, document storage company, collection agent or shredding firm. HIPAA requires a covered dental practice and business association to have a signed, written agreement (often called a business associate agreement or a business associate contract) containing certain required provisions before a business associate can access patient information. Due to the 2013 HIPAA Omnibus Final Rule, business associates may now be subject to the same enforcement actions as a covered dental practice. The Florida Dental Association provides copies of Florida HIPPA-compliance forms for its members at floridadental.org/hipaa. The American Dental Association has resources available to help dentists meet HIPPA requirements at ebusiness.ada.org/productcatalog/596/HIPAA/J598. In addition, the Office For Civil Rights has a searchable database of HIPAA frequently asked questions at hhs.gov/ocr/privacy/hipaa/faq/index.html. If you have any questions or concerns, you may contact FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire at cstoutamire@floridadental.org or 850.350.7202.

The HIPAA-cratic Oath: Do No Harm to Patient Data HIPAA, PHI, IoT, BYOD, SMS. A few of these acronyms may be recognizable. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides for the security and protection of protected health information (PHI). Cyber criminals are targeting medical records with greater frequency than ever before. A patient’s complete medical record contains a treasure trove of actionable data on people and their families, that’s why it’s so important that this information is protected with the utmost care.

LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS

Mr. Darnell can be reached at ldarnell@floridadental.org.

“

The other acronyms represent the greatest risks to HIPAA compliance that most medical professionals face. IoT (internet of things) simply refers to the sheer number of devices that are now capable of receiving and transmitting data on the internet. Examples of IoT might be a heart monitor implant, a microchip transponder or even a security camera. BYOD stands for “bring your own device” and refers to workers bringing one or more internet-capable devices with them to work and then using them for work purposes. These BYOD might include smartphones, tablets, wearable technology, etc. Clearly, with so many devices capable of communication on the internet, the security of information often takes a back seat to the convenience of communication. HIPAA requires that PHI must be encrypted either at rest (stored on a device) or in transit. Encryption is a process that “scrambles” data and can only be decrypted by the keyholder. This encryption often is the function of software that facilitates this process. Which brings us to the last acronym in the title: SMS, or short message service, often refers to texting. Almost all standard texting is unsecure and non-encrypted, which means texting PHI data is likely a HIPAA violation for each offense. Basic email also is unsecure and non-encrypted and not to be used for PHI either. This can feel like a HIPAA nightmare given the technological advances today. Unfortunately, most medical professionals find out after the PHI data has been stolen or breached that there was a security risk right in front of them.

HIPAA compliance starts with having a plan, proper procedures and the right technology to remain compliant.

TODAY'S FDA

JANUARY/FEBRUARY 2019

”

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SO, WHAT DO YOU DO? HERE ARE THREE THINGS TO BEAR IN MIND:

1 2 3

PHI data must be encrypted at rest and in transit, so using texts, Facetime/ Skype and email are not appropriate unless using special software that provides encryption.

Each medical professional authorized to access and transmit PHI must have a unique user identifier, so access can be monitored, controlled or terminated if needed. Again, this requires a special software system to facilitate access of patient health data that is HIPAA compliant.

The use of any technology must have an auto-logoff procedure to prevent the unauthorized access of PHI. If you lose your phone or laptop and the finder has access to privileged PHI, that is going to be a huge HIPAA violation.

HIPAA compliance starts with having a plan, proper procedures and the right technology to remain compliant. Prohibiting the use of unsecure BYOD devices for patient information communication is critical. Most are not sure what devices/methods are secure and which ones are not. It’s too costly not to know — it’s your responsibility. Conveniently, FDA Services provides Crown Savings programs to handle both HIPAA-compliant practice management and email solutions, which can be found at fdaservices.com/icore-dental.

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PSC Group, Inc.

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diy dentistry

RISKS ALERTING FLORIDIANS TO THE RISKS OF DIY DENTISTRY 52

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From YouTube videos on do-it-yourself (DIY) teeth straightening and viral charcoal teeth whitening posts to ads promoting at-home teeth straightening and whitening kits, there is a growing trend of DIY dentistry aimed at consumers. Recently, the American Dental Association (ADA) launched a public awareness campaign discouraging DIY dentistry, and we’ve heard from members across the state concerned about this trend. As Florida’s advocate for oral health, the Florida Dental Association (FDA), in coordination with our public relations firm, The Moore Agency, have launched a media campaign to help alert Floridians to the dangers of DIY dentistry and undergoing dental services without the expert care of a dentist or specialist. With the help of our members, we have been working with several television stations in cities across Florida on stories calling attention to the risks posed by DIY dentistry, from jaw problems and abnormal bite to tooth loss and gum disease. Our message is to urge patients to consult with an FDA member dentist before using unconventional dental products or at-home treatments. In Fort Myers, the local NBC station recently aired a story, “‘Do-it-Yourself Dentistry’ becoming disturbing trend among children,”1 featuring FDA member Dr. Phil Kraver. It warns against the dangers of DIY dentistry. Additional stories are in the works.

“

The FDA is working to educate Florida consumers on the risks posed by the growing trend of do-it-yourself dentistry treatments.

”

If you have treated a patient who has attempted DIY dentistry and experienced negative effects — or even no effects — as a result, we would like to hear from you. Please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire at cstoutamire@floridadental.org or 850.681.3629.

Patients and dentists can report issues with medical devices to the U.S. Food and Drug Administration (US-FDA), including any problems they have had with devices related to direct to consumer (DTC) dental laboratory products. The US-FDA’s MedWatch voluntary reporting form2 can be used to report problems patients encounter with DTC products, such as aligners, partial dentures and snoring appliances. The ADA House of Delegates adopted a resolution3 that “strongly discourages the practice of direct to the consumer (DTC) dental laboratory services because of the potential for irreversible harm to patients.” If you are contacted by the media on this issue or any other issue, we encourage you to contact the FDA or your local affiliate, so that we can help vet media requests and determine the best course of response. We also strongly urge you not to mention any specific company names when discussing DIY dentistry and at-home dental treatments in any media interviews or public or online forums. References 1. bit.ly/2E90BMx • 2. bit.ly/1KGErtT• 3. bit.ly/2zIzLXx

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CROWN SAVINGS BENEFITS CATALOG FDA Services has researched and vetted business solutions so FDA members can take advantage of exclusive deals and discounts offered through the Crown Savings program. Members who participate will save time, money and hassle â&#x20AC;&#x201D; putting the focus back on patient care. Crown Savings benefits members and the association as the program produces revenue for the FDA. Greater participation means more revenue for the association and adds value to your FDA membership.

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25% WORKERS’ COMP DIVIDEND The Doctors Company Mission: Defend, Protect, Reward Benefits for FDA Members Eligible FDA members receive a 5% program discount and an additional claims-free credit of up to 10%. FDA members also receive automatic protection against privacy breach allegations and Medicare reviews, and have access to free webbased and live continuing education.

The Tribute® Plan The Tribute® Plan is an unrivaled financial benefit that rewards members for their loyalty and their dedication to superior patient care. More than $7 million is currently earmarked for Tribute Plan awards for Florida dentists. Eligible FDA members also participate in the company’s generous multiyear dividend program, which has returned more than $415 million in dividends since the program’s start in 1976.

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Practices with an annual workers’ compensation premium of $500 or more are now eligible (down from $1,000)! Available for dental offices that meet the following requirements: 1. annual workers’ compensation premium of $500 or more 2. claims-free the past three years (current year plus two prior years) The carrier will immediately apply a 25% dividend of your earned annual premium to all new and existing policies that meet the program guidelines starting July 1, 2018.

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Association members receive a 50% reduction in loan administration fees. Purchase and Startup: • practice sales and purchases • new practice startups • owner-occupied commercial real estate products

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PRACTICE SOFTWARE

The only cloud-based practice software designed by 1,000 dentists. iCoreDental: Practice Management • Members get 33% off. • Easily manage patient treatment plans, scheduling and 3D tooth charting. • Submit billing and insurance claims electronically. • Improve patient experience and reduce practice liability with e-prescription (including narcotics). • Easily process meaningful-use reporting.

iCoreExchange: HIPAA-compliant Email • Members get 35% off. • Email anything to anyone, anywhere, including patients and third parties. • No file size limits.

Get Started: Phone: 888.810.7706 Email: salesinfo@icoreconnect.com Website: iCoreConnect.com

DENTAL SUPPLIES

FDASupplies.com keeps dental supplies affordable by making it easier than ever before to price-shop efficiently. Only FDA members can sign up for and use FDASupplies.com.

What You Should Know • Now offering 3M products. • FDASupplies.com only offers products from direct manufacturers or authorized distributors. • No gray market, expired or counterfeit items are supplied. • Vendors ship exactly what a dentist orders — no alternative brands. • All FDASupplies.com vendors offer free ground shipping on any order — regardless of size.

Get a Price Estimate Get a price estimate by sending your current dental supply invoice using SKU or distributor item numbers via email, phone or fax. FDASupplies.com will send you an estimate with projected savings.

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DR. STEVE TAUBMAN

Dr. Steve Taubman has a private practice in Burlington, Vt. and is the creator of the UnHypnosis Method. He can be reached at steve@stevetaubman. com. Dr. Taubman will be a keynote speaker at the 2019 Florida Dental Convention. His keynote, “How to Remove Mental Barriers to Practice Success,” will be on Friday, June 28 at 7:45 a.m.

The Mindful Dental Professional: How a Dose of Awareness Can Transform Your Practice Raise your hand if you ever feel a sense of futility in your practice. Frustration? Despair? Irritation? Do you ever bring your work concerns home with you at the end of the day? And does that ever lead to guilt for not giving your fullest to the people in your life? Every day, we’re confronted by a barrage of challenges and issues dealing with insurance, staff, patients, regulations and the list goes on. On a good day, we’re able to stay centered and balanced, provide high quality care to our patients and lead our staff in a conscious and empowering way. But, there are plenty of days when the weight of those challenges affects our emotional well-being, and we become less capable of living up to the ideal we’ve set for ourselves. When that happens, the consequences can be grave. We alienate our staff. We disempower our patients. We procrastinate to take actions necessary for our practice growth. And, we feel miserable. What we need is a method for staying centered, calm and productive on life’s battlefields. What if there was a way to clear the mental debris as it begins to collect around you? What if you could wave a magic wand, release a lot of the stress you’re experiencing and replace

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JANUARY/FEBRUARY 2019

it with a consistently optimistic attitude? How would that impact your practice growth, office harmony and patient outcomes? In my work, I lay out a formula for thriving under pressure. It’s particularly valuable for health care practitioners and has helped many function more peacefully and productively. The formula starts with the choice to seek happiness independent of circumstances and then offers tangible tools and strategies to make that choice possible. At the core of the formula is the notion that mindfulness is the one indispensable skill that transforms everything. So, what is mindfulness? Simply put, mindfulness is a quality of mind that includes awareness and acceptance. It’s often described as non-judgmental awareness. We see the nature of our current reality, whether our outer circumstances or our inner state, but we don’t react negatively to it. We experience the moment through eyes of compassion, merely noticing what is, without an attachment to having it go away. Every one of us has stumbled on this experience from time to time. Maybe we were just in an exceptionally good mood. Maybe it was drug induced. Maybe everything in our lives

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THE POWER OF THE COMPLETE TEAM was going so well that the glitch of the moment had little power to throw us off track. But the truth is, this quality of mind can be cultivated so that it’s not an accident. We can develop the ability to see everything in our lives in that way through disciplined practice, such as meditation. These three primary obstacles are what stops us from achieving a predominantly mindful stance: 1. We don’t see the value. We’re programmed to be problem solvers, to “take the bull by the horns,” and to not let go until we’ve wrestled a given circumstance, person, thought or mood to our will. So, the idea of acceptance is repugnant. “If I accept what is, it’ll never change!” The reality is that, paradoxically, the more you resist something, the more it persists. Acceptance is a useful stance for achieving a calm, peaceful state of mind through which you’re more likely to achieve your objectives. 2. We don’t know how. Mindfulness often starts for people as a pleasant theory, without a clear method for achievement. So, we say, “I think I’ll be more mindful,” as if we could shift our mindfulness quotient through mere desire. Mindfulness must be developed through practice, much as physical strength results from exercise. We can exercise our mindfulness muscles through practices like meditation, focused eating, noticing the beauty around us, observing our inner experience before reacting and doing chores without distraction. Each can produce demonstrable results in a relatively short period of time. 3. We lack the necessary strength, which is why until we’ve mastered our minds, we need to build a support structure, perhaps another individual or group with whom we can share our process. When mental habits tempt us, we phone our mindfulness partner and say, “My mind is trying to convince me that this concern is real.” A good mindfulness partner will act as the witness you were unable to be for yourself. They’ll stand on the sidelines and remind you that you’re bigger than your concerns; there’s nothing to do but stay with your mindfulness practice and you’ll eventually see that for yourself. With such a lifeboat, you’ll prevent

yourself from drowning in your own mental content, always being pulled out to a place of equanimity, choice and personal power. Here’s a mindfulness practice we teach beginning students. It’s simple but effective. All you need to do is commit to following the steps, and you will see results. 1. Sit comfortably upright with your back straight, hands in your lap. 2. Keep your eyes and your mouth closed. 3. Take a few cleansing breaths, forgetting your cares. 4. Commit to using this time for self-inquiry, not thought. 5. Focus on your breath as it enters and leaves your nostrils. 6. Don’t try to change anything you notice. Accept it as it is. 7. Maintain perfect awareness and perfect equanimity throughout this process. 8. Move your attention up and down your body, noticing whatever sensations arise. 9. Observe boredom or other unpleasant emotions as you do all other sensations. 10. Practice for no less than 10 minutes, twice per day. When you see the value of mindfulness, develop a disciplined practice to attain it and surround yourself with supportive partners who value the cultivation of a mindful stance, you’ll begin to have a quiet mind. You’ll walk through your stress as if you were the calm in the eye of the storm and have the power to stay engaged and productive despite the pull of your issues. For now, consider the possibility that nothing in your life needs to change for you to find inner peace. Consider the possibility that inner peace will influence everything you do, from your clinical acumen to your doctor-patient relationships to your confidence in building your practice to your sense of happiness and well-being.

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Approaching Acute Dental Pain Management to Reduce Opioid Prescribing PAMELA J. SIMS, PHARM.D., PH.D.; ERIKA CRETTONSCOTT, PH.D.; AND DANIELLE CRUTHIRDS, PH.D.

Drs. Cretton-Scott and Cruthirds are associate professors and Dr. Sims is a professor in the Department of Pharmaceutical, Social and Administrative Sciences at Samford University McWhorter School of Pharmacy. Dr. Sims is a corresponding author on this article and be reached at pjsims@ bellsouth.net. She will be speaking at the 2019 Florida Dental Convention and presenting four courses. On Friday, June 28, “Pharmacologic Considerations for Minimal and Moderate Sedation” will be at 9 a.m. and “Medical Marijuana” will be at 2 p.m. that same day. On Saturday, June 29, “Managing Acute Dental Pain with Current Concerns for Opioids Prescribing” will be at 9 a.m. and “Medications and Dental Care for Your Older Patients” will be at 2 p.m.

TODAY'S FDA

Results from the 2015 National Survey on Drug Use and Health indicate that for individuals misusing analgesics, 36 percent were prescribed the pain reliever by a single prescriber and 54 percent obtained the pain reliever free from a friend or relative; 84 percent of those friends and relatives were prescribed the pain reliever by a single prescriber.1 In the U.S., prescriptions for hydrocodone and oxycodone products increased three-fold from 1991 to 2012.2 Of the top 25 prescribers for Medicare Part D opioid prescriptions in 2014, dentists ranked 13th and oral surgeons 20th.2 Hydrocodone/Acetaminophen is the opioid combination most commonly prescribed by dentists.3 Furthermore, more than one-half of opioid analgesics prescribed after surgical tooth extraction were left unused by the patient.4 In March 2018, the American Dental Association (ADA) announced a new policy on opioid prescribing supporting statutory limits on dosage and duration of no more than seven days for the treatment of acute pain. By early April 2018, 28 states had enacted legislation with some guidance, limit or requirement for opioid prescribing.5 This new ADA policy on opioid prescribing encourages dentists and oral surgeons to minimize their contribution to the opioid epidemic.5

JANUARY/FEBRUARY 2019

Table 1 (on following page) provides a summary of analgesic doses appropriate to manage mild to moderate to severe pain. The use of acetaminophen in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) often can eliminate the need for opioids. When opioids may be indicated, the use of acetaminophen and/or NSAIDs in combination with opioids can reduce the dose of opioid required.6 When available, the use of dispersible dosage forms such as gelcaps, geltabs and oral dispersible tablets (ODTs) increases the peak concentration and decreases the time to the peak concentration, providing a more rapid onset of analgesia with a greater analgesic effect.7 When using doses of non-selective NSAIDs, such as ibuprofen and naproxen Na that exceed the recommended OTC doses, it’s best to provide the patient with a prescription to be filled by the pharmacist to provide the patient with the correct dose and dosing interval as well as a medication information sheet that includes important patient counseling points. The maximum dose of Ibuprofen for OTC use is 1,200 mg/day, whereas the maximum prescribed dose is 3,200 mg/day.8 The analgesic effects of NSAIDs are most noted in the periphery while acetaminophen is more active in the central nervous

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TABLE 1. ANALGESICS RECOMMENDED TO MANAGE ACUTE PAIN.

MILD PAIN Acetaminophen

325 – 500 mg Q 4-6 h NON-SELECTIVE NSAIDS

Ibuprofen

200 mg Q 4-6 h

Naproxen Na

220 mg Q 8-12 h

MODERATE PAIN NON-SELECTIVE NSAIDS Acetaminophen plus Ibuprofen

500/400 mg Q 4-6 h

Ibuprofen Rx

400-800 mg Q 4-6 h 550 mg Q 12 h

Naproxen Na Rx

275 mg Q 6-8 h

Etodolac

200-400 mg Q 6-8 h

Ketorolac oral

20 mg stat, 10 mg Q 4-6 h SELECTIVE COX II INHIBITOR NSAIDS

Celecoxib

400 mg stat, 200 mg BID

Codeine and Acetaminophen

15-60 mg/325 mg Q 4-6 h

Tramadol tablet or ODT

50-100 mg Q 4-6 h

Tramadol and Acetaminophen

37.5/325 – 75/650 mg Q 4-6 h

MODERATE TO SEVERE PAIN Ketorolac IN

2 sprays each nostril Q 4-6 h

Acetaminophen plus ibuprofen

500-1,000/400-600 mg Q 6 h

Hydrocodone and Acetaminophen

2.5-10 mg/325 mg Q 4-6 h

Hydrocodone and Ibuprofen

2.5-10 mg/200 mg Q 4-6 h

Oxycodone and Acetaminophen

2.5-10 mg/325 mg Q 4-6 h

Meperidine oral

50 -150 mg Q 3-4 h

system (CNS). Analgesic combinations blunt pain centrally and peripherally. The rationale for using combination therapy is two-fold. First, it allows for an increase in the intensity of analgesia. Second, there is a noted decrease in the intensity of adverse effects by decreasing the dose of each agent. Ibuprofen 200-400 mg combined with acetaminophen 500 mg every six

hours has been more effective withOF a longer TABLEshown 2. DRUG INTERACTION.1S NSAIDSduration of effect than codeine and acetaminophen in treating moderate NSAID INTERACTING MEDICATION pain.9,10 Ibuprofen 400-600 mg combined with acetaminophen AVOID ANTIPLATELET DRUGS 650-1,000 mg NSAIDS every six hours has beenINHIBITORS shown effective in NON-SELECTIVE AGGREGATION Clostazol (Pletal) 9,10 Ibuprofenmoderate to severe pain. treating Clopidogrel (Plavix) Naproxen

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Prasugrel (Effient)

As of 2014, all hydrocodone products classified as Schedule Ticagrelor are (Brilinta) Etodolac Ticlopidine HCl (Ticlid) II. A number of hydrocodone/acetaminophen Ketorolac Anagrelide (Agrylin) combination Dipyridamole (Persantine) products are available. Ibuprofen combination products disANTICOAGULANTS play additive as well as anti-inflammatory effects. Vitamin K Anticoagulant Warfarin (Coumadin)

Factor XA Inhibitor Severe pain may be effectivelySelective managed during the first 48 Apixaban (Eliquis) hours with ibuprofen, acetaminophen and hydrocodone comRivaroxaban (Xarelto) Thrombin Inhibitor 9,10 binations. Dabigatran (Pradaxa) AVOID ALL ACE INHIBITORS Hepatotoxicity (necrosis and acute hepatic failure) is a conNON-SELECTIVE NSAIDS Benazepril (Lotensin) Captopril (Capoten) cern with acetaminophen administration. Overdose occurs Ibuprofen Enalapril (Vasotec) atNaproxen a dose of greater than 7 g inFosinopril adults. Chronic (Monopril) alcoholics are Lisinopril (Prinivil, more susceptible to hepatotoxicity, althoughZestril) this is not a conEtodolac Moexipril (Univasc) Ketorolac traindication. Children are lessPerindopril susceptible to hepatotoxicity. Erbumine (Aceon) Quinapril (Accupril) AND SELECTIVE COX-II Chronic toxicity is seen in adults with administration of 3-4 g Ramipril (Altace) INHIBITOR NSAIDS 11 Trandolapril (Mavik) per day. The U.S. Food and Drug Administration has limited Celecoxib ANGIOTENSIN II RECEPTOR ANTAGONISTS prescription products to 325 mg per dosage unit to aid in the Candesartan (Atacand) Eprosartan (Teveten) prevention of hepatotoxicity. Warnings also have been added Irbesartan (Avapro) to prescription drug products.Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Table 2 (on following page) provides a summary of NSAID Valsartan (Diovan)

drug interactions. BecauseHIAZIDE non-selective DIURETICS NSAIDs are reversCAUTION WITH Hydrochlorothiazide NON-SELECTIVE ible inhibitorsNSAIDS of platelet aggregation, they should be avoided LOOP DIURETICS Ibuprofen in patients taking other medications affecting platelet agFurosemide Naproxen BETA-BLOCKERS gregation or in patients taking anticoagulant medications. Selective beta 1 antagonists Etodolac Acebutolol The addition of a non-selective NSAID(Sectral) such as ibuprofen, Ketorolac Atenolol (Tenormin) naproxen, etodolac or ketorolac can further Betaxolol (Kerlone)reduce the ability AND SELECTIVE COX-II INHIBITOR NSAIDS for a patient to clot, which canBisoprolol lead to (Zebeta) prolonged bleeding or Esmolol (Brevibloc) 12 Celecoxib (Lopressor) hemorrhage. Based upon theMetoprolol level of pain, celecoxib and/ Non-selective beta antagonists or acetaminophen would be appropriate options for these Carteolol (Cartrol) Carvedilol (Coreg) patients.

Nadolol (Corgard) Penbutolol (Levatol) Both non-selective and selective COX-II inhibitor NSAIDs rePindolol (Visken) Propranolol (Inderal) duce prostaglandin formation and can reduce renal perfusion. Sotalol (Betapace) As a result, use of any NSAID Timolol should(Blocadren) be avoided in patients Labetalol (Trandate, Normodyne)

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Celecoxib

SEE Avoid prescribing enzyme inhibitors Metronidazole Triazole Antifungals Fluconazole

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JANUARY/FEBRUARY 2019

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SPEAKER PREVIEW

PAIN.

TABLE 2. DRUG INTERACTION.1S OF NSAIDS NSAID AVOID NON-SELECTIVE NSAIDS Ibuprofen Naproxen Etodolac Ketorolac

AVOID ALL NON-SELECTIVE NSAIDS Ibuprofen Naproxen Etodolac Ketorolac AND SELECTIVE COX-II INHIBITOR NSAIDS Celecoxib

-6 h

CAUTION WITH NON-SELECTIVE NSAIDS Ibuprofen Naproxen Etodolac Ketorolac AND SELECTIVE COX-II INHIBITOR NSAIDS Celecoxib

Celecoxib

TODAY'S FDA

INTERACTING MEDICATION ANTIPLATELET DRUGS AGGREGATION INHIBITORS Clostazol (Pletal) Clopidogrel (Plavix) Prasugrel (Effient) Ticagrelor (Brilinta) Ticlopidine HCl (Ticlid) Anagrelide (Agrylin) Dipyridamole (Persantine) ANTICOAGULANTS Vitamin K Anticoagulant Warfarin (Coumadin) Selective Factor XA Inhibitor Apixaban (Eliquis) Rivaroxaban (Xarelto) Thrombin Inhibitor Dabigatran (Pradaxa) ACE INHIBITORS Benazepril (Lotensin) Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil, Zestril) Moexipril (Univasc) Perindopril Erbumine (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) ANGIOTENSIN II RECEPTOR ANTAGONISTS Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) HIAZIDE DIURETICS Hydrochlorothiazide LOOP DIURETICS Furosemide BETA-BLOCKERS Selective beta 1 antagonists Acebutolol (Sectral) Atenolol (Tenormin) Betaxolol (Kerlone) Bisoprolol (Zebeta) Esmolol (Brevibloc) Metoprolol (Lopressor) Non-selective beta antagonists Carteolol (Cartrol) Carvedilol (Coreg) Nadolol (Corgard) Penbutolol (Levatol) Pindolol (Visken) Propranolol (Inderal) Sotalol (Betapace) Timolol (Blocadren) Labetalol (Trandate, Normodyne) Avoid prescribing enzyme inhibitors Metronidazole Triazole Antifungals Fluconazole

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FROM PAGE 63

taking certain medications that are excreted by the kidney and have important toxicity associated with reduced renal clearance. These medications include lithium, used to treat bipolar disorder, and cyclosporine and methotrexate, used as immunosuppressants.12 Based upon the level of pain, acetaminophen, tramadol or opioid medications would be appropriate options for these patients. Due to the effects on renal perfusion, the efficacy of antihypertensive medications including thiazide and loop diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) can be reduced by non-selective and selective NSAIDs.12 Of these the most significant interactions occur with ACE inhibitors (name ends in -pril) and ARBs (name ends in -sartan). Again, based upon the level of pain, acetaminophen, tramadol or opioid medications would be appropriate options for these patients. For patients currently taking celecoxib or when prescribing celecoxib, avoid prescribing metronidazole or triazole antifungals (fluconazole) for those patients. Metronidazole and fluconazole inhibit the CYP2C9 metabolism of celecoxib and can increase celecoxib effects and toxicity.12 All opioid and central analgesics can cause sedation and respiratory depression through their effects on the CNS.13 Care should be taken when prescribing these analgesics for patients taking other medications that cause sedation and/or respiratory depression. The additive pharmacologic effects can increase the risk of over-sedation and respiratory depression in patients.12 The central analgesic tramadol and the phenanthrene opioids including codeine, oxycodone and hydrocodone are metabolized by CYP2D6 and CYP3A4. They are metabolized by CYP2D6 to an active metabolite and inhibitors of 2D6 can reduce the conversion to the active metabolite and therefore, reduce the efficacy.13 Due to the potential for reduced analgesia, metoclopramide â&#x20AC;&#x201D; a CYP 2D6 inhibitor â&#x20AC;&#x201D; should be

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THE POWER OF THE COMPLETE TEAM

avoided with their use.12 When prescribing hydrocodone and oxycodone, dentists should avoid prescribing CYP3A4 enzyme inhibitors including the macrolide antibiotics, clarithromycin or erythromycin, or the triazole antifungal, diflucan.8,14 These and other CYP3A4 inhibitors of opioid metabolism can increase the risk of opioid toxicity including over-sedation or respiratory depression. The macrolide antibiotic, azithromycin, does not inhibit the metabolism of opioids and would be a safe alternative. Nystatin (topically) is a safe alternative for diflucan as an antifungal.

References 1. Lipari RN, Hughes A, How People Obtain the Prescription Pain Relievers They Misuse, The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. Available from: https://www.ncbi.nlm.nih. gov/books/NBK343537/ 2. Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician: Opioid Special Issue 2017; 20:S3-S92 3. McCauley JL, Hyer JM, Ramakrishnan VR, et al. Dental opioid prescribing and multiple opioid prescriptions among dental patients: administrative data from the South Carolina prescription drug monitoring program. JADA. 2016;147(7):537-544 4. Maughan BC, Hersh EV, Shofer FS, et al. Unused opioid analgesics and drug disposal following outpatient dental surgery: a randomized controlled trial. Drug Alcohol Depend. 2016;168:328-334. 5. http://www.ncsl.org/research/health/prescribing-policiesstates-confront-opioid-overdose-epidemic.aspx)

6. Helander EM, Menard BL, Harmon CM, et al. Multimodal Analgesia, Current Concepts, and Acute Pain Considerations. Current Pain and Headache Reports. 2017 21(3). 7. Saano V, Paronen P, Peura P, et al. Relative pharmacokinetics of three oral 400 mg ibuprofen dosage forms in healthy volunteers. Int J Clin Pharmacol Ther Toxicol. 1991 Oct;29(10):381-5. 8. Ibuprofen [package insert]. Montvale, NJ: Ascend Laboratories LLC; February 2009 9. Hersh EV, Kane WT, O’Neil MG, et al. Prescribing recommendations for the treatment of acute pain in dentistry. Compend Contin Educ Dent. 2011 Apr;32(3):22-32. 10. Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc. 2013 Aug;144(8):898-908. 11. James LP, Mayeux PR, Hinson JA. AcetaminophenInduced Hepatotoxicity. J Drug Metab&Dispos. 2003 Dec; 31(12):1499-1506. 12. answers.factsandcomparisons.com.ezproxy.samford.edu (Accessed March 4, 2017). 13. Brunton LL, Chabner BA, Knollmann BC. Eds. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 12e New York, NY: McGraw-Hill; http://accesspharmacy.mhmedical.com.ezproxy.samford.edu/book.aspx?bookID=1613. Accessed March 4, 2017. 14. Armstrong SC, Wynn GH, Sandson NB. Pharmacokinetic Drug Interactions of Synthetic Opiate Analgesics. Psychosomatics 50:169–176, 2009.

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CONGRATULATIONS TO THE 2019 FDA AWARD RECIPIENTS!  PRESIDENT’S AWARD

Dr. Jolene O. Paramore

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Dr. Jolene Paramore

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Increasing our presence and value to our members is a key to our membership growth.

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FROM PAGE 69

Presidential Favorites Hobbies: traveling, spending time with family and friends, photography, gardening Food: sushi Memory: our wedding day! Guilty pleasure: Alohamacs (chocolate-covered macadamia nuts) Sport/sports team: Gators Leisure activity: chillin’ at Compass Lake Vacation destination: Hawaii or Banff Book: “The Water is Wide” by Pat Conroy Flower: magnolia, gardenia, tulip Dessert: blueberry cobbler with Blue Bell Homemade Vanilla ice cream Candy: Hershey’s with almonds Drink: unsweet tea Movie: “The Wizard of Oz” Music: rock ’n’ roll or anything with a great beat Artist: JoAnn Walker, painter Pet: pups and kitties

Tell us where you were born and raised and about your family. I was born in Lakeland, Fla. and moved to Marianna, Fla. when I was 7 years old. My dad was a hospital administrator and my mom was a dental assistant. I have one sister. My parents emphasized that we could be anything we wanted to be — it was our choice to decide and persevere. They especially stressed that education was something no one would ever be able to take away from you. Maybe that’s why I have several college diplomas! Loving without ceasing, living in the present while planning for the future and having “presence of mind” are life lessons I still use from my childhood indoctrination. My grandparents and great-grandparents were huge influences in my life and I would be remiss if I didn’t acknowledge their contributions to my success. None of them ever graduated high school; their diplomas were from the School of Hard Knocks. My great-grandfather would cut cheese into letters to teach us the alphabet (followed by a dose from MOM!) when we still had to sit in a high chair to reach the table. He had me multiplying millions by the time I was 4 years old … of course it was 2 x 1,323,122! My great-grandmother let us “help” her sew our clothes and almost always had a jigsaw puzzle on a card table that I later realized was her version of timeout. I wish I had room to share the lessons that my four grandparents taught me, but suffice it to say, the time they spent educating me in their special ways shaped me more than school books. I’ve have been married to my wonderful husband, John, since 1984 and we’ve lived in Panama City since 1990. He has loved me for better and for worse, been my unfailing encourager and constant rock for more than 40 years. Our families have merged through our union and we love to host the in-laws and the out-laws for birthdays, holidays and lake days. As an extended family, our priority has always been making memories through traditions, travels, and navigating life’s triumphs and tribulations.

Education q University of Florida (UF), BS Chemistry, 1983 q UF College of Dentistry (UFCD), DMD, 1988 q UFCD Dental Specialty Training, Periodontology Certificate, 1990

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Memberships q American Dental Association (ADA) q Florida Dental Association (FDA) q Northwest District Dental Association (NWDDA) q Bay Dental Society q Florida Association of Periodontists

Awards q Fellow, American College of Dentists, 2002 q Fellow, International College of Dentists, 2004 q Distinguished Service Award, FDA, 2007 q Fellow, Pierre Fauchard Academy, 2008 q FDA Dentist of the Year, 2010 q NWDDA Service Award, 2013 q FDA Leadership Award, 2014

Service q Gulf Coast Community College Dental Advisory Committee, 1990-2009 q Gulf Coast Community College Dental Advisory Committee chair, 1994-95 q FDA Board of Trustees, 2007-2014

Photos: 1. Island paradise 2. Bathing in flowers 3. UFCD White Coat Ceremony with Drs. Judith Rodriguez-Bec, UFCD Alumni president, and Isabel Garcia, UFCD dean. 4. JADA cover article on the FLA-MOM.

q ADA, Florida Delegation chair, 2012-2017

5. Mardi Gras party office krewe

q Conventions and Continuing Education Committee, 2006-2018

6. Girls just want to have fun! Mom, Heather and Ella.

q FDA Governmental Action Committee, 2012-2018 q FDA Workforce Innovation Task Group, 2014-2018

What are your goals for the FDA? Where do you see the FDA headed? My goal for the FDA is helping members succeed while improving the oral and overall health of Floridians. Increasing our presence and value to our members is a key to our membership growth. Leading the search for solutions that result in better oral and overall health of our citizens and that protect and preserve the dental profession is a crucial focus for the FDA. Through Florida’s Action for Dental Health and our collaborative partners, armed with the data from the FDA Foundation’s Florida Mission of Mercy Impact Study, we can make a real difference in the lives of others. With the momentum of America’s Action for Dental Health national legislation recently signed into law, we are working to push oral health to a higher priority for our Florida legislators. I would love to see oral health education mandated for all of Florida’s children, as education is the most powerful weapon you can use to change the world. WWW.FLORIDADENTAL.ORG

7. My father-in-law, W.E. Paramore. 8. Mom, Dad and their girls, Jolene and Heather. 9. Life motto: Lead by example. 10. Yankee Doodle Jolene

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compleat dentistry

CRITICAL MASS

DR. EDWARD HOPWOOD

Dr. Hopwood is restorative dentist in Clearwater and can be reached at edwardhopwood@gmail.com.

Compleat dentistry is a slower-paced, deliberate style of dentistry, espoused by Pankey, Dawson and so many others, in which the dentist knows the patient well, knows the work, knows their own abilities and limitations, and uses this knowledge to take care of the patients who trust them with their care. The world will change, but the principles of compleat dentistry will remain the foundation of an exceptional practice. The spelling is an homage to Isaak Walton, whose book, “The Compleat Angler,” was about so much more than fishing.

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For years, I’ve used the analogy of critical mass in my talks with young dentists who are transitioning into private practice. You see, when we apply the concept to a business, the critical mass is the minimum number of customers to maintain a business. So, a young dentist looking to establish their practice is trying to build a critical mass. It was only recently that I recognized it’s more applicable to those of us who have been in practice for a long time. This analogy works well when describing the number of patients you need to run and sustain a dental practice. Once you have enough patients, then for every patient who leaves the practice another one enters. Once you reach a critical mass of patients, then you can do your work and feed your family without having to grow the practice. For a young dentist who wants to practice dentistry, there are two ways to achieve this critical mass: 1. Buy it. Purchase an existing practice and transition the patients to you as their new dentist. 2. Grow it. Open a door and grow the practice until you have enough patients. Darryl Caine accurately describes the first option as stress with money (where you have stress, but at least you have money coming in) and the second option as stress without money (where you still have stress, but you don’t have money coming in). Appropriately enough, there will be stress either way and depending on the location of the practice, one approach may be favorable over the other.

JANUARY/FEBRUARY 2019

But when we think about it, critical masses have different qualities. A critical mass of patients who simply picked you off an insurance list may not stay with you if that list changes, even if you had nothing to do with that change. Therefore, a critical mass of patients who picked you because you are on the list from the insurance company is less valuable than a critical mass of patients who picked you because they value your care, skill and judgement. This is where the concept of critical mass becomes more complicated because we realize that we can refine our critical mass. When we set out to refine our critical mass, it becomes harder because we must decide what we stand for. We must decide what’s important to us and why we want patients to pick us as their dentist, and then set up our practice to deliver as such. This is deeper than deciding if we are going to have a family practice, an implant practice, a “teeth-in-a-minute” practice, a cosmetic practice, an aesthetic practice or (my favorite) a cosmetic aesthetic practice. Refining a critical mass is about more than can be written on a sign. A health-centered reconstructive practice treating upper-middle class families in the local neighborhood has a significantly different critical mass than a hotshot aesthetic guru with a practice dedicated to superstars who fly into town for treatment. In fact, those two practices both do “dentistry,” but they are doing two completely different things. A successful practice with a well-

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refined critical mass will have a deep understanding of the person it hopes to serve. And, equally important, it will have a deep understanding of the patient it is not designed to serve. However, this is kind of scary since some people (a lot of people, actually) won’t pick us because they won’t value what we set out to deliver. If we don’t stick to our core values, then we try to be all things to all people and we’ll wind up on a treadmill of constantly seeking more and more patients — something that is unsustainable. Or, even worse, we go on tangents seeking to be popular because we think they will make money (i.e., holistic dentist, hi-tech dentist, spa dentist). This is a fine line, because if you envision yourself as a spa dentist and pedicures are one of your core values, then I’m all for it. But if you are only in it to make more money, then the wheels are bound to fall off somewhere between the yoga mats and the sauna. If you have “reinvented” your practice three times in the past 10 years, you may want to try to get in touch with your core values. This is the brilliance of L. D. Pankey’s admonition, “Know yourself.”

critical mass [crit-i-cal mass] noun the minimum amount of fissile material needed to maintain a nuclear chain reaction.

There is some magic that happens when we align our practice with our core values — we become passionate about our work and our patients. Our critical mass becomes a “tribe” (as Seth Godin perfectly defines) of dedicated patients who send their friends to see us and share our core values. The tribe then grows to be a well-refined critical mass that’s difficult to break up — not even with insurance changes or recessions. Once we become good at it, we then work to get the minimum number of patients (customers) to maintain our practice (business). Perhaps the key word in the definition is “minimum” because it’s certainly easier to search for the minimum than to always be searching for more. We have the opportunity to express ourselves and build our own tribe. But we can’t do it if we’re simply a part of a huge corporation that’s set up to treat the maximum number of people. It’s a shame that some people are stuck as faceless parts of a larger corporation, but it’s even more of a shame that some people have an opportunity to build their own tribe, but they don’t take it.

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DRS. AUSTIN BELKNAP,* ABDULAZIZ BANASSER,* INDRANEEL BHATTACHARYYA, DONALD M. COHEN AND NADIM M. ISLAM

A 59-year old Caucasian male presented to Dr. Elizabeth Linder, a periodontist from Palm Harbor, Fla., with thickened white and yellow lesions on the lateral borders and dorsum of his tongue. The patient stated that the lesions have been present for the last three to four months and were painful. The patient has a medical history that includes psoriasis vulgaris or plaque psoriasis and reported that he was recently prescribed Taltz (Ixekizumab), a monoclonal antibody administered subcutaneously for plaque psoriasis. The following intra-oral photographs were taken by Dr. Linder and submitted with the biopsy specimen. Fig. 1a-c depict the lesions on the lateral border and the dorsal anterior two-thirds of the tongue. Fig. 2 depicts the cutaneous psoriasiform rash present on the patient’s digit on the day of the biopsy. Dr. Linder performed an incisional biopsy on the right lateral tongue and submitted it to the University of Florida Oral and Maxillofacial Pathology Laboratory for a diagnosis.

Fig. 1: Well-demarcated zones of erythema, diffuse loss of filiform papillae and slightly elevated white and yellow plaques present on the a) left lateral border of the tongue, b) right lateral border of the tongue and c) dorsal surface of the tongue.

Question: Based on the patient’s history, clinical images and medical history, what is the most likely diagnosis? A. Erythema multiforme

B. Mucosal drug reaction C. Lichen planus D. Hand, foot and mouth disease E. Psoriasis and psoriasis-related geographic tongue (benign migratory glossitis)

Fig. 2: Two erythematous cutaneous patches located on patient’s digit on the day of the biopsy.

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diagnostics FROM PAGE 77

erythema multiforme. EM is considered a type of allergic reaction, and this patient has no documented allergies.

C. Lichen planus

Diagnostic Discussion A. Erythema multiforme Incorrect, but a good guess! Erythema multiforme (EM) is a self-limiting hypersensitivity reaction that is characterized by the presentation of skin and oral lesions, but the main difference for these oral lesions is the localization of the lesions only to the tongue. According to the literature, 25-50 percent of patients with EM that exhibit cutaneous lesions also have the oral lesions.1 The oral lesions have been characterized as aphthous-type ulcers that mainly occur on moveable mucosa and are usually surrounded by a wide red border. The tongue lesions can appear like erythema migrans or geographic tongue as in this case. As for the skin lesions, you might remember this entity from your dental school days. The classic skin lesions of EM are red and may have that bull’s-eye or target appearance that typically affect the extremities. This patient’s cutaneous lesions are not targetoid but do match those seen in many EM patients. Importantly, EM typically has an acute onset and is not chronic and constant as in this patient, has a slight female predisposition, and commonly affects younger adults. The diagnosis of EM often is clinical, but histology and immunofluorescence can help distinguish EM from other vesiculobullous conditions.

B. Mucosal drug reaction

Incorrect, but another good differential diagnosis. This chronic mucocutaneous disease affects about 1-3 percent of the population and has an unknown cause. The severity of this disease usually parallels with the patient’s amount of stress. The typical presentation of lichen planus in the oral cavity is bilateral white lesions, usually limited to the posterior buccal mucosa. These lesions may ulcerate. There are multiple types of lichen planus: reticular, plaque, erythematous, erosive and bullous. Of these various types, the oral presentation of our case is most like the red erosive or atrophic form of lichen planus. The clinical oral presentation of atrophic or erosive lichen planus is red and white as in this patient, but must have white striate not seen here.

D. Hand, foot and mouth disease Incorrect; but of our differentials, this entity is the only viral diagnosis. Hand, foot and mouth disease (HFMD) is transferred from host to another individual through either fecal-oral contamination or spread airborne. This disease is caused by picornavirus of the Coxsackie group of viruses and is considered highly contagious. Importantly, about 90 percent of affected patients are children who are younger than 5 years old, unlike our patient. The chief complaint is most commonly pain from the oral lesions. The signs and symptoms associated with HFMD include a low-grade fever, malaise, lymphadenopathy and sore mouth. The oral lesions begin as vesicles that rapidly become yellow fibrinous membrane-covered ulcers, surrounded by an erythematous halo. The oral lesions are multiple ulcers that most frequently occur on the palate, buccal mucosa and tongue. Shortly after the appearance of the oral lesions, multiple maculopapular lesions occur typically on the feet, nose, fingers and hands. Due to relatively short duration, the self-limiting nature and the deficit of virus-specific therapy, treatment for HFMD disease is usually symptomatic.

Incorrect, but a great consideration, especially considering the introduction of his new medication to treat his psoriasis. The skin and the oral mucosa are frequent targets for drug reactions. Practically any drug has the potential to elicit a drug reaction. According to the literature, by 2030, 20 percent of the population will be over 65 years old. As the population ages, there is an increase in those effected by chronic diseases, and the number of patients who are taking multiple medications has escalated. It’s extremely beneficial when a patient presents with E. Psoriasis and psoriasis-related geographic a possible drug reaction, that all medications taken — including tongue (benign migratory glossitis) Correct, great job! Benign migratory glossitis is frequently both over-the-counter and prescribed ones — be evaluated. known as geographic tongue (GT). This common, benign The cutaneous manifestations of drug reactions are widely varcondition is seen in approximately 2 percent of the U.S. popuied and include maculopapular rash, urticaria (hives), vesicles, lation. This condition has an unknown etiopathogenesis and ulcers, erythema and target lesions. The oral manifestations of generally goes unnoticed by patients. The characteristic clinidrug reactions may be vesicular, ulcerative or erythematous. cal features are seen on the anterior two-thirds of the tongue Of the multiple different patterns of oral mucosal disease, the and are erythematic areas, surrounded by slightly elevated tongue lesions our patient presented with mostly resemble

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white- or yellow-scalloped borders. The erythema is due to atrophy of the filiform papillae, which can cause some slight sensitivity to hot or spicy foods. The name “benign migratory glossitis” explains the clinical feature for patients who are aware of the lesions and often can describe the appearance, the lesions healing within a few weeks and then the development of the same lesions in a different area. Approximately one-third of patients with GT have reported a fissured tongue (FT) and a genetic linkage between these two entities has been documented in younger individuals. Importantly, both FT and GT are found much more commonly in patents with psoriasis — especially psoriasis vulgaris (plaque psoriasis) and pustular psoriasis. Now, the question regarding our patient is: Does psoriasis and GT have any relationship? Psoriasis is an inflammatory, cutaneous autoimmune disease and FT is found in about one-third of these patients and 10 percent often have GT in combination with FT. This association is highly significant and about double the incidence found in the normal population. Therefore, it’s been suggested that GT is the oral manifestation of psoriasis due to the similarities in clinical, histologic and genetic patterns. The literature states GT has been associated, coincidentally, with several different conditions, including psoriasis, seborrheic dermatitis, Reiter’s syndrome, and atopy or allergy.2 Multiple studies have found that patients with both the plaque form of psoriasis and GT were more likely to have the same human leukocyte antigen (HLA-Cw6) group.3,4 This HLA subtype is associated with prolonged epithelial proliferation. A second set of psoriasis patients with pustular psoriasis share the IL36RN gene, which has been documented to cause this specific form of psoriasis and GT as well. Therefore, GT is likely a form of oral psoriasis, but it’s much more often caused by other gene mutations that involve similar gene loci to those that cause psoriasis but with subtle differences. Importantly, GT most often is seen in patients with more severe psoriasis and is a marker of the psoriasis severity. Its presence may be used as an additional criterion for disease severity in patients with psoriasis. Due to the usually asymptomatic nature and the self-limitation of this entity, treatment is not required. More importantly, reassurance to the patient that this condition is totally benign generally relieves anxiety. As for our patient, upon microscopic examination, a superficial fungal colonization was noted. After the appropriate antifungal therapy was completed, Dr. Linder prescribed Clobetasol 0.05 percent gel to be applied sparingly to affected areas twice a day, to assist with the patient’s reported discomfort. WWW.FLORIDADENTAL.ORG

References: 1. Regezi, JA., et al. Oral Pathology: Clinical Pathologic Correlations. Saunders/ Elsevier, 2008 2. Neville, BW., et al. Oral and Maxillofacial Pathology. Elsevier, 2016 3. Picciani BL., et al. Geographic Tongue and Fissured Tongue in 348 Patients with Psoriasis: Correlation with Disease Severity. Sci World J 564326:1–7, 2015 4. Picciani BL., et al. Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation—a literature review. An Bras Dermatol 91(4):410–421, 2016. 5. Darwazeh AM, Al-Aboosi MM, Bedair AA. Prevalence of oral mucosal lesions in psoriatic patients: A controlled study. J Clin Exp Dent. 2012 Dec 1;4(5):e286-91.6. Daneshpazhooh M, Moslehi H, Akhyani M, Etesami M.Tongue lesions in psoriasis: a controlled study. BMC Dermatol. 2004 Nov 4;4(1):16.

Diagnostic Discussion is contributed by UFCD professors, Drs. Indraneel Bhattacharyya, Don Cohen and Nadim Islam, who provide insight and feedback on common, important, new and challenging oral diseases. The dental professors operate a large, DR. BHATTACHARYYA multi-state biopsy service. The column’s

case studies originate from the more than 12,000 specimens the service receives every year from all over the United States. Clinicians are invited to submit cases from their own practices. Cases may be used in the “Diagnostic Discussion,” with credit given to the submitter. DR. COHEN

Drs. Bhattacharyya, Cohen and Islam can be reached at oralpath@dental.ufl.edu. Conflict of Interest Disclosure: None reported for Drs. Bhattacharyya, Cohen and Islam.

The Florida Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental DR. ISLAM Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/ goto/cerp. *senior resident in oral and maxillofacial pathology at the University of Florida College of Dentistry

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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! As an added benefit, we will continue to publish the basic text of paid, online Career Center ads in Today’s FDA, at no additional cost to you. All ads posted to the online career center will be published during the contracted time frame for which you have posted your online classified advertisement. Today’s FDA is published bimonthly; therefore, all active ads online will be extracted from the Career Center on roughly the following dates of each year: ISSUE

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2019 Graduating Dentist - Greater Tampa. The Central Florida Region is currently looking for a full-time Associate Dentist to add to our successful and growing practice in Tampa, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Our Offices offer: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; Our offices pay all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2Rx4GBd. Space Share/Buy in — Seeking Motivated Dentist. Are you a GP or Specialist working for someone else? Are you ready to be your own boss? Here is the answer: Share space in our beautiful office. Experienced doctor of many years seeks a younger practitioner who wishes to have their own business without the huge up-front expense. Work as many days as you like; there are a total of three equipped rooms with three others that can be equipped. Rent can be negotiated as a flat rate; a percentage of collections or a combination of both. This is the best way to start your own practice without the financial headaches. Location: South Palm Beach County; growing and busy area. Will consider GP or specialist; no Pedo please. Three or more years’ experience; willingness to be a busy entrepreneur! drglerum@ smilesbyglerum.com. Associate Dentist. Dr. Katie McCann Lee, Owner of Daniels Modern Dentistry, is currently looking for a full-time Associate Dentist to add to her successful and growing practice in Fort Meyers, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Dr. McCann Lee offers: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; Dr. McCann Lee pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2ClSoRN. Dental Associate wanted for established non-corporate South East Florida Dental Practice. General dental skills as well as the ability to do extractions/implants would be a plus. Send Resume to RRRdentist@aol.com. Associate Dentist. Pacific Dental Services Supported Offices are currently looking for a full-time Associate Dentist to add to their successful and growing practice in South Brandon, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. The Supported Office offers: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; The Supported Office pays all lab & Supply fees, malpractice insurance, and any CE credits taken through

JANUARY/FEBRUARY 2019

the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@ pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2Cm0cmj. Associate Dentist. Dr. Minh Pham, Owner of Dentists of South Naples, is currently looking for a full-time Associate Dentist to add to his successful and growing practice in Naples, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Dr. Pham offers: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; Dr. Pham pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2RNSj2P. Associate Dentist. Dr. Katie McCann Lee, Owner of Wildwood Dentists, is currently looking for a full-time Associate Dentist to add to her successful and growing practice in Wildwood, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Dr. McCann Lee offers: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; Dr. McCann Lee pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2Dd1SAl. Associate Dentist. Supported Practice Name OR Dr. Katie McCann Lee, Owner of Dentists of Riverview, is currently looking for a full-time Associate Dentist to add to her successful and growing practice in Riverview, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Dr. McCann Lee offers: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; Dr. McCann Lee pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@pacden.com. If you prefer to apply directly online, you can follow the link below: https://bit. ly/2HeT4xM. Associate Dentist. Dr. Katie McCann Lee, Owner of Daniels Modern Dentistry, is currently looking for a full-time Associate Dentist to add to her successful and growing practice in Fort Myers, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Dr. McCann Lee offers: Competitive earning potential, with no earning

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cap; Benefits, including: Medial, Dental, Vision, 401K; Dr. McCann Lee pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2Dd2fed. Associate Dentist. Pacific Dental Supported Practices is currently looking for a full-time Associate Dentist to join to their successful and growing practice in Lakeland, FL. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. We offer: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; The office pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2sslo5C. Dentist Opening (Sunset Park) – Tampa, FL. Are you an experienced, Florida Dentist seeking a busy office where you can focus on providing excellent patient care? We have an immediate opening for a full-time, General Dentist (5+ years’ experience) to lead our solo, digital, South Tampa practice located on Bay Boulevard near the beautiful Sunset Park neighborhood! Enjoy a rewarding role with a dedicated and experienced staff (including hygienist) with an established patient base! Be able to provide a high quality of patient care with treatment autonomy (we handle the rest)! High Compensation: Unlimited Earning Potential: Production Percent vs. Six Figure Annual Amount. Benefits/Perks: Practice Leadership: Clinical Freedom; Patient Focus: Established and Growing Patient Foundation; Partnership Model – Investment Opportunities/Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Group Practice Camaraderie – Technique Development assistance, Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! DENTAL ASSISTANT. DENTAL ASSISTANT PART TIME OR FULL TIME FOR A DENTAL OFFICE ON BRICKELL AVENUE. CANDIDATES WITH EXPERIENCE/BILINGUAL AND WHO LIVE NEAR THE AREA ARE PREFERRED, ZIP CODE 33131. NEEDED RIGHT AWAY. ENGLISH IS A MUST, CERTIFICATION IS PREFERRED, EXPANDED DUTIES PREFERRED, BILINGUAL PREFERRED. brickelldental@ gmail.com. Associate Dentist -- $10,000 Sign-On Bonus. Dr. Minh Pham, Owner of Port Orange Modern Dentistry, is currently looking for a full-time Associate Dentist to add to his successful and growing practice in Port Orange, FL.

This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Dr. Pham offers: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; Dr. Pham pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. If you would like to discuss the opportunity in more detail, please reach out directly to rooneya@ pacden.com. If you prefer to apply directly online, you can follow this link: https://bit.ly/2AMrLoR. DENTIST GENERAL ASSOCIATE. Implant Dentistry is a private practice founded in 1982. We practice all aspects of dentistry (except pedo) with an emphasis on dental implants and cosmetic dentistry. In December 2017 we moved into expanded modern facilities utilizing new state-of-the-art equipment. We utilize CEREC in-office single visit restorations and Galileos cone-beam for enhanced diagnostics and implant planning. This position is for a full time associate dentist who will be an independent contractor. Compensation is on a sliding scale based upon production. The ideal candidate will have either: 1) GPR; 2) military dental experience; or 3) three years private practice experience. Florida dental license with no BOD discipline. Malpractice insurance meeting BOD requirements. To learn more about the office, check us out on our website: drimplant.com. Associate Dentist Wanted for Private Practice. Grand Oaks Dental Care, a private practice in Ocala, FL is seeking a replacement for our associate who starts endo residency in July 2019. Our ideal candidate wants to work in a non-corporate setting, loves people, loves to learn, and is ethically motivated above all else. We are looking for someone with at least one year experience out of school, with preferably interest and ability in endo and overall excellent clinical skills. Our office opened in 2016 and has been growing rapidly, averaging 100 new patients a month. We do all facets of general dentistry with plenty of cosmetics, crown and bridge, root canals, and some removable and surgery. We are adding implant surgery and in-house clear aligner therapy to our mix of procedures early in 2019. We have a mix of fee for service and some select PPO plans- no HMO’s and no Medicaid. Dr. Amir is the upcoming president of the Marion County Dental Association and is accredited as a courtesy clinical assistant professor at UFCD. He teaches dental students once a month at local free clinics with other mentor dentists and accompanies UFCD on their yearly mission trip to Jamaica. Ocala is a nice medium size town in the heart of horse country. It’s a great place to raise a family, and property is reasonably priced- a high standard of living is within reach. We are 30 minutes from Gainesville, an hour and 15 minutes from downtown Orlando, and an hour and 30 minutes from Tampa. If you are interested and want to learn more, text us at 352-682-7640 or email your CV to office@smileocala. com. FL dental license, one year experience out of school with 2 or more preferred.

leadership and one of the best practice models in modern dentistry. In working with our practice you will have the autonomy to provide your patients the care they deserve. In addition, you’ll enjoy the opportunity to earn excellent income and have great work-life balance without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and have a career that will serve you for a lifetime. With us, you will have a balanced lifestyle, fantastic income opportunities, and you’ll work for an office that cares about their people, their patients and their community. Our practice is an office supported by Pacific Dental Services®, which means you won’t have to spend your career navigating practice administration. Instead, you’ll focus on your patients and your well-being. Add on excellent benefits, including malpractice insurance, medical, dental and vision insurance, retirement plans and much more and you’ll feel well taken care of throughout your career. The average full-time PDS-supported Associate Dentist earns $160,000 in their first year. The average income for a PDS-supported Owner Dentist, whose practice has been open at least two years, is $390,000. The Future: As an associate dentist, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. If you are interested in a path to ownership, our proven model will provide you with the training needed to become an owner of your own office. PDS® is one of the fastest growing companies in the US which means we will need excellent dentists like you to continue to lead our growth in the future. Apply Today: Apply now or contact a recruiter anytime at rooneya@pacden.com. We’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Associate Dentist – Daytona. Port Orange Modern Dentistry, a practice supported by Pacific Dental Services in Port Orange, FL, is seeking a full-time associate dentist to join their team in providing excellent patient care. This thriving, modern practice offers full-time hours, competitive pay, full benefits, and is currently offering a $10,000 sign-on bonus!* To learn more, please email Amanda at rooneya@pacden.com or apply directly online through this link: https://bit.ly/2yQ9WEA. Dentist Associate. Great opportunity for an Associate Dentist at a newly relocated state of the art dental office. Highly trained, experienced, and friendly team with a laid-back fun atmosphere. Very busy averaging 80 plus new patients a month! Would work full time (4 days per week). 6 operatories and 3 hygienists; Dentists work in shifts; $75/h or 30% of Net Production whichever is greater giving you unlimited income potential. Please read our online reviews and check out our website at KilmanDental.com. At least 1 year experience preferred. Additional Salary Information: $1.9 million production so far this year $1.7 million production last year.

2019 Graduating Dentist. You’ve invested the time to become a great dentist, now let us help you take your career further with more opportunity, excellent clinical

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career center FROM PAGE 81 Pediatric Dentist -Tampa, FL. Available Spring/Summer 2019. Position availability -Spring/Summer 2019. Private Pediatric dental practice - Non-corporate. Two office locations in the Tampa bay area. Newly renovated office has 15 chairs and is 5 days a week. 2nd office has 7 chairs and is a currently 2 days per week, with potential for growth. The ideal candidate I am seeking is full time, 5 days per week and will work at both office locations. PPO insurance and fee-for-service patients in both practices, no government plans or HMO plans. High-income potential, guaranteed $225K ++ in the first year with our compensation structure and patient volume. Both offices have digital radiographs and digital charting. In office IV-sedation provided on a regular basis with a certified Pediatric Anesthesiologist group. Fully trained and certified pediatric dental staff in place. Orthodontic treatment is provided in both locations by an orthodontist in our practice. Full autonomy over treatment plans. Must have a current Florida dental license, previous experience in private practice is preferred but not necessary. Must be a certified pediatric dentist. Candidate should have excellent communication skills and enjoy a fast pace, fun work environment. We are now interviewing qualified candidates, if interested please email current CV to: sugarbugdude@gmail.com. Requirements: Must have a current Florida dental license. Previous experience in private or corporate offices is preferred. Must be a pediatric dental specialist. General Dentist’s, limited to children only, need not apply. Excellent communication and people skills are a priority.

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who agree to represent the FDA with individual legislators as legislative contact dentists (LCDs). Once a year we meet in Tallahassee to visit lawmakers as a group in one big effort to draw attention to the pending laws that will affect the profession and our patients on Dentists’ Day on the Hill.” That was when Mrs. Gruntbuns hit me right between the eyes with her most important question. “Do you and your fellow dentists do everything you can to support your profession, your patients and the people you ask to represent you?” I wish I could have answered yes. There are many new legislators and I’m certain a dentist knows each one, but they have yet to volunteer to be an LCD. Most of our members do not belong to the Century Club, meaning they haven’t seen the value of supporting our legislative efforts at the level of one night out on the town. We’ll never quit working, but it would be nice to have a little more help.

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My favorite patient, Ima Mae Gruntbuns, has taught me many things. She was in my office the other day when I was feeling particularly down about politics. I must have been talking out loud when I complained that everyone seems to be polarized and have lost the art of meaningful compromise. That it looks like big groups with billions of dollars are controlling the politicians and the media only seems to support one side of any argument. Mrs. Gruntbuns took it upon herself to set me straight. “Son, you are a dentist. How many times has TV had a dentist that looked like a hero? Does that make you any less of a hero to your patients? Can you imagine that maybe they don’t portray lobbyists in the best light, either? “Do you know who speaks for you in Tallahassee?” she asked. “Well, yes, Mrs. Gruntbuns. I know Joe Anne Hart and she is a wonderful person — smart, charismatic and respected by legislators as a knowledgeable and fierce defender of the profession of dentistry,” I replied. “Does she buy votes by passing out dollars to folks in the House or the Senate?” “Well no, and that’s partly because we don’t give her too many dollars to use. We have a program called the Century Club. Each of us

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is asked to contribute at least $150 a year, but participation is poor among the general membership. There’s a limit to how much our political action committee, FDAPAC, can give an individual legislator. Joe Anne tells us all the time that you must build relationships to be a player in the legislative game and having financial resources is a nice way to show your support. It’s a fact — she and our volunteer dentists present themselves as experts in dentistry only and speak to matters of providing oral health care to the people of Florida. As they say, ‘We are not Democrats or Republicans — we are the Tooth Party.’ We are definitely a special interest group and that special interest is dentistry!” Then Mrs. Gruntbuns asked me, “Does Joe Anne work alone? Is she expected to represent you all by herself?” “Well, no. We have a governmental affairs office in Tallahassee that’s staffed by Joe Anne and Alexandra Abboud. In addition, we have member dentists who volunteer on the Governmental Action Committee (GAC). GAC members continuously study the actions of our state legislature and meet by phone every week during session to help promote the Florida Dental Association’s (FDA) positions on oral health. There are other dentists SEE PAGE 82 WWW.FLORIDADENTAL.ORG

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