TFDA July/August 2023

EDITOR

Dr. Hugh Wunderlich, CDE Palm Harbor

BOARD OF TRUSTEES

PRESIDENT

Dr. Beatriz Terry Miami

FIRST VICE PRESIDENT

Dr. John Paul

IMMEDIATE PAST PRESIDENT

Dr. Gerald Bird Cocoa

TREASURER

Dr. Rodrigo Romano Miami

TRUSTEES

Dr. Tom Brown Orange Park

Dr. John Coroba Lake Mary

Dr. Karen Glerum Boynton Beach

Dr. Reese Harrison Lynn Haven

Dr. Eddie Martin Pensacola

Dr. Enrique Muller Aventura

SPEAKER OF THE HOUSE

Dr. Don lIkka Leesburg

DIRECTOR Drew Eason, CAE Tallahassee

Dr. Christopher Bulnes Tampa

Dr. Bethany Douglas Jacksonville

Dr. Fred Grassin Spring Hill

Dr. Bertram Hughes Gainesville

Dr. Richard Mufson Miami

Dr. John Pasqual Delray Beach

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

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

EXECUTIVE OFFICE

Drew Eason • chief executive officer/executive director

FLORIDA DENTAL CONVENTION AND CONTINUING EDUCATION

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

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

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

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

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

GOVERNMENTAL AFFAIRS

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

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

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

INFORMATION SYSTEMS

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

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

MEMBER RELATIONS

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

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

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

Maria Johnson • membership coordinator maria.johnson@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 scott.ruthstrom@fdaservices.com

Ext. 7144 Davis Perkins • Atlantic Coast membership commercial account advisor davis.perkins@fdaservices.com Ext. 7145

Danielle Basista • commercial account advisor dbasista@fdaservices.com Ext. 7156

Tessa Daniels • commercial account advisor tessa.daniels@fdaservices.com Ext. 7158

Kelly Dee • commercial account advisor kelly.dee@fdaservices.com Ext. 7157

Jamie Idol • commercial account advisor jamie.idol@fdaservices.com Ext. 7142

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

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

YOUR RISK EXPERTS

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

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

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

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

Dennis Head, CIC director of sales • Central Florida 877.843.0921 • cell: 407.927.5472

dennis.head@fdaservices.com

DSOs Are Significantly Changing the Dental Practice Landscape

By Beatriz E. Terry, DDS, MS, FDA President

Recent grads and younger dentists are opting to practice under the Dental Service Organization (DSO) model in higher numbers. According to the American Dental Association Health Policy Institute article published June 1, 2023, 13% of U.S. dentists are affiliated with a DSO.

This number increased from 8.8% in 2017 to 10.4% in 2019. More specifically, 23% of dentists in practice for 10 years or less, 11% of dentists between 11-25 years and 7% of dentists in practice for 25 years or more are practicing under this model.

What does this say about the solo private practice model?

Is it disappearing? DSOs have emerged as a significant force in dentistry, transforming the traditional landscape of dental practices. According to their model, they have

the ability to streamline operations, increase efficiency and improve patient care. Because of this claim, DSOs have become increasingly popular in recent years. But what is the impact of DSOs on dental practices and patient care? I will highlight the pros and cons of this evolving model to understand its effect on our profession.

DSOs provide comprehensive non-clinical support services to dental practices, allowing dentists to focus primarily on patient care. These organizations handle administrative tasks, including billing, marketing, human resources, purchasing and enabling dentists to concentrate on their clinical expertise.

Pros of the DSO Model

Streamlined operations: DSOs centralize administrative functions, allowing dental practices to benefit from economies of scale. This leads to efficient operations, reduced overhead costs and optimized resource allocation. By taking care of tasks like billing, marketing and staffing, DSOs alleviate the administrative burden on the dentists, enabling them to focus on providing dental care.

Enhanced clinical support: DSOs often offer specialized training and professional development opportunities to dentists and their staff. By facilitating continuous education, mentorship and access to advanced technologies, DSOs help dental professionals stay updated with the latest industry practices and deliver high-quality care to patients.

Improved access to capital: DSOs can provide financial resources to dental practices, which can be crucial for growth and expansion. With access to capital, dentists can invest in state-of-the-art equipment, renovate their facilities and expand their services, ultimately enhancing patient experience and outcomes.

Increased efficiency and productivity: By leveraging economies of scale, DSOs can optimize processes, streamline workflows and implement standardized protocols across multiple dental practices. This leads to increased efficiency and productivity, allowing dentists to see more patients while maintaining the quality of care.

Cons of the DSO Model

Loss of autonomy: Decisions relating to practice management, treatment options and staffing might be influenced or controlled by the DSOs, limiting the individual dentist’s freedom to make independent choices i.e., buying new equipment, hiring or firing team members and decision-making on patient care.

Potential profit-sharing arrangements: Some DSOs require dentists to share a portion of their practice’s revenue or profits, which may impact the overall financial

returns for the individual practitioner. Dentists must carefully evaluate the financial arrangements and understand the long-term implications before joining a DSO.

Standardization versus individuality: While standardization can lead to operational efficiency, some argue that the DSOs model may compromise the personalized patient experience and individualized treatment approaches. Critics argue that DSOs might prioritize volume-based dentistry over the tailored care that patients may desire.

Potential lack of continuity: DSOs may involve frequent changes in staff and dentists, which could impact patient continuity of care. Patients may prefer long-term relationships with their dentist and dental care teams; frequent turnover could disrupt that continuity.

In conclusion, DSOs have significantly changed the dental practice landscape by offering benefits such as streamlined operations, enhanced clinical support and improved access to capital. This may be what makes it so attractive to 13% of U.S. dentists. However, dentists considering joining a DSO should carefully evaluate the potential loss of autonomy, profit-sharing arrangements and the balance between standardization and personalized care. Ultimately, the decision to affiliate with a DSO should be based on individual circumstances and a commitment to delivering quality patient care. I am a solo practitioner and enjoy the freedoms of this model, and I recognize that over 80% of dentists still practice under this model. I now better understand the DSO model and recognize why some dentists choose this practice style.

I consider it a privilege to belong to organized dentistry. All dentists, regardless of practice modality, are welcome and encouraged to become a member of the Florida Dental Association.

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

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

OPIOIDS

SUMMARY:

DOCUMENT IN PATIENT’S RECORD

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.

Exclusive Member Benefit!

FOR THE LATEST ON OPIOIDS, GO TO: FLORIDADENTAL.ORG/NYK

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.

NON-OPIOID ALTERNATIVES

LAW: GO TO bit.ly/2KXvZ2h

Dental Sedation

By Casey Stoutamire, FDA Chief Legal Officer

Did you know the Florida Board of Dentistry (BOD) and the Florida Department of Health (DOH) held a dental sedation workshop on May 18? The workshop aimed to educate permit holders about the inspection process. The BOD and DOH plan to offer the workshop at various locations around the state in the future. The Florida Dental Association (FDA) will make sure to keep you updated.

For a copy of the presentation, please go to bit.ly/3MFGoyt.

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

2023 FDA Legislative Session Highlights

By Joe Anne Hart, FDA Chief Legislative Officer

APPROVED

Dental Student Loan Repayment Program and Donated Dental Services

The Legislature allocated $2 million (recurring) to implement the Dental Student Loan Repayment Program (dentists eligible for $50,000 per year maximum for five years as a Medicaid provider in a public health setting) and Donated Dental Services (two full-time coordinators, plus operating expenses).

Florida Mission of Mercy

The Legislature allocated $500,000 (nonrecurring) to support the 2024 Florida Mission of Mercy scheduled to be held in Lakeland, May 30 – June 1, 2024.

Permanent Sales Tax Exemption on Oral Hygiene Products

The 2023 Legislative Session convened on Tuesday, March 7 and adjourned 60 days later on Friday, May 5, 2023. Each year, the Florida Dental Association (FDA) prepares legislative issues to be addressed during session, including policy issues and budget proposals. For several years, the FDA has pursued funding to implement programs that will help expand access to dental care in rural and underserved areas around the state and support initiatives to help get individuals out of dental pain. The Legislature approved a budget totaling approximately $117 billion, which included funding for several FDA priorities. On June 15, the governor signed the budget into law, and kept intact the FDA budget priorities. The new state budget for fiscal year 2023-24 went into effect on July 1.

As a part of the tax relief package, Florida will implement a permanent sales tax exemption on oral hygiene products (toothbrushes, toothpaste, dental floss, dental picks, oral irrigators and mouthwash). The governor approved the legislation for the tax relief package and the bill went into effect on July 1.

Veterans Dental Care Grant Program

Legislation was passed and signed into law to create a Veterans Dental Care Grant Program, which will be administered through the Florida Department of Veterans Affairs. The grant program will allow nonprofit organizations that provide oral

FDA Immediate Past President Dr. Gerald Bird, Jerilyn Bird, House Speaker Paul Renner (R-Palm Coast) and Joe Anne Hart.

health care services for veterans to apply for funding to cover expenses to treat these individuals. Although the policy to create this grant program was approved, funding needed to implement the program was not approved in the budget. The FDA will pursue funding for this program next year.

DEFEATED

Universal Occupational Licensing Legislation was proposed this year to create an interstate, universalrecognition occupational licensing act. This legislation would have required licensing boards governed under ch. 455 (Department of Business and Professional Regulation) and ch. 456 (Department of Health, which includes dentists), to issue an occupational license (universal license) to applicants who meet specific criteria. The FDA, other professional groups and the Florida Board of Dentistry opposed this legislation. This legislation did not pass and died in committee.

Dental Therapy

Dental therapy legislation was not filed or considered in this legislative session.

For a comprehensive report on the 2023 Legislative Session, read the Sine Die edition of Capital Report, available at bit.ly/44jKtQg.

FDA Chief Legislative Officer

Joe Anne Hart can be reached at jahart@floridadental.org.

FDA 2023 LEGISLATIVE AWARDS

Freshman Legislator of the Year

Champions for Dentistry

Rep. Kim Berfield (R-Clearwater)

Sen. Jim Boyd (R-Bradenton)

Sen. Danny Burgess (R-Zephyrhills)

Sen. Colleen Burton (R-Lakeland)

Rep. Sam Killebrew (R-Winter Haven)

Rep. Patt Maney (R-Fort Walton Beach)

Each year, the Florida Dental Association (FDA) prepares legislative issues to be addressed during session, including policy issues and budget proposals.

ARE YOU A MEMBER OF FDAPAC CENTURY CLUB?

A portion of your 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.

FDC2023 COURSE RECORDINGS

Wish you could attend two courses offered at the same time? Want to bring course information back to your team? FDC2023 course recordings are available for you to purchase!

Listen to FDC2023 courses at the convenience of your home or office with these MP4 audio recordings. Course recordings are $20 each or purchase all 75+ recorded sessions for only $299*.

Vist education.floridadentalconvention.com to purchase your FDC2023 course recordings today!

Why DSOs Should Choose FDA Services as Their Insurance Broker to Support Organized Dentistry

By Carrie Millar, CAE

Dental Support Organizations (DSOs) have a unique opportunity to contribute to organized dentistry and shape the future of the dental profession. Making the right choices in selecting partners and services can significantly impact the advancement of organized dentistry.

In this article, we will explore why DSOs should choose FDA Services (FDAS), the wholly-owned insurance brokerage of the Florida Dental Association (FDA), as their insurance broker to support organized dentistry and the benefits it brings to the dental community.

Aligned with Organized Dentistry: FDAS understands the importance of organized dentistry and actively promotes its growth and success. By partnering with FDAS, DSOs demonstrate their commitment to the principles and values that drive our profession forward. Supporting an insurance broker aligning with organized dentistry’s goals reinforces the collective efforts to advance the dental community.

preventive action

Expertise in Dental Practice Insurance: With more than 36 years in the dental industry, FDAS possesses specialized knowledge in dental practice insurance. We understand the unique challenges and requirements faced by DSOs, ensuring comprehensive coverage and tailored solutions that align with their specific needs. By choosing an insurance broker with expertise in dental practice insurance, DSOs can know that their practices and employees are well-protected.

Advocacy and Representation: FDAS actively advocates for the dental profession and works closely with top insurance carriers to get policies and coverage customized to dentistry. For example, our malpractice program with The Doctors Company (TDC) is based on dental malpractice claims only (not other medical professions), ensuring that the coverage provided is specific to the needs of dental professionals. Premiums today are 20% lower than 36 years ago when the brokerage was created. By partnering with FDAS, DSOs contribute to a collective

Support for FDA Members in DSOs: For DSOs with dentists who are members, partnering with FDAS is a natural choice. It supports organized dentistry and provides an avenue for FDA members working in DSOs to contribute directly to their professional organizations. By choosing FDAS, DSOs allow their dentists to actively participate in organized dentistry initiatives and support the dental community.

Conclusion: Choosing the right insurance broker is a critical decision for DSOs as it protects their practices and employees and demonstrates their commitment to supporting organized dentistry. FDAS, with its alignment with organized dentistry, expertise in dental insurance, advocacy efforts and support for FDA members in DSOs, provides an ideal choice for DSOs looking to make a positive impact on the dental community. By partnering with FDAS, DSOs can contribute to the advancement of organized dentistry, ensuring the growth and success of our profession.

By partnering with FDAS, DSOs demonstrate their commitment to the principles and values that drive our profession forward.

By choosing FDAS, DSOs allow their dentists to actively participate in organized dentistry initiatives and support the dental community.

effort to improve the malpractice insurance landscape for dental professionals.

Boutique Brokerage with National Presence: FDAS stands out as a boutique brokerage with a national presence in the dental malpractice insurance industry. Our dedication to serving the dental community has positioned us nationally as the top dental malpractice insurance broker with TDC. Additionally, FDAS is recognized as one of the top 20 medical malpractice brokers with TDC nationally. This national recognition and reputation demonstrate our expertise and ability to provide superior service to DSOs nationwide.

If you are an FDA member working in a DSO, I encourage you to urge your human relations or chief financial officer to contact FDAS for a proposal. Together, we can support organized dentistry, secure the lowest premium possible for the DSO as we do for our members and make a difference in the lives of dentists, patients and the dental community.

FDAS Director of Insurance Operations Carrie Millar can be reached at carrie.millar@fdaservices.com.

LEAD Reception: A Celebration of Networking and Excellence

By Lianne Bell, FDA Leadership Affairs Manager

The Florida Dental Association (FDA) Leadership Development Committee (LDC) recently hosted an event that brought together distinguished leaders in the dental profession at the Gaylord Palms in Orlando. The Leaders Emerging Among Dentistry (LEAD) reception, held during the Florida Dental Convention (FDC), was a memorable evening celebrating the dental professionals participating in the FDA’s LEAD programs. The reception served as a networking opportunity for those dedicated to advancing dentistry and interested in growing their leadership skills. The event featured Dr. George Shepley, American Dental Association (ADA) president, and included the members of the LDC, LEAD program attendees, the FDA Board of Trustees and several FDA past presidents.

The LEAD reception was a cheerful occasion where dental professionals could connect with like-minded colleagues and forge meaningful professional relationships. It provided a platform for attendees to expand their networks and gain valuable insights from individuals who have made significant contributions to organized dentistry. A highlight of the evening was the presence of Dr. Shepley, who delivered a brief message to attendees that focused on the importance of leadership and dedication in shaping

Photos: Attendees enjoying the networking and mentorship opportunities at the LEAD reception.

the future of dentistry. Dr. Shepley’s vast experience and leadership within the dental community gave the LEAD participants valuable guidance and encouragement. The reception reinforced the significance of leadership, mentorship and networking that the LDC looks to provide for FDA member dentists.

The LCD also met during FDC to continue its work on future LEAD programs, including planning for the 2024 program. After hearing testimony given at the FDA’s House of Delegates (HOD) annual session regarding the success of LEAD and the desire to grow the program and also continue the semi-annual meeting of the HOD, the committee discussed potential speakers and topics for the 2024 program, such as expanding the program to feature multiple sessions and training for new members of the FDA’s HOD.

Be sure to save the date for Friday, Jan. 19, 2024, for the next LEAD program held in Orlando. The 2024 program will undoubtedly inspire and empower attendees to continue their journeys of leadership and excellence in dentistry.

Leadership Affairs Manager Lianne Bell can be reached at lbell@floridadental.org

Register Now For Women Inspire & Navigate Dentistry!

Women Inspire & Navigate Dentistry (WIND) is back on Sept. 8 at the Opal Grand in Delray Beach! WIND will feature peer-to-peer learning by the water, inspired and led by Florida women in dentistry. Earn eight hours of continuing education while learning from experts in the field and networking with your peers, all in beachfront luxury. Go to fdawind.com to register and learn more about this can’t miss event.

FDA’s Communities of Interest Officially Launch at FDC2023!

During the past three years, the Florida Dental Association (FDA) has updated its governance structure. While that includes revisions of important documents like the bylaws and manuals, it also allowed the FDA House of Delegates to be creative and introduce new ways to get grassroots members involved. One of these is the FDA’s Communities of Interest (COI).

To create the COI, several councils were disbanded and, moving forward, task groups will be formed when issues about those topics arise. These include the Council on Dental Education and Licensure, the Council on Dental Benefits and Care, the Council on Membership and the Council on the New Dentist. Yes, these are important areas where members should be involved. That is why the COI has been created.

The FDA’s new COI give more opportunity for involvement with topics that affect dentistry. These communities exist in an online platform and are open to all interested members. COIs are moderated and staffed by the appropriate FDA team member and focus on active discussion and sharing of information about specific topics areas. Members of the communities will receive and post educational materials, questions, news articles and updates related to the topic of interest. Discussion and discourse are encouraged! Then, when an issue of import arises, the FDA Board of Trustees can pull members from a specific community of interest to form a task group with a focused mission and time frame.

The initial COI are Dental Education and Licensure, Dental Benefits and Care, Membership and Leadership and New Dentists. Please go to bit.ly/3NSln4u to join!

If you have thoughts, feedback or questions, please email coi@floridadental.org or call FDA Chief Legal Officer Casey Stoutamire at 850.350.7202.

Appointees Represent Florida Across Various ADA Committees

Recently, 17th District Trustee Dr. Rudy Liddell provided an American Dental Association (ADA) update that includes several committee appointees representing the Sunshine State. One of those committees includes the strategic forecasting committee — a special task force comprised of delegates nominated from each trustee district tasked with evaluating the existing business model and determine how best to improve current processes to enable innovation, speed and transparency within the health care landscape. We, at the FDA, would like to thank all of those people who are contributing their time and energy into making sure Florida is represented nationally.

The following is a list of people from Florida appointed to various positions:

• Dr. Tom Brown will serve on the Strategic Forecasting Subcommittee.

• Kelsey Bulnes, Dr. Karen Glerum and Dr. William Parker will serve on the Professional/Public Customers Action Group.

• Pat Bauer Drew Eason and Angel Henry will serve on the Tripartite Customer Action Group.

• Spencer Boone (American Student Dental Association), Dr. Jacinta Lamontagne, Dr. Priscilla Sosa and Lissette Zuknick, will serve on the Direct-toCustomer Action Group.

Partner with Walmart.com to Support the FDA Foundation

The FDA Foundation recently partnered with Walmart. com and the Spark Good Round Up program.

Customers with a Walmart.com account can round up their online purchases to the nearest dollar and donate the change to the FDA Foundation.

Go to walmart.com/sparkgood to learn more and to choose FDA Foundation as your ROUND UP charity. Don’t have a Walmart.com account? Sign up today at bit.ly/3pHh9o4.

One hundred percent of your ROUND UP donation is tax-deductible to the extent otherwise allowed by law. You can track the total monetary contributions to Spark Good Round Up in your Walmart.com account.

The FDA Foundation is the philanthropic arm of the Florida Dental Association promoting dental health for all Floridians. A COPY OF THE OFFICIAL REGISTRATION (CH2435) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING 1-800-HELP-FLA TOLL-FREE WITHIN THE STATE OR GO TO http://www.freshfromflorida. com/. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

FDA Past President Dr. David Boden

Represents the FDA at FDLA’s 2023

Southern States Symposium

On June 2, FDA Past President Dr. David Boden represented the FDA at the Florida Dental Laboratory Association’s (FDLA) 2023 Southern States Symposium at the Hilton Signia Bonnet Creek in Orlando. Dr. Boden spoke to attendees and thanked the FDLA for its outstanding partnership with FDA. Dr. Boden sent a thank you letter to

FDLA President Danielle Wünsche, thanking her for the hospitality and inviting members to attend the 2024 Florida Mission of Mercy in Lakeland.

Contact Your Senators to Improve the Dental Workforce Pipeline

The ADA recently sent out an action alert (to view the alert, go to bit.ly/44DkkMs) asking dentists to request their senators’ support for legislation that will address dental workforce issues so that there are enough dentists in underserved areas, offices are fully staffed and more patients can receive dental care.

The FDA encourages you to reach out and urge support for:

● Reauthorizing Action for Dental Health workforce grants directed towards programs for dentists and other dental professionals;

● S. 862, the Restoring America’s Health Care Workforce and Readiness Act, which would double funding for the National Health Service Corps’ (NHSC) scholarships and loan repayment programs for health care workers, including dentists and dental hygienists, who serve in federally designated shortage areas;

● Allowing dental professional student loan borrowers to modify the interest rate on student loans to the current applicable rate; and

● Supporting S. 704, the Resident Education Deferred Interest Act (REDI Act), which would address the difficulty, or inability, of those who must undertake several years of dental residency with very low pay to begin repaying student debt immediately.

The alert provides a sample letter that dentists can send to Capitol Hill by visiting the ADA’s Legislative Action Center. If you have not yet sent a letter to your members of Congress, please do so!

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

Welcome New FDA Members

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

Atlantic Coast District

Dental Association

Dr. Jose Carcamo, Lighthouse Point

Dr. Carolina Garcia, Delray Beach

Dr. Luciano Garcia, Sunrise

Dr. Janet Stoess-Allen, Highland Beach

Dr. Vanessa Mancuso, Fort Lauderdale

Dr. Kelli Riddle, Lighthouse Point

Dr. Elizabeth Rife, Palm Beach Gardens

Dr. Amanda Rodrigues, Boca Raton

Central Florida District

Dental Association

Dr. Nenar Barazi, Palm Bay

Dr. Yesell Candelario Benitez, Winter Park

Dr. Tyler Flynn, Palm Coast

Dr. Muhammad Khan, Orlando

Dr. Andrea Martin, Minneola

Dr. Maria Martinez-Polo, Orlando

In Memoriam

Dr. Duy Nguyen, Lady Lake

Dr. Michael Perna, Saint Cloud

Northeast District

Dental Association

Dr. Adam Crell, Jacksonville Beach

Dr. Zubad Newaz, Jacksonville

Dr. Robert Thousand III, Saint Augustine

Dr. Nathaniel Williams, Saint Johns

Northeast District

Dental Association

Dr. Susan Cottrell, Panama City Beach

South Florida District

Dental Association

Dr. Nicte Babin, Hialeah

Dr. Eliana Burguera, Miami

Dr. Marijan De Vanna, Miami

Dr. Yanel Echemendia, Miami Gardens

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

Laurent Belanger

Saint Petersburg

Died: 06/09/2023

Age: 92

Brian Decker

Newberry

Died: 05/14/2023

Age: 65

William Hale

Beverly Beach

Died: 05/19/2023

Age: 78

Curtis Moore

Tampa

Died: 06/10/2023

Age: 86

Randall Rigsby

Pensacola

Died: 06/05/2023

Age: 69

Bruce Scarola

Brandon Died: 05/06/2023

Age: 65

Dr. Erika Fernandes D’Angelo, Hialeah

Dr. Anat Gozlan, Hollywood

Dr. Megan Levya, Miami

Dr. Sandorf Montero, Bay Harbor Islands

Dr. Faisal Muayad, North Miami

Dr. Lizza Rivera Del Toro,

San German, PR

Dr. Daniela Robaina Rodriguez, Miami

Dr. Evandro Silva, Weston

Dr. Carolina Vizcarra, Doral

West Coast Dental Association

Dr. Isaac Alshrouf, Wesley Chapel

Dr. Nathan Estrin, Sarasota

Dr. Jacqueline Fulop, Sarasota

Dr. Marni Hansill, Bradenton

Dr. Maggie Misch, Sarasota

Dr. Karen Orozco, Fort Myers

Dr. Nicholas Ressel, Weeki Wachee

Dr. Graziela Torino Reginato, Naples

John Westine

Delray Beach

Died: 05/13/2023

Age: 91

Where in the World is Today’s FDA?

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

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

Robert Ettleman Gilbert Principe

GET FREE COURSE TUITION AT FDC2023!

GET FREE COURSE TUITION AT FDC2023!

Tobacco Free Florida

Volunteer to be an FDC Speaker Host.

Volunteer to be an FDC Speaker Host.

Thank you, Dr. Cecilia Hines, for taking Today’s FDA to Budapest, Hungary with you!

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

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

Where will Today’s FDA venture next?

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

Volunteering has its perks!

Volunteering has its perks!

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

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

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

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

Volunteer today at education.floridadentalconvention.com

Volunteer today at education.floridadentalconvention.com

QUESTIONS?

QUESTIONS?

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

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

Nelson Castellano

MORE THAN $1 MILLION PAID TO FLORIDA DENTISTS

AN UNRIVALED MEMBER BENEFIT A REMARK ABLE MILESTONE

Unlike commercial insurance companies, which look for ways to reward shareholders, The Doctors Company is dedicated to rewarding our members. Fif teen years ago, we created the Tribute® Plan, an unrivaled financial benefit that rewards you and your fellow dentists for your loyalty and dedication to superior patient care.

As an organization committed to providing the best imaginable ser vice, we are profoundly honored to have now attained an industr y-leading achievement the distribution of more than $150 million in Tribute Plan awards. While other insurers 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.

CALL FDA SERVICES AT 800.877.7597

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

$20M+

600 + Tribute awards paid to date

$1.3M Tribute balance for Florida dentists LE ARN MORE ABOUT TRIBUTE Visit thedoctors.com/tribute

board of dentistry

Florida Board of Dentistry Meets in Jacksonville

By Casey Stoutamire, FDA Chief Legal Officer

The Florida Board of Dentistry (BOD) met in Jacksonville on Friday, May 19, at 7:30 a.m.

BOD Liaison Dr. Steve Hochfelder and Chief Legal Officer Casey Stoutamire represented the Florida Dental Association (FDA). Dr. Jim Haddix was also in attendance.

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

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

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

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

(1) Dental Record: The dental record shall contain sufficient information to record each patient/dentist in person encounter, identify the patient, support the diagnosis, identify and justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient

The next BOD meeting is scheduled for Friday, Aug.11, 7:30 a.m. ET in Ft. Lauderdale.

histories; X-rays (if taken); examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultation or referrals; identification of all treatments and procedures performed and when they were performed, and copies of records or reports or other documentation obtained from health care practitioners at the request of the dentist and relied upon by the dentist in determining the appropriate treatment of the patient.

The BOD also passed modifications to Rule 64B5-16.0061, supported by both the FDA and University of Florida (UF), which updated the language on the Restorative Function Dental Auxiliary training requirements for dental hygienists. The BOD passed the exact same language for training for dental assistants at its February 2023 meeting. Now, a portion of the training on live patients can be done in a local dentist’s office under his/her supervision. The dentist must complete training beforehand and be calibrated on the clinical requirements and procedures. UF should now be able to include an additional class while also reducing the course tuition.

There were eight disciplinary cases and one voluntary relinquishment dealing with, among other things, failing to meet the minimum standard of care by a general dentist providing orthodontic care, root canals by a general dentist and failing to keep adequate records. It is much better to be a spectator than a participant in BOD disciplinary cases.

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

FDA Career Center

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

CAREER CENTER BENEFITS

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

Searchable Resumes Average Montly Visits Job Views Per Month Average View Per Jobs

Looking for Your Next Recruitment Solution?

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

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

• Quick and easy job posting

• Broad health care field exposure to high quality candidates

• Online reports providing job activity statistics

• Simple, affordable pricing options

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

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

Workforce Problems and Solutions in Florida

By Paul Miller, DDS

According to data from Florida Health and Human Services, Florida needs 1,200 more dental hygienists and 2,500 more dental and administrative assistants. The ADA Health Policy Institute (HPI) surveys showed that nationally, 35.8% of offices are looking for dental assistants, 28.8% are looking for dental hygienists and 26.5% are looking to hire administrative staff. The situation in my county (Pasco) and Florida is considerably worse, with 87% looking for hygienists. According to the Bureau of Labor Statistics, labor costs are up 70.7% across the board in the last six years.

This begs the question: So why do dental assisting and dental hygiene schools need help to attract students? In Pasco County, even though the local dental association offered a $1,000 grant to every student, they only had eight qualified applicants for a 20-space class, so they were forced to close the program.

Data from HPI shows that numbers have been decreasing even before the pandemic. Schools can’t keep pace with the number of retirees and staff who chose to leave the field. The demand for labor has caused dramatic shifts in all the health care professions. Starting wages are higher than wages of long-term staff leading to raises based on the risk of flight versus merit. Twenty years ago, 98% of dental assistants stayed in the same office they started with

untill retirement. That has changed to just 2%. For hygienists, whereas 85% used to live out their time with the first dentist, now only 36% do. Fortunately, a massive influx of people from other states are certified in dental careers, making up 25.1% of the dental ancillary force.

When surveyed by HPI, only 60% of assistants and 54% of hygienists say they feel satisfied with their jobs. The complaints for assistants were low pay, being overworked and unappreciated and the workplace culture in that order. For hygienists, it was first the workplace culture, compensation and then being overworked. Why do I mention these? Because for young adults who have just graduated from high school, these attitudes change how they see their plans for the future. The students of Gen X and Z culture plan their lives around low-anxiety situations and not highstress jobs where the reward is only determined by performance.

From the school’s perspective, they also have the challenge of finding teachers with advanced degrees as required by the Commission on Dental Accreditation (CODA). Some schools have closed or, in the case of assisting schools, decided to continue without CODA approval. Students see tuition as too high for their budgets. Community colleges cannot continue programs without demonstrating local needs to the state and without community support, and that threshold is often not met by administrations.

Our state is in the top three for growth, and many counties like Pasco are in the top 100 for growth in the country. New dentists and corporations know the demographics and set up in those counties and then realize they need to entice employees away from other offices to find staff. This speeds up wage inflation for everyone.

In conclusion, it is up to all of us to think long-term about this problem. Of course, the problem runs deeper than can be described in a few hundred words. Unless we start thinking differently, this situation will worsen quickly. Even in small practices, human resource personnel may be needed to keep employees motivated and maintain a high morale environment. Dental career information needs to be in every office, and staff needs to be ready to answer questions, especially from the parents of students. The dental community and schools need to be represented at career fairs. High school students should be encouraged to shadow

at offices. Schools need to provide related classes that could be taken as dual enrollment credits to reduce the costs and time for matriculation into dental careers. Dentist employers must be more attentive to the needs of their staff so that they can have a good work-life balance and not jump to another practice. The long-term solution is to support the schools and not just job placement companies. Write and speak to your legislators and let them know how much this affects the cost and, ultimately, access to care for everyone.

Dr. Miller can be reached at molar01@msn.com.

Our state is in the top three for growth, and many counties like Pasco are in the top 100 for growth in the country.

dental assisting Florida Dental Assisting Schools

22 Accredited Dental Assistant Schools in Florida

Do you need a dental assistant? More than 21,000 people are employed as dental assistants in Florida. What does this mean for you? Contact the programs below to consider utilizing their required externships.

Santa Fe College: Gainesville

352.395.5000

bit.ly/3IHyfs8

Broward College: Fort Lauderdale

954.201.7350

bit.ly/3OIbVm7

Tallahassee Community College: Tallahassee

850.201.6200 bit.ly/3IFs5IY

Eastern State College: Cocoa

321.433.7575

bit.ly/3qgKDJb

South Florida State College: Avon Park

863.453.6661

bit.ly/3IJrV3z

Manatee Technical College: Bradenton

941.751.7900

bit.ly/3oG5Lbo

Cape Coral Technical College: Cape Coral

239.574.4440

bit.ly/3BVxGaz

Atlantic Technical College: Coconut Creek 754.287.1718

bit.ly/3q9ESNA

Daytona State College: Daytona Beach 386.506.3000 bit.ly/43nAPLQ

Florida State College: Jacksonville 904.713.4545

bit.ly/3qbeiUg

Palm Beach State College: Lake Worth 561.967.7222

bit.ly/42cjiFv

Traviss Technical College: Lakeland 863.499.2700

bit.ly/3WCA2EL

Robert Morgan Educational Center & Technical College: Miami 305.253.9920

bit.ly/3OFac0K

Lorenzo Walker Technical College: Naples 239.377.0900

bit.ly/3BU7kFX

College of Central Florida: Ocala 352.873.5801

bit.ly/3oDhM1h

Orange Technical College: Orlando 407.317.3212

bit.ly/42b9g7F

Charlotte Technical College: Port Charlotte 941.255.7500

bit.ly/436YrET

Pinellas Technical College: St. Petersburg 727.893.2500 ext. 2352

bit.ly/423uZhG

Hillsborough Community College: Tampa 813.253.7279

bit.ly/45zCnEE

Erwin Technical College: Tampa 813.769.5180

bit.ly/3oGi5Zc

Sources: healthcaregraduate.com/dentalassistant-schools-in-florida nursingprocess.org/dentalassistant-programs/florida/

Florida Dental Hygiene Schools

Are you looking to hire a dental hygienist? Florida has 21 accredited dental hygiene schools throughout the state. What does this mean for you? Contact the programs below to assist in filling current job openings.

South Florida State College: Avon Park

561.868.3600 bit.ly/3WINBCz

State College of Florida ManateeSarasota: Bradenton 941.752.5245 bit.ly/3BYQlCj

Eastern Florida State College: Cocoa

321.433.7575 bit.ly/3BYQlCj

Daytona State College: Daytona Beach 386.506.3000 bit.ly/3ovj5zx

Hodges University: Fort Myers

1.800.466.8017 bit.ly/3MFC6ae

Broward College: Ft. Lauderdale 954.201.7350 bit.ly/3OIbVm7

Florida SouthWestern State College: Fort Myers

239.489.9105 bit.ly/438KRAS

Indian River State College: Ft. Pierce

1.866.792.4772 bit.ly/3MWmaSq

Santa Fe College: Gainesville 352.395.5000 bit.ly/3qiaTTx

Florida State College: Jacksonville 904.713.4545 bit.ly/43apSOb

Palm Beach State College: Lake Worth 561.967.7222 bit.ly/3WINBCz

Miami Dade College: Miami 305.237.4141

bit.ly/3WyTySA

Pasco – Hernando Community College: New Port Richey

727.847.2727

bit.ly/3BW2ojV

Valencia College: Orlando

407.299.5000

bit.ly/3MulDpu

Concorde Career College: Orlando

1.800.693.7010

bit.ly/3q55CP8

Concorde Career Institute: Tampa

1.800.693.7010

bit.ly/3Mu0wDy

Gulf Coast State College: Panama City

850.747.3244

bit.ly/3osLxSG

Pensacola State College: Pensacola

850.484.2544

bit.ly/3MXZNfk

St. Petersburg College: Pinellas Park 727.341.4772

bit.ly/3qdLL0o

Tallahassee Community College: Tallahassee

850.201.6074

bit.ly/3MBNAf8

Hillsborough Community College: Tampa

813.253.7426

bit.ly/45AW12Q

Sources:

healthcaregraduate.com/dentalhygienist-schools-in-florida/

The Florida Dental Association presents

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

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

Dental Education and Licensure

Dental Benefits and Care

Membership and Leadership New Dentists

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

Dentistry is Changing!

By Terry L. Buckenheimer, DMD

Dentistry is changing! One of the last, “Cottage Industries,” is undergoing consolidation! Small and large group practices are being formed and taking the shape of Dental Service Organizations (DSOs), corporate entities and private equity holdings. The practice of dentistry used to be single dentists owning their concierge, solo practices.

But, as the market changes, the American Dental Association’s (ADA) Health Policy Institute (HPI) is finding that fewer dentists are privately owning their own practice and dental procedures are being done by dentists in these consolidated clinics with profit, overhead control and EBITDA (earnings before interest, taxes, depreciation and amortization) being the key ingredients to success.

Some dentists fight the changes occurring, while others accept this new market of dentistry and sell their practic-

es at above-average prices. Neither approach is right nor wrong, and it all boils down to how we, as dentists, want to treat the patients that have entrusted their oral health to our care.

Today’s FDA is shedding light on how this new dentistry era affects the dental workforce. Although my past experiences as president of our local society, component and state dental associations and trustee of the ADA have influenced my thought processes, I hope that this article will not be viewed as prejudiced toward any particular workforce model.

Solo practitioners could work at a pace that fits their needs. They knew their margins and needed enough income to cover overhead and team member costs and then have enough left to live comfortably, provide for their families and save for retirement. The patient care model for DSOs and corporations is more geared toward production. To ensure a high patient flow, patients are driven to these practices by marketing plans and social media campaigns. Staff in these locations perform quicker to see more patients. Dentists in these settings are asked to generate a certain amount in fees to keep the engine running. It can lead to higher incomes for staff because of the increased work, but burnout can happen because of the more rapid pace of the practice.

Because dentists are employees of the corporation or DSO, they know the amount of income they are guaranteed, and then bonuses are sometimes worked on the amount of production generated. They can sign a contract providing enough income for their debts and a nice living. But they are employees, and thus there are limitations to the earning power of the dentist. Getting several dentists to work in these settings is relatively easy. New graduates looking for a place to settle and older dentists selling their practices and working for the corporation are all sources of dentists looking for work at a DSO. When a dentist and staff member do not make a good team, there are enough places within these settings to change locations for one or both employees. Since pay is typically higher at the DSO practice, assistants and hygienists are attracted. In traditional models of solo dentists or small groups, assistants, hygienists and front desk staff have a “normal” workflow but advancement to higher-paid positions maybe somewhat limited.

Another trend impacting dentistry is the advancements in technology. Diagnostic tools, digital imaging, practice software systems, scanning, 3D printing and many other advancements are costly. Because of their structure and financing, large DSOs and corporate practices can pool their cash together to purchase these advanced technologies. Single-owner practices may be more limited in their revenue to make such large technological purchas-

The Florida Dental Association and ADA have something to offer dentists working within the DSOs and corporate practices. Advocacy for the proper treatment of patients, oversight of insurance practices and governmental agency interference are all issues best handled by organized dentistry.

es. Large practices with several offices usually acquire better prices when purchasing larger quantities. As for the workforce, those more seasoned assistants and hygienists may need help keeping up with the demands of modern practices. Their choice might be to retire early or become employed part-time to avoid the demands.

The Florida Dental Association and ADA have something to offer dentists working within the DSOs and corporate practices. Advocacy for the proper treatment of patients, oversight of insurance practices and governmental agency interference are all issues best handled by organized dentistry. The HPI of the ADA provides insight into both the newest trends in dentistry and into making the best decisions concerning the economics of the dental profession. Trends can also be determined regarding artificial intelligence and its use in providing common and predictable diagnostics within a practice using multiple providers.

Even with the effects of COVID, the loss of many employees in the dental field, and the changes in the way dental care is delivered, the future is bright for dentistry. The efforts of dedicated people (especially dentists) who put the care of patients before all else will eventually solve the problems associated with the trends we face today.

tlbdmd1@gmail.com

Dr. Buckenheimer can be reached at

Beyond the Money: How to Retain Your Top Team Members

By Suzanne Ebert, DMD

Retention is a growing problem – but there are ways to ensure your best team members feel engaged, satisfied and rewarded. In this article, you’ll consider how to hire the right person (the first time), help nurture your teams’ professional development and goals and do the “little things” that can foster a better workplace.

Retaining your best team members is hard, but recruiting qualified staff is even more challenging — 74% of private practice dentists report that it is “extremely challenging” to find qualified dental hygienists (go to bit.ly/3XsJafJ to view information).

While raises and benefits can help, you can also decrease turnover by ensuring your best team members feel engaged and satisfied. Let’s explore how to boost staff satisfaction and retention.

Hire Someone with the Right Personality and Shared Expectations

Retention starts with hiring the right person for your practice. Pay attention to how a prospective hire can fit in to support you, the rest of the team and your patients. Specific skills can be trained; finding someone with the right personality, work ethic and similar expectations is more important.

To identify the right person, listen closely during the interview process. Discuss how the office runs and how that meshes with your prospect’s experience, preferences and expectations. Review a typical week’s schedule to de-

tail how the team works together, how roles are divvied up, the typical pace and how time off is covered.

Nurture Your Team’s Professional Development

More money only goes so far if your team is miserable. Help team members define (and pursue) a satisfying career path. Ask each team member about their goals, including:

● What do they want to learn?

● Would they like more autonomy? More mentorship?

● Do they want to manage junior staff or take a more significant role in the business?

Make a plan to help each team member reach their goals with concrete actions and dates. Revisit these conversations periodically to check in and celebrate progress and problem-solving.

Do “Little Things” That Add Up

Make sure you show appreciation for your team’s hard work. Even little things matter, such as treats, unexpected extra PTO or competitions with prizes. Recognize birthdays and work anniversaries. A handwritten note or sincere thanks can be gratifying.

Pass along compliments from patients. Share these publicly during a team meeting or on your practice’s social media.

Try to be flexible to help your team balance personal commitments. Ask about their ideal schedule — you may discover easy adjustments that allow one team member to attend their child’s Wednesday afternoon activity and another to hit their favorite Friday yoga class.

Fundamentally, ensure you are always treating your team fairly and with respect.

Be the Kind of Leader that Inspires Your Team

The reality is that good people stay when they are happy, appreciated and empowered. It is less about the money and more about the environment. Are you helping your best people advance? Are you LISTENING to their concerns? If you value honesty and integrity, do you display those qualities daily?

As the practice leader, it’s up to you to establish and nurture an atmosphere that encourages team members to stay, resulting in more satisfaction for everyone, including patients.

ADA Practice Transitions™ can help you buy or sell a practice, hire an associate or find an associateship. Visit adapracticetransitions.com to learn how to get the support you need throughout the process.

Dr. Suzanne Ebert is the Vice President of Dental Professional Career Services at the American Dental Association and can be reached at eberts@ada.org

Fundamentally, ensure you are always treating your team fairly and with respect.

The reality is that good people stay when they are happy, appreciated and empowered. It is less about the money and more about the environment.

How Do DSOs and Private Practices Work?

By Greg Auerbach, MBA, Henry Schein and Stuart Auerbach, DDS, Henry Schein

Operating and maintaining a quality dental practice or business takes work. Doing both at the same time can be incredibly difficult. Further, the complexity is only magnified as the individual practice grows into a multi-location or multi-doctor practice. Staff and associates are the highest singular expenses of any dental practice (both in dollars and personal energy) and can be the most difficult to control. Let’s consider how this looks for the multi-location/DSOs versus private practice.

For general practitioner associates, it is first important to note that while an associate rarely controls it, pay is typically on collections or “net” production. Private practice compensation is often better than a corporate office at 30% to 35%, but those opportunities can be limited.

In a corporate model, compensation typically ranges from 25% to 33%, and positions are consistently available in nearly every part of the state. In these cases, most practices are in a network with many dental insurance plans, so paying on usual, customary and reasonable (UCR) production is unrealistic due to discounting/write-offs. Corporate offices constantly need to retain associates and may offer a minority equity share as an incentive. This attempts to increase stickiness to the practice, creating a higher barrier

Greg Auerbach

Stuart Auerbach

to leave. Initially, this may not be offered to new grads/hires, but we often see it in the medium term to incentivize staying with the practice by receiving an “owners” share of the profits. One DSO in Florida has been offering this for many years, with others adding it recently.

This is nearly always a requirement for sellers transitioning to the DSO model, and it is sold as the possibility of a lucrative increase in a future practice sale. This does not come without risk, though.

Beyond practitioner staffing, team retention continues to be difficult. Staff compensation increased across all positions even as about 30% of the dental workforce says that it is considering or actively applying for a job change. The American Dental Association’s (ADA) statistics show that team members, especially clinical, prefer to work in private practice. Still, corporate entities typically have more capacity to absorb a higher staff cost when necessary.

How much have staff costs increased with the tight labor market? Hygienist salaries are up 4.5% in private and 7.5% in DSO practices — assistants 7.25% and 9.5%, respectively. The general office staff is up 8.5% in private practice but just 1% in DSOs, indicating a strong push for the private practitioner to retain those team members. Beyond salaries, benefits are now also nearly universally expected. This can include vacation, sick days, holidays, retirement plans, dental work, health insurance and even paid conference attendance. When asked, higher pay, positive work culture and

appreciation from their employer were among the top reasons dental professionals sought to change jobs. Note it does not appear that DSOs are mainly responsible for the shortages in staffing, as overall attrition from the jobs themselves seems to be more constraining.

Everyone is feeling the pinch. The survey results report increases in team income and benefits to correspond to the gains we’ve seen in the practice financials of our valuations.

In most cases, this is not yet noticeably suppressing practice value. It is imperative to continue developing productivity from your team as their share of the overhead goes up to keep individual expense ratios reasonably controlled and your business’ overall viability strong.

Mr. Greg Auerbach is a transition specialist and consultant for Henry Schein and can be reached at Greg.Auerbach@ henryschein.com. Dr. Stuart Auerbach is a transition specialist and consultant for Henry Schein and can be reached at Stuart.Auerbach@henryschein.com

It is imperative to continue developing productivity from your team as their share of the overhead goes up to keep individual expense ratios reasonably controlled and your business’ overall viability strong.

Event Information

West Palm Beach, FL

Drive Shack

1710 Belvedere Rd, West Palm Beach, FL 33406

Seller Seminar

Friday, February 17th, 2023

9:00 a.m. to 1:30 p.m.

Aspiring Owner Seminar

Saturday, February 18th, 2023

9:00 a.m. to 5:00 p.m.

Tampa, FL

Top Golf

10690 Palm River Rd, Tampa, FL, 33619

Seller Seminar

Friday, September 29th, 2023

9:00 a.m. to 4:30 p.m.

Aspiring Owner Seminar

Saturday, September 30th, 2023 9:00 a.m. to 5:00 p.m.

Are You Ready for Ownership or Retirement? Start Planning Today.

We cordially invite you to attend this immersive seminar about planning for your future. Learn from industry experts on how to successfully navigate selling or buying a practice as well as starting a practice from scratch. RSVP today and choose the location closest to you.

Topics of Discussion

Aspiring Owner Seminar

● Zero down financing: Acquisitions, startups and commercial real estate

● Buying or starting from scratch –What is right for you?

● Learn the 13 steps to a successful startup

● Taxes, allocation, and financial reporting. Designed for success and growth

● Legal review: LOI, lease, asset purchase agreement and more

● Trends to attract/retain employees in today's marketplace

● Do's & Don'ts of personal insurance and financial planning

Seller Seminar

● How to prepare for a future practice transition

● What a dental practice is worth and what determines value

● Market conditions & trends

● Should I sell my practice to a DSO (Corporate Dentistry)

● Legal review: From LOI through closing and everything in between

● Pitfalls of the legal process

● How to prepare your business financials and documentation

● Taxes, allocation, and how to minimize costs

Featured Speakers

Scan to register today!

Greg Jones, Dental Practice Broker Doctors Choice

Jason Kaplan, Esq. Palm Beach Law Group

Michael DeMeola, CPA, CVA, CFE Getsee & DeMeola CPA

Informed Refusal

By Richard F. Cahill, JD, Vice President and Associate General Counsel, The Doctors Company

Consistent with the evolving trend of increased patient autonomy and patient participation in the decision-making process, individuals with adequate mental capacity are provided an appropriate disclosure of the options, risks, benefits, costs and likely outcomes of care are legally entitled to exercise their freedom of choice.

They may choose not to undergo any recommended course of treatment, despite potentially dire consequences.

Over the last decade, the concept of informed refusal has often created confusion for the medical and dental community regarding its legal importance in the clinical setting. When a patient declines recommended treatment and an adverse event occurs — even though it may

be the result of the natural course of the disease process — the patient may retain counsel and pursue a professional liability claim. In that setting, the plaintiff may contend that if a complete discussion had taken place about the consequences of failing to accept the recommended treatment, the patient would have taken the health care provider’s advice and achieved a better outcome. A better outcome might include increased longevity, an enhanced quality of life, no loss of earnings or earning capacity and no out-of-pocket expenses.

Informed Consent Process

Before a patient can provide an informed refusal, the informed consent discussion must take place. Informed consent is an ongoing process, not simply executing a document that describes the proposed course of treatment with a laundry list of possible adverse consequences.

The informed consent conversation should be candid and include a clear discussion of the patient’s existing condition using terms that are readily understandable. Discuss the available treatment options along with the associated benefits, risks, anticipated costs and short-term and extended prognoses. Finally, outline the consequences of failing to undertake any treatment. Provide the opportunity for patient questions to be asked and answered.

dure. A clear discussion in advance decreases potential misunderstandings, disappointment, surprise or even anger if an undesirable result occurs. For a more detailed discussion of informed consent, see our article “Informed Consent: Substance and Signature” at bit.ly/3UneUkA.

Informed Refusal Process

Conduct the informed refusal dialogue with the same degree of specificity and care used in the informed consent discussion. If a patient indicates an unwillingness to undertake treatment — especially if failure to do so may result in death — attempt to determine the basis of the patient’s decision. It may simply be a misunderstanding about factors that can be resolved, such as the patient’s treatment options, what the treatment entails, costs or payment methods. Partner with the patient to overcome treatment barriers when possible.

of treatment options and the risks of refusal and improved documentation may all help to reduce the risk of professional liability claims when the patient declines to follow

recommendations.

The health care provider ordinarily must always conduct the discussion directly and never delegate it to a staff member. Otherwise, critical communication may be obscured or inadvertently omitted and patient inquiries may be inaccurately addressed. The statutes governing advanced practice clinicians are currently being revised in many states. In the event that an independent advanced practice clinician is involved in the treatment, it is recommended that you consult with the law in your jurisdiction regarding how the applicable statutes may affect the consent process.

During the informed consent process, it is imperative to provide the patient with realistic expectations of what might be achieved by the treatment, therapy or proce-

The health care provider should assess and document the patient’s capacity to understand the information and to make a reasoned decision based on the facts presented. The provider’s assessment must recognize that a patient’s ability to comprehend may be impaired by factors that might include mental or emotional issues (such as dementia), cultural or language barriers or personal issues (such as substance abuse).

If the result of the assessment is that the patient may not be competent to give an informed refusal, the provider should consider involving the facility risk manager (if applicable) for further guidance or contacting a member of the patient’s family to ask if an advanced directive

Increased communication, enhanced patient understanding

or a health care power of attorney has previously been executed. Document all conversations with the patient, facility risk manager and family members (including the reason for believing that the patient may not be competent).

Documentation Strategies

In the event of litigation, the patient record is one of the most important components of the defense. Regardless of the record format, document the details of all informed consent or informed refusal discussions. The documentation should include when and where the discussion occurred; who participated or was physically present; the options, risks, benefits, costs and possible outcomes addressed; and a notation that the patient’s questions were answered.

Documentation of a refusal should also include the following notations in the patient’s record:

• Information the provider gave to the patient concerning the patient’s condition and the proposed treatment or test. Reasons for the treatment or test should also be noted.

• The patient was advised of the possible risks and consequences of failing to undergo the treatment or test, including the loss of life or limb, if appropriate.

• The provider’s referral to a specialist, including the reasons for the referral and the possible risks of not seeing the specialist.

• The patient’s refusal of the treatment/testing plan or advice. In this circumstance, consider asking the patient to sign a specific refusal form. (See TDC’s

sample form “Refusal to Consent to Treatment, Medication, or Testing” at bit.ly/437JYrC). Although a form is optional, it offers providers the strongest protection against subsequent claims alleging a lack of informed consent.

The paternalistic approach to providing care has given way to a much more patient-centered environment in which patients enjoy greater autonomy and participation in the delivery of professional services. (View our article “Best Practices in Patient-Centered Care and Shared Decision Making” at bit.ly/41kPlmJ.) Increased communication, enhanced patient understanding of treatment options and the risks of refusal and improved documentation may all help to reduce the risk of professional liability claims when the patient declines to follow recommendations.

For guidance and assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at 800.421.2368 or patientsafety@thedoctors.com

The guidelines suggested here are not rules, do not constitute legal advice and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission from The Doctors Company.

Richard F. Cahill, JD, Vice President and Associate General Counsel, The Doctors Company,

can be reached at rcahill@thedoctors.com

Becoming a Special Needs Warrior: Your Training Begins Here

By Jacob Dent, DDS, FDC 2024 Speaker

Working on teeth is as easy as riding a bike for many of us who went into the dental profession. We know the what, why and how when it comes to oral health care. Unfortunately, most dental providers and team members (including me) rarely have any previous training on how to care for patients who are intellectually or developmentally disabled.

Dental school for me was abysmal regarding any real-world training or experience working with special needs patients.

“That is pediatrics’ responsibility.”

“It is not your problem, so do not worry about it.” This is what I was told when it came to treating patients with intellectual or developmental disabilities when I was in school, and I believed it. As fate would have it, in 2006, my son was diagnosed with moderate autism spectrum disorder, and my personal and professional world were

changed forever. I realized how inept I was when it came to my base knowledge of autism as well as other forms of intellectual and developmental disabilities, including Down syndrome and cerebral palsy. These conditions have unique intellectual, physical, sensory, behavioral and dental characteristics and challenges.

For 10 years after my son’s diagnosis, I spent as much time as possible learning how to treat patients with special needs with an outside-the-box approach to the status quo regarding persons with intellectual and developmental disabilities. This journey led to redesigning my practice to be sensory-integrated and focusing on desensitization versus sedation.

A great example of this outside-the-box approach happened in 2018, when I first met Rosie and her family. At that time, Rosie was four years old and very medically compromised. She was adopted from an orphanage in Russia along with her two older brothers, who were also severely intellectually and developmentally disabled. Rosie had extensive dental needs due to the neglect she suffered at the orphanage. She was extremely anxious about any doctor because of the multiple surgeries she had already had to undergo for her physical disabilities. Unfortunately, Rosie could not be sedated any more that year per her medical doctor without severe risk to her cognitive abilities. Medical immobilization and stabilization were also unavailable because of complications from her recent spinal surgery that made it so she could

not lie down flat. So, we adapted our dental environment and procedures to meet Rosie where she was. Allowing her to remain in her stroller, we utilized silver diamine fluoride to treat her active decay and glass ionomer filling material to cover affected areas that were in need using a silver modified atraumatic restorative treatment technique. This halted her disease progression, and over the next five years, we were able to treat all of Rosie’s dental needs with desensitization and have not had to sedate her once.

At the end of the day, as a dentist, hygienist, assistant or team member, you will have people with special needs walk into your practice who need your help. Treating patients with intellectual or developmental disabilities requires more time, patience and emotional skills versus dental skills. It does not always go well, and not every visit succeeds. However, after learning the basics in my “Becoming a Special Needs Warrior: Your Training Begins Here” course at FDC2024, you will have the competence and confidence to return to your office and begin your journey as a special needs warrior.

Dr. Dent earned his dental degree from Louisiana State University School of Dentistry. He is an Academy of Dentistry International fellow and clinical director for the Special Olympics Special Smiles. Dr. Dent is the co-founder of Brush and Bite Collection and maintains a private practice in Lake Charles, LA. Dr. Dent will present his course at FDC2024 and can be reached at drdent@specialneedswarriordoc.com

I spent as much time as possible learning how to treat patients with special needs with an outside-the-box approach to the status quo regarding persons with intellectual and developmental disabilities. This journey led to redesigning my practice to be sensory-integrated and focusing on desensitization versus sedation.

ON YOUR SCHEDULE

DENTAL RADIOGRAPHY CERTIFICATION ON YOUR SCHEDULE

Take the first step on the path to dental radiography certification. Train online, at your own pace. Study anywhere!

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

*Non-members pay $385.

IN THE KNOW WITH GAO

Webinar series for FDA members to stay informed on legislative and political issues.

The Florida Dental Association’s Governmental Affairs Office (GAO) would like to invite you to join in on our listening sessions to learn about legislative issues that may have an impact on the dental profession, political issues that could affect the dental industry, and a number of other hot topics that may be of interest to you!

The listening sessions will be scheduled for mid-afternoon, 30-minutes long and will allow you to ask questions of the speakers. These sessions are meant to give you a quick update on issues and topics during your lunch hour, without interrupting the flow of your day.

POTENTIAL GUESTS:

• Elected officials (federal, state and local)

• Candidates running for office

• State agency and department heads

• FDA Members

• National dental leaders/experts

GOVERNMENTAL AFFAIRS TEAM:

JOE ANNE HART Chief Legislative Officer jahart@floridadental.org

ALEXANDRA ABBOUD Governmental Affairs Liason aabboud@floridadental.org

JAMIE GRAVES Legislative Assistant jgraves@floridadental.org

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

By the American Dental Association

SmileCon® 2023, the American Dental Association’s (ADA) reimagined annual meeting, heads to Orlando, Oct. 5–7. SmileCon, a new kind of dental meeting, is changing how dental professionals gather. Learning is always in session, but so is having fun and connecting with your peers!

Actor Constance Wu will be the keynote speaker at the opening session on Oct. 5, kicking off the meeting by discussing wellness and her personal journey. “Her words will be a vital reminder to all who hear them that taking care of yourself is the first step in sharing your talents with others,” said ADA President Dr. George R. Shepley. The opening session also includes recognition of the ADA 10 Under 10 Award winners, musical entertainment and remarks from Dr. Shepley.

The line-up of educators includes big names and new voices who will ignite your passion for learning and bolster your career goals.

One featured speaker at this year’s SmileCon will be Dr. Uche Odiatu. Dr. Odiatu is a practicing dentist in Toronto and a National Strength and Conditioning Association (NSCA)-certified personal trainer, author, certified yoga instructor and boot camp instructor. His courses will focus on nutrition, gut health and fitness and how they impact your patients’ overall health and your perfor-

mance as a health care professional. “My goal for my audiences is to ignite or reignite their enthusiasm for total patient health,” Dr. Odiatu said. “I am using my insider strategies as an NSCA-certified personal trainer, lifetime athlete experience and practicing dentist. The new science of the mouth-body-mind connection is very compelling.”

To view the full course list and speaker line-up visit the Agenda Builder at smilecon2023.eventscribe.net/.

Dental Central, the heart of SmileCon, will be filled with hubs where dentists and team members can meet, play, learn and smile.

New this year to the reimagined exhibit hall is the Oral Medicine Hub, where dentists can earn an hour of continuing education (CE) credit by completing a dental-themed escape room with teammates.

“SmileCon is thrilled to showcase our very own escape room in Dental Central this year,” said Dr. Victor Rodriguez, a member of the ADA

Advisory Committee on Annual Meetings who is helping to plan the Oral Medicine Hub. “The hub will be interactive, allowing participants to answer questions and learn about pathology and oral-systemic connections in an escape room format.”

Another new area will be the Wellness Hub, where attendees can find support for their physical, mental and financial wellness — from learning best ergonomic practices for addressing the neck, back, hand and other pain that often plagues dentists to shutting out the noisiness of the day by unplugging in a quiet area.

Returning this year is the Dental Team Hub, which last year brought together thousands of dentists and their team members for CE and networking opportunities designed specifically for teams.

The Podcast and Influencer Hub are also back, bringing dentistry’s top podcasters to the SmileCon stage, where dentists can catch a behindthe-scenes glimpse at how podcast magic is made and interact with influential dental thought leaders.

Dental Central will also highlight the latest dental technology in the Tech Hub, including augmented intelligence (AI). Attendees can learn how to use AI in their practices and get excited about future technological breakthroughs. Dentists can also learn about other cutting-edge products from exhibitors in Dental Central.

On Thursday, Oct. 5, the ADA has reserved the entire Universal Islands of Adventure theme park, hosting a

Grin & Gobblin’ Fest on Friday night — so get ready for a spooktacular time and having a closing party in Dental Central on Saturday.

Registration for SmileCon is open at SmileCon.org. Registration options include the Smile Pass, Platinum Smile Pass and Dental Central Pass. All three give you access to the opening session, Dental Central and Saturday Keynote.

The Smile Pass — the meeting’s most popular pass and best value — gets you in the classroom for a wide variety of CE. You can also add hands-on activities (workshops) for an additional fee.

For those who want it all, the Platinum Smile Pass features most hands-on activities at no additional

charge, fast-track entry into presentations and other special upgrades. The Botox course is available for an additional fee.

The Dental Central Pass is a great option for those who just want a taste of SmileCon and do not need much CE. It provides access to Dental Central, the CE offered there (related to wellness, technology, and the dental team) and exhibits.

Pricing for an ADA member dentist is $499 for the Smile Pass, $3,499 for the Platinum Smile Pass and $149 for the Dental Central Pass. This pricing ends Sep. 22.

Be a part of the SmileCon magic Oct. 5–7 in Orlando at the Orange County Convention Center. Register today at SmileCon.org

Learning is always in session, but so is having fun and connecting with your peers!

The beauty of the AI in the glidewell.io™ In-Office Solution is that you can take on as much of the responsibility of designing crowns as you want. I enjoy taking a hands-on approach with my cases, but I can always combine that with the AI tool, and glidewell.io has made me a better dentist for it. To anyone hesitant about going digital, I 100% recommend glidewell.io. This technology is a great benefit to any practice and their patients.

Effortlessly mill the crowns you want when you want:

• Mill fully sintered BruxZir® crowns and bridges with no oven time required — just polish and cement, and you’re done.

• Let MarginAI™ and CrownAI™ do the design work for you so you can spend your time with your patients.

• You’re connected directly to Glidewell for training and support at any time.

• Love your scanner? Great — glidewell.io is an open system and works with your preferred scanning system.

We’ll show you how easy same-visit crowns should be! Scan the code to learn more about glidewell.io.

Pair

Contact

$49,995

− Sandeep V. Patel, DDS, FAGD | Daytona Beach, FL Graduate of New York University glidewell.io user since 2021

Practice Consolidation Is Cresting

It’s

Time to Understand the Value of Your Practice

Silent Partners Buy Part of Your Practice

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

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

Long-Term Wealth Building Partnership

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

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

Six or More Choices in Partnership

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

Your Value in Today’s Consolidation Frenzy

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

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

Diagnostic Quiz

By Drs. Saja Alramadhan, Neel Bhattacharyya and Nadim M. Islam

A 47-year-old female was presented to Dr. Angela Wilson, a periodontist in Lawrence, KS, to evaluate a lesion on the maxillary gingiva. The patient’s medical history was unremarkable. The lesion was painless and was first noted by the patient around 18 months ago. Clinical examination revealed a mucosal-colored “slightly red,” smooth-surfaced, sessile mass on the facial interdental papillae of teeth # 10 and 11 (Fig. 1 A-B). An excisional biopsy was performed, and the specimen was submitted to the University of Florida Oral Pathology Laboratory Biopsy Service.

Question:

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

A. Drug-induced gingival hyperplasia

B. Peripheral giant cell granuloma

C. Gingival cyst

D. Neurofibroma

Fig. 1. A-B. Slightly red, smooth-surfaced, sessile mass on the facial interdental papillae of teeth # 10 and 11.

Fig. 2. A. Nodular cellular mass. B, Diffuse spindle-shaped cells (arrow) with numerous mast cells (circle) distributed within delicate collagen bundles.

diagnostic discussion

A. Drug-induced Gingival Hyperplasia

Incorrect. Gingival overgrowth associated with medications can occur anywhere on the gingiva but usually is not isolated, as seen in this case.

In addition, the patient’s medical history did not indicate that she was on any offending medication. Medication-related overgrowth of gingiva can be an adverse effect of various systemic medications. The most well-recognized associations are with phenytoin, cyclosporine and nifedipine, although other anticonvulsants, immunosuppressants, calcium channel blockers, oral contraceptives and antibiotics have also been implicated in some studies. Poor plaque control is considered a significant contributing factor. Genetic factors are also likely involved, as certain histocompatibility leukocyte antigen types and other genetic polymorphisms have been associated with increased or decreased susceptibility.

In many cases, drug-induced gingival overgrowth develops within the first one to three months of starting drug treatment, with a second peak observed after 12 months. The gingival enlargement is often multifocal, unlike the solitary lesion in this case. Lesions begin in the interdental papillae, particularly in the anterior and facial segments. As it progresses, the overgrowth may become more diffuse, partially or fully covering adjacent tooth crowns. The tissue may exhibit varying degrees of fibrosis and inflammation, and the mucosal surface can appear lobulated, smooth, granular, pebbly or papillary. Some patients may experience difficulties with speech, mastication and aesthetics. Discontinuation of the offending medication(s) or switching to an alternative drug may cease the progression and potentially induce regression. Effective plaque control, including professional cleaning, frequent recall visits, reinforcement of oral hygiene practices and chlorhexidine rinse, is also beneficial. Surgical removal of excessive gingival tissue may be considered in severe or refractory cases. In this case, the clinical presentation and the lack of known medication preclude the diagnosis of medication-related gingival hyperplasia.

B. Peripheral Giant Cell Granuloma

Incorrect. Good consideration! Peripheral giant cell granuloma (PGCG) is a reactive lesion typically arising from local irritation, such as dental calculus or chronic trauma. The typical purplish-blue coloration of PGCG was absent in this case, as was the frequently noted resorption of the immediate underlying bone. PGCG is usually asymptomatic and exclusively found on the gingiva or alveolar ridge, typically in the anterior region.

Additionally, they often cause superficial “cupping-out” resorption of the alveolar bone. Peripheral giant cell granulomas are more frequently observed in females and commonly present as sessile interproximal lesions. A notable characteristic of peripheral giant cell granuloma is its distinct purplish-blue color, which often aids in distinguishing it from other bumps on the gum. Peripheral giant cell granuloma displays very characteristic histologic features. Therefore, it is important to biopsy these lesions and submit the tissue for histologic examination, as soft tissue tumors and even malignancies can mimic bumps on the gum.

C. Gingival Cyst

Incorrect. Great choice! As their name implies, gingival cysts typically present as cystic lesions with a bluish and dome-shaped appearance. The lesion seen here did not appear to be cystic; instead appeared fleshier and reddish. Also, the location of gingival cysts is very characteristic and an essential clue to their diagnosis. These cysts share similar microscopic features with the lateral periodontal cyst, their bone counterpart. Like the lateral periodontal cyst, gingival cysts demonstrate a striking predilection for the mandibular canine-premolar region in about two-thirds of cases. These cysts commonly occur on the facial gingiva or alveolar mucosa and rarely on the marginal gingiva, as seen here. They originate from remnants of the post-functional dental lamina. Clinically, lesions appear as painless, dome-like swellings with a bluish or bluish-gray appearance. Occasionally, the cyst may cause a superficial “cupping-out” resorption of the alveolar bone, which cannot be detected through radiographs. Although it may resemble mucocele, it is im-

portant to note that the clinical differential diagnosis of mucocele is incorrect for gingival cysts, as salivary gland tissue is absent in the gingiva.

D. Neurofibroma

Correct. Excellent! Neurofibroma is a rare gingival example of a benign neoplasm, which is fairly common on the skin. A neurofibroma is a benign tumor composed of Schwann cells, perineural fibroblasts and axons. It is the most common peripheral nerve tumor. While it is commonly found on the skin, it can also occur within the oral cavity. A neurofibroma typically presents as a slow-growing, painless, soft nodular mass. Solitary tumors are most commonly diagnosed in young adults, and if multiple tumors are present, it strongly suggests the possibility of neurofibromatosis type I.

In some cases, neurofibromas can occur within the bone and may appear as single or multiple radiolucent areas. It is important to consider the possibility of neurofibromatosis in any patient with multiple neurofibromas. Surgical removal is the primary treatment for solitary tumors; recurrence is rare. While the malignant transformation of a solitary neurofibroma is uncommon, individuals with neurofibromatosis have an increased risk of developing a malignant peripheral nerve sheath tumor. Histologically, neurofibroma appears as diffuse interlacing bundles of spindle-shaped cells that often exhibit wavy nuclei. These cells are distributed within delicate collagen bundles (Fig. 2 A). In some cases, variable amounts of myxoid matrix are also seen. A notable feature of neurofibroma is the presence of numerous mast cells, which can aid in the diagnosis (Fig. 2 B).

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

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

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

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

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

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

References:

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

2. Agrawal AA. Gingival enlargements: Differential diagnosis and review of literature. World J Clin Cases. 2015;3(9):779-788. doi:10.12998/wjcc.v3.i9.779.

3. Venkataswamy, Asha Reddy; Ranganath, Shesha Prasad; Challapalli, Sri Manasa; Mohanthy, Leeky1. Non-syndromic solitary neurofibromas in the oral cavity: Case series and literature review. Journal of Indian Academy of Oral Medicine and Radiology 28(1):p 52-56, Jan–Mar 2016. | DOI: 10.4103/09721363.189992.

4. Bhattacharyya, I. Oral Neurofibroma. https://emedicine. medscape.com/article/1079193-overview.

5. Dayal P, Ahmed J, Ongole R, Boaz K. Solitary neurofibroma of the gingiva. Saudi Med J. 2014;35(6):607-611.

Dr. Alramadhan

Dr. Bhattacharyya Dr. Islam

FDA’s Career Center

The FDA’s online Career Center allows you to conveniently browse, place, modify and pay for your ads online, 24 hours a day. Our intent is to provide our advertisers with increased flexibility and enhanced options to personalize and draw attention to your online classified ads!

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

Associate Dentist Position, Lakeside Family Dental Care, Spring Hill. Associate Dentist Needed. We are a privately-owned practice, looking for an extremely motivated and talented General Dentist to join our growing dental team! We work with patients of all ages. LakesideFamilyDentalCare. 8454 Northcliffe Blvd. Spring Hill, FL 34606. (352) 686-1122. Job Type: Full-time, Commission. Job Types: Full-time, Contract. Florida License, Active DEA. Visit careers.floridadental.org/jobs/18678694/.

Periodontist, Tallahassee. Great career opportunity in a growing practice in Tallahassee, FL. Full time associateship with opportunity to buy into the practice. Visit careers. floridadental.org/jobs/18674347/.

Space Coast dental office building, property & equipment for sale. Free standing 2883 sq ft building, 4 operatories equipped, 6 others plumbed. Perfect for general dentist starting out, dental specialist or medical doctor. Equipment is functional but older Pelton Crane that could be updated gradually. The office is located in the middle of a 7 mile stretch of residential homes (3 miles to the north and 4 to the south) and is the only dental office on this east side of Merritt Island. The property is also 1.5 miles from the new hospital under construction making it ideal for a medical office. $600k Property, Building & Equipment. Send inquiries and cell phone number/ contact info to : STA@cfl.rr.com. I will initially respond with same by text message. Photos and specs on request. Visit careers.floridadental. org/jobs/18444978/.

Interin Services, Robert Zock, DDS, MAGD, PA. General Dentist Will Travel Anywhere in Florida:Sick Leave, maternity leave, vacation or death, I will cover your practice so that production continues while you are out. Experienced in covering general dentists, pedodontist and orthodontist. Please call or text Robert Zoch, DDS, MAGD at 512517-2826 or email: drzoch@yahoo. com. Visit https://careers.floridadental.org/jobs/18047931/.

General Dentist, Healthcare Network, Naples. This position will provide comprehensive dental care to patients in a primary health care delivery system. The dentist assumes the responsibility of providing the best care possible for all of patients. Provide preventive and restorative treatments for problems affecting the mouth and teeth. High moral character, ethics, and conduct are mandatory. Responsibilities and Standards. Perform oral examinations of hard and soft tissue while working with patients to maintain and restore quality health to everything within the mouth. Examine teeth and diagnose patients’ dental conditions by using tools such as x-rays, dental instruments, and other diagnostic procedures. Clean, restore, extract, and perform oral replace teeth, using rotary and hand

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

Post an ad on the FDA Career Center and it will be published in our journal, Today’s FDA, at no additional cost. Today’s FDA is bimonthly, therefore, the basic text of all active ads will be extracted from the Career Center on roughly the 5th of every other month (e.g., Jan. 5 for the Jan/Feb issue, March 5 for the March/April issue. etc.).

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

instruments, dental appliances, medications, and/or surgical equipment. Evaluate the current health and condition of the patient’s teeth to determine diagnosis of dental condition, if any. Completes treatment planned procedures that are agreed upon by patient and parent/ guardian, such as restoring teeth affected by decay and treating gum disease. Perform Dentistry services, including the diagnosis and treatment of diseases, injuries, and malformations of teeth, gums, and related oral structures. Consults with the patients and advises them of their dental status, prescribes the treatment required, provides risks and alternatives. Perform oral cancer examinations, take and interpret radiographs and provides limited prosthodontic services. Provide dental services at any and/or all HCN dental facilities as necessary to meet department needs. Supervise and evaluate dental students and residents during their rotations at HCN’s dental facilities as agreed upon with the AEGD Director Performs other related duties as indicated or when requested by a supervisor. Job Specifications. To view the full version of the ad, please visit careers.floridadental.org/jobs/18707921/.

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

Seeking Qualified Dental Radiographer?

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

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

compromised children to perform restorative procedures under general anesthesia. Job Specifications. To view the full version of the ad, please visit careers.floridadental.org/ jobs/18561218/.

General dentist, Melbourne. Patient centric privately owned dental office is seeking a full-time associate. The owner dentist has spent the last 21 years building a reputation focused on excellence in the Florida Space Coast community. We pride ourselves on developing patient relationships, employing the latest technology, and constantly innovating with the times. Our completely digital office utilizes CEREC Primescan and Primemill CAD/CAM , Sirona XG3D CBCT, Sprint Ray 3D printers, soft tissue diode laser and intra oral cameras. We also have a knowledgeable and supportive dental team with over 200 years of experience combined. We are looking for a motivated and compassionate person who is comfortable with comprehensive treatment planning. Minimum of 2 years of experience with surgical, implant, and CEREC knowledge preferred. Please forward resume or CV to Ree@chenetdental. com. Two years’ experience, active FL license. Visit careers.floridadental. org/jobs/18805298/.

Dentist, Tampa Family Health Centers. In accordance with the policies and procedures of Tampa Family Health Center, Inc., the General Dentist performs professional dental care in the diagnoses and treatment of patients; performs all duties according to Florida statute as

it pertains to general dentistry.

Essential Functions:

• Provides care in the following disciplines of a general dental practice: Diagnosis, preventative dentistry and restorative dentistry. • Proficiency in the diagnosis and treatment of dental oral diseases. • Proficiency in the principles, standard practices methods and techniques of dentistry.

• Proficiency in preventative dentistry and educational methodologies utilized in prevention.

• Proficiency in oral operative techniques and ability to establish and maintain effective working relationships with patients and staff.

• Maintains timely and accurate electronic health record documentation on all patients including office visits and telephone calls, if applicable.

• May be required to work in multiple locations. General Duties:

• This position requires traveling to cover different locations when needed.

• Performs other duties as assigned by COO, CMO, or Director of Dental Operations.

• Support the Mission, Vision and Values of Tampa Family Health Centers (TFHC). • Effectively and efficiently completes all duties as assigned.

• Adheres to all HIPAA, State, Federal, accreditation agency, and HRSA rules and regulations, and TFHC policies and procedures.

• Is accountable to ensure patient rights and ensures an environment that promotes the privacy, dignity and well-being of all patients in a safe, secure environment. • Supports and participates in common teamwork; fosters a culture of teamwork and cooperation.

• Promotes positive public relations with patients, visitors and the

community. To view the full version of the ad, please visit careers.floridadental.org/jobs/18812105/.

General Dentist, Kingsway

Dental, Port Charlotte, FL. 4 daya-week private practice looking for a general dentist with a variety of skills. Port Charlotte, Florida. Near beaches and Peace River. Practice has been in the area since 2003. Adult to geriatric patient base. High needs community. Friendly, small town practice with sister location in Bradenton, FL. Opportunity for growth and expansion. Requirements: comprehensive treatment planning, restorative, some surgery, removable, fixed, some endo, and restoration of implants. Practitioner should be independent, experienced, skilled, and self motivated. Visit careers.floridadental.org/ jobs/18785023/.

General Dentist, DECA | Ideal Dental, Jacksonville. $250,000$450,000 Annual Salary, Production Based, PPO/FFS, Fully Digital, 4x a week! We are looking for an exceptional General Dentist committed to providing high-quality dentistry and excellent patient care to join our DECA Dental Group | Ideal Dental family. This position is a perfect opportunity to join a fast-growing practice with ownership potential and includes placement at a premier office location! What does our practice offer? The industry-leading mentorship, training, and education we provide our doctors. Our training program is one of the best learning programs in the nation. We provide our general dentists with the train-

ing to do all procedures from molar endo, surgical extractions, Invisalign, implant dentistry, and much more! We supply state-of-the-art equipment, including iTero scanners, fully digital practices, and robust KPI online dashboards at our offices. PPO and Fee for Service Guests with high reimbursement rates for maximum income potential. 100% clinical autonomy and strong new guest marketing – most dentists see 60100+ new guests each month DECA general dentist’s average salary is $200,000 per year, and many of our tenured general dentists earn $450,000+ per year! Our general dentists make significantly higher than the national average. Ownership opportunities for candidates who are interested in continued personal, professional, and financial growth!

Once you become an Owner Doctor, you can earn additional income through our equity buy-in program while continuing to practice without taking on any additional operational burdens, risk, or debt! Visit careers. floridadental.org/jobs/18779478/.

General Practice Belleview/ The Villages For Sale incl. Real Estate. Owner Financing. Practice Available Immediately. 11 year Fee For Service General Dental Practice For Sale on US 301 just north of The Villages. Only other dentist in vicinity is a Heartland Office. Belleview is a rapidly growing family community in a central location drawing patients from Ocala, The Villages, and many other 55+ neighborhoods full of cash paying patients wanting a private dentist. 950 sq. foot building

built in 2008 sits on almost an acre of land with room for an addition or another building. 2 operatories are fully equipped with digital sensors and Patterson Fuse cloud-based software. All equipment is included. 250 patients are scheduled for recall with over 1000 patients of record. All new patients have been referred to a colleague due to family health obligations for the last 2 years. This would be a perfect practice to get started 2-3 days per week and it is a feasible daily commute from Orlando, Tampa, or Gainesville. $325k includes practice, equipment, building, and 2 commercial lots. Owner will finance with $50K down and 5 year balloon. Visit careers.floridadental. org/jobs/18722455/

IS IT TIME TO EXAMINE

your malpractice insurance?

With yet another of Florida’s dental liability insurers selling out to Wall Street, there’s an important question to ask. Do you want an insurer that’s driven by investors? Or do you want an insurer that focuses on you, and has already paid more than $140 million in awards to its members when they retire from practice?

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

our journal advertisers support

WHEN YOU SUPPORT OUR ADVERTISERS, PLEASE MENTION TODAY’S FDA!

Advertising Information

For display advertising information, contact: Deirdre Rhodes at drhodes@floridadental.org or 800.877.9922, Ext. 7108.

For Career Center advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113.

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 2023 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.

Ex Machina?

By Hugh Wunderlich, DDS, CDE, FDA Editor

Now students can factor in math apps on their phones and engage AI/Chat GPT to produce a 500-word report on War and Peace in two seconds. Is this wrong or is it just another tool? Dentistry is not without AI possibilities –crafting ideal restorations, diagnosis of diseases and predicting treatment outcomes. In your best HAL 9000 voice >>> “I am sorry Dave … there is still a bit more decay on the mesial wall.”

So here is your own Turing Test. I asked Chat GPT to explain itself and craft this month’s unedited editorial about dental auxiliary shortages.

If your dental license has only four digits, you will remember this. If not, bear with me. When I took Physics in high school, we were allowed a slide rule. Some teachers thought that was cheating. Then, for many who had today’s equivalent of $2,600, you could acquire a hand-held scientific calculator. Some teachers thought that was cheating. And to add to that academic agony English papers were required to be typed on onion-skin non-erasable bond paper. One “typo” cost you a letter grade. Lucky students used an electric typewriter. Some teachers thought that was cheating. Onion skin paper is exactly what it sounds like. I think it was the same paper Kung-Fu used to walk on to prove “it is time for you to leave.” Maybe my instructors and Kung-Fu’s Shaolin priests were teaching us to be disciplined. Every word means something. You must know the math to understand if your HP-35 was “in the ballpark.”

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

Will it be Deus or Diabolus ex machina?

Drew Headroom