Today's FDA July/August 2022 Issue by Florida Dental Association

Top 10 HR Tips for Dental Practices

10 Tips for Developing a Dental Office Emergency Plan

Top 10 Digital Marketing Strategies

THE FDAS TEAM IS FOCUSED ON YOU AND YOUR PRACTICE

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TABLE OF CONTENTS

JULY/AUGUST 2022 floridadental.org

TOP 10 issue 8 | Top 10 HR Tips for Dental Practices 16 | FDAPAC-Supported Candidates 28 | Top 10 Frequently Asked Questions That Help FDA Members Succeed 31 | FDA Foundation’s Top 10 Things to Know 34 | Top 10 Reasons to Buy Your Dental Supplies from The Dentist Supply Company 36 | The Top 10 Things You Need to Know to Recognize and Avoid Cyber Attacks

40 | Top 10 Misconceptions Health Care Providers Have About Leasing or Purchasing Their Office Space 46 | 10 Tips for Developing a Dental Office Emergency Plan 50 | Top 10 Digital Marketing Strategies to Help You Attract, Acquire and Retain Patients 54 | Employees Are Your Most Important Asset

56 | A Clinical Presentation of the Direct Gold/ Composite Sandwich Restoration

IN EVERY ISSUE 2 Staff Roster

20 news@fda

4 Contributors

65 Diagnostic Discussion

7 President’s Message 12 Did You Know? 14 Legislative

CHECK OUT TODAY’S FDA ONLINE!

70 Career Center 73 Advertising Index 75 Off the Cusp

18 Preventive Action

1 | TODAY'S FDA july/august 2022

545 John Knox Road, Ste. 200 • Tallahassee, FL 32303 • 800.877.9922 or 850.681.3629

EDITOR Dr. Hugh Wunderlich, CDE • Palm Harbor DIRECTOR OF PUBLICATIONS Jill Runyan

COMMUNICATIONS AND MEDIA COORDINATOR Shey Loman

GRAPHIC DESIGN COORDINATOR AJ Gillis

BOARD OF TRUSTEES PRESIDENT Dr. Gerald Bird • Cocoa

PRESIDENT-ELECT Dr. Beatriz Terry • Miami

SECRETARY Dr. Dan Gesek • Jacksonville

FIRST VICE PRESIDENT Dr. Jeffrey Ottley • Milton

IMMEDIATE PAST PRESIDENT Dr. Dave Boden • Port St. Lucie

SECOND VICE PRESIDENT Dr. John Paul • Lakeland

EXECUTIVE DIRECTOR Drew Eason, CAE • Tallahassee

To contact an FDA board member, use the first letter of their first name, then their last name, followed by @bot.floridadental.org. For example, to email Dr. Hugh Wunderlich, his email would be hwunderlich@bot.floridadental.org. To call a specific staff member below, dial 850.350. followed by their extension.

EXECUTIVE OFFICE Drew Eason • chief executive officer/executive director Greg Gruber • chief operating officer/chief financial officer Casey Stoutamire • director of third party payer and professional affairs Lianne Bell • leadership affairs manager Judy Stone • leadership affairs specialist Lywanda Tucker • peer review coordinator

deason@floridadental.org • Ext. 7109 ggruber@floridadental.org • Ext. 7111 cstoutamire@floridadental.org • Ext. 7202 lbell@floridadental.org • Ext. 7114 jstone@floridadental.org • Ext. 7123 ltucker@floridadental.org • Ext. 7143

ACCOUNTING Breana Giblin • director of accounting Leona Boutwell • finance services coordinator Deanne Foy • finance services coordinator Jamie Idol • FDAS support services coordinator Mitzi Rye • fiscal services coordinator Stephanie Taylor • membership dues coordinator

bgiblin@floridadental.org • Ext. 7137 lboutwell@floridadental.org • Ext. 7138 dfoy@floridadental.org • Ext. 7165 jamie.idol@fdaservices.com • Ext. 7142 mrye@floridadental.org • Ext. 7139 staylor@floridadental.org • Ext. 7119

COMMUNICATIONS AND PUBLICATIONS Renee Thompson • director of communications and marketing Jill Runyan • director of publications AJ Gillis • graphic design coordinator Shey Loman • communications and media coordinator

rthompson@floridadental.org • Ext. 7118 jrunyan@floridadental.org • Ext. 7113 agillis@floridadental.org • Ext. 7112 sloman@floridadental.org • Ext. 7115

FDA FOUNDATION R. Jai Gillum • director of foundation affairs Kristin Badeau • foundation coordinator

rjaigillum@floridadental.org • Ext. 7117 kbadeau@floridadental.org • Ext. 7161

FLORIDA DENTAL CONVENTION AND CONTINUING EDUCATION Crissy Tallman • director of conventions and continuing education Brooke Martin • FDC marketing specialist Isabelle McCreless • FDC program coordinator Deirdre Rhodes • FDC exhibits coordinator Mackenzie Johnson • FDC meeting assistant

ctallman@floridadental.org • Ext. 7105 bmartin@floridadental.org • Ext. 7103 imccreless@floridadental.org • Ext. 7106 drhodes@floridadental.org • Ext. 7108 mjohnson@floridadental.org • Ext. 7162

GOVERNMENTAL AFFAIRS Joe Anne Hart • chief legislative officer Alexandra Abboud • governmental affairs liaison Jamie Graves • legislative assistant

jahart@floridadental.org • Ext. 7205 aabboud@floridadental.org • Ext. 7204 jgraves@floridadental.org • Ext. 7203

INFORMATION SYSTEMS Larry Darnell • director of information systems Charles Vilardebo • computer support technician

ldarnell@floridadental.org • Ext. 7102 cvilardebo@floridadental.org • Ext. 7153

MEMBER RELATIONS Kerry Gómez-Ríos • director of member relations Megan Bakan • member access coordinator Joshua Braswell • membership coordinator Christine Trotto • membership concierge

krios@floridadental.org • Ext. 7121 mbakan@floridadental.org • Ext. 7100 jbraswell@floridadental.org • Ext. 7110 ctrotto@floridadental.org • Ext. 7136

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

Scott Ruthstrom • chief operating officer Carrie Millar • director of insurance operations Carol Gaskins • commercial accounts manager Marcia Dutton • membership services assistant Porschie Biggins • Central FL membership commercial account advisor Maria Brooks • South FL membership commercial account advisor Davis Perkins • Atlantic Coast membership commercial account advisor Melissa Staggers • West Coast membership commercial account advisor Danielle Basista • commercial account advisor Tessa Daniels • commercial account advisor Kelly Dee • commercial account advisor Liz Rich • commercial account advisor

scott.ruthstrom@fdaservices.com • Ext. 7146 carrie.millar@fdaservices.com • Ext. 7155 carol.gaskins@fdaservices.com • Ext. 7159 marcia.dutton@fdaservices.com • Ext. 7148 porschie.biggins@fdaservices.com • Ext. 7149 maria.brooks@fdaservices.com • Ext. 7144 davis.perkins@fdaservices.com • Ext. 7145 melissa.staggers@fdaservices.com • Ext. 7154 dbasista@fdaservices.com • Ext. 7156 tessa.daniels@fdaservices.com • Ext. 7158 kelly.dee@fdaservices.com • Ext. 7157 liz.rich@fdaservices.com • Ext. 7171

Group & Individual Health • Medicare Supplement • Life Insurance • Disability Income • Long-term Care • Annuities Professional Liability • Office Package • Workers’ Compensation • Auto • Boat

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

Joseph Perretti, SBCS director of sales • South Florida 305.665.0455 cell: 305.721.9196 joe.perretti@fdaservices.com

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

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

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

3 | TODAY'S FDA july/august 2022

GUEST CONTRIBUTORS july/august 2022

CATHERINE CABANZON CRDH, BASDH catherinecabanzon@gmail.com Page 54

ANNA DAVIES

R. JAI GILLUM

WHITEBOARD MARKETING

DIRECTOR OF FOUNDATION AFFAIRS

anna@whiteboard-mktg.com Page 50

rjaigillum@floridadental.org Page 31

DB HENRY, DDS

DEREK HOUSH

SHEY LOMAN

FORMER FDA PRESIDENT

CARR

golddoc46@gmail.com

derek.housh@carr.us

FDA COMMUNICATION AND MEDIA COORDINATOR

Page 56

Page 40

sloman@floridadental.org

ROBERT MCDERMOTT

DEBORAH S. MINNIS

PRESIDENT/CEO ICORECONNECT

AUSLEY MCMULLEN

TDSC.COM

sales@icoreconnect.com

dminnis@ausley

Madison.Schwarz@tdsc.com

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MADISON SCHWARZ

JERRY BIRD, DDS

DONALD COHEN, DMD

oralpath@dental.ufl.edu

FDA PRESIDENT

oralpath@dental.ufl.edu

gbird@floridadental.org

Page 65

850.681.3629 Page 7

JOE ANNE HART

NADIM M. ISLAM, DDS

CASEY STOUTAMIRE, ESQ.

FDA CHIEF LEGISLATIVE OFFICER

oralpath@dental.ufl.edu

FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

Page 65

jahart@floridadental.org

cstoutamire@floridadental.org

850.350.7205

850.350.7202

Page 14

Page 12 & 28

SCOTT RUTHSTROM FDA SERVICES CHIEF OPERATING OFFICER

HUGH WUNDERLICH, DDS, CDE FDA EDITOR

scott.ruthstrom@fdaservices.com

hwunderlich@bot.floridadental.org

850.350.7146.

850.681.3629

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5 | TODAY'S FDA july/august 2022

CONTRIBUTORS july/august 2022

INDRANEEL BHATTACHARYYA, DDS

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Tuesday, March 28, 2023 Tallahassee

Hotel Duval room block reserved, visit bit.ly/39roOPh or call 850.224.6000 and reference the Florida Dental Association

president’s message

My top ten favorite things about the By Jerry Bird, DMD, FDA President

The Florida Dental Association’s (FDA) mission is helping members succeed. As our professional organization, the FDA helps members from the beginning of their career to the end. I have been asked to write about the top 10 benefits of my membership in the FDA. I am sure many are the same as yours and together we can come up with a big list. My top 10s:

We have the most extraordinary executive director, Drew Eason, and an excellent FDA team. The whole team is a 10 out of 10. Always helpful with winning attitudes.

The Florida Dental Convention (FDC) in June. It is an excellent meeting planned by the best planning committee ever. No wonder it is one of the greatest dental meetings anywhere!

The Incredible FDA Lobbying Team – always on top of legislation affecting the profession of dentistry and helping us support dental-friendly candidates.

4. 5. 6. 7. 8.

FDA Services – I love the medical insurance they allow me to provide my team. They also know us by name when we see them at meetings. Free preregistration for our team members at FDC! I have the most incredible colleagues, mentors and friends through the FDA. They are there when you need them!

9. 10.

Corporate discounts with FDA business partners that support us. Learning from the best in our profession!

The FDA was with me when I opened my practice in 1985. They helped me navigate the business side of dentistry. My friends and colleagues in the FDA also helped me recover after my serious bicycle accident in 2020. The FDA has an amazing team of professionals at the ready to help us navigate the challenges of practice. The FDA, together with the American Dental Association, delivers programs, services and advocacy to maximize value and service at every level. As dentists in Florida, our strength and voices together make a difference in our profession. Encourage others to join and remember to invite that new dentist who just moved into your community. A personal ask is the best recruitment tool for membership. More members lead to more membership advantages! What are your top 10 benefits of membership in the FDA? I am a proud member of the FDA and I am grateful to belong. Thanks to the FDA for all they have done for me, my practice, my family and my patients. The FDA makes a difference in all of our lives! Jerry Bird

Free online continuing education to meet licensing requirements! The Florida Mission of Mercy – the best event ever. Providing free dental care to those in need. We are filled with love, compassion and caring.

7 | TODAY'S FDA july/august 2022

human relations

HR TIPS FOR DENTAL PRACTICES

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provisions protect individually identifiable health information referred to in the regulations as protected health information (PHI) and generally provide for protection of both privacy and security of the PHI. HIPAA – PRIVACY. HIPAA established privacy standards for certain health information. The privacy provision controls a covered entity’s use and disclosure of PHI. Covered medical provider entities include doctors of dental surgery or dental medicine and their business associates. The regulations provide for the following regarding uses and disclosures. These are examples in each category; they are not intended to be all-inclusive. Permitted uses and disclosures: to the individual; for treatment and payment. Required uses and disclosures: To the individual when requested; when required by the Department of Health and Human Services in connection with an investigation or to determine a covered entity’s compliance with the HIPAA provisions. Business associates: Permitted uses and disclosures must be only as permitted or required by its business associate contract or other arrangement which cannot violate any of the HIPAA provisions. Required uses and disclosures: When required by the Department of Health and Human Services; to the covered entity, individual or individual’s designee. Prohibited uses and disclosures: Genetic information for underwriting purposes; sale of PHI.

”

By Deborah Minnis

Overly broad social media policies that simply prohibit employees from saying anything disparaging or unfavorable about the employer are violations ...

”

This article is for informational purposes only and is not intended to be a substitute for professional legal advice. If you have a specific concern or need legal advice regarding your dental practice, you should contact a qualified attorney.

HIPAA - SECURITY - Security of electronic protected health information (e-PHI). HIPAA security provisions are an attempt to balance the privacy of the patient while allowing the provider to “adopt new technologies to improve the quality and efficiency of patient care.”

Policies and procedures to ensure that e-PHI is not improperly altered or destroyed. Technical security measures to prevent unauthorized access to e-PHI that is being transmitted over an electronic network.

Administrative Safeguards

Covered entities must go through a security management process. Conduct a risk analysis. Evaluate the likelihood and impact of potential risks to e-PHI. Implement appropriate security measures to address identified risks. Document the chosen security measure and the rationale for adopting the measure. Maintain continuous, reasonable and appropriate security protections.

SERVICE ANIMALS - Dental offices are a place of public accommodation under Title III of the Americans with Disabilities Act. Places of public accommodation are businesses that are open to the public or that provide goods and services to the public. A service animal is a dog that has been individually trained to perform specific tasks for a disabled person directly related to the person’s disability. The law does not limit people to one service dog. For example, if two service dogs are needed to assist the person with stability in walking, the person is allowed to be accompanied by both dogs if the space can accommodate both dogs.

Designate a security official who is responsible for developing and implementing security policies. In accordance with the privacy provisions, create policies limiting uses and disclosures of PHI to the “minimum necessary” and authorize access to e-PHI only when access is appropriate based on the user or recipient’s role.

There is a distinction between a psychiatric service animal and an emotional support animal; animals needed simply for emotional support are not covered by the law. As a public accommodation, only limited inquiry is permitted relating to a patient’s service dog.

Provide appropriate training and supervision of workforce members who work with e-PHI. The workforce must be trained on policies and procedures and entity must apply appropriate sanctions to workforce members who violate policies and procedures.

Acceptable inquiries related to a patient’s service animal where disability is not obvious are: Is the dog a service animal required because of a disability?

Physical safeguards

What work or task has the dog been trained to perform?

Limit access to the facility. Implement workstation and device security policies and procedures.

You cannot ask for documentation or require the dog to demonstrate its task or inquire about the nature of the person’s disability.

Technical Safeguards – Providers must implement the following:

The facility cannot require that the service dog be certified, trained or licensed as a service dog.

Policies and procedures that allow only authorized persons to access e-PHI.

A service dog can be any breed of dog. Individuals cannot be denied access based on assumptions or stereotypes about the dog’s breed or how the dog might behave. t

Hardware, software and procedural mechanisms to audit and examine access and other activity in information systems that contain or use e-PHI.

human relations Consider if allowing the service animal would create an undue hardship.

If a particular service dog acts in a way that poses a direct threat to the health or safety of others, has a history of such behavior or is not under the control of the handler/patient, that particular dog may be excluded.

Consider if allowing the service animal would pose a direct threat to the health or safety of the employee, his or her co workers or patients.

SERVICE ANIMALS - Florida Law.

Florida Law: There is no companion provision for private employers in Florida law.

Though the law generally references places of lodging and modes of transportation, the definition of public accommodation includes the catch-all phrase “and other places to which the general public is invited.” In addition to dogs, the Florida law’s definition of service animal includes miniature horses.

Ways for a minor to become emancipated:

An individual with a disability has a right to be accompanied by a service animal in all areas of a public accommodation where the public or customers are allowed to go.

A court order is issued emancipating the minor. The minor is no longer residing with his/her parent or guardian and is financially independent.

The service animal must have a harness, leash or other tether unless due to a disability the handler is unable to use a harness, leash or tether or these items would interfere with the service animal’s ability to safely or effectively perform its task. Documentation of training cannot be a precondition for providing service to the individual. Any public accommodation that interferes with rights of a disabled person or trainer of a service animal while engaged in training of such animal or denies them admittance is guilty of a second-degree misdemeanor and must perform 30 hours of community service.

The minor is married. (Note: Pregnant minors are emancipated only as it relates to agreeing to treatment related to their pregnancy.) Prior to treatment of a potentially emancipated minor, steps should be taken to document his/her status as such.

TREATMENT OF MINORS - Unemancipated Minors. Either parent, whether divorced or not, has the right to consent to medical treatment (includes adoptive parents and legal guardians/custodians). The parent with whom the minor primarily resides does not have the sole right to determine treatment.

SERVICE ANIMALS - Dental offices as an employer.

Absent a court order terminating the rights of the non-residential parent, he/she continues to have rights to make decisions about the minor’s medical care.

Under the Americans with Disabilities Act, applies to employers with 15 or more employees, allows the employer to do the following:

In order of priority, here are others who have the power to consent where, after a reasonable attempt, a parent cannot be contacted: legally designated healthcare surrogate; stepparent; grandparent; adult sibling; adult aunt or uncle.

Request documentation establishing the disability and how the animal assists. Request documentation of the animal’s training. Discuss where the animal is not permitted to go.

TREATMENT OF MINORS - Emancipated minors are considered adults and can consent to their own medical treatment.

Discuss ways to deal with coworkers who are allergic or afraid of animals. Discuss other possible accommodations.

SOCIAL MEDIA POLICIES – Since at least 2011, the General Counsel of the National Labor Relations Board has actively evaluated company social media policies for violation of Sections 7 and 8 of the National Labor Relations Act.

Health care providers with a gross annual volume of at least $250,000 are covered under the National Labor Relations Act.

10.

Exemption from overtime requires that the employee be paid on a salary basis and fall within certain designated categories.

Certain provisions of the National Labor Relations Act apply to all employers and not just employers where unions are present.

Being paid on a salary basis is defined to mean that the employee receives his/her full salary for any week in which he/ she performs work without regard to the number of days or hours worked.

Section 7 of the National Labor Relations Act gives employees the right to engage in “concerted activities for the purpose of mutual aid and protection.”

If improper deductions are taken from the salary, the employee’s exempt status is lost for the work week in which the improper deduction occurred. (Note: If improper deductions are taken on a regular basis, the U.S. Department of Labor Wage and Hour Division may question whether the employee is truly a salaried employee.)

Section 8 makes it unlawful to interfere with these rights. In a memorandum dated March 31, 2021, the Acting General Counsel stated his intention to vigorously enforce this provision. General examples of the type of language considered a violation of the provision:

There are a limited number of exceptions to the rule against taking deductions from salary. They are:

Overly broad social media policies that simply prohibit employees from saying anything disparaging or unfavorable about the employer are violations of Section 7.

Absences from work for one or more full days for personal reasons other than sickness or disability.

In addition, even more specific language that prohibits communications that would be embarrassing, harassing or that might damage the reputation or goodwill of the employer is considered a violation of this provision

Absence from work for one or more full days because of sickness or disability and the employer has a bona fide plan to compensate the employee for the absence, i.e., PTO or sick leave plan.

Violation of these provisions can lead to hefty civil money penalties and fines.

Deductions from salary can result in loss of exempt status for the employee under the Fair Labor Standards Act.

Penalties imposed in good faith for infractions of safety rules of major significance.

DISCUSSIONS RELATING TO SALARIES fall under the auspices of the National Labor Relations Act.

These deductions do not have to be in full-day increments

Prohibiting employees from discussing their wages/salaries is considered by the General Counsel of the National Labor Relations Board to be a violation of Sections 7 and 8 of the National Labor Relations Act.

Safety rule is defined very narrowly to be relating to preventing serious danger in the workplace or to other employees. Unpaid disciplinary suspensions of one or more full days for infractions of certain workplace conduct rules. The rule or policy must do the following:

This activity is also a part of the General Counsel’s vigorous enforcement policy and can result in civil money penalties and fines.

Be in writing.

Employees have the right to discuss their wages when not at work, when at work or on break if other non-work-related conversations are allowed.

Apply to all employees. Relate to conduct and not performance or attendance issues. Relate to serious workplace misconduct, i.e., sexual harassment, violence, drug or alcohol violations or violations of state or federal law.

Employers cannot interrogate employees about such conversations, threaten them for having such conversations or put the employee under surveillance for having such conversations.

The employee takes leave under the Family Medical Leave Act.

It is unlawful to punish or retaliate against employees for discussing their wages.

The employee is absent for the entire workweek or performs no work during the entire workweek.

diddid youyou know? know?

The FDA Offers Peer Review for for Members Members?

By Casey Stoutamire, FDA Director of Third Party Payer and Professional Affairs

Did you know that your Florida Dental Association (FDA) offers peer review for its members? The goal of this member benefit is to help resolve patient disputes and often can help you avoid costly legal fees, malpractice suits and Board of Dentistry complaints. Please see below for an overview of how peerBoard reviewofcase works.complaints. Please see below for an overview fees, malpractice suits,a and Dentistry of how a peer review case works. We are happy to announce that the administrative duties We are happy to announce that the administrative duties of the peer review program will now be handled through the Tallahassee office by Lywanda Tucker, the FDA’s peer da Tucker, the FDA’s Peer Review Coordinator. However, if there is a review needed by review coordinator. However, if there is a review needed by a dentist, that will still be a dentist, then that will still be handled at the local component level by a dentist from handled at the local component level by a dentist from your area. your area. Lywanda has over 16 years of experience in dentistry. She graduated from the Lywanda has moreprogram than 16 at years of experience in dentistry. Sheingraduated fromthe thecourse dental assisting Tallahassee Community College 2005 and over dental assisting program at Tallahassee Community College in 2005, and during the course of her career in dentistry, she has worked at periodontal, general and orthodontic offices as a chairside assistant as well as a treatment coordinator and front office staff. We are excited to have cases. Lywanda staff as her previous experience makes her well suited to assist with review Youon can reach Lywanda at ltucker@floridadental.org. peer review cases. You can reach Lywanda at ltucker@floridadental.org. You often can avoid costly legal fees often cansuits avoid andYou malpractice bycostly using legal this fees and malpractice suits using this free service available only to by members. free service available only to members.

PEER REVIEW

Section 466.022(1), Florida Statutes, states (among other Section Florida Statutes,orstates (amongofother things) that “a466.022(1), professional organization association things) that “a professional organization or association dentists which sponsors, sanctions, or otherwise operates of dentists which sponsors, sanctions, otherwise operates or participates in peer review activities is or hereby afforded the same privileges and immunities afforded to any

Patient calls the Florida Dental Association with a concern.

peer review and can start the paperwork. the peer review chair (volunteer dentist) in the area near the patient. The peer review chair calls the patient to discuss the issue. The peer review chair then calls the dentist to discuss the issue and see if the dentist is willing to settle by refunding all or some of the fee. If not in agreement, the chair convenes a peer review panel and collects information from the dentist who treated the patient.

If there is an agreement, the peer review chair negotiates a settlement to which the patient and dentist both agree.

The FDA notifies the patient of the proceeding’s outcome.

member of a duly constituted medical review committee of aSection duly constituted medical review committee by s. member 766.101(3).” 766.101(3)(a), Florida Statutes, by s.that 766.101(3).” Section 766.101(3)(a), Floridaon Statutes, provides “[t]here shall be no monetary liability the provides “[t]here shall for be no monetary part of, and nothat cause of action damages shallliability arise on the partany of, member and no cause of action for damages arise against, of a duly appointed medicalshall review against,or any member of a provider duly appointed medical committee, any health care furnishing any review committee, or anyinformation health careconcerning provider furnishing information, including the pre-any information, including concerning the prescribing of substances listedinformation in s. 893.03(2), to such comscribing substances listedany in s.person 893.03(2), toas such mittee, or anyofperson, including acting a committee, or any person,to, including any person as a witness, incident reporter or investigator for, aacting medical witness, incident to,proceeding or investigator for, a medical review committee, for reporter any act or undertaken review committee, anyof actthe or functions proceeding or performed within the for scope of undertaken any performed within the scope of the functions any such or committee if the committee member or health of care suchacts committee if the committee or health care provider without intentional fraud.”member These statutory provider acts withouttointentional statutory protections are intended encouragefraud.” good These faith participrotections intended to encourage good faith participation in the peerare review process without fear of liability. pation the peer review process that without fear of liability. However, it in is important to remember records However, it is important to remember that records generated in the peer review process may be subject to generated in the peer process maylegal be subject disclosure in response to a review subpoena or other pro- to in response to(patient’s a subpoena or and other legal process,disclosure and the original records chart dental cess,and andunderlying the original records (patient’s chart and records) facts of a matter submitted to dental and underlying of a matter submitted to peer records) review are almost alwaysfacts discoverable. peer review are almost always discoverable.

OPIOIDS information from the FDA

HEALTH CARE PROVIDER CHECKLIST: INFORM Non-opioid alternatives for pain treatment, which may include non-opioid medicinal drugs or drug products are available. Non-opioid interventional procedures or treatments, which may include: acupuncture, chiropractic treatments, massage, physical or occupational therapy, or other appropriate therapy are available.

DISCUSS Advantages and disadvantages of non-opioid alternatives. Patient’s risk or history of controlled substance abuse or misuse, and patient’s personal preferences.

DOCUMENT IN PATIENT’S RECORD Non-opioid alternatives considered.

SUMMARY: All health care providers must include non-opioid alternatives for pain and pain management electronically or in printed form in their discussions with patients before providing anesthesia, or prescribing, ordering, dispensing or administering a schedule II controlled substance for the treatment of pain. Effective July 1, 2021.

PROVIDE “Alternatives to Opioids,” an educational information pamphlet created by the Florida Department of Health printed or in electronic format (required, available at bit.ly/2KXvZ2h). Also, a checklist and poster.

NON-OPIOID ALTERNATIVES r You FDA ve R lusi exc EMBE ! M EFIT BEN

LAW: FOR THE LATEST ON OPIOIDS, GO TO:

FLORIDADENTAL.ORG/NYK

13 | TODAY'S FDA july/august 2022

GO TO bit.ly/2KXvZ2h

legislative

Top 10 Reasons Why You Should Advocate for Your Profession! By Joe Anne Hart, FDA Chief Legislative Officer

Dentistry continues to evolve and change as innovation progresses and technology advances. As this happens, it is important for individuals who have authority to change policies that may affect the way you practice dentistry be aware of the importance of education and training in dentistry. Let us look at why it is important for YOU – as a member of the American Dental Association (ADA) and the Florida Dental Association (FDA) – to advocate for your profession.

10.

If you are silent, then others who may not share your interest, will have a louder voice and influence over elected officials impacting your profession.

You are the dental expert – use your voice to help educate elected officials (local, state and federal) on policies that will have an impact on your patients and your profession.

People do not understand the level of training required to practice as a licensed dentist. Do not leave your skill level to the imagination of others – be vocal about your profession.

Invest in your profession and reap the benefits of knowing and understanding how the FDA and the ADA represent your interests.

There are national groups spending time and money advocating to change the way dentistry is practiced. You must be pro-active and develop relationships with your elected leaders, who will come to you first as their dental resource.

Dentistry is not a technical license – it is a comprehensive dental degree provided to those who are proficient in comprehensive dentistry, and later afforded the privilege of acquiring a dental license to practice.

Scope of practice is pitched as a solution when groups try to address access to care issues – it is important for policymakers to get the facts about why expanding scope may have a negative impact on patient care.

For the FDA to be effective, we must speak with one voice. Participating in events like Dentists’ Day on the Hill, shows legislators that you believe in your profession and are willing to get involved to protect it.

Investing in your profession by becoming a member of the Florida Dental Association Political Action Committee (FDAPAC) Century Club helps secure resources to support dental-friendly candidates.

save the date!

And last, but not least ...

If you are not at the table, then you are on the menu.

The FDA works every day to ensure you have representation at the table and that policies are thoroughly vetted and debated at all levels of government. We cannot do this without YOU! Don’t sit on the sidelines as a spectator. Take an active role and advocate for your profession!

Mark your calendar to attend Dentists’ Day on the Hill Tuesday, March 28, 2023 in Tallahassee. More information coming soon!

ARE YOU A MEMBER OF FDAPAC CENTURY CLUB? Join now: floridadental.org/centuryclub

A portion of your required dues is transferred to the Florida Dental Association Political Action Committee (FDAPAC). FDAPAC provides campaign contributions to dental-friendly candidates. FDAPAC Century Club members provide additional financial support of $150 or more for state campaigns. FDAPAC dues and contributions are not deductible for federal income-tax purposes. Dr. Rudy Liddell FDAPAC Chair

“Your support of the PAC helps the FDA build relationships with leaders who will be making important decisions in Tallahassee that will impact our profession and our patients.” — Dr. Rudy Liddell

15 | TODAY'S FDA july/august 2022

candidates

! E T VO

FDAPAC-Supported Candidates (as of June 21, 2022)

Primary Election: Tuesday, Aug. 23 Thanks to your Florida Dental Association Political Action Committee (FDAPAC) membership and support, FDAPAC has contributed to many candidates’ campaigns for the 2022 Primary Election. Without the FDAPAC membership, FDAPAC Century Club members and FDAPAC Capital Hill Club members, organized dentistry would not be as effective during the Legislative Session. Below is a list of FDAPAC-supported House and Senate candidates for the 2022 Primary Election.

CENTRAL FLORIDA DISTRICT

ATLANTIC COAST DISTRICT Dana Trabulsy, R-Fort Pierce

H-84

Paul Renner, R-Palm Coast

H-19

John Snyder, R-Palm City

H-86

Yvonne Hayes Hinson, D-Gainesville

H-21

Michael Caruso, R-Boca Raton

H-87

Chuck Clemons, R-Jonesville

H-22

Jervonte Edmonds, D-West Palm Beach

H-88

Taylor Yarkosky, R-Montverde

H-25

Kelly Skidmore, D-Boca Raton

H-92

Tom Leek, R-Daytona Beach

H-28

Christine Hunschofsky, D-Parkland

H-95

Elizabeth Fetterhoff, R-DeLand

H-29

Dan Daley, D-Sunrise

H-96

Chase Tramont, R-Port Orange

H-30

Mike Gottlieb, D-Sunrise

H-102

Tyler Sirois, R-Merritt Island

H-31

Robin Bartleman, D-Weston

H-103

Randy Fine, R-Palm Bay

H-33

Felicia Robinson, D-Miami Gardens

H-104

Carlos Guillermo Smith, D-Orlando

H-37

Bobby Powell, D-West Palm Beach

S-24

David Smith, R-Winter Springs

H-38

Lori Berman, D-Boynton Beach

S-26

Travaris McCurdy, D-Orlando

H-41

Tina Polsky, D-Boca Raton

S-30

Anna Eskamani, D-Orlando

H-42

Gayle Harrell, R-Stuart

S-31

Kristen Arrington, D-Kissimmee

H-46

Lauren Book, D-Plantation

S-35

Thad Altman, R-Indialantic H-32

H-32

Tom Wright, R-Port Orange

S-8

Keith Perry, R-Gainesville

S-9

Jason Brodeur, R-Sanford

S-10

Dennis Baxley, R-Lady Lake

S-13

WEST COAST DISTRICT

Kamia Brown, D-Ocoee

S-15

Linda Stewart, D-Orlando

S-17

Ralph Massullo, R-Beverly Hills

H-23

Debbie Mayfield, R-Melbourne

S-19

Sam Killebrew, R-Winter Haven

H-48

Victor Torres, D-Kissimmee

S-25

Josie Tomkow, R-Auburndale

H-51

Randy Maggard, R-Zephyrhills

H-54

NORTHEAST DISTRICT

Kim Berfield, R-Clearwater

H-58

Sam Garrison, R-Orange Park

H-11

Jennifer Wilson, R-Bellair Bluffs

H-59

Wyman Duggan, R-Jacksonville

H-12

Michele Rayner, D-St. Petersburg

H-62

Garrett Dennis, D-Jacksonville

H-14

Susan Valdes, D-Tampa

H-64

Lake Ray, R-Jacksonville

H-16

Traci Koster, R-Tampa

H-66

Cyndi Stevenson, R-St. Johns

H-18

Fentrice Driskell, D-Tampa

H-67

Bobby Payne, R-Palatka

H-20

Andrew Learned, D-Riverview

H-69

Clay Yarborough, R-Jacksonville

S-4

Mike Beltran, R-Valrico

H-70

Tracie Davis, D-Jacksonville

S-5

Will Robinson, R-Bradenton

H-71

Jennifer Bradley, R-Flemind Island

S-6

Michael Grant, R-Venice

H-75

Travis Hutson, R-Palm Coast

S-7

Spencer Roach, R-North Fort Myers

H-76

Jenna Persons-Mulicka, R-Fort Myers

H-78

Adam Botana, R-Bonita Springs

H-80

NORTHWEST DISTRICT Michelle Salzman, R-Pensacola

H-1

Bob Rommel, R-Naples

H-81

Alex Andrade, R-Pensacola

H-2

Blaise Ingoglia, R-Spring Hill

S-11

Patt Maney, R-Shalimar

H-4

Colleen Burton, R-Lakeland

S-12

Allison Tant, D-Tallahassee

H-9

Janet Cruz, D-Tampa

S-14

Doug Broxson, R-Gulf Breeze

S-1

Darryl Rouson, D-St. Petersburg

S-16

Jay Trumbull, R-Panama City

S-2

Nick DiCeglie, R-Bellair Bluffs

S-18

Loranne Ausley, D-Tallahassee

S-3

Jim Boyd, R-Bradenton

S-20

Ed Hooper, R-Palm Harbor

S-21

SOUTH FLORIDA DISTRICT

Joe Gruters, R-Venice

S-22

Christopher Benjamin, D-Miami Gardens

H-107

Danny Burgess, R-Zephyrhills

S-23

Dotie Joseph, D-Miami

H-108

Ben Albritton, R-Bartow

S-27

Alex Rizo, R-Coral Gables

H-112

Kathleen Passidomo, R-Naples

S-28

Alessandro D’Amico, D-South Miami

H-113

Demi Busatta Cabrera, R-Coral Gables

H-114

Juan Carlos Porras, R-Miami

H-119

Shevrin Jones, D-Miami Gardens

S-34

Ana Maria Rodriguez, R-Miami

S-40

Please note, those listed in purple are FDAPAC-supported candidates who were elected to office without opposition after the June 17 qualifying deadline. Their names will not appear on the election ballot. For additional information about FDAPAC-supported candidates, contact the FDA Governmental Affairs Office at 850.224.1089 or gao@floridadental.org.

17 | TODAY'S FDA july/august 2022

preventive action

TOP

Reasons Your Practice Should be Using FDA Services as Its Insurance Agency possible levels. The price for malpractice insurance in 2022 is 24% lower than it was in 1989.

By FDA Services

2. 3.

They know dental offices: Unlike your local insurance agency, which insures all types of businesses, FDA Services (FDAS) specializes in insuring dental offices.

Created and run by dentists: FDAS was created by Florida Dentists in 1989, and is currently led by a board of 11 FDA member dentists.

They keep premiums low: FDAS was specifically created to address the rising cost of malpractice insurance and strive to keep rates at the lowest

They keep up with new threats to dental offices: Cyber breaches have increased dramatically in the last two years, but FDAS has offered coverage for cyber attacks since 2012 and has partnered with Coalition Insurance to offer the most comprehensive plan on the market. West Coast Members have Rick D’Angelo: With over 20 years at FDAS and the 2022 employee of the year, Rick is available to all assist Coast District members. Call or text him today at 813.267.2572.

FDAS’ check presentation, in the amount of $2,131,188, to the FDA during FDC 2022.

Central Florida Members have Dennis Head: With more than 18 years at FDAS and a degree in Risk Management Insurance, Dennis is available to assist all Central Florida dentists. Call or text him today at 407.927.5472. South Florida Members have Joe Perretti: With more than 18 years at FDAS Joe is available to assist all South Florida dentists. Call or text him today at 305.721.9196. Atlantic Coast Members have Dan Zottoli: With more than 15 years at FDAS and a degree in Risk Management Insurance, Dan is available to assist all Atlantic Coast Florida dentists. Call or text him today at 561.601.5363.

North Florida Members have Mike Trout: With over 10 years of experience in insurance and a degree in Risk Management Insurance, Mike is available to assist all North Florida dentists. Call or text him today at 904.254.8927.

10. Profits from insurance products go to or-

ganized dentistry! In 2021-22 more than $2.1 million went to support organized dentistry! You need to purchase insurance to run your practice. Why not purchase what you need from FDA Services and support the Florida Dental Association?

”

You need to purchase insurance to run your practice. Why not purchase what you need from FDA Services and support the FDA?

19 | TODAY'S FDA july/august 2022

news@fda Save the Date for 2023 Florida Mission of Mercy

to respond positively to personable posts that draw emotion rather than clinical posts about dentistry? All these questions and more are answered in a new episode of “Chew on This” with FDA Executive Director Drew Eason and special guest, FDA member dentist, Dr. Joshua Golden. Dr. Golden is a social media influencer who shares his knowledge about successful social media from a dental perspective. This is an episode you won’t want to miss! Watch it now at vimeo.com/721540906.

Email Scammers Promoting Identity Protection to Dentists We have received reports from members that scammers may be promoting identity protection to dentists. In general, please be Florida Mission of Mercy (FLA-MOM) is a large-scale, two-day, professional dental clinic that provides care to any patient at no cost to them, with the goal of serving the under-served and uninsured in Florida — those who would otherwise go without care. With a target of treating 1,500 patients in 2023, FLA-MOM needs your help – volunteer today! Pre-register to volunteer for the 2023 Florida Mission of Mercy at FLAMOM.org. We need dental, medical and community volunteers to help make FLA-MOM successful for those searching for dental care. FLA-MOM will be held in West Palm Beach on Feb. 24-25, 2023 at the Expo Center in the South Florida Fairgrounds.

New “Chew on This” Focuses on Social Media for Dentists

aware of phone calls — or, possibly, emails or texts — in the coming days and weeks that ask for detailed, personal or confidential information. Make sure to hover over links and attachments before clicking to see what’s actually enclosed. The FDA recommends that you not release information over the phone to callers you were not expecting and have not verified. While it’s true that the American Dental Association (ADA) experienced a cybersecurity incident recently, the investigation to this point has revealed that no data from the ADA’s membership database was accessed. Also, it’s important to note that the FDA’s systems were not affected and have not been compromised.

Member Benefit Spotlight: Peer Review

Do you want to know more about social media marketing for yourself or your practice? Have you wondered what to post or how to cater to the audience you’re trying to foster on your social media pages? Did you know that new patients are more likely

Lywanda Tucker has joined the FDA as peer review coordinator. She brings a wealth of experience in the dental field, including more than 16 years working in periodontal, general and orthodontic offices. In her new role with the FDA, Lywanda will manage the administrative duties of the peer review program. If a dentist needs to perform the review, that will still be handled at the local component level by a dentist in the area.

A graduate of the dental assisting program at Tallahassee Community College, during the course of her career Lywanda has held various positions including chairside assistant, treatment coordinator and front office staff. She will use knowledge gained through all of these positions as she communicates with patients and dentists about peer review cases. Peer review is offered as an FDA member benefit and helps dentists resolve patient disputes in order to avoid costly legal fees, malpractice suits and Board of Dentistry complaints. You can reach Lywanda at ltucker@floridadental.org.

Make a Life-Changing Impact by Volunteering for Donated Dental Services Today! With more than 7,000 patients currently on the national Donated Dental Services waitlist, ADA President Dr. Cesar Sabates is calling upon dentists nationwide to make a huge impact in their communities and volunteer to see at least one patient with Dental Lifeline Network (DLN) this year. With your generous support, DLN will be able to provide access to free dental care for hundreds more people with disabilities, who are elderly or medically fragile. DLN also makes volunteering as easy as possible by screening patients, coordinating appointments and completing paperwork. To watch Dr. Sabates’ announcement, go to youtube.com/ watch?v=t17dKJYPMbE. Or you can answer the call by signing up to volunteer at willyouseeone.org.

Dental Professionals Use Medical Emergency Training to Help Overdose Victims ADA President Dr. Cesar Sabates recognized three dental professionals for their quick actions that helped save the lives of two women during a medical emergency on April 9 in Chicago, according to ADA News. Dr. James Purvis, his wife Veronica, a former dental assistant and 17th District Trustee Dr. Rudy T. Liddell, used their medical emergency training to perform initial assessments on the women and inform emergency responders about treating an opioid overdose. Highlighting the medical emergency resources provided by the ADA to its members, Dr. Sabates said the incident showed that “dentists are an important part of the community.”

Governor Announces Launch of Florida Hometown Heroes Housing Program

Gov. Ron DeSantis announced that starting June 1, Florida will launch the Hometown Heroes Housing Program to help front-line workers purchase their first home. The list of eligible health care professionals includes dentists and dental hygienists. The program, which includes income and purchase price limits, will be administered by the Florida Housing and Finance Corporation. For more information, please visit floridahousing.org/hometownheroes. Go to bit.ly/3ay9lNP to view the announcement of the program and go to bit.ly/3P1Rpu8 to view information on income and purchase price limits. t

21 | TODAY'S FDA july/august 2022

news@fda FDA Leadership Meets with Florida Dental Laboratory Association

Central Florida District Dental Association Dr. Paola Gomez-Castro, Gainesville Dr. Juan Carlos Ortiz Cedeno, Gainesville Dr. Oliver Chan, Palm Bay Dr. Daniel Kortyka, Palm Coast Dr. Desiree McMillen, Ocala Dr. Amanda Puustinen, New Smyrna Beach Dr. Eric Rabinowitz, Gainesville Dr. Kelli Rike, Sebastian Dr. Kevin Shan, Orlando

Left to right: Alexander Wunsche (FDLA Immediate Past President), FDA President Jerry Bird, Danielle Wunsche (FDLA upcoming President-elect), Jessica Sapp (Florida Board of Dentistry ED), Dory Sartoris (current FDLA president), FDA Immedida Past President David Boden, Chris Peterson (FDLA President-elect).

Dr. Laura Van de Water, Orlando

Northeast District Dental Association Dr. Andrew Awad, Jacksonville

Drs. Dave Boden and Jerry Bird met with the Florida Dental Laboratory Association in June to discuss the importance of dental labs and the important work they do.

Northwest District Dental Association Dr. Melissa Laite, Pensacola Dr. Katherine Michel, Pensacola

Welcome New FDA Members

Dr. Christian Stanford, Panama City

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

South Florida District Dental Association Dr. Javier de la Fuente Balboa, Miami Dr. Norberto Coerezza, Royal Palm Beach Dr. Jose Lopez Comesanas, Miami

Atlantic Coast District Dental Association

Dr. Samantha Griborio, Weston

Dr. Carlos Solano Almonte, Delray Beach

Dr. Tania Diaz Klintcharska, Miami

Dr. Jenna Cote, Jupiter

Dr. Maria Mas, North Miami

Dr. Daniel Feit, Fort Lauderdale

Dr. Laura Perez Morejon, Palmetto Bay

Dr. Ellys Fernandez, Lake Worth

Dr. Panagiota Sandoval, Miami

Dr. Arianna Romero Guerra, Wellington

Dr. Yoel Santiago, Hialeah

Dr. Fouad Khan, Weston

Dr. Emily Suarez, Miami

Dr. Hardik Kundaria, Palm Beach Gardens

Dr. Alessandro Villa, Miami

Dr. Elizabeth Le, Wellington Dr. Alberto Lemus Novo, Wellington

West Coast Dental Association Dr. Yetunde Adedeji, Lutz Dr. Maritza Britton, Doral Dr. Collin Chavous, Ellenton

Tobacco Free Florida

Dr. John Contreras, Trinity Dr. Sean Coyle, Cape Coral Dr. Victor Daza, Naples Dr. Ami Desai, Tampa Dr. Mary Dixon, North Venice Dr. Kelley Downs, Naples Dr. Justin Hynton, Bradenton Dr. Gabriela Portmann, Vero Beach Dr. Olivia Rosato, Palm Harbor Dr. Devan Schulert, Fort Myers Dr. Mirtha Veloz, Hernandez Tampa

FDA: Well-being program

23 | TODAY'S FDA july/august 2022

PRACTICE SOLUTIONS

Limited-time offer on fixed-rate commercial real estate secured loans

Fee waivers include: 1

• Loan packaging, loan processing and miscellaneous fees on Practice Solutions commercial real estate secured loans

• Bank portion fee of permanent SBA 504 term loan

2.99

introductory rate for the first 12 months. Plus fee waivers on appraisals and originations.1

STILL NOT TRAINED IN RADIOGRAPHY? IT’S TIME TO FIX THAT.

• Bank packaging fee on SBA 7(a) and SBA Express loans

• Appraisal fee on owner-occupied commercial real estate secured loans if ordered by Bank of America

Act now! Offer expires September 30, 2022 and loan must close and fund by January 31, 2023.

Talk to a Practice Specialist today

To learn more about Bank of America Practice Solutions: bankofamerica.com/practicesolutions | 800.497.6076

For the limited time beginning with new credit applications submitted May 1, 2022, through September 30, 2022, take advantage of the following promotion: A promotional interest rate of 2.99% for the first 12 months on qualifying approved new and refinanced Small Business conventional and SBA term loans that are secured by collateral. Qualifying secured term loans are those with single fixed interest rates and no draw, revolving or interest only periods. The promotional rate supersedes other rate discounts during the promotional period. A waiver of the bank portion of certain fees for the approved qualifying fixed rate secured term loans will also be included. These fees may be categorized as loan origination, loan packaging, loan processing, permanent, or miscellaneous fees, depending on the approved product. Any and all fees or costs not specifically waived shall apply and will be due and payable by you at or before closing. Bank ordered appraisal fees on approved qualifying real estate secured term loans will also be waived (however, appraisal fees not directly ordered by Bank of America will not be waived or paid by Bank of America). The appraised real estate must meet the bank definition of owner-occupied, which will be determined in underwriting but has a general requirement of 51% occupancy by the borrower or affiliated company. Any and all fees or costs not specifically waived shall apply and will be due and payable by you at or before closing. To be eligible for this promotion, the qualifying secured term loan must close and fund by January 31, 2023. This offer is only for qualifying secured term loans described above with a minimum approved amount of $100,000 and a maximum approved amount of $5,000,000. All credit terms and repayment structures are subject to credit approval. Bank of America credit standards, collateral and documentation requirements apply. Other restrictions may apply. Small Business Administration (SBA) collateral and documentation requirements are subject to SBA guidelines. SBA financing is subject to approval through the SBA 504, SBA 7(a) and SBA Express programs. Exclusions include, but are not limited to, variable rate loans, franchisor guaranteed lending programs, Practice Solutions loans not secured by commercial real estate and the refinancing of existing Practice Solutions loans. All promotional and marketing materials are Bank of America Practice Solutions property and, as such, cannot be changed, altered or modified, orally or in writing. All questions regarding these materials should be directed or referred to a Bank of America Practice Solutions Sales Associate. OOCRE: For Owner-Occupied Commercial Real Estate loans (OOCRE), terms up to 25 years and 51% occupancy are required. Real Estate financing options are subject to approval and product availability is subject to change. For SBA loans, SBA eligibility and restrictions apply. Bank of America Practice Solutions is a division of Bank of America, N.A. Bank of America and the Bank of America logo are registered trademarks of Bank of America Corporation. ©2022 Bank of America Corporation. | MAP4671659 | FL-04-22-0025.E | PS-551-FL | 05/2022

AMATEUR PHOTOGRAPHY IS GREAT FOR VACATIONS (JUST NOT GREAT FOR RADIOGRAPHY) If you’re doing radiography without the proper training, it’s really more like amateur photography. There’s no room for amateurs in dentistry and it violates Florida law. The Florida Dental Association (FDA) Online Radiography Training Program provides you the formal training you need, with the professional development you want. This training enriches your career path while contributing a vital service to your patients and dental team. It’s the most convenient and economical way to get the radiography training required by Florida law. No travel. No time away from work. Train online, at your own pace. It’s affordably priced, too — just $285 per student for FDA members!

$100 MILLION PAID TO MEMBERS $100 MILLION PAID TO MEMBERS AN UNRIVALED BENEFIT—A REMARKABLE MILESTONE $928,808 PAID TOMEMBER MEMBERS Unlike commercial insurance companies, which look for ways to reward shareholders,

—AtoREMARKABLE AN UNRIVALED MEMBER BENEFIT MILESTONE The Doctors Company is dedicated rewarding our members. In 2007 we created the Tribute Plan, an unrivaled financial benefit that rewards you and your fellow Unlike commercial insurance companies, which look for ways to reward shareholders, dentists for your loyalty and dedication to superior patient care. The Doctors Company is dedicated to rewarding our members. In 2007 we created Plan, an unrivaled financialtobenefit thatthe rewards you and your fellow we are the Tribute As an organization committed providing best imaginable service, dentists profoundly for your loyalty and dedication superioran patient care. honored to have nowtoattained industry-leading achievement—the ®

distribution of more than $100 million in Tribute Plan awards. While other insurers As an organization committed to providing the best imaginable service, we are have attempted to follow our lead, The Doctors Company is by far the only profoundly honored to have now attained an industry-leading achievement—the dental malpractice insurer that celebrates the careers of dentists with rewards distribution of more than $100 million in Tribute Plan awards. While other insurers of this magnitude. have attempted to follow our lead, The Doctors Company is by far the only dental malpractice insurer that celebrates the careers of dentists with rewards of this magnitude. Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see thedoctors.com/tribute.

Call FDA Services to learn more 800.877.7597 Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see thedoctors.com/tribute.

No other insurer pays

GREATER TRIBUTE TO FLORIDA DENTISTS. $16,907,176

$928,808 519

TO LEARN MORE ABOUT TRIBUTE: Visit thedoctors.com/tribute

third party payer

Top 10 frequently asked questions that help FDA members succeed lated from the date the patient was last examined or treated (Rule 64B5-17.002(4)). However, your malpractice carrier may recommend you keep the records for seven years for statute of limitations purposes.

By Casey Stoutamire, FDA Director of Third Party Payer and Professional Affairs

The Florida Dental Association’s (FDA) mission statement is “Helping Members Succeed.” We take that to heart and want you to call us first whenever you have a question related to your practice, whether it be related to practice management, finance, scope of practice, anesthesia or sedation, licensure, CDT coding, insurance plans — the list goes on and on! And if we don’t know the answer, we will find it for you or point you to the expert in that subject. Below is just a few of the type of questions we can help you with. We look forward to talking with you soon!

3. What do I need to have in my patient records? Rule 64B5-17.002(1) states: The dental record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; X-rays (if taken); examination results; test results; records of drugs prescribed, dispensed or administered; reports of consultation or referrals; and copies of records or reports or other documentation obtained from health care practitioners at the request of the dentist and relied upon by the dentist in determining the appropriate treatment of the patient. Remember, your records are your best defense if you ever have a patient complaint so the more thorough they are, the better!

1. Do I have to take the dental licensure exam again if I want to relocate to Florida? The Florida Board of Dentistry (BOD) is the body that regulates and licenses dentists in the state. Currently, Florida accepts the ADEX exam, as administered by the Commission on Dental Competency Assessments (CDCA) as its licensure exam. This means if you take this exam, whether in Florida or another state, you can use those results to apply for licensure in Florida. The BOD accepts all scores after Oct. 1, 2011, which means you only have to take the exam again if you took the licensure exam before that date. And, as of May 2022, Florida now accepts the non-patient-based exam for licensure.

4. Dental plan XYZ denied a patient’s claim. Or, can the dental plan bundle all the CDT codes for a crown or the dental plan only reimbursed for x procedure when I performed y?

2. How long do I have to keep patient records? The BOD rule states that patient records must be kept for at least four years and the four-year retention period is calcu-

I am the Director of Third Party Payer and Professional Affairs. Please don’t hesitate to reach out to me with any and all questions related to insurance and dealing with insurance plans. I can’t guarantee a positive outcome, but I do have contacts with decision makers at most of the dental

plans, so I can put them in contact with your office to help resolve a case. Additionally, before you sign a contract with a plan, make sure to send me a blank, unsigned copy. The ADA and FDA offer a free contract review as a member benefit.

5. What task can my hygienist or assistant perform and under what supervision level? I am not a dentist – (I like to say I play one on tv!) however, I can discuss the BOD rules about assigning remediable tasks to hygienists and assistants with you to determine what tasks can be performed and what supervision level and training is required.

6. I have a patient claiming I “messed up” their treatment and now they want a refund? The FDA offers peer review as a member benefit. Ms. Lywanda Tucker is our peer review coordinator. She is happy to work with the patient and your office to resolve the claim and try to prevent a BOD complaint or a lawsuit.

7. I’m looking at the new CDT code book and I’m not sure which code I should submit for x procedure. Again, I’m not a dentist, but I can review the CDT code book with you. And, if I’m not able to decipher the correct code, I can put you in touch with the point person in the coding department at the ADA.

8. My office just received a subpoena for records related to a patient I previously treated. or I’m having issues with one of my employees and I’m not sure how to handle. (I don’t want to get sued!) While we cannot give individual legal advice, I do triage legal questions. Always give us a call with your legal questions and I will either answer it or refer you to the law firm the FDA uses that also provides FDA members with a discount.

”

Remember, your records are your best defense if you ever have a patient complaint so the more thorough they are, the better!

9. I’m tired of being in-network with insurance plans and I want to drop all of them, can you help? Yes, we can give you advice on the required notice timelines in the contract you signed with the plan and help you with notifying patients of the change. In addition, we can answer questions about setting up your own in-house plan to benefit your patients.

10. I just saw a post on Instagram of a non-dentist providing dental services. Do NOT report this to the BOD. This is an area where anti-trust issues are a major concern. Luckily, the state of Florida has a special unit, the Unlicensed Activity Bureau, which will investigate all complaints related to unlicensed practice of dentistry. You can find more information and file a complaint here: https://flhealthsource.gov/ula/. As you can see, your FDA offers guidance on a variety of topics you will encounter during your day-to-day practice. Please don’t hesitate to call us so we can fulfill our mission of “Helping Members Succeed”!

29 | TODAY'S FDA july/august 2022

FLORIDA MISSION OF MERCY February 24-25, 2023 West Palm Beach Expo Center at the South Florida Fairgrounds

Visit FLAMOM.org to VOLUNTEER or DONATE

foundation

foundation’s top 10 things to know By R. Jai Gillum, Director of Foundation Affairs

Are you a dentist who wants to Give, Lead and Volunteer? If so, the Florida Dental Association (FDA) Foundation is for YOU! The FDA Foundation (FDAF) is the philanthropic arm of the FDA, and we are committed to promoting dental health for all Floridians. As Florida’s advocates for oral health, the FDA and FDAF work collaboratively to champion policies and programs that make oral health achievable for all.

We host one of the most meaningful, impactful and fun charitable dental clinics that you can attend every year! FLAMOM provides you with an opportunity to improve smiles and change lives all across the state as you volunteer with your colleagues and your team. Visit www.FLAMOM.org to find out how you can volunteer and support the 2023 FLAMOM being held in West Palm Beach on Feb. 24-25, 2023.

We multiply the impact of member donations by combining them with grants and corporate donations.

All contributions to the FDAF are deductible to the greatest extent allowed by law, and we offer the maximum tax advantage for all applicable donations.

The FDAF also provides support to Florida dentists impacted by disasters through the Emergency Disaster Assistance Grant Program.

The FDAF, along with our partner organization Florida •

10.

We help you create a legacy for yourself and your family.

The top 10 things to know about FDAF:

We are an organization you can trust. Since 1980, the FDAF has impacted thousands of people in need – including the underserved, uninsured, elderly, disabled and medically fragile. We make it easy for your philanthropy to have an impact within the dental profession. Joining the FDAF’s Emerald Club with an annual donation can be done through your FDA dues or by visiting emeraldclub.floridadental.org. We support the causes you care about most. Your donations to the FDAF support our programs: Florida Mission of Mercy (FLA-MOM), Project: Dentists Care and Donated Dental Services. We can help you find volunteer opportunities that fit your lifestyle and schedule – annual events like FLA-MOM, weekly or monthly opportunities with a local nonprofit dental program or the ability to provide charitable care in your office on your schedule.

”

Dental Lifeline, has provided more than $20 million in donated dental care in the state! Both organizations were recently recognized by the Florida Cabinet for our collective impact.

For more information about the FDAF and how you can support our efforts, please contact Director of Foundation Affairs R. Jai Gillum at rjaigillum@floridadental.org or 850.350.7117.

We make it easy for your philanthropy to have an impact within the dental profession. 31 | TODAY'S FDA july/august 2022

FDA Services Welcomes Our New 2022-2023 Student Advisors! Thank you for volunteering to provide the insight and perspective we need to serve the next generation of Florida dentists! Congratulate your peers the next time you see them!

VICTORIA CARROLL LECOM School of Dental Medicine

DELANEY VALDES Nova Southeastern University College of Dental Medicine

CAMERON KOCAN University of Florida College of Dentistry

fdaservices.com | insurance@fdaservices.com | 800.877.7597

dental supplies

Top 10

Reasons to Buy Your Dental Supplies from The Dentist Supply Company By TDSC

As a dentist, you give your patients the confidence to smile again. At TDSC.com, we offer proven dental supplies that your practice can rely on and patients will love. Here are our top 10 reasons you should consider buying your supplies from TDSC.com:

1. 2.

TDSC offers free shipping on supply orders of $99 or more. You’ll save on your favorite dental supplies and on shipping costs too. Double the savings!

In 2021, we added 8,800 more products from well-known brands to our shopping site. You’ll enjoy a wider product selection and more savings than ever before. TDSC offers a wide selection of the best dental supplies from the brands you love and trust including: Colgate

3M ESPE Cranberry Dentsply Sirona Henry Schein Inc. Kerr Corp and more!

Buy supplies anytime – day or night. Even on holidays! No There’s no need to work with a representative to get great more waiting until the next business day to place your ordeals when you shop with TDSC. We offer competitive der. If you work long hours, it’s good to know you can shop prices to all dental practices – small and large. New dentists at TDSC.com on your schedule. Get everything you need in can take advantage of the best pricing even if their practice one quick checkout process. just opened. Dental supply pricing can be confusing, but customer care team offers product Newtransparency. shoppersWhen get you 10%shop offfortheir ofknowledgeable $150 we believe in price dentalfirst orderOur information and shopper support before, during and after more byrest using promo code: WELCOMEFL10. supplies with or TDSC, you can assured that you’re paying (Promotion valid from 2/1/22 – 3/31/22) the sale. Give us a call at 888.253.1223 or send an email to the same exact price as any other dental practice, and we’ll support@tdsc.com. A friendly supply expert will promptly show you the price you’re actually paying. What a relief! contact you to answer your questions or help with an order.

TDSC is an authorized source for proven, brand-name dental supplies. You’ll have peace of mind knowing we sell only top-quality, well-established dental brands and products. It may seem like a good idea to buy from a third-party vendor, but what if the product isn’t the quality you expected? It can be difficult to obtain a refund from a third-party seller. What if your new equipment suddenly stops working? Was it sold with a warranty? In addition to our everyday low prices, we offer frequent Flash Deals. Flash Deals include savings on top-selling brands and dental categories for a limited time. Stay tuned for the next Flash Deal! Click the link below to create an account and sign-up for emails. Create An Account at tdsc.com/b2bregister.

In addition to Flash Deals, we offer Site-Wide Savings Events throughout the year. The most recent Site-Wide Savings Event: Save an additional 10% off orders over $500, PLUS $50 off your next order was in April 2022, in celebration of an important milestone. So far, our customers have saved $30 million on their supply purchases. Don’t miss our next SiteWide Savings event! Keep in touch with TDSC to learn about new dental products and the latest innovations in dentistry.

Testimonials from Happy Customers and Partners

”

No more waiting until the next business day to place your order. If you work long hours, it’s good to know you can shop at TDSC.com on your schedule.

Dr. Cedric Chenet says, “I heard about TDSC through an email sent by the Florida Dental Association (FDA). We started buying dental supplies from TDSC about two years ago. The prices are much better. The savings are definitely worth it! So far, we’ve saved approximately $4,500 by purchasing our supplies from TDSC. With the money saved, I’m thinking about buying additional equipment for the practice.”

Ruthstrom, FDA Services chief operating officer, says, 10. Scott “TDSC has presented unique offers that have really resonated with our members. New buyers are enrolling every month! TDSC is very proactive and provides new content monthly that we feature for our members.” Want to learn more? Give us a call at 888.253.1223 or send an email to support@tdsc.com. We’re happy to assist you with your dental supply purchase.

35 | TODAY'S FDA july/august 2022

The Top Things You Need to Know to Recognize and Avoid Cyber Attacks

”

By Robert McDermott, President and CEO, iCoreConnect

Cyber attacks are hitting too close to home in the dental industry. The American Dental Association was attacked in April by a new ransomware gang that claims to have accessed sensitive information. The investigation is ongoing. According to Verizon’s 2022 Data Investigation Report, ransomware breaches increased by 13 percent, and 82 percent of breaches involved the “human element.” One of the easiest ways for these aggressive cyber gangs to get into your system is through email trickery. Phishing emails will look like they come from a legitimate source. They may be personalized to appear to be from a trusted person or company. They want you to take a seemingly harmless action, like making a phone call, clicking a link or providing login or other information that gives them a key to hold your practice hostage. Then they demand a ransom in order for you to get your practice up and running again.

You may not be the only door the cyber criminal is knocking on, but you can be the first line of defense to protect your whole team.

”

cyber attacks

Using real examples, here are the 10 things you need to know about what cyber criminals are doing to target you and what you can do to avoid catastrophe.

The sender requests you call a phone number.

Logos and company names are too prominently placed in the email.

Example:

Example: Auto Renewal Confirmation

Customer Support Desk: +1 (877) 750-6660 Date: 25th Jan,2022

Thank you for your Subscription! We have successfully renewed your service. Your subscription services have been auto renewed. Charged 148.88 USD for the auto-renewal. Invoice Number - #BH87GS98JQ

What They’re Doing: Once you call, the person posing as a customer service representative will try to convince you of a couple of things. You may be told to go to an online site and put in a code or other information to request a refund. The scammers may also tell you that you accepted a free trial of the product several years ago and now they need to log on to your computer to delete the program. They may request bank information so that they can “refund” the money. A real company will not request this information from you.

The sender’s name looks legitimate, but the email address is spoofed or doesn’t remotely resemble the company it claims to be.

Example: From: “Larry@billing” <ekeraslihan410@gmail.com> Subject: Subscription_auto_renewal_receipt_177G2994M32560DG Date: January 25, 2022 at 9:43:18 AM CST

What They’re Doing: The cyber crime group expects you to read quickly and think the email is coming from a trusted source. A closer look reveals the name in the “From” line and the email address are inconsistent, both with each other and the actual company they claim to represent. This nuanced detail is often missed when rapidly scanning through the pile of emails in your inbox.

What They’re Doing: Cyber criminals want to appear credible. They use every possible asset to convince you to take the action requested. But sometimes the logos are just a little off. These are blurry and the layout isn’t consistent with the way Microsoft presents them on its website.

Logos, company name and sender emails are often at odds.

Example: Amazon Com Amazon com

inbox n Yesterday at 10:16 AM

To:

@mail.gmail.com> This message is from a mailing list.

Unsubscribe n

What They’re Doing: Blurry logos aren’t the only sign an email might not be credible. The criminals may also include what appears to be the company web address or company name. In this example, Amazon is represented as “Amazon Com.”

You have to click a link to take action.

Example: We noticed you haven’t used your Nokia account to access Nokia services in quite a while. To protect your privacy, this accont will be deleted in 14 days, so sign in now.

What They’re Doing: This email combines several tactics addressed thus far. In addition, the “sign in” link is embedded so you can’t see where it actually takes you unless you hover over it without clicking. The fake sender hopes you won’t think to check the URL before clicking. Once you click, you’ve possibly exposed yourself to any kind of malware, including ransomware, which can shut down your practice and stick you with a very high price for data recovery.

37 | TODAY'S FDA july/august 2022

cyber attacks

10. Always hover before you click.

TAKE ACTION Those are five key methods cyber criminals use to trick you via email. Now, here’s what you should do to avoid each attack.

Never call the phone number provided.

What You Should Do: If you call the number, they’ll likely ask you to provide information they can use to access your private information or bank details. Avoid the trick by checking your bank or credit card account before you take any action. Call your bank or credit card company to report the suspicious email and alert them to monitor your account. As an additional check, visit the supposed source’s actual website to look up the correct number for support or account issues.

Catch the sender info mismatch.

What You Should Do: Always look at the “From” line with care. This is often your first line of defense. If information in the sender’s name or email address doesn’t match, it’s an indication that the source is not legitimate. Now you can cautiously discern if the rest of the email bears action.

Poor logo quality means suspicious sender.

What You Should Do: Taking note of details like extremely oversized or fuzzy logos helps you zero in on a illegitimate sender. You can clearly see the big picture (pun intended) intent of a phishing email. If you’ve ever received communication from the legitimate source, compare previous emails.

If logos and names don’t agree, question the security.

What You Should Do: Pay attention to the details. Using “Amazon com” in the “From” line is a poor attempt to pretend they’re Amazon. It’s not a verified email, business name or web address. If you’re in doubt, search the company to see if the actual company information aligns with the email.

What You Should Do: Embedded links may seem convenient, but they’re also a quick way to get you to click on something malicious. Before you click, hover your cursor over the link and you should see a small pop-up indicating the URL it points to. A false hyperlink will look something like http://www.FAKEURL. com/FAKE KEY WORDS/COMPANY NAME. If it looks remotely suspicious, don’t click the link! When you receive an email you think is suspicious for any of these reasons, after you take the proper action to avoid the attack, be sure to alert your information technology personnel as well as the rest of your team. You may not be the only door the cyber criminal is knocking on, but you can be the first line of defense to protect your whole team. Equally important is the type of email service you are using, especially when sending or receiving Protected Health Information (PHI). Make sure your email is encrypted at the highest level, transmitted across a private network and in compliance with every federal HIPAA requirement. The most secure, compliant email requires your office to initiate emails with anyone outside your verified network of contacts. The best protection is to keep criminals from getting to your inbox in the first place. FDA endorses iCoreExchange HIPAA-compliant email. iCoreExchange not only meets or exceeds every compliance and security requirement, it also allows you to attach as many large files as you want to any single email. Speed up your workflow, protect patients and your practice. Check out this convenient and compliant service at iCoreConnect.com/FL2 or 888.810.7706. FDA members receive a substantial discount on iCoreExchange.

39 | TODAY'S FDA july/august 2022

Top 10

Misconceptions Health Care Providers Have About Leasing or Purchasing Their Office Space

”

By Derek Housh, CARR

It can be difficult to discern fact from fiction when dealing with commercial real estate deal points. A misunderstanding of these key issues can have serious consequences for your practice. The following information should help dispel some common misconceptions and prevent costly mistakes in your next negotiation.

Misconception #1: Your renewal is not negotiable Most leases provide an option for the tenant to renew their lease when it expires, and may even detail the exact terms of the renewal. However, it is important to understand that your renewal is negotiable, even if you have renewal terms specified in your current lease. A landlord who says you cannot renegotiate the terms for your renewal is usually doing so because they can get you to pay more by exercising the option to renew instead of negotiating new terms. The only way to be certain you have the best possible terms for your renewal is to compare those terms with current market rates in the area, a vital step often missed by health care professionals entering this process alone.

Going without representation typically results in the tenant or buyer losing money and receiving substantially inferior terms.

office space Misconception #2: The landlord is on your side Many landlords attempt to befriend their tenants, making it difficult for tenants to remember the landlord’s primary goal is financial gain. They are seeking to secure a lease with the tenant paying as much as possible. Even the friendliest landlord wants to make the maximum profit on his space, just like the nicest tenant seeks the lowest possible lease rate so his business can thrive. Financial burdens quickly arise for tenants who place undue trust in their landlord and fail to properly negotiate their lease. By having representation, you can learn how your lease compares to the market and ensure you are getting the best possible terms.

Misconception #3: You are not entitled to representation Some landlords employ intimidation, instead of friendliness, to achieve their goal. The intimidation tactics may include telling tenants they are not allowed to have representation. This is not true. Lease negotiations are different than negotiating the price of a car or trying to haggle for a better price at a flea market. They are complex transactions, layered with hidden opportunities for landlords to take advantage of anyone not represented by an expert. Landlords are professionals who are aware of these complexities. If a landlord says you are not allowed to have representation, that is a clear signal they do not respect your desire to be treated fairly.

Misconception #4: You are already getting the best possible rate for your space There are many conditions that factor into lease rates for a commercial space. Things such as current building vacancy, length of the lease, amount of tenant improvement allowance, building condition and many other considerations impact the appropriate rate for a particular space. Several of these considerations are specific to spaces for health care tenants, highlighting the need for a real estate professional who has expertise in health care. Health care practices are often told they are getting the best possible rate for their space, yet they can receive a much better offer from the landlord when an expert assesses these mitigating factors.

Misconception #5: You have no other options; the landlord has many This common myth might be the most important to address, because it is fundamental to how landlords operate. The landlord wants you to believe that his property is the only suitable location for your practice. The truth is there are likely several other properties that would fit the needs of your practice, and the landlord should be competing to keep you in his building. The landlord also wants you to believe he has several potential tenants ready to occupy your space if you don’t take it. This position is used to force a tenant to rush into signing an unfavorable lease, when, in fact, it usually takes months or years to fill a commercial space. Each leasing situation is unique, and a healthcare real estate professional who knows your strengths as a tenant can help you understand what type of leverage you have.

Misconception #6: My Lease is keeping me from purchasing or building new construction Have you ever said, “as soon as my lease ends, then I’ll…” If you think your lease is preventing you from taking the next steps in growing your practice, it’s not. Most people think the costs and penalties associated with breaking a lease are too much to consider. However, that isn’t always the case. Consider the following: construcion matertials, labor, interests rates and real estate have steadily increased since 2015. Waiting even one year on new endeavour could cost you hundreds of thousands of dollars more from one year to the next. Additionally, in that time of waiting you might lose your desired location or be too late to market to find competition who beat you there. Lastly, how much revenue could you be losing the extra oporatories or patient base? Those factors combined make it worthwhile to not wait when it comes to planning for your future growth.

Misconception #7: Owning commercial real estate is always better than leasing it Owning a home can create one of your largest assets and is typically seen as a relatively safe investment opportunity. Conventional wisdom says the same is true for medical real estate as there are legitimate benefits to owning, such as paying down the loan principal and building equity, receiving loan interest, propt

41 | TODAY'S FDA july/august 2022

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office space erty tax deductions and more. However, you need to consider the following: Are you located where you want to be for the next 10 to 15 years? Is your leased space in a higher trafficked area than where you are considering purchasing? Are there purchase opportunities in your desired area? Does your current space allow for expansion? The answers to these questions and many others have direct impact on if it’s better to lease or purchase your space.

Misconception #8: Landlords don’t give concessions on renewals Has your landlord ever told you they don’t offer concessions on lease renewals? If so, you’re not alone. Why would a landlord say that? It’s simple, if they can get away with it and save tens to hundreds of thousands of dollars by giving an objection that you accept, then why not try? Would a landlord say that to a “big-box” tenant? No, because they know they couldn’t get away with it due to the number of deals a “big-box” company transacts. Simply put, the landlord is banking on you not having representation or being unwilling to push back.

Misconception #9: You don’t need an agent if you have an attorney Your real estate agent should not be giving you legal advice and your attorney should not be telling you what building or space to choose, how much to pay, or negotiating terms for you. Lease and purchase contracts are legally binding documents and should always be handled by an attorney who understands real estate law to review, advise and protect you. Your real estate agent should not be drafting language in a binding contract. Similarly, unless an attorney spends 40 to 50 hours per week evaluating the market and negotiating on properties, he or she is likely unqualified to act as your real estate agent.

Misconception #10: You can save money negotiating your own real estate without a tenant or buyer agent Listing agents frequently insinuate or make this comment with the goal of keeping the tenant or buyer uneducated about their medical real estate. An uneducated tenant or buyer means more money for the owner and listing agent. In most cases, when a tenant or buyer does not have a healthcare real estate agent, the listing agent will get paid the full commission set aside for both brokers who close a transaction. Listing agents are incentivized to get the highest price, lowest concessions and to work alone. Sometimes the owner will simply pocket that money. This leaves the tenant or buyer in a position where they do not save money at all, and what’s worse, they typically receive a substantially inferior deal by paying more and receiving fewer concessions than they should have. Landlords are in the business of making money and real estate negotiations are how they do that. It’s common for a landlord and listing agent to put together a “padded offer” that contains a lot of room for negotiation that provides the illusion to the tenant of receiving a good deal but in reality was the landlord’s strategy all along. Going without representation typically results in the tenant or buyer losing money and receiving substantially inferior terms. Using a real estate professional with expertise in health care will help protect you from falling victim to these and other common misconceptions.

CARR is the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of health care practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases and practice transitions. Health care practices choose CARR to save them a substantial amount of time and money; while ensuring their interests are always first. Visit CARR.US to learn more and find an expert agent representing health care practices in your area.

43 | TODAY'S FDA july/august 2022

FLORIDA DENTAL CHATTER This Facebook group is designed for dentists to interact with other members, receive the latest updates and information, and engage with FDA leaders and staff. This is the place to be in the know!

Join us at facebook.com/groups/floridadentalchatter.

Read, Learn and Earn! Visit floridadental.org/online-ce for this FREE, MEMBERS-ONLY BENEFIT. You will be given the opportunity to review the “Diagnostic Discussion” and its accompanying photos. Answer five multiple choice questions to earn one hour of CE.

Contact FDC Marketing Coordinator Brooke Martin at bmartin@floridadental.org or 800.877.9922. 45

Tips for Developing a Dental Office EmergencyPlan

” By Shey Loman, FDA Communication and Media Coordinator

Unfortunately, natural disasters and manmade threats, including active shooters, are occurring more frequently throughout the nation. Most people don’t want to entertain the thought of the unthinkable happening; however, threats and responses should be discussed and practiced with dental teams just as they are at schools, places of worship and shopping malls. A frustrated employee or patient could make your office and staff victims of preventable violence or other attacks. Office staff should be informed and prepared with a plan that can be performed faultlessly in the unfortunate event that a nightmare scenario becomes reality. Following are 10 tips to best protect your staff and your practice during a threat or disaster:

Tips for General Threats 1.

Set an emergency action plan (EAP) for your dental office to employ in the case of a threat. Make sure that all staff members are aware of—and fully trained for—the procedures of your office plan. It may be a bit uncomfortable to have these discussions with staff, but not having a plan is no longer a responsible option.

Always be aware of your office’s exit locations. Evacuation is the best option in most threat scenarios. Once safe, call 911, and provide as much information as possible

Ultimately, being prepared is the first step to protecting your staff and your practice from threats or disaster.

”

threats

including the location, a physical description of the threatening person or people, any weapons involved, the number of potential threats and the number of potential victims at the scene.

3. 4.

Help yourself first. Whether or not others decide to follow your office’s emergency plan, follow it yourself. Help others, if possible, but secure your safety first. If evacuation is not an option, find a hiding place and put obstacles between yourself and the threat, such as a locked door. Barricade doors with upturned furniture or whatever you can find to add to the obstacles between you and the threat. Try to have an escape route from your hiding place in case it’s needed and remain as quiet as possible. If you are confronted by the threat and feel as though your life is in danger, attempt to disrupt or incapacitate the attacker. Be aggressive, throw any items within reach and use any type of improvised deflector that you can. Commit to your actions and don’t stop until the threat has been immobilized.

Tips for if the Threat is a Patient 1.

Try to move the patient away from public space. Ask the patient to move into a consult room or private office.

When the patient is speaking to you, do not speak until he or she is finished. Be sure to allow the person the time and space needed to feel heard, do not interrupt, and only speak when you’re absolutely sure the patient is finished or asks a question for you to answer.

When it is your time to speak, focus on empathy. Connect with the patient and try to understand the person’s frustration in order to see the issue from that perspective. Do not shut the person down or try to rationalize with them; simply make him or her feel heard.

Make notes about all of the information the person tells you. Not only will this give you a chance to document the scenario, but it also assures the patient that you’re taking

his or her concerns seriously. Show the patient the notes you took and ask if anything should be added. Explain to the patient that you will investigate the problem and respond as soon as you’re able. Review all of the facts of the situation from an objective point of view and then follow up with the patient in a timely fashion.

If all of the above tips do not help to diffuse the angry patient and the person threatens or becomes violent, contact local law enforcement immediately and follow through with your emergency plan.

Threat situations can be chaotic and unpredictable, which is why it’s important to have a plan in place. In some instances, law enforcement will need to be immediately dispatched so they’re able to quickly get control of the situation. Ensure all building exits are marked and have an evacuation plan in place with a central meeting location to account for all staff members. Implement an emergency notification system so all staff members are on the same page during a disaster and use code words during emergencies to prevent patients from panicking. Ultimately, being prepared is the first step to protecting your staff and your practice from threats and disasters. If the unthinkable happens, you and your team will be ready. An EAP will help your staff respond efficiently to unplanned events ranging from violent threats to fires and other natural disasters. Learn more about creating an EAP for your practice through the U.S. Department of Labor at dol.gov or the Occupational Health and Safety Administration at osha.gov. Ready.gov has information about how plans for disasters and emergencies ranging from severe weather to chemical emergencies and more. Also, find the Federal Bureau of Investigation’s guide to active shooter planning and response for a health care setting at bit. ly/2QSlP7R.

References Scott Fredrick, D.D.S., Planning Journal of the Colorado Dental Association, Fall 2019. U.S. Department of Labor at dol.gov Occupational Health and Safety Administration at osha.gov Ready.gov

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47 | TODAY'S FDA july/august 2022

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marketing strategies

Top 10 digital marketing strategies to Help You attract, acquire and retain patients 2.

By Anna Davies, Whiteboard Marketing

Make Your Website Work for You

Gone are the days of patients simply calling their neighborhood dentist for an appointment. If you want to thrive as a practice, you need to adjust to today’s digitally driven consumer mindset and invest in strategies across the digital marketing ecosystem to reach your prospective patients.

Your website is a window into your practice, and its look and ease of use gives potential patients their first impression. You need a website that not only looks sleek and modern but is also designed to convert new patients. This includes features like:

Here at Whiteboard Marketing, we know how to put together the right combination of strategy and services to help our dental clients succeed in patient attraction, acquisition and retention. Here’s where we start:

Clear calls to action (CTAs), so patients are prompted to take action like schedule an appointment. Mobile-responsiveness, so patients can access your site on both their cell phone and their desktop.

A clear, cohesive color scheme and professional photos of your staff.

Plan Ahead

No marketing idea will ever succeed without strategic planning. To develop a strong marketing plan for your practice, you need to dedicate the time and resources to identifying what your goals are for growing your practice and evaluate how your ideas will work together to obtain your desired outcome.

At Whiteboard Marketing, these are standards for each site we build and maintain for our clients.

Working with a trusted marketing partner is an excellent way to start. For example, at Whiteboard Marketing, we work closely with our clients utilizing our proprietary process to ensure they have a marketing roadmap that sets them up for both short- and longterm success.

Modernize Your Patient Experience Today’s patient is constantly online, and they expect their dental practice to be, too. We recommend implementing 24/7 conveniences on your website so it can convert new patients even when your office is closed. Popular features that meet the needs of your modern patient include:

Online bill pay, so patients can pay on their own time.

Patient reviews

Online scheduling, so patients can make appointments outside of usual office hours.

Recent photos

Live chat to talk with patients while they explore your website. Dental insurance checker, so patients can see if you’re in-network with their insurance without calling your office.

Service and business summary Forty-six percent of all Google searches are local, and here at Whiteboard Marketing, 50 percent of all our clients’ phone calls come from local searches.

6. Show Up on Google

Get Social on Facebook Patients live their lives on social media. Facebook alone has nearly 1.5 billion active daily users — more and more patients are finding their healthcare providers through the platform, too. For dental practices, Facebook allows you to:

With 5.6 billion Google searches made per day, search engine optimization (SEO) is essential for getting your practice in front of patients. SEO best practices we use at Whiteboard Marketing include: Properly structuring websites in a way that is simple for both Google and searchers to understand.

Build brand awareness.

Writing keyword-rich original content for websites.

Communicate with current and prospective patients.

Updating practice listings in online directories, like Yelp and Healthgrades.

Highlight your practice’s culture.

Show up in Google searches. Advertise easily. Our team builds purposeful Facebook strategies for each client that speaks to their target audience. Posting standards include:

Generate Immediate Leads with Advertising Pay-per-click (PPC) advertising is the fastest way to get new patient leads. Your practice can run ads on Google, so you show up as one of the first results when patients search for certain keywords, and on Facebook, so you show up to targeted demographics.

Services offered Celebrations Dental tips Patient photos Staff action shots Team activities outside of the office

5. Be the “Dentist Near Me”

Google Ads are best for ambitious goals, like growing your practice by a set number of patients each month. Facebook Ads are good for promoting your practice and the unique services you offer. Determine your goals and work with your marketing partner to set up a Google Ads and Facebook Ads Manager account.

Show up when patients search for a “dentist near me” by optimizing your Google Business Profile with essential information like: Your name, address and phone number (NAP) Website links Office directions Hours

Track Your Analytics If you’re investing money into a marketing strategy to acquire patients, you want to see your return on investment and make sure it’s money well spent. Here at Whiteboard Marketing, we track analytics for our clients by: t

51 | TODAY'S FDA july/august 2022

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marketing strategies

”

No marketing idea will ever succeed without strategic planning. Working with a trusted marketing partner is an excellent way to start.

Closely following where new patients are coming from, like a Google Business Profile or social media. Having their front desk team ask each patient, “How did you hear about us?”

For our clients, we develop a proactive review strategy that gets practices a steady flow of patient reviews. This shows both Google and potential new patients that the practice is trustworthy and credible.

10.

Regularly checking web and social media analytics. Recording and listening to phone calls from patients and prospective patients. Reevaluate your marketing plan every month to see if you’re adequately investing enough time and money into where your patients are coming from.

9. Reviews Matter Consider how many patients start their dental health journey by looking at reviews from other patients. According to Google, having plenty of positive reviews–and responding to them–has a positive impact on helping you show up when a patient searches for a new dentist.

Record Your Calls for Training and Quality Assurance Recording and listening to your calls help both your staff and your patients. You can analyze the needs of callers and the performance of your front desk staff in answering their questions. You can also identify patient trends by listening to calls, like what campaigns are bringing patients through the door and what services are most popular. Whiteboard Marketing is a full-service, nationally recognized and endorsed digital agency dedicated exclusively to dental practice marketing and based in Dublin, Ohio. Since 2005, the agency has created unique, customized solutions that deliver the results clients want.

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employees

Employees Are Your Most Important Asset By Catherine Cabanzon, CRDH, BASDH

Of the practice owners who responded, 35.8% were seeking to add dental assistants to their practice and 26.5% were seeking to add dental hygienists.¹ Comparing this data before and after the pandemic may provide some insight into workforce difficulties experienced in Florida.

Since the pandemic began in early 2020, there have been so many unforeseen changes that impact every aspect of our lives. Workforce issues are impacting almost every business across the country and, for dentists trying to staff their practice, the problems can be overwhelming.

Just over 88% of dental hygienists renewing their Florida license responded to the Biennial Workforce Survey from February 2018. Of the respondents, 15,140 were dental hy-

In May 2020, the American Dental Association Health Policy Institute, polled 1,587 practice owners on workforce issues.

COVID-19 changed the way the world works. Employers learned that productivity did not have to suffer because an employee worked from home. But the pandemic also changed employees’ attitudes toward their work. A recent study found that work-life balance; compensation and benefits; and colleagues and culture were the three most important components for job candidates. Many articles about the current dental workforce cite staff discontent with working conditions, inadequate pay and benefits as areas of concern.⁵ These articles provide insight into what applicants seek from their employers and give dental practices a roadmap for becoming more competitive in the market. High turnover in a dental practice is costly and it has been proven that retaining team members is far more profitable than hiring new staff. In fact, new hires cost more in lost production than it would to provide cost of living raises to your staff.⁶ A prevalent belief in the dental hygiene community is that one must find a new job in order to get a raise. Increasing job satisfaction can begin with taking steps to create a practice culture that promotes value, respect and empowerment of your team. Cutting staff workdays due to open appointments or asking staff to clock out when a patient cancels creates job insecurity and can increase turnover. There are many activities your staff can perform to promote the practice when they are not with a patient. During my early days of practice, I used open time to call patients to fill my schedule as well as the dentist’s schedule. Your dental team wants to feel secure and respected at their workplace. So, if you are struggling to find employees, take another look at your practice and talk to other practice owners who have retained staff. Consider implementing changes that promote a collaborative and secure work environment to increase employee retention. If you follow the motto, “employees are your most important asset” you will find yourself on easy street when others are riding the turnover merry-go-round.

”

gienists with an active license, practicing in Florida.² The Florida Department of Health Annual Report and Long-Range Plan for the Fiscal Year of 2020-2021 found there are 13,680 licensed dental hygienists and 30,059 certified dental radiographers practicing in this state.³ The data on dental radiographers cannot be measured because they are not required to renew their certification. Further, these practitioners work in other settings that are not tracked by the state. However, the report seems to show that the current dental hygiene workforce may not be as saturated as it was in past years.

Increasing job satisfaction can begin with taking steps to create a practice culture that promotes value, respect and empowerment of your team.

Catherine Cabanzon, CRDH, BASDH. Catherine has been a clinical dental hygienist for 21 years. She served on the Florida Board of Dentistry from 2012 to 2021. Additionally, Catherine is a clinical adjunct Professor at Palm Beach State College and a National and International Speaker.

References: 1. ada.org/publications/ada-news/2021/june/dentists-face-applicantshortages-as-they-emerge-from-covid-19-pandemic 2. floridahealth.gov/programs-and-services/community-health/dental-health/reports/_documents/FloridaWorkforceSurveyReportofDentalHygienists2017-2018FINAL.pdf#Workforce%20Report%20of%20Dental%20Hygienists%202017-2018 3. floridahealth.gov/licensing-and-regulation/reports-and-publications/2020-2021-annual-report.pdf 4. business.linkedin.com/talent-solutions/resources/talent-strategy/ talent-trends-covid-report 5. dentalproductsreport.com/view/bullying-and-burnout-in-dental-hygiene 6. actdental.com/blog/dental-employee-turnover-can-cost-you-bigbucks

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operative dentistry

A Clinical Presentation of the Direct Gold/Composite Sandwich Restoration By Dr. DB Henry

Clinical Relevance Studies indicate the failure of posterior composite restorations, where bonding to dentin is required, continues to be an issue. The results are leading to the need to replace and/ or repair existing restorations earlier than has been the experience using traditional restorative materials.

SUMMARY The intent of this paper is to present a new idea for increasing the life expectancy of class II composite restorations where the proximal marginal seal is compromised by the necessity to rely on dentin bonding. As implied by the Clinical Relevance statement, studies show that bonding to dentin in areas with high levels of bacterial action, combined with sustained high plaque formation, tends to be the “Achilles heel” with regard to sustained longterm restorations. Therefore, this paper will present a thought experiment, combined with clinical evidence, for combining gold foil with composite in these areas for the class two composite restoration. The results, if proven viable, will be to develop a procedure utilizing the properties of gold foil that make it one of the longest-lasting restorative materials with the recent development of modern cosmetic materials for a truly longlasting and healthy class II restoration.

Fig. 1. Two class 2 foils in tooth 4 (2012).

INTRODUCTION The results of relying upon dentin bonding in proximal and subgingival areas have shown decreased longevity for class two composite restorations as compared to previous restorative materials used in the past 80 years.1-6 The results suggest the need to replace and/ or repair existing restorations earlier than has been the experience when using traditional restorative materials.5,6 The central problems arise from leakage and subsequent breakdown of the bond at the gingival and subgingival dentinal

Fig. 2. Final restoration of foil and composite in tooth 4 (2012)

margins for class 2 and class 5 procedures (personal correspondence between Dr Lloyd Baum and Dr Giancarlo Gallo).3,4,7 Due primarily to bonding properties associated with the organic and water composition of dentin being at 50% as compared to 12% for enamel, dentin bonding characteristics are not ideal for longterm durability.1-9 The clinical use of gold foil to seal dentin margins in class 2 and class 5 gingival prep areas has proven to be one of the most predictable restorative techniques with a long history of success.5,10-12 Operative Dentistry return for removal of the composite and completion of the foil later. However, the patient did not return for six months, at which time the restoration was evaluated and found to be doing well clinically. The decision was made not to replace the composite. The restoration is now six to eight years in function. No clinical photos exist. Following the original restoration and upon discussions with Dr. Clyde Roggenkamp of Loma Linda, CA, it was discovered that Dr. Lloyd Baum had conceived of the idea for combining foil and composite and had discussed this with his friend Dr. Giancarlo Gallo of Italy. Thanks to Dr. Roggenkamp, the correspondence from 1992 to 1997 between Dr. Lloyd Baum of Loma Linda University and Dr. Giancarlo Gallo of Alba, Italy, was forwarded for review. Their discussion centered around the concept of utilizing a sandwich technique combining gold foil and composite. The properties of gold foil indicate it is an ideal material to both create a seal and maintain that seal over time in the gingival and subgingival environments encountered in class 2 and class 5 restorations.13-16 These properties include: (1) a marginal fit approaching 1 micron, (2) a coefficient of expansion close to tooth structure, (3) no corrosion, and (4 ) an oligodynamic effect. The first three are important; and when combined with the oligodynamic effect of interfering with cell membrane transport, one has a material with a disinfecting property when placed in areas where pathogenic organisms can lead to margin failure.5,6,13,14,16-18 This paper describes a clinical restorative technique to address the limitations of dentin bonding in the class 2 composite dental restoration. It is a procedure that combines the proven long-term application of gold foil with the cosmetic aspects of composite resin by removing the need to bond to dentin in the proximal box, where leakage and breakdown occur at an accelerated rate due to dentin bonding issues. In addition, this is a clinical presentation and will not engage in debate about the use of available direct gold options or the use of different composites/bonding techniques. It is a first look at the possibility for combining two proven materials and techniques utilizing the long-term sealing

ability of gold foil and the long-term enamel bonding ability of composite for the benefit of patients.

A CLINICAL DECISION PROCESS Approximately eight years ago, while completing class 2 foils in my private practice, there was an emergency patient who needed immediate care. The interruption necessitated the need to temporize the two class 2 foils that were approximately at mid-completion (Fig. 1). The proximal boxes in both foils had been completed. Both proximal boxes were filled with E-Z Gold (Lloyd Baum Dental Center, Loma Linda, CA, USA) to the level of the occlusal floor in the preparation. E-Z Gold is the author’s choice for bulk fill when doing a gold foil. Due to the ease of use and faster build up, E-Z Gold is the gold of choice within a busy private dental practice where gold foil is routinely placed. The E-Z Gold is veneered with #4 gold foil when the restoration is to be completed with direct gold. In this case, to temporize the restorations, the foil was micro etched with 50-micron aluminum oxide then completed utilizing a total etch (Ultra-Etch, Ultradent, South Jordan, UT, USA) and resin bonding (3M Universal Scotchbond) material to the remaining tooth structure and the micro-etched foil. A posterior composite (3M Silux Plus) was used at that time to complete the restoration. (Fig. 2) The patient was to return for removal of the composite and completion of the foil later. However, the patient did not return for six months, at which time the restoration was evaluated and found to be doing well clinically. The decision was made not to replace the composite. The restoration is now six to eight years in function. No clinical photos exist. Following the original restoration and upon discussions with Dr. Clyde Roggenkamp of Loma Linda, CA, it was discovered that Dr. Lloyd Baum had conceived of the idea for combining foil and composite and had discussed this with his friend Dr. Giancarlo Gallo of Italy. Thanks to Dr. Roggenkamp, the correspondence from 1992 to 1997 between Dr. Lloyd Baum of Loma Linda University and Dr. Giancarlo Gallo of Alba, Italy, was forwarded for review. Their discussion centered around the concept of utilizing a sandwich technique combining gold foil and composite resin for the class 5 restoration. Their designs can be seen in the hand drawings from their correspondence in Fig. 3 (reprinted with permission from Dr. Roggenkamp). Combining what was learned from Dr. Baum and Dr. Gallo, a refinement of the technique was developed to be applied to a class 2 foil restoration. The refinements included micro etching the gold and remaining prep with 50-micron aluminum oxide, t

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operative dentistry

Fig. 5. Initial bur penetration into carious lesion distal-proximal on tooth 13. Fig. 3. Original drawings from correspondence between Dr. Lloyd Baum of Loma Linda University and Dr. Giancarlo Gallo of Alba, Italy.

Fig. 6. Distal box filled with EZ Gold, also showing the glass ionomer liner located proximally.

Fig. 4. Metaltite by Tokuyama Dental America Inc. Fig. 7. Foil and prep after micro etching with 50-micron aluminum oxide.

then applying Metaltite (Tokuyama Dental America, Inc, Encinitas, CA, USA) to the gold via manufacturer’s directions. Metaltite MTU-6, a thiouracil monomer, which, according to the manufacturer, “enhances a tenacious chemical bond between resins and precious metals” (Figure 4). In addition, it was decided to place E-Z Gold into the proximal box of the class 2 prep to the level of the occlusal floor of the prep to create the contact in gold for the final restoration (Figure 1). The author’s reasoning for the procedure was to enhance the longevity of posterior composite class 2 restorations by utilizing the properties of E-Z Gold for stabilization of the proximal area and the adjacent contact over time. The result is a restoration that combines the use of E-Z Gold in the proximal box to facilitate longevity with the aesthetic appeal of composite where effective bonding to enamel has been proven. This restorative combination takes into consideration concerns that the patient, the operator, or both might have with the cosmetic appearance of gold in areas where it can be seen during normal function. Also, it is hoped that this paper could begin to re-assert the value of utilizing direct gold to enhance the so-called “bondodontic” explosion within dentistry and prioritize restorative outcomes and longevity in selecting restorative options.

CLINICAL CASES Three cases are presented; first a class 2 DO/MO in a maxillary second bicuspid (Figs. 1-2). The second case is a DO class 2 on tooth 13 (Figs. 5-13). The third case is a DO class 2 on tooth 4 (Figs. 14-23).

CLINICAL PROCEDURES Clinical Case 1: Class 2 in Tooth 4, DO and MO Class 2 Foil-Composite Sandwich As stated previously, the class 2 foil was terminated at the point of completion of the gold placement in the proximal boxes of both class 2 restorations in tooth 4 (Fig. 1). The photo shows the completion of E-Z Gold placement in both proximal boxes and the placement of a GI liner proximal to the gold. Following this, the gold was micro etched with 50-micron aluminum oxide, washed and dried, then a total etch with 35% phosphoric acid (Ultra-Etch, Ultradent) then bonded with 3M Universal Scotchbond (3M Oral Care, St Paul, MN, USA). Finally, 3M Silux Plus (repeat manufacturer’s name here) composite was used to complete the restoration. This procedure was originally intended to be a temporary fix (Figure 2).

Following reevaluation of the restoration, it was decided to continue using the procedure with the modifications of adding Metaltite (Tokuyama Dental America, Inc) to increase bond efficiency between gold and composite resin plus filling the proximal box with E-Z Gold to ensure no dentin bonding and to make the contact in gold. All personal observations are from the author’s private practice. Clinical Case 2: Class 2 DO #13 FoilComposite Sandwich The procedure consists of removing all caries, then filling voids created with GI (3M ESPE Fil Quick Aplicap (Need manufacturer’s name and location unless same manufacturer has already been noted). This is followed by preparing a classic class 2 preparation for placing gold foil or amalgam under a rubber dam (Figs. 5-13). The initial penetration into tooth 13 was with a 169 bur (Brasseler) to determine the extent of the carious lesion (Fig. 5) This was followed by removal of all caries. Healthy tooth structure is not removed; therefore, Black’s rules are not observed at this point. Following the insertion of the GI the preparation is completed to Black’s specifications. Fig. 6 shows the placement of the remaining glass ionomer for the deep caries destruction and the final prep with E-Z Gold placed in the proximal box. The glass ionomer proximal to the foil acts as a liner and thermal insulator in cases where deep caries penetration into the dentin occurs (Fig. 6). A dead-soft Tofflemire matrix band is placed (HO Band), wedges inserted, and the band is burnished prior to placement of E-Z Gold (Lloyd Baum Dental Center) into the proximal box. In placing class 2 foils, the author normally uses no band (Fig. 16, Case 3). However, a brass T band can be used as well, depending on the situation. Following the placement of E-Z Gold to the level of the occlusal floor of the prep (Figs. 6-10), the foil and remaining tooth structure were micro-etched (Fig. 7), utilizing a chairside micro etcher and 50-micron aluminum oxide. The preparation and gold were then washed and dried to clear the aluminum oxide prior to etching. In addition, the prep was treated with 2% chlorhexidine (Consepsis, Ultradent) for 60 seconds prior to total etch. A total etch with 35% phosphoric acid for 30 seconds was completed. In this case, Ultra-Etch by Ultradent was used. These steps were followed by applying Metaltite (Tokuyama) via a micro brush to the gold only (Fig. 8). Manufacturer’s directions were followed with air drying of one-two layers of Metaltite. Again, the procedure was completed under rubber dam. t

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operative dentistry

Fig. 8. Foil treated with two layers of metaltite metal bonding resin.

Fig. 9. Initial layer covering gold with shade A2.5 3M Filtek flowable composite.

Fig. 10. Middle layer of shade A-2 3M Filtek flowable composite.

Fig. 11. Final layer of shade A-1 3M Filtek flowable composite.

Fig. 12. Completed DO class 2 foil/composite sandwich on tooth 13.

Fig. 13. Radiograph showing the placement of the foil in the proximal box distal on tooth 13.

Fig. 14. DO 4 169 bur penetration to see caries.

Fig. 15. DO 4 caries removed and GI placed prior to final prep.

Following the treatment of the E-Z Gold with Metaltite, 3M universal bonding was applied to the complete prep and cured. Next, 3M Filtek flowable composite was layered into the final preparation and cured in multiple increments until the restoration was completed (Figs. 9-12). A darker or more opaque shade of composite was used in the first layer to mask the color of the gold, in this case, Shade A-2.5 (Fig. 9) . Finishing of the composite was completed using increasingly lighter shades layered and cured (Figs. 9-11). Polishing points and 3M disc and finishing diamonds were used to shape and finish the final restoration (Fig. 12). Fig. 13 is a radiograph showing the class 2 foil placement in the gingival 1/2 for the completed foil/composite sandwich restoration in tooth 13. The presence of a GI liner can be visually differentiated beneath the composite as well. There appears to be a small radiolucency within the GI. It is not known if this is an artifact or a small void. Because damage to the foil would likely occur with removal and replacement of the GI, it was decided to watch over time. Case 3: DO Virgin Caries Tooth 4 A penetration cut with a 169 bur (Brasseler) showing proximal caries at DO 4 is shown in Figure 14. This is followed by Fig. 15, showing the placement of GI following complete caries removal. Fig. 16 shows the final DO prep ready with E-Z Gold in place. In this case E-Z Gold was placed without a matrix band. This is the usual procedure when class 2 foils are completed by the author. This ensures maximal contact and gives better access to the proximal gingival floor for gold placement. After finishing of the gold contact utilizing VisionFlex Diamond Strips (Brasseler) a dead soft matrix band was placed prior to micro etching (Fig. 17). This was to prevent etching the adjacent tooth or restoration. Figs. 18 and 19 show the micro etching of the gold and prep followed by treating the gold with Metaltite (Tokuyama). Figs. 19 through 22 show the placement of the composite bonding and layers of 3M Filtek flowable composite. A final veneer of compactable composite can be used in heavy occlusion cases. Fig. 23 shows the final radiograph of the DO restoration with the placement of foil, GI, and composite.

CONCLUSIONS Fig. 16. DO 4 With EZ Gold Placed to the Level of the Occlusal Floor of Prep Creating the Contact in Gold. Gold Placed Without Matrix Band to Ensure Easier Access to Gingival Margin and a tight contact.

This presentation is intended to be a thought exercise to demonstrate one possible solution to improving the success for class 2 posterior composite resin procedures. More research is needed, especially to observe what is happening at the bond interface between the composite resin and gold. A comprehensive evaluation of the overall success of adding t

61 | TODAY'S FDA july/august 2022

Fig. 17. DO #4 micro etched with 50-micron al oxide and dead soft matrix band used to prevent micro etch 3 and control composite placement. contact is already established in gold.

Fig. 18. DO 4 treated with two layers of Metaltite (Tokuyama).

Fig. 19. First layer shade 3.5 to cover the Gold 3M Filtek.

Fig. 20. Second layer flowable shade 2.0 applied and cured (3M Filtek).

Fig. 21. Final layer a-1 laid in and cured (3M Filtek).

Fig. 22. Completed restoration DO 4 foil-composite sandwich.

operative dentistry 2. Fontana M & Gonzalez-Cabezas C (2000) Secondary caries and restoration replacement: An unresolved problem Compendium of Continuing Education in Dentistry 21(1) 15-18, 21-24. 3. Roulet JF (1997) Review of the clinical survival of direct and indirect restorations in posterior teeth of permanent dentition Journal of Dentistry 25(6) 459-4733. 4. Manhart J, Chen H, Hamm G, & Hickel R (2004) Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition Operative Dentistry 29(5) 481-508. 5. Henry DB The Consequences of Restorative Cycles Operative Dentistry (2009) 34(6) 759-760. 6. Henry DB (2008) A philosophy for restoring virgin caries Operative Dentistry 22(5) 475-483.

Fig. 23. Radiograph showing completed gold GI composite DO 4.

foil to this procedure would also be beneficial. This is a project that should be completed in an academic setting. Obviously, anyone attempting this procedure is expected to be proficient in the placement of gold foil in a clinical setting. A start would be to contact the American Academy of Gold Foil Operators. The author is also personally available for comment. Acknowledgements The author would like to thank Dr Clyde Roggenkamp and Dr Frederick Eichmiller for their help in putting together this paper. Conflict of Interest The author of this article certifies that he has no proprietary, financial, or other personal interest of any nature or kind in any product, service, and/or company that is presented in this article.

7. Challenges of Dentin Bonding In: Sturdevant’s Art and Science of Operative Dentistry 5th edition Mosby, Maryland Heights, MO 248-249. 8. Small BW & Johnson W (2006) Gold foil and its use in modern dentistry Dentistry Today 25(3) 92, 94, 96. 9. Opdam N JM van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, Gaengler P, Lindberg A, Hiysmans MCDNJM, & van Dijken JW (2014) Longevity of posterior composite restorations: A systematic review and meta-analysis Journal of Dental Research 93(10) 943-949. doi: 10.1177/0022034514544217 10. Overton JD & Sullivan DJ (2012) Early failure of class II resin composite versus class II amalgam restorations placed by dental students Journal of Dental Education 76(3) 338-340. 11. Zhou Y, Kong Y, Kundu S, Cirillo JD, & Liang H (2012) Antibacterial activities of gold and silver nanoparticles against Escherichia coli and bacillus Calmette-Guérin Journal of Nanobiotechnology 10(19) 1-9. doi: 10.1186/1477-3155-10-19 12. Gordon JC (2021) Longevity of Direct and indirect dental restorations Clinicians Report 14 (10) 1-3. 13. Stibbs GD (1951) An appraisal of the gold foil restoration Journal of the Canadian Dental Association (Toronto) 17(4) 191-199. 14. Brinker HA Jr (1972) Gold foil - can we afford to do without it? Journal of the American Academy of Gold Foil Operators 15(1) 25-33.

Henry, DB (2022). Clinical Presentation of the Direct Gold/Composite Sandwich Restoration J Op Dent, 47(2), 123-130. Used by permission. © Operative Dentistry, Inc. Transmission or reproduction of protected items beyond that allowed by fair use requires the written permission of Operative Dentistry, Inc.

15. Goldstein GR (2010) The longevity of direct and indirect posterior restorations is uncertain and may be affected by a number of dentist-, patient, and material-related factors Journal of EvidenceBased Dental Practice 10(1) 30-31. doi: 10.1016/j.jebdp.2009.11.015.

REFERENCES

17. Mjör IA & Ferrari M (2002) Pulp-dentin biology in restorative dentistry. Part 6: Reactions to restorative materials, toothrestoration interfaces, and adhesive techniques Quintessence International 33(1) 35-63.

1. Moore DL & Stewart JL (1967) Prevalence of defective dental restorations Journal of Prosthetic Dentistry 17(4) 373-378. doi: 10.1016/00223913(67)90008-x

16. Hilton TJ & Broome J(2006) In Fundamentals of Operative Dentistry: A Contemporary Approach (Chapter 10) 3rd Edition Quintessence Publishing, Chicago, IL.

18. Zhang Y, Dasari TPS, Deng H, & Yu H (2015) Antimicrobial activity of gold nanoparticles and ionic gold Journal of Environmental Science and Health, Part C (33)3 286-327. doi: 10.1080/10590501.2015.1055161

63 | TODAY'S FDA july/august 2022

By: Drs. Saja Alramadhan*, Neel Bhattacharyya, Donald M. Cohen

Read, Learn and Earn! and Nadim M. Islam

A 70-year-old, healthy white male presented to Dr. Charles DeWild, Oral & Maxillofacial Surgeon at the Florida Oral Surgery Visit floridadental.org/online-ce for this FREE, MEMBERS-ONLY BENEFIT. You will be given the in Sanford, with a two-month history of a non-healing ulcer. Examination revealed a red, endophytic lesion (crater-like) with a opportunity to review the “Diagnostic Discussion” and its accompanying photos. Answer five verrucoid center on the palatal gingiva of tooth #14 (Fig. 1). The multiple choice questions to earn one hour of CE. patient was completely asymptomatic. Dr. DeWild performed an incisional biopsy. This was then submitted to the University of Florida Oral Pathology Laboratory biopsy service for a diagnosis. t

Question:

Contact FDC Marketing Coordinator Brooke Martin What is the most likely diagnosis? at bmartin@floridadental.org or 800.877.9922. A.

Verrucous Carcinoma

Inverted ductal papilloma

Traumatic Ulcer

Verruciform Xanthoma

Fig. 1. A red, ulcerated and endophytic lesion located on the palatal gingiva of tooth #14.

65 | TODAY'S FDA july/august 2022

quiz A. Verrucous Carcinoma

B. Inverted Ductal Papilloma

Incorrect — a good choice though. Verrucous carcinoma is a lowgrade, well-differentiated variant of the more common squamous cell carcinoma. It is associated with smoking and/or chronic use of chewing tobacco or snuff, typically arising in locations where tobacco is habitually held such as the labial and buccal vestibule. Verrucous carcinoma predominantly occurs in males over 55 years of age. The mandibular vestibule, buccal mucosa and the hard palate are the most commonly involved sites. It is usually extensive at the time of diagnosis and may be present for two to three years before it is diagnosed. Clinically, verrucous carcinoma is usually a speckled (white/red), well-demarcated, painless exophytic mass with prominent granular, verruciform or papillary architecture (hence the verrucous name). Another salient point we have noted in our experience is that verrucous carcinoma of the gingiva tends to “creep” into the periodontal ligament space and eventually destroys bone by invasion along with the periodontal ligament space and not into surrounding bone. Histologically, verrucous carcinoma is characterized by an epithelial proliferation surfaced by a thickened layer of papillary or verrucoid parakeratin. No invasion is observed at the connective tissue interface, only invagination of the squamous epithelial rete ridges which are bulbous and elongated and appear to push into the underlying connective tissue. Parakeratin typically fills the numerous clefts or crypts between the surface projections “parakeratin plugging”. Combined characteristics such as integrity of the basement membrane and normal epithelial maturation, along with the absence of frank dysplastic changes, give the disease its deceptively benign appearance. The histology would be somewhat of a match except for the finding of xanthoma cells (foam cells) seen in this patient’s biopsy sample.

Incorrect – inverted ductal papilloma is a rare benign ductal papillary neoplasm that arises in the secretory duct of the minor salivary glands. Inverted ductal papilloma is part of the ductal papillomas neoplasms group, along with intraductal papilloma and sialoadenoma papilliferum. The exact etiology is unknown; however, human papillomavirus (HPV) types 6 and 11 have been identified in some cases. Some authors have related it to trauma which could possibly play a role in the development of this tumor. Inverted ductal papilloma affects middle-aged patients with no significant gender predilection. Clinically, the lesion appears as an asymptomatic nodule that varies in size from 0.5 to 1.5 cm in diameter with either smooth or verrucoid surface. The lower lip and mandibular vestibule are the most frequently affected sites.

Metastasis is extremely rare, therefore, surgical excision without radical neck dissection is the treatment of choice. For gingival lesions, due to the tendency of “creeping” into periodontal ligament space around teeth, surgery often involves the removal of the involved teeth and gingiva. The prognosis is excellent with 90% of patients being disease-free after 5 years. Radiotherapy is not indicated and several reports in the literature have documented development of poorly differentiated or anaplastic carcinoma within the lesion after radiotherapy.

Microscopically, inverted ductal papilloma shows papillary intraductal proliferation immediately subjacent to the mucosal surface. The ductal lumen is usually lined by cuboidal or columnar epithelium cells, with scattered goblet cells. The tumor may be continuous with the surface mucosa. Conservative surgical excision is the treatment of choice for inverted ductal papilloma.

C. Traumatic Ulcer Incorrect – but another great differential diagnosis. Though the clinical appearance may be suggestive of an ulcer, the absence of tenderness and history indicative of any trauma are not supportive of traumatic ulcer. Traumatic ulcer tends to be described as painful and usually located on areas that are subjected to trauma, such as the tongue, buccal mucosa or the labial mucosa. Sites such as the palate may be exposed to trauma mainly from food items such as chips, or a dental prosthesis. Ulcers tend to be depressed lesions which may or may not have raised borders. Additionally, if there is no repeated injury, most traumatic ulcers tend to heal within two weeks unless there is constant irritation and/or formation of a granuloma. As for this case, the lesion has been present for 2 months, which made this lesion suspicious of another entity rather than traumatic ulcers and warrants an incisional biopsy.

D. Verruciform Xanthoma Correct! – verruciform xanthoma is a relatively uncommon, oral benign lesion characterized by papillary epithelial proliferation with the accumulation of lipid-laden macrophages (xanthoma cells “foam cells”) within the superficial lamina propria and the connective tissue papillae. Unlike other papillary lesions it is not associated with HPV. The exact etiology of verruciform xanthomas is unknown. However, they are considered reactive lesions, associated with trauma and/or chronic irritation. Other investigators suggest that verruciform xanthomas may represent an unusual immunologic reaction to local epithelial disturbances; this hypothesis is supported by documented cases of verruciform xanthomas in association with other pathologic disorders such as lichen planus, epithelial dysplasia, squamous cell carcinoma and pemphigus vulgaris. Unlike, dermal xanthomas, oral verruciform xanthomas are not associated with diabetes, hyperlipidemia or any other metabolic or systemic disease. The gingiva, alveolar ridge and hard palate are the most commonly involved sites but any other oral site may be involved. Oral verruciform xanthomas occur over a broad age group, with no significant gender predilection.

Clinically, verruciform xanthomas typically appear as asymptomatic, solitary, well-demarcated plaques or nodules with a papillary, verrucoid or granular surface that measured less than 2 cm in diameter. Lesions also have a characteristic white, yellow-white or reddish-orange color. This color is thought to reflect collections of large numbers of lipid laden or foamy macrophages (Fig. 2- green arrow) found in this lesion. The clinical differential diagnoses may include squamous papilloma, condyloma acuminatum and squamous cell carcinoma. The classic microscopic appearance of verruciform xanthoma is of a papillary epithelial proliferation with hyperkeratosis, elongated rete ridges and collections of xanthoma cells “foamy macrophages”. The keratin layer is usually described as orange in color. In the present case, the endophytic clinical appearance is a bit unusual and so is the histology. Notably, the invagination of the squamous epithelium with elongated rete ridges into the underlying connective tissue and deep crypts of keratin extending into the spinous layer (Fig. 2-yellow arrow) are seen, mimicking verrucous carcinoma. However, the presence of xanthoma cells “foamy macrophages” (Fig. 2-green arrow) are diagnostic for verruciform xanthoma. Simple surgical excision is generally curative and lesions usually do not recur.

References Santosh HN, Nagaraj T, Saxena S, Biswas A, Pai SA. Verrucous carcinoma: A clinicopathological study. J Oral Maxillofac Pathol. 2019;23(2):303. doi:10.4103/jomfp.JOMFP_59_19 Betz SJ. HPV-Related Papillary Lesions of the Oral Mucosa: A Review. Head Neck Pathol. 2019;13(1):80-90. doi:10.1007/s12105-019-01003-7 Alramadhan SA, Fitzpatrick SG, Bhattacharyya I, Islam MN, Cohen DM. Changing Trends in Benign Human Papillomavirus (HPV) Related Epithelial Neoplasms of the Oral Cavity: 1995-2015 [published online ahead of print, 2022 Mar 7]. Head Neck Pathol. 2022;10.1007/s12105-022-01426-9. doi:10.1007/s12105-022-01426-9 Belknap AN, Islam MN, Bhattacharyya I, Cohen DM, Fitzpatrick SG. Oral Verruciform Xanthoma: A Series of 212 Cases and Review of the Literature. Head Neck Pathol. 2020;14(3):742-748. doi:10.1007/s12105019-01123-0

Fig. 2. Histopathologic slide depicting incisional biopsy.

67 | TODAY'S FDA july/august 2022

quiz

Neville, BW, Damm DD, Allen CM, and Chi AC. (2016) Oral and Maxillofacial Pathology. 4th edition, WB Sanders, Elsevier

Diagnostic Discussion is contributed by University of Florida College of Dentistry 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, multi-state biopsy service. The column’s case studies originate from the more than 14,000 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.

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 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. *Fellow in Oral and Maxillofacial Pathology University of Florida College of Dentistry.

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

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69 | TODAY'S FDA july/august 2022

Career Center

The FDA’s online Career Center allows you to conveniently browse, place, modify and pay for your ads online, 24 hours a day. Our intent is to provide our advertisers with increased flexibility and enhanced options to personalize and draw attention to your online classified ads! Post an ad on the FDA Career Center and it will be published in our journal, Today’s FDA, at no additional cost! Today’s FDA is bimonthly; therefore, the basic text of all active ads will be extracted from the Career Center on roughly the 5th of every other month (e.g., Jan. 5 for the Jan/Feb issue, March 5 for the March/April issue, etc). Please note: Ads for the Nov/Dec issue must be placed no later than Nov. 1.

Please visit the FDA’s Career Center at careers.floridadental.org. Endodontic Associate - Tampa Bay Area. Well established, busy Endodontic group practice seeking energetic, quality Endodontist. Modern office with latest technology including microscopes, digital radiography, CBCT, and experienced support staff. Excellent earning potential and benefits. Recent graduates encouraged to apply. Visit careers. floridadental.org/jobs/17109281. Established general and implant private practice on the beautiful Treasure Coast is seeking Associate Dentist. Our practice is committed to providing the highest quality dental care to our community. To learn more about this opportunity, please email your CV and/or any questions to ccp1222@bellsouth. net. Must have a Florida Dental License. Visit careers.floridadental.org/jobs/17062849. Ormond Beach. We are seeking a team-oriented expanded functions dental assistant. Must have a servant’s heart, caring personality that caters to our patients. Must be able to get along easily with staff and be an eager to help team player. Ideally 5+ years experience. Benefits and pay will be discussed with the Dr. based on experience and talent. Monday - Thursday 7:45- 5:00. Expanded Functions certificate. Visit careers. floridadental.org/jobs/16961485 Oral Surgeon wanted for busy, well established 27 year Boca Raton Dental practice. 1 day/week. Comfortable environment, experienced staff. Visit careers.floridadental. org/jobs/16954798.

Well-established private endo practice seeking a quality-driven, skilled, fulltime endodontist licensed in the state of Florida. The practice is equipped with state-of-the-art equipment, including CBCT, microscopes, digital radiography, PBS Endo, and paperless charts. The practice was established in 2002 and has an outstanding reputation in the dental community for the highest level of endodontic quality patient care and comfort. We are looking to expand and incorporate a new associate into our growing practice. The practice has strong established referrers in the Miami/Doral area. Doral is conveniently located in the heart of the Miami metro area and was named the fastest-growing city in Florida. Because of our patient population, doctors must be bilingual, in both English and Spanish. To learn more about this position, please email your resume to: endospecialistsofsouthflorida@gmail.com. Vsit careers.floridadental. org/jobs/16961145. Come join us! If you are looking for an associate opportunity with room for growth, an excellent earning potential, and opportunity to partner (if desired) in a great office. We are currently seeking a full-time associate for our Volusia County location but are open to discussing part-time availability. Mentorship and guidance will be provided for recent residency graduates. We are a well-established, privately owned endodontic practice with two locations in Central Florida. Our office is looking for a compassionate, energetic, quality-oriented endodontist to join our

team. Our newly renovated offices have the latest technology including but not limited to: LED surgical microscopes, digital radiographs, CBCT on site, intraoral cameras, and remotely accessible practice management software. This is the perfect opportunity for someone looking to be the only associate in an office with access to, and support from, a great clinical/business mentor. Associate will have their own desk, scheduling autonomy, and monthly marketing budget. Compensation will be 47% of collections with a $1,000 daily minimum guarantee. Florida Dental License acquisition assistance is available for those who are not currently licensed in Florida. This is a unique opportunity that will fill fast! Ideal for someone who would like to see what private practice ownership is like, or practice in an “owner style” associateship. If you are interested in this opportunity, please send your CV/ Resume and a copy of the qualification documents listed below listed below to office@ daytonendo.com. Be sure to include contact information in the body of the email and our doctor will contact you as soon as possible. We look forward to connecting with you! Required for consideration: 1. DDS/DMD from an accredited Dental School 2. Certificate of Completion from an accredited US Endodontic Residency Program 3. Active Florida Dental License. Visit careers.floridadental. org/jobs/16958506. General Dentist – Dental Partners, Melbourne. Sign-On Bonus Incentive $10,000 $50K Student Loan Repayment Program.

career center Relocation Incentive. Making a difference each and every day is what we do at Gainesville Dental Associates! Our teams serve our patients by building valuable relationships, providing excellent dentistry and a range of services to suit the needs of the community. If you are looking for a Full-Time opportunity to help lead a well-established and successful dental practice, consider scheduling a confidential appointment with us today. We are seeking a General Dentist to work in a fast paced, well established dental office. We prefer a candidate with a minimum of 2 years work experience and who is able to perform a range of services to our patients however well qualified **NEW GRADS** welcome to apply. Our talented team of dental professionals will work along side you to ensure your successful entry into the practice and long term success. As a team member, you’ll enjoy the following: Competitive Daily base rate with performance incentives; Sign-On Bonus of $10,000; Student loan repayment program available for this location! Let us help you pay your student loans down!; If you do not live in the area, we will help you get here with our relocation benefit; Full health and wellness benefits. Employer paid life insurance and contribution to a Health Savings Account; Saving for retirement made easy with a best in class 401K program and generous employer match; Keep your clinical skills up to date through CE with our yearly allowance program; Opportunities to contribute to your community through education and charity events; Practice Full-Time with friendly days/ hours; A full team of support from qualified and educated dental assistants to work along side you, to a regional leadership team and finally a corporate service center with all the departments to ensure your practice runs smoothly. You take care of providing great care to your patients and we will take care of the rest. Sound interesting? We’d love to speak with you today! We are an Equal Opportunity Employer and Drug Free Workplace with opportunities for all. We pride ourselves on our diverse organization and our family friendly and inclusive culture. We have a Veteran’s and AARP Hiring Pledge. We are a certified Great Place to Work company! www.puredentalbrands. com. #WeHaveWhatMakesYouSmile. You want to work with the best organization and we want to work with the best providers. Therefore, all candidates must be licensed to practice in the State of Florida with no

board reprimands or issues and have a valid DEA license. Visit careers.floridadental.org/ jobs/16938245. Lake Mary, fee for service, 5 star, highend practice is looking for a part-time/ full-time dentist. Applicant must have knowledge of, or would be willing to learn holistic/biological dentistry. We spend quality time with our patients and are not in a rush to treat them fast. We develop trusting relationships that are long lasting. In addition, we have up-to-date equipment and an experienced staff to help provide quality dentistry! If you are interested in a great opportunity please contact us at 407.333.1335 and provide us with a resume at timtiralosi@ tiralosidental.com. Visit careers.floridadental.org/jobs/16906913. Offering a General Dentistry Associateship position that can lead to partnership. Family practice. Long standing practice been in the area for over 40 years. Great location on the main road through Ormond Beach. Great staff. We have a CT scanner, CAD CAM milling, soft tissue laser and more. Looking for someone who enjoys engaging the patients and practicing high quality dentistry. For details please contact Dr. Drake at drake@drdrake.com. Active DDS/ DMD and Florida dental license. Visit careers. floridadental.org/jobs/16872179. Kissimmee. 25+ year, multi-doctor, privately owned family practice seeking a highly motivated General Dentist to help treat our great patients and work with a wonderful and experienced team. Join a successful practice and jump right in to a strong schedule with over 100 new patients a month waiting for quality, comprehensive care. Enjoy a base salary with percentage based incentive compensation. Visit our website: https://www. kissimmeefamilydental.com Please forward CV to Holly Lance: holly@kissimmeefamilydental.com. Visit careers.floridadental.org/ jobs/16797765. Bay Dental Center is looking for associates that value long term relationships in life. Bay Dental Center is expanding operations in the Gulf Coast area. We have been a Family Private Practice for nearly 15 years. We provide all aspects of General Dentistry. We have one year positions, as well as positions that are geared towards eventual partnerships. DDS or DMD with or without MS. Visit careers.floridadental.org/ jobs/16759880.

71 | TODAY'S FDA july/august 2022

Bradenton. Are you a growth-minded, Goal-oriented, self-motivated individual who is motivated to learn and treat patients well? Are you looking for a great income potential and an option to partner up in a practice to own it? Do you wish to live and raise a family in a friendly town full of lifestyle opportunities? Do you want a dentistry career to be fulfilled with all the above? Too good to be true? Trust me, this is all possible if you are with the correct practice!!! My Name is Dr Nish Patel and I have been living of all the above for the past 12 years on the west coast of Florida. We are growing FFS/ Some PPO Practice looking for an associate to be able to make dentistry a fulfilling career. We have a leadership team in place to handle all the management, marketing and generating new patients. We offer great income potential, an uplifting work environment, and a team that feels like family. We can Sponsor work Visa. Check out our reviews online at www. Smylmanatee.com.Essential Core Competencies: Excellent patient communication - Educate patients on maintaining proper oral health during treatment. Carefully and methodically document all treatment-related notes, comments, instructions, etc. Desire to learn and grow professionally. Compensation & Benefits: Compensation to include a payroll draw/advance and a commission structure that provides incentive. Benefits to include medical insurance, an in-house dental plan, life insurance and a 401(k) plan with a match. Receive mentoring, training, and development from our Chief Clinical Officer regarding ethical and optimal patient care. Team culture with autonomy. A steady stream of patients to keep you busy and exposure to all types of procedures • Associate will have 4 available ops, dedicated assistants, and hygiene support Potential for future partnership and attainment of mutual goals. If you’re interested, please send your cover letter, resume and references to Hr@ SmylManatee.com. In your cover letter Write us a little bit about. Where you currently practice and a brief description of your situation there. What is your biggest hurdle in Life Right now? Qualifications: DDS or DMD from an accredited dental school with a min of 4 years general dentist experience. Dedication to integrity and achieving the highest standards of ethical patient care. Visit careers. floridadental.org/jobs/17115773

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PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly by the Florida Dental Association (FDA), 545 John Knox Road, Ste. 200, Tallahassee, FL 32303. FDA membership dues include a complimentary subscription to Today’s FDA. Nonmember subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, FL and additional entry offices. Copyright 2021 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, FL 32303.

EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the FDA 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 FDA.

EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. Hugh Wunderlich, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, FL 32303. FDA office numbers: 800.877.9922, 850.681.3629; fax: 850.561.0504; email address: fda@floridadental.org; website address: floridadental.org. Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.

73 | TODAY'S FDA july/august 2022

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off the cusp

The most interesting man in world ...

It happened again last week, and at least a dozen times over the years. I was once again mistaken for “the most interesting man in the world.” In case you have no idea what I’m talking about, the most interesting man in the world comes from a national Dos Equis advertising campaign. In the advertisement, Dos Equis claims that this really, really good-looking guy leads such an interesting life that he lives vicariously through himself, speaks Russian in French and prefers to drink Dos Equis of course. Then again, maybe it is not my doppelganger worthy good looks, but my punctilious dental skills that caused the confusion. <cue the classical Spanish guitar Dos Equis melodic theme song>

I can carry all the groceries with one arm and still prep a perfect crown.

I can talk about Fight Club during my consultations.

When I use dental equipment, it increases in value.

Once in an operatory, a rattlesnake bit me. After five days of excruciating pain, the snake died.

My Florida dental license only has one digit.

If I were to submit a crown procedure to an insurance company without a radiograph, they would pay for it. t

75 | TODAY'S FDA july/august 2022

off the cusp 7.

The Board of Dentistry often questions me just because they find me interesting.

My 10-gallon amalgam separator holds 20 gallons.

I can do dentistry both left-and right-handed.

10. My business cards say, “I will call you.” But what is there to do parents poorly or don’t esting beer? How do you esting when your dental interesting than mine?

if you picked your drink a most interbecome more interskills are less

You can start by becoming more influential and take the advice sent to me by Omar Ahmad about how to create action for the issues you care about. To be more interesting you need to share your ideas and influence your region’s legislators. However, your legislators are being broadcast to by other people all the time. So how do you stand out and really grab their attention? If you send an email, you compete with the hundreds of impersonal, “spammy” messages they receive and end up lost in their inbox. Face-to-face meetings do serve a purpose, but they’re not practical when you’re trying to send an accordant, persistent message. We’re in an age filled with iPhones, emails and YouTube, but one of the best communication tools when it

comes to contacting your legislators is the mighty analog, better known as the handwritten letter. Or, even better yet, dig out your father’s 1924 Underwood typewriter. See, it got you to read this “interesting” editorial. Be proactive and write to your elected officials at least once a month. If you are consistent, within three months your elected officials will start calling you when that issue comes up to ask, “What do you think?” There is, of course, a method to constructing letters you send to your elected officials. In the first paragraph, you appreciate them. You may not actually appreciate the person, but maybe you appreciate that they have a “tough gig.” In the next paragraph, get to the point and be blunt, but don’t attack the person. Attack the tactics. Smear attacks will get you nowhere. You need to be the nurturing agent. Become a safe place and a resource for them. Tell them, “If no one is providing this information, let me help.” Finally, when you sign the letter, be sure to include your title. You are a dentist. You are already interesting and worthy of their curiosity. This will make you “the most interesting person in the world” on this issue. And best of all, you don’t need to have the Dos Equis trademarks like “charm so contagious it rivals COVID” or “enemies that list you as their emergency contact.” Stay thirsty my friends.

77 | TODAY'S FDA july/august 2022

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Today's FDA July/August 2022 Issue

Articles inside

Employees Are Your Most Important Asset

Top 10 Misconceptions Health Care Providers Have About Leasing or Purchasing Their Office Space

Top 10 Reasons to Buy Your Dental Supplies from The Dentist Supply Company

The Top 10 Things You Need to Know to Recognize and Avoid Cyber Attacks

10 Tips for Developing a Dental Office Emergency Plan

Top 10 Digital Marketing Strategies to Help You Attract, Acquire and Retain Patients

A Clinical Presentation of the Direct Gold Composite Sandwich Restoration

Top 10 Frequently Asked Questions That Help FDA Members Succeed