FDC2017 Speaker Previews All Aboard Exhibit Marketplace 2017 FDA Award Recipients
FDC2017 HAS SOMETHING FOR EVERYONE!
KEYNOTES • HOT TOPICS • NIGHTLY SOCIAL EVENTS • FAMILY FUN • AWARDS • EXHIBIT HALL
Team to Technology VOL. 29, NO. 2 • MARCH/APRIL 2017
VOL. 29, NO. 2 • MARCH-APRIL
TRY YOUR AGENTS INSURANCE FOR YOUR DENTAL CAREER
BOOTH
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VISIT US AT FDC2017 • PLAY BEAN BAG TOSS TO WIN A BOTTLE OF WINE! • PLAY CROWNOPOLY TO MEET THE CROWN SAVINGS MERCHANTS. • DISCUSS YOUR INSURANCE PORTFOLIO WITH YOUR AGENT.
contents FDC Issue Learning is fun and interactive at the Florida Dental Convention. Preview this event in this special issue of Today's FDA.
news
literary
16
news@fda
20 Letter to the Editor
26
Board of Dentistry
28
House of Delegates
30
Medicare and Delta Dental’s New Contract Requirements
columns 3
Staff Roster
5
President’s Message
6
Legal Notes
13
Did You Know?
40 FDC2017 Speaker Preview — Dr. Van B. Haywood
15
Information Bytes
44 FDC2017 Speaker Preview — Dr. Mark Kleive
83
Diagnostic Discussion
50 FDC2017 Speaker Preview — Marvelless Mark Kamp
96
Off the Cusp
f e at u r e s 33
Keynotes
34
FDC2017 Speaker Preview — Dr. Anna Marie Avola
54 Six is Better Than One 58
Exhibit Marketplace
64
2017 FDA Award Recipients
79
The Digitization of Dental Education
Read this issue on our website at:
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Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.
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FLORIDA DENTAL ASSOCIATION
L A C LO Y L E V I &L
MARCH/APRIL 2017 VOL. 29, NO. 2
EDITOR Dr. John Paul, Lakeland, editor
STAFF Jill Runyan, director of communications Jessica Lauria, communications and media coordinator Lynne Knight, marketing coordinator
BOARD OF TRUSTEES
GATHER FOR FUN & CONTINUING EDUCATION IN YOUR DISTRICT. SFDDA ANNUAL BUSINESS MEETING
WEDNESDAY, APRIL 26, 2017 TROPICAL ACRES RESTAURANT, FORT LAUDERDALE Speaker: Dr. Richard Mufson; plus SFDDA State of the Association Address; leadership elections; statemandated courses for relicensure www.sfdda.org • 305.667.3647 • sfdda@sfdda.org
WCDDA PRESIDENT’S TRIP FRIDAY, APRIL 28, 2017 DISNEY CRUISE • PORT CANAVERAL TO BAHAMAS Six CE credits will be provided. www.wcdental.org • 813.654.2500 • kelsey@wcdental.org
CFDDA ANNUAL MEETING THURSDAY-SATURDAY, MAY 11-13, 2017 ROSEN SHINGLE CREEK, ORLANDO Speakers: Friday – Dr. Steven Rasner; Saturday – Dr. Robert G. Ritter www.cfdda.org • 407.898.3481 centraldistrictdental@yahoo.com
2018 NWDDA ANNUAL MEETING
FRIDAY & SATURDAY, FEB. 2-3, 2018 THE GRAND SANDESTIN
www.nwdda.org • 850.391.9310 • nwdda@nwdda.org
ACDDA WINTER CONFERENCE
FRIDAY, FEB. 23, 2018 EMBASSY SUITES, WEST PALM BEACH www.acdda.org • 561.968.7714 • acdda@aol.com
Dr. William D’Aiuto, Longwood, president Dr. Michael D. Eggnatz, Weston, president-elect Dr. Jolene Paramore, Panama City, first vice president Dr. Rudy Liddell, Brandon, second vice president Dr. Andy Brown, Orange Park, secretary Dr. Ralph Attanasi, Delray Beach, immediate past president Drew Eason, Tallahassee, executive director Dr. James Antoon, Rockledge • Dr. Steve Cochran, Jacksonville Dr. Richard Huot, Vero Beach • Dr. Jeannette Pena-Hall, Miami Dr. George Kolos, Fort Lauderdale • Dr. Jeffrey Ottley, Milton Dr. Paul Palo, Winter Haven • Dr. Howard Pranikoff, Ormond Beach Dr. Barry Setzer, Jacksonville • Dr. Beatriz Terry, Miami Dr. Stephen Zuknick, Brandon • Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Spring Hill, Treasurer • Dr. John Paul, Lakeland, editor
PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914. FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2017 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, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.
EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.
EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914. FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; email address, fda@floridadental.org; website address, www.floridadental.org.
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CONTACT THE FDA OFFICE 800.877.9922 or 850.681.3629 1111 E. Tennessee St. • Tallahassee, FL 32308 The last four digits of the telephone number are the extension for that staff member.
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Drew Eason, Executive Director deason@floridadental.org 850.350.7109
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ACCOUNTING Jack Moore, Director of Accounting jmoore@floridadental.org 850.350.7137 Leona Boutwell, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 Joyce Defibaugh, FDA Membership Dues Assistant jdefibaugh@floridadental.org 850.350.7116
Meghan Murphy, Program Coordinator mmurphy@floridadental.org 850.350.7161
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INFORMATION SYSTEMS Larry Darnell, Director of Information Systems ldarnell@floridadental.org 850.350.7102 Rachel Burch, Computer Support Technician rburch@floridadental.org 850.350.7153
Tessa Daniels, Membership Services Representative tessa.daniels@fdaservices.com 850.350.7158 Liz Rich, Membership Services Representative liz.rich@fdaservices.com 850.350.7171
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COMMUNICATIONS AND MARKETING
800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308
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FDA SERVICES
RISK EXPERTS Dan Zottoli Director of Sales Atlantic Coast 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com
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MEMBER RELATIONS Kerry Gómez-Ríos, Director of Member Relations krios@floridadental.org 850.350.7121
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To contact an FDA Board member use the first letter of their first name, then their last name, followed by @bot.floridadental.org. For example, Dr. John Paul: jpaul@bot.floridadental.org.
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Go to www.floridadental.org/foundation or call 800.877.9922 Contributions to the FDA Foundation may be tax deductible. All contributions, including those to named funds, are considered unrestricted unless a specific purpose is designated by the donor. The organization is located at 1111 E. Tennessee St., Tallahassee, FL 32308. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE: 1-800-HELP-FLA OR VIA THE INTERNET AT WWW.800HELPFLA.COM. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. SPONSOR’S REGISTRATION NUMBER IS CH2435. NO CONTRIBUTIONS ARE RETAINED BY PROFESSIONAL SOLICITORS THEREFORE 100% OF ALL CONTRIBUTIONS ARE RECEIVED BY FDAF.
PRESIDENT’S MESSAGE BILL D'AIUTO, DDS
Florida Dental Convention:
“Fun” is the Engine That Keeps it Growing! Twenty-five years ago, I was on the Florida National Dental Congress (FNDC) — now the Florida Dental Convention (FDC) — committee as a new dentist. At that time, our meeting was growing, as is the case now with the FDC. However, there are few similarities to the reasons for the meeting growth then compared to now. In the old days of the 1990s, the FNDC had no real hard competion for our members’ attendance because we virtually were the only game in town. In the 90s, there were no internet continuing education (CE) courses, few group practices offered their members CE, and the national and local study club phenomena had not developed to the degree it has today, all of which offers CE cart blanche. So, why is it that in a time when gathering the desired CE is so easy and competition for our members’ professional development dollars is fiercer than ever, that the FDC is steadily growing, when large state and national dental meetings around the country are shrinking? Perhaps, it is because of what I — and many others — consider the “lost component” of most professional development venues: FUN. They are not fun! There is a reason why for the past several years, two of the largest dental meetings in the country have sent representatives to our meeting! Meeting planners and program developers from around the country see www.floridadental.org
our growth and try to capture the intimacy that is at the heart of our success. The FDC’s growth has been carefully honed to produce the desired effect: FUN. It’s evident from the growing number of attendees, the quality and quantity of the more than 350 vendors — a growing number of which sponsor corporate classroom courses — who add to the richness of the meeting. Every morning, a keynote speaker has proven to be a highlight of the day and is designed to set a positive tone, thereby enriching the entire learning experience during the rest of the day. The keynote sessions are free for all Florida Dental Association (FDA) members during pre-registration, which ends June 9. The course menu has been built to underpin and define our 2017 theme: “Get Connected: Team to Technology.”
made an impact on the profession through community volunteerism or FDA leadership excellence, which blends together to enrich our membership. The FDA awards recognize some of our hardest-working colleagues. Their actions will inspire our members and the generations of new dental leaders who follow. How these honorees are highlighted for their achievements is something to see.
FDA members receive free pre-registration, which includes: discount course pricing, up to 18 hours of free CE, access to the Exhibit Hall and entrance into nightly social events with live music tailored to our theme for the evening. And on Friday, there is a second after-hours event for the new dentist — hey, as your president, can I come?
We invite you to experience the fun with your colleagues, friends and family. The Gaylord Palms is a destination resort for the whole family and is second to none. Don’t miss out on the fun, networking and professional development for your whole team. See you there!
My personal favorite event is the Awards Luncheon, and in the last couple of years this event has developed into a membership favorite as well. The luncheon serves as the event that honors fellow members who have
There are so many to thank for the continued success of our dental meeting. A big thank you goes to the entire FDC committee and staff. While under the leadership of the FDC General Chair Dr. Bert Hughes and Director of Conventions and Continuing Education Crissy Tallman, we are the envy of the large dental meeting industry!
Dr. D’Aiuto is the FDA President and can be reached at bdaiuto@bot.floridadental.org.
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Legal Notes
How Well Do You Know the Board of Dentistry Disciplinary Process? Part 3 Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)
In Part 1, we looked at common misconceptions about Florida’s licensure disciplinary process, and in Part 2 we looked at each step in the disciplinary process. Now, this article will take you through the next steps and will provide practical risk-management advice (“tips”) along the way on how to defend against licensure complaints.
STEP 4: The Timing of the DOH Investigative Process We have seen that Department of Health (DOH) must investigate some complaints but has broad discretion to investigate others. In general, you will be given notice that they are investigating you, but not always (more on that later).
Statute of Limitations There is a statute of limitations on licensure cases, but we will see it has little practical effect. Section 456.073(13), Fla. Stats., says an Administrative Complaint (AC), which is the formal charging document, must get filed within six years after the time of the
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incident or occurrence giving rise to the licensure complaint. TIP: This time frame is significantly longer than the two-year statute of limitations on malpractice litigation (which often can be extended) and the four-year minimum records retention period under Board of Dentistry (BOD) Rule 64B5-17.002, Fla. Admin. Code. Thus, you should consider retaining your records for a longer time period if you anticipate problems. When the clock starts ticking also is different. For licensure discipline, it’s six years from the incident; for medical malpractice litigation, it’s two years from when the patient “knew or reasonably should have known that the injury was caused by malpractice;” for the BOD records retention rule, it’s four years “from the date the patient was last examined or treated by the dentist.” Participating provider agreements for managed-care plans and Medicaid rules also specify different records retention periods.
(subsections 456.057(10) and (11), Fla. Stats., requires that: all records owners shall develop and implement policies, standards and procedures to protect the confidentiality and security of the medical record. Employees of records owners shall be trained in these policies, standards and procedures. Records owners are responsible for maintaining a record of all disclosures of information contained in the medical record to a third party, including the purpose of the disclosure request. The record of disclosure may be maintained in the medical record. TIP: How will you prove compliance if the policy, training and record of disclosures are not written down? TIP: Have one rule for all your records or else you will get totally confused and end up not following your own policy, which will be used against you at trial.
So, recognizing that the original records are literally the “best evidence” in licensure and malpractice litigation under the Florida Evidence Code (chapter 90, Fla. Stats.), how long should you keep them to protect yourself? I would recommend seven years.
I recommend seven years from the last scheduled appointment or treatment of any kind, regardless of who did it. These dates usually coincide, but not always. For example, think about the emergency procedure you did, the prophy you authorized 13 months ago, or the script you called in and forgot about.
TIP: If you don’t already have a written records management policy that says how long to keep records, you need to make one as soon as possible. The “records owner” statute
TIP: An exception to the recommended seven-year rule would be where your records
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Legal Notes
are unhelpful to your defense (i.e., another doctor looking at them would immediately see you did something wrong). Then it is in your best interest to dispose of them as quickly as possible. Note that this strategy comes with an unacceptably high risk of “spoliating” evidence because you are departing from your written records retention policy, which means that the judge can instruct the jury to assume wrongdoing on your part simply because evidence is missing due to your action. Also, recognize that there is no “one-sizefits-all” answer to how long to keep records. For example, the six-year filing time frame for licensure actions doesn’t apply when “criminal actions, diversion of controlled substances, sexual misconduct or impairment by the licensee” is involved. As another example, in licensure cases where it can be shown that “fraud, concealment or intentional misrepresentation of fact prevented the discovery of the violation of law,” the complainant gets up to, but no more than, 12 years to file from the time of the incident or occurrence. Many dentists keep records forever, especially now that they are electronic. Once the investigation starts, there is no time frame within which the DOH must file an AC or suffer dismissal. Section 456.073(4), Fla. Stats., encourages the DOH to complete the investigation “within one year after the filing of the complaint.” But the case doesn’t get dismissed if it takes longer. Rather, at the one-year mark it simply gets referred to the BOD for their decision on what to do. It does not get automatically dismissed.
“Laches” Unlike malpractice litigation, there is no effective statute of limitations or “repose” on licensure investigations or BOD disciplinary actions. But under Florida case law, the equitable doctrine of “laches” may apply to dismiss stale investigations and prosecutions. Laches applies if the finder of fact determines that an unreasonable delay in prosecuting has prejudiced the respondent’s ability to defend herself against the complaint. See, e.g., R. Timothy Carter, O.D. v. DPR, 613 So.2d 78, at 80 (Fla. 1st DCA, 1993): … (the statutory requirement) that the department “expeditiously investigate complaints” is not an idle recitation, but a directive to act promptly for the protection of the public as well as to assure timely due process to the licensee. And we must assume that the legislature used the words “time limit” (in section 456.073(2), Fla. Stats.) advisedly to communicate clear legislative intent that complaints against licensed professionals regulated by the department and its boards should be expeditiously processed without unjustifiable delay. This expeditious handling of complaints serves to protect the public from potential harm or injury caused by violations of the law and standards governing the professional’s practice. Of course, these time limits also accord to the licensee complained against the right to a speedy determination of the matters giving rise to the complaint and provide protection against the potential prejudice that flows from unreasonable delays, such as loss of documents, unavailability of witnesses and fading memories.
“
Recognize that there is no “one-size-fits-all” answer to how long to keep records.
”
Please see LEGAL, 8
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Legal Notes
LEGAL from 7
STEP 5: Will You Even Know if You Are Being Investigated? Once under investigation, the respondent usually will receive notification of the investigation. Under section 456.073(1), Fla. Stats., the DOH is required, upon request, to provide a copy of the complaint to the respondent or his or her attorney. TIP: Always request a copy of the complaint and any attachments considered, and do so in writing. The DOH is legally required to provide this information “promptly.”
Fifth Amendment Due Process Requirements You may have heard in dental school that “licensure is a privilege not a right,” implying that it is easy for the government to take away your license to practice. From a legal perspective, this is inaccurate in the health care professions. TIP: There is a difference between disciplinary proceedings that are “penal” in nature versus those that are “remedial” in nature. You have more protection when discipline is penal rather than remedial. In Florida, health care licensure discipline is considered penal or “quasi-criminal,” not remedial. Interestingly, however, there is a line of cases, starting with DeBoch v. State of Florida, 512 So.2d 164 (1987), that say disciplinary actions by The Florida Bar are remedial, not penal, making it easier for the state to punish lawyers than dentists despite the fact that state regulation of both professions aims to protect public safety.
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The leading Florida Supreme Court case on this issue is State ex. rel. Vining v. Florida Real Estate Commission, 281 So2d. 487 (Fla. 1973). The Fifth Amendment of the U.S. Constitution and Article 1, Section IX of the Florida Constitution extend civil rights present in criminal cases such as the right to be informed of the accuser and the accusations against you as well as the right to cross-examine the accuser and witnesses (i.e., due process of law under the Fifth Amendment). Vining is noteworthy because it extends criminal Fifth Amendment protections to licensure cases against dentists. Specifically, Vining extends the privilege against self-incrimination to penal cases, defined as those that “… tend to degrade the individual’s professional standing, professional reputation or livelihood.” Specifically, this case dealt with the right to remain silent. But remember, in the first article we identified five circumstances under which a dentist is compelled to self-report, which would seem to violate the privilege against self-incrimination. Further, under Sheppard v. Florida State Board of Dentistry, 369 So.2d 629 (Fla. 1st DCA 1979), there is no Fifth Amendment privilege when records are required to be made and maintained by statute. Subsection 466.018(3), Fla. Stats., requires you to “maintain written dental records and medical history records which justify the course of treatment of the patient. The records shall include, but not be limited to, patient history, examination results, test results and, if taken, X-rays.” TIP: Don’t expect any Fifth Amendment protection for your clinical records. Also, we will learn below that under certain circumstances, the DOH may lawfully in-
vestigate licensees without informing them, which raises due process of law considerations under the Fifth Amendment. TIP: DOH proceedings work differently than other litigation; you will probably not be given all of the information the DOH has against you, especially in the early steps.
When You Will Not Be Told The DOH may investigate without notifying you under three circumstances. First, under section 456.073(1), Fla. Stats., “if the act under investigation is a criminal offense.” TIP: Not all crimes constitute legally sufficient grounds to investigate. Section 456.074, Fla. Stats., enumerates what crimes constitute disciplinary violations. In general, they are fraud, controlled substance violations and sexual misconduct. Second, under section 456.073(1), Fla. Stats., notification will be withheld if the state surgeon general, the BOD chair and the chair of the Probable Cause Panel (defined below) “agree in writing that such notification would be detrimental to the investigation.” This gives wide discretion. Third, when an Emergency Suspension Order (ESO) is involved, the first time you learn of it will be when you are served and told to immediately stop practicing. This is analogous to a nuclear bomb being dropped on your head and is the worst form of licensure discipline. More information on the ESO process follows.
ESOs ESOs are issued for serious violations relating to the commission of crimes, standard of care or drug use, as well as for student loan defaults. Section 120.60(6), Fla. Stats., section 456.073(8), and section 456.074, Fla. Stats., outline the procedures for ESOs. www.floridadental.org
Legal Notes
TIP: ESOs are intended to deter others, and for that reason, they are released to the media and plastered all over the internet. You will see your name in the newspaper. ESOs are significantly different when compared to regular AC. ESOs are issued when the DOH finds that “immediate serious danger to the public health, safety or welfare” requires emergency suspension, restriction or limitation of a license. An ESO is effectively a stop-work order or temporary injunction to cease practicing. Under section 120.60(6), Fla. Stats., the DOH is authorized to issue ESOs. Issuance must be consistent with the Fifth Amendment privilege (see above) and should be limited to only that action necessary to protect the public interest. The DOH must state in writing at the time of, or prior to, its action the specific facts and reasons for finding an immediate danger to the public health, safety or welfare, and its reasons for concluding that the procedure used is fair under the circumstances.
TIP: The agency’s findings of immediate danger, necessity and procedural fairness are judicially reviewable by the appropriate District Court of Appeal (DCA), not the Circuit Court or the Division of Administrative Hearings (DOAH). This is because an ESO does not constitute an agency Final Order, as no hearing occurs prior to the ESO being issued. In most cases, the ESO gets issued before the AC because there is an immediate threat to public health. The AC should get filed shortly after the ESO is issued. TIP: You have a right to get the AC, and it will have more detail.
Discretionary and Mandatory ESOs Section 456.073(8), Fla. Stats., places further restrictions on the DOH’s issuance of “discretionary” ESOs as does section 456.074, Fla. Stats., on “mandatory” ESOs. In discretionary ESOs, the surgeon general typically takes responsibility for issuing the final summary order but he or she can delegate authority to someone else in the DOH. There is discretion to immediately
suspend or restrict the license of any dentist or dental hygienist who tests positive for drugs on a pre-employment or employer-ordered drug test. The licensee is given 48 hours from the time the Surgeon General is notified of the confirmed positive test to produce a lawful prescription for the drug or else an ESO will be issued. TIP: Self-prescriptions are not lawful. Section 466.028(1)(q), Fla. Stats., prohibits a dentist from “prescribing, procuring, dispensing or administering” schedule drugs or controlled substances to himself or herself. Section 465.074, Fla. Stats. regulates “mandatory ESOs” and requires emergency suspension in two situations. First, for a licensee who “pleads guilty to, is convicted or found guilty of, or who enters a plea of nolo contendere to, regardless of adjudication, a felony under chapter 409 (social and economic assistance), chapter 817 (fraud), chapter 893 (controlled substances)” the Federal Controlled Substances Act or Please see LEGAL, 11
What Florida Dentists Need to Know about Prescription, Controlled Substance and Pain Management Laws (LC01) Patient Abandonment (LC02) Take these courses online to earn free CE credit. For links, go to floridadental.org/members. FDA Members Only!
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The mentors are FDA member dentists who volunteer their time and experience to provide professional guidance to dental students. All member dentists are encouraged to participate as mentors. A select number of dental students (depending on the number of mentors available) from each Florida dental school (LECOM, Nova and UFCD) will be able to participate as mentees.
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What Does It Involve?
The online mentoring program has been designed with the needs of the student and busy dentist in mind. Connecting is easy: 1. Member dentists can volunteer by completing a quick and easy online form at floridadental.org/ mentors. 2. The mentee will select a mentor from the bios available at floridadental.org. 3. The mentee will contact the mentor directly via email.
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The Florida Dental Association (FDA) Mentorship Program was developed by the FDA Council on the New Dentist as a resource to help dental students gain a practical and professional perspective from established member dentists.
4. The mentor will contact the FDA Director of Member Relations, Kerry Gomez-Rios, to inform the FDA that he/she has accepted a mentee. If at any time a change in the mentor/mentee relationship is needed, please contact Kerry GomezRios at membership@floridadental.org.
Questions?
For more information, contact Kerry Gomez-Rios at membership@floridadental.org.
hip gui ns
Legal Notes LEGAL from 9
Medicare/Medicaid regulations. Second, the DOH must issue an ESO upon receipt of information that a licensee has defaulted on a student loan issued or guaranteed by state or federal government. The DOH will notify the licensee via certified mail of the default and, unless the licensee submits proof that new payment terms have been agreed to, the ESO will go into effect 45 days later. TIP: You might think that not paying a student loan is far less harmful than illicit drugs or fraud; but both will result in mandatory ESOs.
How to Respond to an ESO This is counterintuitive, but — most importantly — stop practicing immediately or else you will be prosecuted for felony unlicensed practice under sections 466.026 and chapter 775, Fla. Stats. While Section 120.06(6), Fla. Stats. requires that an AC in support of the ESO be filed “promptly,” it often is not — so being served with an ESO may be your first introduction to licensure discipline. TIP: Recognizing that you are losing income and have liability exposure for patients who do not receive necessary care, you must take immediate legal action.
TIP: Don’t be fooled by the nomenclature of informal hearings and expedited review.
of your practice as well as harm to patients when you cannot complete treatment plans.
Even if you get an expedited hearing, there is a significant delay in getting back to work. After the trial, the recommended orders are submitted to the Administrative Law Judge (ALJ); the recommended order gets filed by the ALJ; the parties have the right to take exceptions to the final order; and then, the case is finally presented to the BOD, which may reject findings of fact but not conclusions of law in the ALJ’s final order. The process is lengthy, and during that time you are out of work.
TIP: When you file the petition, also file a Motion Requesting a Stay of the Final Order. If the motion is granted, you can return to practice while the lengthy appeals process works its way through the DCA.
TIP: There may be a faster way to get back to your practice. ESOs and emergency licensure restrictions are appealable to the 1st DCA in Tallahassee where the DOH maintains its headquarters. TIP: You also can file an appeal with the DCA where you reside. You may get a faster docket, it will be cheaper to litigate closer to home and there may be favorable case law that is not present in the 1st DCA.
If an AC is filed with the ESO, you may challenge it through the DOAH via informal hearing under section 120.569 or formal hearing under 120.57, Fla. Stats. More on the difference between the two will be provided later on in this series. You also have the right to an expedited hearing.
A Petition for Review of a Non-final Order to the DCA is authorized under sections 120.60(6)(c) and 120.68(1) and (2)(a), Fla. Stats. The petition should ask for the ESO to be quashed or, in the alternative, modified based on the allegation that the department has not followed the essential requirements of Florida law. The basis for the DCA appeal is that DOAH review will not provide an adequate legal remedy if you prevail because it takes so long.
TIP: Consider if you will have enough time to complete discovery if you request an expedited hearing.
The leading case is Cunningham v. AHCA, 677 So.2d 61 (Fla 1st DCA 1996), which requires the DCA to consider disruption
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The basis of your petition will be the DOH’s failure to comply with section 120.60(6)(b), Fla. Stats. TIP: You have three arguments to support your petition and motion for stay. First, argue that the DOH could have taken other actions short of an ESO to protect public safety. For example, they could have placed an emergency restriction requiring you to practice under the supervision of another doctor. Second, argue that the ESO does not set forth with specificity the facts and reasons for the alleged immediate danger. In Commercial Consultants Corp. v. DBR, 363 So.2d 1162 (Fla 1st DCA 1978), the court held that the agency’s reasons for an ESO “must be factually specific and persuasive concerning the existence of a genuine emergency” (emphasis added). TIP: You essentially are arguing that the conduct complained of will not continue in the future regardless of whether it actually happened in the past. Third, argue that it is unfair or violates your due process rights discussed above. The next article in this series will walk you through the investigative process and the government's authority to subpoena your records. Graham Nicol is the FDA’s Chief Legal Counsel.
March/April 2017
Today's FDA
11
REGARDING THIRD-PARTY PAYERS …
WHO SPEAKS FOR YOU?
WE DO! RECENT EXAMPLE: July Letters from Medicaid Managed Care Plan to Medicaid and Florida Healthy Kids Providers Restricting Patient Care
dental sealants only on high-risk teeth age limit on permanent crowns immediate dentures no longer covered limited children’s X-rays
PLEASE REPORT PROBLEMS WITH THIRD-PARTY PAYERS TO THE FDA. WE CAN HELP!
FDA Members Send Copies of July Letters to the FDA. FDA staff evaluates and determines that the plan is unlawfully restricting care.
FDA STAFF CONTACTS THE AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA) ABOUT PLAN’S RESTRICTION OF CARE.
RESULT! AHCA TELLS PLAN IT CANNOT IMPLEMENT CHANGES THAT RESTRICT CARE TO MEDICAID RECIPIENTS.
HELPING MEMBERS SUCCEED
?
For additional information, contact Casey Stoutamire, Director of Third Party Payer & Professional Affairs: 800.326.0051 • 850.224.1089 cstoutamire@floridadental.org
for s n o i t p Prescri ces i v r e S y b f Dentistr airs o La d r a o B a ssional Aff er & Profe the Florid ay Liason to ird Party P A h T D f F o , r a k to k c Dire Dr. Don Il mire, FDA ta u to S y e Ms. Cas
Did you know there is a Board of Dentistry Rule requiring a dentist to have the lab license number on each and every prescription the dentist sends in? Rule 64B5-17.006, Prescription Forms, went into effect in 2009. The details on all the requirements for prescription forms can be found in the rule language below.
Dr. Ilkka
Ms. Stoutamire
(d) Patient’s name or number (e) Date sent to lab (f) Signature of the licensed dentist, which may be an electronic signature (g) Sufficient descriptive information to clearly identify each separate and individual piece of work to be per- formed by the dental laboratory (h) Specification of materials to be contained in each work product. (2) Copies of prescription forms must be maintained, either on paper or stored electronically in an encrypted data base, in the prescribing dentist’s office for a period of four (4) years following the date the prescription was issued. The original prescription shall be retained in a file by the dental laboratory for a period of four (4) years.
64B5-17.006, Prescription Forms (1) Approved prescription forms must contain all information necessary for completion of the assigned work and must include at a minimum: (a) Title – “Laboratory Procedure Prescription (b) Name, address and license number of the registered dental laboratory (c) Name, address and license number of the Florida licensed dentist who owns the prescription form and is authorizing the procedure
(3) A registered dental laboratory may perform work for another registered dental laboratory if that work is performed pursuant to a written authorization form containing all information necessary for comple- tion of the assigned work and must include at a minimum (a) Title – “Laboratory Procedure Authorization”
U O Y DID
(b) Name, address and license number of the originating registered dental laboratory (c) Name, address and license number of the registered dental laboratory performing the work (d) Evidence that the originating laboratory has obtained a valid prescription which shall include the name, address and license number of the licensed dentist who wrote the original prescription authorizing the procedure. (e) Sufficient descriptive information to clearly identify each separate and individual piece of work to be performed by the dental laboratory (f) Specification of materials to be contained in each work product. If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at 850.350.7202 or cstoutamire@floridadental. org, or Dr. Don Ilkka, FDA Liaison to the Board of Dentistry at 353.787.4748 or donjilkkadds@aol.com.
?
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23
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Information Bytes
My First Florida Dental Convention By Larry Darnell DIRECTOR OF INFORMATION SYSTEMS
I know some of you have been attending the Florida Dental Convention (FDC) even when it went by a different name. Well, my first one was 22 years ago, I had been employed at the Florida Dental Association (FDA) for two short months at that time. Three days after I was hired, I was on a plane to Tampa to fix the dental convention database system I’d never seen or worked on before, but managed to get operational again. A few days before the convention, I loaded up all the PCs the FDA had available and went back to Tampa to get more equipment before I headed over to Orlando. The FDA setup, staffed and managed all aspects of registration back in those days, and my sole responsibility was the technical side of it. In those days, we printed badges and the registration lines were LONG and always a pain for attendees. That was the longest week of work ever for me, and surely the most stressful situation I have ever experienced. Fast-forward to FDC this year, and gone are the days of paper badges and long lines! We have a great registration company, Tradeshow Multimedia Inc. (TMI), which han-
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dles all aspects of registration before, during and after the convention. Now, registration stays open 24 hours a day, so you can register in your pajamas at midnight while you are onsite if you want. FDC attendees have one badge with near-field communication (NFC)* technology for the entire convention. This badge encompasses everything attendees have registered for and will need for the convention, such as courses, nightly events, the Exhibit Hall and even lunch vouchers. It’s an all-access pass to FDC! With this new technology TMI has brought to the convention, attendees no longer need to worry about the inconvenience of individual course tickets, having a code to report continuing education (CE) or waiting in long lines to report CE credit. Everything is now done on-demand to ensure accuracy and ease for attendees, which means you can spend a few more hours in the office or time at the pool with your family. In addition, attendees also can download the FDC mobile app and have all the convention information conveniently on their mobile device. From access to their personalized schedule and handouts to an interactive photo scavenger hunt game and live Exhibit Hall floor plan, the FDC mobile app is a one-stop destination for attendees. The app is simple to download and can be accessed on an Android or Apple device beginning in June.
My contributions are a far cry from 22 years ago now that TMI has taken over the FDC registration. My technical contributions involve laptop and projector setup, email support and photography. Now I actually get to interact with you, instead of frantically printing badges. I enjoy going to FDC each year and working the welcome table, meeting members, answering questions and giving away prizes. My experience on the “other side” makes me appreciate all the work that goes in to making a convention successful. I marvel at how technology has made the things I was once so familiar with easier. However, make no mistake, there are still a lot of great people making FDC happen. Take away all the technology, and I believe FDC would still be one of the best conventions to attend. Somehow, they would still make it happen. Helping members succeed — no matter what! See me during FDC to discuss your technology questions. I look forward to seeing you there! *NFC is a short-range wireless connectivity standard that uses magnetic field induction to enable communication between devices when they’re touched together, or brought within a few centimeters of each other. Mr. Darnell can be reached at ldarnell@ floridadental.org or 850.350.7102.
March/April 2017
Today's FDA
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*Please note that FDA members have their names listed in bold.
Introducing the FDA Fan Shop! The Florida Dental Association (FDA) is excited to announce the creation of our official online store, FDA Fan Shop! Now members can order apparel and other merchandise featuring your favorite FDA family-logo (FDA, FDA Services and FDA Foundation) — including scrubs! The store features top brands and quality apparel for all ages. As an added benefit, you can even personalize your apparel with your practice/ specialty and your name for a small additional fee. Show your FDA member pride and order online at www.fanshop.floridadental.org. Save 10 percent from April 10 - May 10.
Send Us Your Photos for Throwback Thursdays!
highest honor, the Paragon Award. The Paragon Award recognizes an individual who has significantly contributed to the advancement of the rights, interests and welfare of dental students throughout her career. Dr. Niessen was presented with the award during ASDA’s Annual Session, on Saturday, Feb. 25. Prior to joining the Nova Southeastern faculty, Dr. Niessen served as president of the American Academy of Esthetic Dentistry, president of the American Association for Women Dentists, president of the American Association of Public Health Dentistry and president of the Dallas County Dental Society. She also is a member on the U.S. Department of Health and Human Services Advisory Committee on Training in Primary Care Medicine and Dentistry.
The New, Upgraded Online Licensing and Renewal System is Now Live!
The FDA would love to showcase our members having fun at anything FDA-related to post to our social media for Throwback Thursdays (#TBT). Please send any photos from past events, meetings, etc. along with a caption to communications@floridadental. org for the chance to be posted on the FDA’s Facebook and Twitter accounts. We look forward to seeing what you send in!
The Florida Department of Health, Division of Medical Quality Assurance has launched an upgraded online licensing and renewal system. Register and log into your new account now at www.FLHealthSource.gov/ mqa-services, or go to http://bit.ly/2mAHORk for more information.
Nova Dean Receives the Paragon Award
These dentists recently joined the FDA. Their membership allows them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry.
The American Student Dental Association (ASDA) is pleased to announce that Dr. Linda Niessen, dean and professor at Nova Southeastern University College of Dental Medicine, was awarded the association’s
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Today's FDA
March/April 2017
Welcome New FDA Members
Atlantic Coast District Dental Association David Bloom, Boca Raton Marc Goldenberg, Boca Raton Rafael Morales, Boca Raton Macdalie St. Preux, West Palm Beach Cindy Wilson, Stuart
Central Florida District Dental Association Abimbola Adewumi, Gainesville Luz Barrera Alviar, Gainesville Ryan Brennan, Orlando Aaron Campbell, Winter Park Tai Wai Chan, Pinellas Park Belisa Cruz, Orlando Jessica Fernandez, Ocala Alejandro Gonzalez, Winter Park Matthew Hall, Orlando Hoang Ho, Lake Mary Gretchen Jungermann, Orlando Robert Kalifeh, Gainesville Justina Kennedy, Orlando Michael Morra, Orlando Jennifer Ortega, Winter Park Julio Sanchez, Ocala Terrance Soule, Orange City
Northeast District Dental Association Annalee Asbury, Jacksonville Marie Basco, Jacksonville Christopher Henry, Saint Johns Linda Johnson, St. Augustine Christopher Kragor, Jacksonville Haleh Nadji, Jacksonville
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Northwest District Dental Association Anne Green, Hurlburt Field Herb Salisbury, Niceville
South Florida District Dental Association Tasneem Chaballout, Hollywood Dolcie Chin, Palmetto Bay Luis de la Puente, Miami Celia Espinosa, Miami Luisa Garcia, Miami Shane Hodson, Aventura Marco Leyte-Vidal, South Miami Mayra Lopez, Miami
Santiago Lopez, Miramar Katia Mattos, Miami Nicol Miranda, Miami Dominic Morel-Maynard, Fort Lauderdale Tatyana Nudel, Parkland Annette Perez, Miami Mauricio Ramirez, Homestead Paola Suglio Villalon, Doral Christopher Tolmie, Miami
West Coast District Dental Association John Babcock, Sarasota Chelsea Benza, Naples Daniel Branca, Brandon
Will Deliz, Tampa Shawn Douglas, New Port Richey Joel Felsenfeld, Lakewood Ranch Adriana Gabaldon, Naples Charles Guenther, Port Richey Jerri Hines, Medley Caroline Inaba, Lithia Priyanka Iyer, Tampa Leah Kanner, Tampa Wayne Kuo, Fort Myers Beach Amanda Newcity, Brandon Mehulkumar Trivedi, Tarpon Springs William Urschel, Venice Chelsea Wilson, Pinellas Park Please see NEWS, 19
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March/April 2017
Today's FDA
17
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NEWS from 17
In Memoriam The FDA honors the memory and passing of the following members: Barry Weber Spring Hill, FL Died: 1/10/2017 Age: 61
In Memory of Dr. Clifford Marks By Dr. Robert Ferris
Dr. Clifford Marks distinguished himself as a leader in American dentistry in many ways. In Florida, he rose from president of the South Florida District Association to become
Robert Litowitz Miami Beach, FL Died: 1/4/2017 Age: 97 R. Maurice Downs Miami, FL Died: 1/28/2017 Age: 81 Robert P. Williams Lakeland, FL Died: 2/6/2017 Age: 85 Raymond S. Sullivan Sebastian, FL Died: 2/12/2017 Age: 88
president of the Florida Dental Association (FDA). He served as a delegate to the American Dental Association (ADA) House of Delegates for decades. From there, when Florida was named the 17th District of the ADA, he became our first trustee on the Board of Trustees of the ADA. In that position, he elevated the national status of our district and all Florida member dentists. He was the recipient of the FDA’s highest honor, the Leon Schwartz Lifetime Service Award. Dr. Marks was a board certified orthodontist and he achieved great recognition in his specialty. He was considered a masterful clinician as well as an organizational leader. He was instrumental in founding the South Dade Dental Association and served as its president. He also founded the minor-tooth movement section in the Dade County Dental Research Clinic, which he chaired for 10 years. He also served as president of the Florida Dental Health Foundation (now the FDA Foundation), the Florida Society of Orthodontics, the Southern Society of Orthodontics and then as the president of the American Association of Orthodontics.
Cesar L. Sabates Coral Gables, FL Died: 3/14/2017 Age: 84
In his private life, he was an accomplished boat captain. He and his wife, Harlene,
Clifford Marks Vero Beach, FL Died: March 14, 2017 Age: 79
to emulate him and be like Cliff — friendly, compassionate, dedicated and always
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regularly took their yacht up the Atlantic coast to their summer residence in Camden, Maine. Most of all, he is recognized by his colleagues as a mentor and friend who guided many of us along our career paths in organized dentistry. We all wanted ready to lead.
March/April 2017
Today's FDA
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Members‘ Opinion
Letter to the Editor The Florida Dental Association (FDA) welcomes letters from readers on articles that have recently appeared in Today’s FDA (TFDA) and matters of general concern to Florida dentists. The FDA reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and may cite no more than five references. Brevity is appreciated. No illustrations will be accepted. You may submit your letter via email to tfdaeditor@floridadental.org, by fax to 850.561.0504 or by mail to Florida Dental Association, Attn: TFDA Editor, 1111. E Tennessee St., Tallahassee, FL 32308-6914. By sending a “Letter to the Editor,” the author acknowledges and agrees that the letter and all rights of the author in the letter become the property of the FDA. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily
60 and 100 deaths from preventable dental conditions in the past decade! Combine this lack of access and tragic consequences with the new reports that show the important link between poor oral health and poor overall health related to diseases such as diabetes and cardiovascular disease, and I think we are forced to agree that the dental care system is broken and that people are suffering because of this.
reflect the opinion or official policy of the editor, staff, officials, Board of Trustees or members of the FDA.
Letter to the Editor Why is Dental Therapy Good for Patients and Dentists? By Dr. Frank Catalanotto I was excited to see the article entitled, “Midlevel Dental Provider,” by Dr. C.J. Henley in the January/February 2017 issue of Today’s FDA. I would like to take this opportunity to make a few comments in rebuttal. I usually respond to opponents of dental therapy as follows: “Doctor, I understand how you feel about dental therapy, but can you provide me with any published, factual evidence that dental therapy is unsafe or ineffective in improving access to care for underserved patients?” Responses usually are silence or more “feelings,” but no data. My support for dental therapy is grounded in more than 10 years of study on this issue, reading published papers and visiting dental therapists at work in Alaska and Minnesota. It also is based on my belief that the dental health care system in this country is broken,
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Today's FDA
March/April 2017
which leaves many people with poor access, poor oral health and serious consequences. For example, last year, approximately 180,000,000 people could not or chose not to visit a dentist. According to the American Dental Association (ADA), the primary reasons are high costs and poor oral health literacy. Several recent papers demonstrated impaired school performance related to dental problems. If you cannot learn, it is difficult to break out of the cycle of poverty. In Florida, hospital emergency department visits for preventable dental conditions have increased 68 percent over the past decade from 104,642 in 2005 to 171,465 in 2016 at a cost of $267,091,298. Florida has one of the worst Medicaid reimbursement rates in the U.S., which results in one of the lowest dentist participation rates – about 8 percent. This also results in one of the lowest patient utilization rates in the U.S., with only about 34 percent of Medicaid-eligible children getting regular dental care last year. Dr. Henley referenced the tragic death of a young boy, Deamonte Driver, in Maryland from a dental infection. While we have not had any such deaths in Florida as far as we know, the U.S. has experienced between
I agree with Dr. Henley that we must improve Medicaid reimbursement rates. Unfortunately, that is an extremely expensive solution, and the increase in participating dentists and patient utilization is quite modest. In addition, there are other reasons why dentists do not participate in Medicaid that are not based on reimbursement, including social stigma and altruism. I certainly agree that there are important problems in patients’ oral health literacy, which results in what Dr. Henley called “underutilization,” but this lack of appreciation of the importance of oral health also is present in other members of the broader health care team as well as legislators. Many dentists do have a great sense of philanthropy in quietly providing pro bono care in their offices and in supporting events such as the Mission of Mercy and Give Kids A Smile. However, philanthropy is not a system of care; in fact, it can be demeaning to patients. Based on the available evidence, I do believe that dental therapists are one of the important ways to address poor access to oral health care. I think dental therapists are good for both patients and dentists. First, based on numerous studies and reports, the
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Members‘ Opinion
quality of care and the effectiveness of dental therapists to reach underserved patients is unequivocal. A dental therapist is not a new member of the oral health care team. Nash and colleagues, in a review of about 1,100 papers in the international literature from more than 54 modern, industrialized countries who have used dental therapists for up to 100 years, concluded: “There is no question that dental therapists provide care for children that is high quality and safe.” A recent report about the Canadian program that many opposing dentists claimed was closed because it did not work, clearly documented that the dental therapy program was closed because of a change in government. Moreover, this report cited a number of studies documenting quality, safety and effectiveness. Many opponents of dental therapy cite a New Zealand report that stated that the dental therapy program was not effective, but these opponents misrepresent what the report actually said. The report concluded that the program was not effective because it was not reaching enough people and the government expanded the program, making some changes in education, recruitment of new providers and infrastructure. Even the ADA Council on Scientific Affairs concluded a review of the existing literature on dental therapy with this statement: “The results of a variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality services, including irreversible procedures, such as restorative care and dental extractions.” Dr. Henley also did not mention the incredible success of Minnesota’s implementation of dental therapy, where the therapists work under the general supervision of dentists. The most recent evaluation in 2016, after four years of 54 graduates, is available
on the Minnesota Department of Health (DOH) website. The Minnesota DOH was unequivocal about the success of the program. For example, ADA staff opponents of dental therapy claim that it is a failure because only 56 percent of graduates work in rural areas. I view it a success when 44 percent of therapists work in rural areas and more than 80 percent of their patients are underserved. Eight dentists in private practice have hired 24 dental therapists and are thrilled. The therapists take care of the routine work while the dentists focus on the more complex patients and procedures, actually netting increased profits. These dentists have the joy and satisfaction of performing a great social deed, while making more money at the same time. The vast majority of the existing therapists work for not-for-profit groups, not “mills.” Dental therapists are employed by the nonprofit, Appletree Dental, and provide safe oral health care to institutionalized elderly patients. They are employed by the 100-year-old nonprofit Children’s Dental Services and provide excellent care to children in more than 100 remote sites such as schools. Dental therapists are safe practitioners. Dental therapists are less expensive to educate, thus less student debt. They only learn about 50 procedures compared to the approximate 500 dentists learn. They cost less to employ and are more willing to work in nonprofit settings. They can be equally productive as dentists in terms of numbers of patients served. They provide preventive as well as restorative care, and employ such techniques as motivational interviewing, a useful technique to reduce early childhood caries. The Minnesota DOH recently published a dental therapy toolkit on their website, which contains a lot of useful information about the implementation of dental therapists. The website and two other
useful references are provided at the end of this letter. The ADA Commission on Dental Accreditation has finally approved accreditation standards for dental therapy education. Would they approve the education of a member of the oral health care team who was unsafe? I think not! Dr. Henley appropriately pointed out that two large, major foundations — The Pew Trusts and the W.K. Kellogg Foundation —support the expansion of dental therapy. That is true, but they both have a long history of supporting improved health for all. This comment also ignores the 40 grassroots organizations I saw in New Mexico when I testified in support of dental therapy a few years ago, and the 15 or so organizations I saw in a legislative hearing in Washington state. I have seen this conflicting support in all the states I have visited — only one organization opposes dental therapy, while numerous other grassroots organizations support it. Dr. Henley ignores the public opinion polls that document broad support for dental therapy. Interestingly, support for dental therapy is a rare bipartisan issue with strong support from liberals and conservative free-market groups. This movement is growing. Dental therapy is fully implemented in two states, authorized in two additional states, and has pending legislation and growing support in about 10 other states. Dr. Henley also comments that he “hates the idea of legislators … advocating for midlevel dental provider (dental therapists).” I would like to remind us all that we receive our dental licenses from such legislators. Dentists have a social contract
Please see LETTER, 23
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March/April 2017
Today's FDA
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Today's FDA
March/April 2017
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Members‘ Opinion LETTER from 21
with society, codified in legislation, that we have a monopoly on dental care in return for providing care to the public — all of the public, not just the ones who can afford our fees. If we do not do our jobs in fulfilling this contract, the legislators will, and they will have my support. One more thought, and hold on to your hats! Florida has two choices from my perspective. The Florida Dental Association can continue to follow the orders of 211 East Chicago Avenue, and mindlessly and expensively fight dental therapy in a failing attempt to show their relevancy to members. Alternatively, they can be the first state in the country where dentists openly embrace dental therapy to provide high-quality care to all patients, not just those who can afford private practice fees. Join me in this challenge of fulfilling our professional responsibilities.
References for papers mentioned are available upon request, but these three links contain a lot of useful information and data. 1. http://www.pewtrusts.org/en/research-and-analysis/analysis/2017/02/17/ new-college-curriculum-teaches-dental-therapy 2. http://www.communitycatalyst.org/resources/publications/document/CommunityCatalyst_DT_Report.pdf. 3. http://www.health.state.mn.us/divs/orhpc/ workforce/emerging/dt/index.html. Dr. Catalanotto is a professor in the Department of Community Dentistry and Behavioral Sciences at the University of Florida. He states, “The views expressed in this editorial are my own; I am not representing the views of the University of Florida or the UF College of Dentistry. I am available to speak to any dental or other groups in Florida who wish to know more about dental therapy.”
Editor’s note: Views and conclusions expressed in all editorials, commentaries, columns or articles are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association. For full editorial policies, see page 2. All editorials may be edited due to style and space limitations. Letters to the editor must be on topics and a maximum of 500 words. Submissions must not create a personal attack on any individual. All letters are subject to editorial control. The editorial board reserves the right to limit the number of submissions by an individual. TFDA is the the place where members are assured their voices can be heard. Given the subject matter of this letter, the editorial board offered Dr. Catalanotto a bit of consideration on the usual 500 word limit expected of letters to the editor.
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Board of Dentistry
Board of Dentistry Meets in Orlando By Casey Stoutamire, DIRECTOR OF THIRD PARTY PAYER AND PROFESSIONAL AFFAIRS
The Florida Board of Dentistry (BOD) met in Orlando on Friday, Feb. 17. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Don Ilkka and FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire. Other FDA members in attendance included Drs. Andy Brown and Chris Cowell. Ten of the BOD members were present, which included: Dr. Joe Thomas, chair; Ms. Cathy Cabanzon, vice chair; Drs. Joe Calderone, Naved Fatmi, Bill Kochenour, Claudio Miro, Robert Perdomo and T.J. Tejera; hygienist, Ms. Angie Sissine; and, consumer member, Mr. Tim Pyle. There is one consumer position open on the board that the governor has not yet filled. Dr. Thomas had to leave as soon as the meeting started; thus, Ms. Cabanzon chaired the meeting. The BOD took action on the following proposals from the Rules Committee.
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Rule 4.005, Advertising of HIV/AIDS status This rule was identified for repeal by the board during the enhanced biennial rules review and has been designated as obsolete because physicians and dentists no longer advertise their HIV status. This rule was promulgated (1991) at a time when there was great fear and misunderstanding of the disease and how it is transmitted. The BOD voted unanimously to repeal this rule. Rule 12.013, Continuing Education This proposed rule amendment reflects a consolidation of rules 64B5-12.013, 64B5-12.019 and 64B5-12.020 to eliminate conflicting provisions and create clarity. The proposed amendment was required to remove provisions that conflicted with amendments made to the statutory provisions during the 2016 Legislative Session in HB 941, which amended section 456.013, FS as follows: Removes the mandatory requirement for an applicant to have completed a two-hour course relating to the prevention of medical errors as a condition of licensure. Rather, the course must only be completed for licensure renewal. HB 941 also amended sections 466.0135 and 466.014 as follows: Impacts licensure renewal by removing the mandate that the applicant shall submit a mandatory affidavit attesting that the applicant has completed the mandatory continuing
education. Compliance will now be accomplished through the electronic continuing education tracking system as established in s. 456.0361, F.S. Also, the bill removed the power of the board to request with cause or at random proof and documentation of compliance with the continuing education. The BOD voted unanimously to adopt the proposed amendment to the rule. Rule 12.019, Courses Required for Initial Licensure, Renewal or Reactivation This rule was recommended for repeal because it is being consolidated with rule 64B5-12.013 (see above). The BOD unanimously voted to repeal this rule. Rule 12.020, Courses Required of Licensees for Renewal and Reactivation This rule was recommended for repeal because it will be consolidated into rule 64B5-12.013 (see above). The BOD unanimously voted to repeal this rule. Rule 13.005, Disciplinary Guidelines The proposed rule amendment is necessary to implement HB 221 (the balanced billing legislation). Mr. Flynn stated the impact of the balanced bill legislation to dentistry was minimal, but the BOD needed to have the rule on the books to be prepared in case the situation ever arose. He also stated that legislation would most likely effect an oral surgeon working in a hospital in an emergency
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Board of Dentistry
situation; thus, the Board of Medicine might have jurisdiction in those circumstances, but it would depend on the facts of the situation. The BOD unanimously passed the amendment to the rule. Rule 15.004, Re-examination Fees This rule was recommended for repeal because with the adoption of the ADEX, the Department of Health does not administer or charge an examination fee. The exam fees are assessed by the Commission on Dental Competency Assessments (CDCA), making the rule obsolete. The BOD unanimously voted to repeal this rule. Dr. Scott Tomar had previously asked the Council on Dental Hygiene if silver diamine fluoride (SDF) could be applied by hygienists without the supervision of a dentist in a health access setting. Currently, a hygienist can apply a sealant or a fluoride varnish in a health access setting without the supervision of the dentist. The FDA’s position, presented by Dr. Ilkka, was that a dentist must first diagnose the patient and prescribe the application of the SDF for the patient if it is the best course of treatment. Once that has occurred, then yes, a hygienist can apply the SDF without the supervision of a dentist. At its meeting in January, the Hygiene Council unanimously passed a motion to amend the rule to allow a dental hygienist to apply SDF varnish in a health access setting without the supervision of dentist because SDF is a fluoride varnish and is the same as the other class II sodium fluoride varnish mentioned in Florida statutes. The BOD discussed whether a practitioner uses SDF per FDA guidelines for hypersensitive dentin (treatment that would require diagnosis by a dentist) or to arrest decay, which is an off-label
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Next BOD Meeting The next BOD meeting is scheduled for Friday, May 19 at 7:30 a.m. EST at the DoubleTree by Hilton Orlando Airport, 407.856.0100. The BOD also will hold a public hearing on the proposed changes to the hygiene rules at this meeting. use. Dr. Ilkka argued that if it is used as a treatment, then a diagnosis must first be done by a dentist. Mr. Flynn stated that California has rules to this effect. In addition, Dr. Ilkka argued, how can the BOD know if the hygienist is using SDF as a treatment or off-label as a preventive measure? Mr. Flynn stated twice on the record that he, and the BOD, are not addressing using SDF by a hygienist in an off-label use. As such, the rule was opened just for development. Mr. Flynn must work on language and bring it back to the Rules en again to the full BOD for approval. So, no change has been made to the rule at this time. Dr. Miro gave the BOD an update from the last Anesthesia Committee call. His main goal as the committee chair is the calibration and standardization of anesthesia inspectors. The committee also discussed the use of EMTs in the outpatient dental office. Mr. Flynn stated that under current rules, a dentist cannot supervise an EMT. Thus, an EMT cannot insert an IV in a dental office in a non-emergency situation. However, it was discussed that some dentists are interested in using EMTs as dental assistants when performing sedation procedures. The committee asked Mr. Flynn to research this issue and report back to the committee in May. Mr. Flynn will cross-reference the EMT training with the dental assistant training to see if the dental assisting rules
can be modified to allow an EMT to use his/her training as an EMT while functioning as a dental assistant. The committee and members of the public did stress that if a dentist cannot insert the needle him/herself and wants to use an EMT for that, then the dentist should not have an anesthesia permit. Mr. David Flynn, BOD attorney, provided the board with an overview of the Sunshine Law. The Sunshine Law prohibits any deliberations or discussions, whether formal or informal, between two or more members on some matter which foreseeably will come before the board, including emails and social media. There were eight disciplinary cases and two voluntary relinquishments that dealt with failure to meet the standard of care, substance abuse and failing to keep proper dental records. If you have not yet attended a BOD meeting, it is suggested that you take the opportunity to attend and see the work of the BOD. It is much better to be a spectator than a participant in BOD disciplinary cases. If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at 850.350.7202 or cstoutamire@floridadental. org.
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House of Delegates
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House of Delegates
On Jan. 27-28, the Florida Dental Association (FDA) House of Delegates (HOD) met at the Tampa Airport Marriott. The HOD discussed many issues, including the following business:
By FDA Staff
Dr. Bill D’Aiuto, 2016-2017 Florida Dental Association (FDA) president, reported that the online merchandise “FDA Fan Shop” is now open for business and noted the success of the social media program. He also reminded members to attend this year’s Dentists’ Day on the Hill, which took place on April 3-4, as well as inviting members to volunteer at the Pensacola Mission of Mercy, which was held March 24-25.
Next House of Delegates Meeting The next meeting will be June 23-24, 2017, at the Gaylord Palms Resort and Convention Center.
17th District Trustee’s Report Dr. Cesar Sabates reported that the American Dental Association (ADA) is focusing on licensure matters such as portability and licensure exams; that it’s business model is changing so that the Board of Trustees rather than the House of Delegates can approve the ADA budget; and that the Federal EPA rule mandating amalgam separators has been placed on hold due to the Trump administration.
Report from FDA Liaison to Florida Board of Dentistry Dr. Don Ilkka reported that the board is undergoing changes regarding recent antitrust law opinions, the fear of personal liability, the need for board volunteers to not ignore
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legal counsel or proceed with improper notice or quorum; he also stressed that the proposed hygiene rules do not impose mandatory requirements on dentists and that the dentist remains fully in charge of what duties are delegated and under what level of supervision.
ADA President’s Report Dr. Gary Roberts, 2016-2017 ADA President, reported that, overall, trends important to the ADA are moving in the right direction (e.g., busyness complaints). He congratulated the FDA for gaining a full percentage point in membership growth and also mentioned that hot topics at the ADA continue to be licensure portability and student loan repayment.
FDA New Building Report Drew Eason, FDA executive director, mentioned similarities between the FDA’s search for new headquarters and the reality television show, “Love It or List It;” that the current building is not compliant with the Americans with Disabilities Act (AwDA); cannot be remodeled without bringing the building into AwDA compliance; and, that the new property was secured at a bargain price.
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Medicare
Medicare and Delta Dental’s New Contract Requirements
By Casey Stoutamire DIRECTOR OF THIRD PARTY PAYER AND PROFESSIONAL AFFAIRS
“
Medicare Advantage also requires a third-party payer’s provider directory to be up to date on a quarterly basis.
”
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Delta Dental of Michigan recently announced that it requires providers to opt in for both their commercial programs as well as their Medicare Advantage programs. Please note, this does not directly apply to Delta Dental in Florida. However, Delta Dental Insurance Company (DDIC) is strongly recommending providers continue to opt in to the referring and prescribed Part D with the enforcement deadline extended to January 2019. For Florida, DDIC is dropping providers from its Medicare Advantage program who have OPTED OUT. Once a dentist opts out, Medicare payment cannot be made directly or indirectly for services furnished by an opt-out provider, except for certain emergency and urgent care services. Therefore, no payments may be made under a Medicare Advantage plan for services rendered.
Below are FAQs regarding the Medicare opt-in and opt-out process and its implications regarding Delta Dental. 1. How do I enroll in Medicare? Providers can enroll in Medicare by using either internet-based PECOS located at https://pecos.cms.hhs.gov/ pecos/login.do or by completing the paper 855I or 855O application, which can be downloaded at https://www.cms. gov/Medicare/CMS-Forms/CMS-Forms/ CMS-Forms-List.html. 2. What are the advantages if I enroll? What are the disadvantages if I don’t enroll? Advantages of opting in (includ- ing as an ordering and referring provider only): r You’ll be listed in Delta Dental’s Medicare Advantage network directory. r You’ll ensure payment as an in-net- work dentist for treatment you provide Medicare Advantage patients with plans offered through the DDIC network. r Your prescriptions for Medicare patients will be covered by the Medicare Advantage plan.
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Medicare
Dangers of opting out or doing nothing: r By opting out, you’ll be excluded from participation in DDIC’s Medi- care Advantage network for two years under present Medicare regulations. r If you do nothing (neither opt in nor opt out), your Part D prescriptions will not be covered. Patients depend on you r Medicare Advantage plans administered by DDIC include Cigna HealthSpring and Aetna Coventry. More Medicare Advantage plans through DDIC are coming on board in 2017 and 2018. 3. I’m not interested in being in-net- work for any of Delta’s Medicare Advantage groups. Do I still need to opt in? Although your dental practice may not be in-network for Delta’s Medicare Advantage groups, your practice and your Medicare patients may benefit in several important ways if you opt in: r Medicare Part D prescriptions you write will be covered. If you don’t enroll, your Medicare patients may choose to find a dentist who is enrolled so that their prescriptions are clearly coverable by the Part D program. r You’ll help your current Medicare Advantage patients retain their benefits, dentist/patient relationships and health.
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4. If I OPT OUT am I still able take to the Medicare Advantage patients in my office? Once you opt out, your participation in the Medicare Advantage network will be terminated. The opt-out status will allow you to prescribe Part D drugs, but no payment can be made by DDIC for the dental services you provide. A dentist who opts out must enter into a written private contract with the Medicare patient prior to rendering any services covered by the patient’s Medicare Advantage plan. This contract notifies the patient that the dentist has opted out of Medicare and the patient must pay the dentist directly. No claim may be submitted by the dentist or the patient for the services provided. Several other important reminders for Medicare Advantage providers are: Non-covered services: Before providing a non-covered service (a service that is not included in the plan’s benefit package), a contracted provider must clearly advise the enrollee of his/her responsibility to pay the full cost of the service. Annual attestation: The yearly requirement for “downstream entities” starts each January. Medicare Advantage providers are required to complete and return the attestation. Providers will receive notification about this requirement throughout the year. The components of the attestation include: r Code of Conduct r Fraud, Waste and Abuse and General Compliance training
r Report Fraud, Waste and Abuse and non-compliance issues r Office of Inspector General and General Services Administration exclusion screening r Offshoring any protected health information r Record retention The attestation should be available online in the second quarter of 2017 on Delta Dental’s website under “Provider Tools.” A copy of the attestation form can be found at http://bit.ly/2jRB4fr. Directory Accuracy: Medicare Advantage also requires a third-party payer’s provider directory to be up to date on a quarterly basis. Providers will receive letters with the current information on file in the DDIC system. If the information is correct, no response is required. If information requires an update, please follow the instructions in the letter from Delta Dental. They currently are working on developing an online process to update the information electronically. A copy of the directory accuracy letter, which is sent to current participating DDIC Medicare Advantage providers, can be found at http://bit.ly/2jRSyWF. If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at 850.350.7202 or cstoutamire@floridadental. org.
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KEYNOTES!
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FDC2017 SPEAKER PREVIEW
Silver Linings Playbook: Strategies for Senior Oral Care By Dr. Anna Marie Avola
It’s 10:30 a.m. You are 30 minutes behind schedule and you just realized that your next patient is Mrs. Smith, who at age 77 talks incessantly, wants to show you pictures of her grandchildren, constantly interrupts your procedure, and takes forever getting in and out of the chair. And you say to yourself, “Oh boy! Why are old people like this!” Be careful. You have just been found guilty of ageism. Just as racism is discrimination against people of color and sexism is discrimination of gender, ageism is discrimination against people just because they are old. Let’s face it: Americans are getting older! Over the next 18 years, one American will turn 65 every eight seconds. By comparison, in 1900, only 4 percent of Americans, or 1 in 25, were older than 65 years of age. As the Baby Boomers entered retirement age in
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2011, 13 percent of the population became 65 and older. Projections estimate that by the year 2030, Americans older than 65 will represent 22 percent of the population, or 1 in 5.1 As each decade passes, the numbers continue to increase.
Americans Are Living Longer As medical care advances, many of these patients who would not have survived a variety of systemic diseases or would have been confined to supervised care in a health care setting are now active and mobile members of society. Coronary bypasses, valve replacements, stents and medications to control hypertension are just a few of the cardiac treatments contributing to longevity. Radiation and chemotherapy in cancer treatments also can be credited with saving and extending lives. In addition, advances in oral health care are responsible for senior patients keeping their natural dentition longer than previous generations. According to a National Health Survey in 1971, more than 40 percent of Americans ages 65 and older were edentulous.2 In a recent report published by the Centers for Disease Control and Prevention, the number of edentulous patients had declined dramatically to 19 percent in
2011-2012. The report also stated that 1 in 5 adults aged 65 and over had untreated tooth decay.3 As a dentist, you already are aware of the prevalence of periodontitis and potential risk for oral cancer lesions, which increase in direct proportion with age. Combining all these factors, it is inevitable that your general dental practice will encounter senior patients.
Senior Patients: A Wide Range of Medical Conditions It is important here to define who are senior patients. For this article, I will refer to all patients 65 and older as senior patients. Treating these senior patients encompasses a wide variety of challenges, especially when you consider that:
half of senior patients have at least one chronic disease.
almost 40 percent of senior patients have one type of disability.4
87 percent of those over 65 take one prescription drug on a regular basis.
those who say they are currently taking prescription drugs regularly say they take on average of four different prescriptions drugs daily.5
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“One of the most common omissions is not listing a regimen of daily aspirin. For some reason, some senior patients feel that only prescribed drugs, not OTCs, are important when listing their medical history.”
Although morbid, it also is important to consider the leading causes of death in the senior population, which will influence the type of oral treatment you provide. Knowing which diseases are most prevalent will encourage you to have your medical emergency protocol in place. It comes as no surprise that heart disease remains the No. 1 leading cause of death among seniors and has remained our nation’s top cause for decades. Malignant neoplasms rank second, followed by chronic lower respiratory disease. Combined, these three diseases account for more than 50 percent of all deaths in this age group. Cerebrovascular disease (stroke), Alzheimer’s disease and diabetes are ranked four, five and six — the next three leading causes of death by age in the United States.6
Aging and Disease Like the rest of the body, the oral cavity ages. But it is important, as heath care professionals, to distinguish age changes from disease. We are well aware of the oral systemic connection to overall health. It goes without saying that oral health is fundamental to general health. Some of the common age changes in the oral cavity, surrounding structures and their implications include the following: Tooth attrition or wear: causes sensitivity and fractured teeth.
Pulp reduction in size from secondary dentin: lack of sensitivity resulting in advanced decay or infection before symptoms of pain occur.
Tongue stereognosis (loss of sensation): causes lack of tactile response to alterations in the mouth. Patients have trouble feeling irregu-
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larities. This is especially prevalent in denture wearers.
Taste reduction: is minor and usually related to medications.
Facial structures atrophy: both the epidermal and dermal become thinner and lose fat, which causes scraped tissue to bleed more easily.
TMJ: muscular atrophy and joint problems can lead to limited trismus. The joint can undergo arthritic changes, but arthritis is not a normal part of aging.
It is important to note that dry mouth and bad breath are not normal signs of aging.
Understanding Seniors Before you can begin to successfully treat senior patients, you need to understand the characteristics of the Baby Boomers. Born between 1946 and 1964, these 80 million Americans have several characteristics in common. Slow to embrace social media, they prefer to communicate face to face or voice to voice. They were workaholics, materialistic and ambitious. They relished (and still do) being respected, valued and
needed. And above all, they do not like being called seniors! As a result of getting older, many boomers now find themselves in a frustrating position. They have to accept that they are growing older while their body is deteriorating, causing physical limitations even though their minds are sharp and clear. They would like to contribute to society, but feel they are not valued. They have had to seek medical care from younger health care professionals either because they have relocated or because their previous health care givers have retired. In many cases, they feel that they are not treated with respect.
Caring for Seniors The first thing you need to do when caring for senior patients is to build their trust. This begins with a team approach from the moment they enter your office. Which would you rather hear as you enter an office for the first time?
Please see SILVER, 36
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35
FDC2017 SPEAKER PREVIEW SILVER from 35
Example 1: “Good morning, Mrs. Smith! Welcome to the office!” Example 2: “Sign here and sit down. I’ll be with you in a minute.” Example 1 immediately establishes the “we care” attitude. In contrast, Example 2 tells the patient that he or she is not as important. Even if the receptionist is busy, she can provide a welcoming greeting before asking the patient to sit and wait a few minutes. Next, get them to relax. As a professional, we all understand how traumatizing dental visits can be. If you are dealing with seniors, you need to reduce their stress as much as possible. You do not want their blood pressure to elevate while they are waiting. So, if they have to wait, offer them some water, coffee or tea. And don’t just put it in the corner — have someone bring it to them. If you make patients feel special, they will be more loyal to your practice. Most offices today have televisions. Have you watched the news lately? It will stress anyone out! Consider having some DVDs of old comedy shows, with Johnny Carson or Carol Burnett. This will have a calming effect and cause them to relax.
Patient Evaluation and Risk Assessment As with all patients, a thorough medical history is essential. But as you review it with your senior patients, you must question them extensively. I have found that many
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seniors skip over certain questions, assuming those questions are not that important to dental treatment. One of the most common omissions is not listing a regimen of daily aspirin. For some reason, some senior patients feel that only prescribed drugs, not OTCs, are important when listing their medical history. Keeping in mind, as mentioned previously, half of all seniors will succumb to the one of the three top diseases; you need to talk to them about heart disease, respiratory disease and cancer, even if they did not note it on your forms. Often, we zero in on the questions patients mark, so I often take a retro approach. In other words, I want to question them about items they might have skipped that I know can interfere with dental procedures. To make it easy, think A-B-C-D for dental treatment. A. Anesthesia and Allergies – potential problems with vasoconstrictors or latex B. Breathing, Bleeding and Blood Pressure C. Chair position – orthostatic hypertension D. Drug interactions or Prosthetic devices7 Stress reduction is an integral part of working with seniors. In addition to elevating blood pressure, stress can affect the immune response and wreak havoc with insulin levels. For many reasons, it is best to follow a general stress reduction protocol when treating senior patients. Keep appointments as short as possible.
Morning appointments usually are best.
Discuss fears and concerns before you start the procedure.
Be open, honest and supportive.
Use topical ointment and profound anesthesia.
Have your assistant stay with the patient at all times (talking and reassuring them).
Use preoperative sedation as needed.
Call patients that evening.
Treatment Plans What kind of a learner are you? Are you a visual learner? Auditory learner? Tactile learner? Keep this in mind when you discuss a treatment plan with the patient. Most senior men have some form of hearing loss and often will not admit it. Many seniors have vision loss as well. If you have an auditory learner and he can’t hear you, or if you present the treatment plan visually, he may not understand it completely. Likewise, some patients will understand the purpose of a bite guard or a crown better if they can feel or see a diagnostic model. The best way to know if a patient understands the treatment plan is to ask them to repeat it. Senior patients require time and patience. This is why a team approach is necessary. You need to have your team create a warm, friendly atmosphere for senior patients. Once the treatment plan is established, staff can take over answering any lingering questions and review the finances. You need to establish value for the treatment plan and how it will make their overall health better. Your team will continue to emphasize this. The team stays with every senior patient and reviews all postoperative instructions before escorting the patient to the front desk. This will allow you to keep on schedule.
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FDC2017 SPEAKER PREVIEW Summary Americans are aging and health care professionals need to recognize that aging patients have special needs. The best practice to care for senior patients includes a team approach. The dentist and every member of the team need to understand potential medical problems that can be exacerbated under stress and make every effort to treat senior patients in a caring environment.
References: 1. Robnett RH, Chop W. Gerontology for the Health Care Professional (3rded). Burlington, MA: Jones & Bartlett 2015. page 3 2. U.S. Department of Health Education and Welfare. Edentulous Persons United States – 1971. Retrieved October 10, 2016 from http://www.cdc.gov/nchs/data/series/ sr_10/sr10_089.pdf 3. Centers for Disease Control, National Center for Health Statistics, Dental Caries and Tooth Loss in Adults in the United States, 2011-2012. Retrieved October 10, 2016 from http://www.cdc.gov/nchs/products/databriefs/db197.htm 4. Robnett RH, Chop W. Gerontology for the Health Care Professional (3rded). Burlington, MA: Jones & Bartlett 2015. page 13
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5. AARP. Prescription Drug Use Among Midlife and Older Americans. Retrieved October 10, 2016 from http://assets.aarp. org/rgcenter/health/rx_midlife_plus.pdf 6. U.S. Department of Health and Human Services, Summary Health Statistics: National Health Interview Survey, 2014. Retrieved October 10, 2016 from http://www. cdc.gov/nchs/data/hus/2015/020.pdf 7. Little JW, Falace D.A, Miller CS, Rhodus NL. Dental Management of the Medically Compromised Patient (8th ed). St. Louis: Mosby 2013 p.3.
Works Cited AARP. Prescription Drug Use Among Midlife and Older Americans. Retrieved October 10, 2016 from http://assets.aarp.org/rgcenter/health/ rx_midlife_plus.pdf Centers for Disease Control, National Center for Health Statistics, Dental Caries and Tooth Loss in Adults in the United States, 2011-2012. Retrieved October 10, 2016 from http://www.cdc.gov/nchs/products/ databriefs/db197.htm
Little, J.W., Falace D.A, Miller CS, Rhodus NL. Dental Management of the Medically Compromised Patient (8th ed). St. Louis: Mosby 2013, p. 3 Robnett, R.H., Chop W. Gerontology for the Health Care Professional (3rded). Burlington, MA: Jones & Bartlett 2015., p. 3, 13 U.S. Department of Health and Human Services, Summary Health Statistics: National Health Interview Survey, 2014. Retrieved October 10, 2016 from http://www.cdc.gov/ nchs/data/hus/2015/020.pdf U.S. Department of Health Education and Welfare. Edentulous Persons United States – 1971. Retrieved Oct. 10, 2016 from http://www.cdc.gov/nchs/data/series/sr_10/ sr10_089.pdf Dr. Anna Avola has a general dental practice in Naples, Fla. and can be reached at dravola@dssnaples.com. She will be speaking at FDC2017 and presenting her course, “Silver Linings Playbook — Strategies for Elder Dental Care,” on Friday, June 23 at 2 p.m.
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FLORIDA DENTAL CONVENTION: THE OFFICIAL MEETING OF THE FDA
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FDC2017 SPEAKER PREVIEW
Tray Tooth Bleaching:
The Right Thing at the Right Time By Dr. Van B. Haywood
If you rob a bank and give the money to the poor, have you done the right thing? If you restore teeth with the best possible porcelain veneers when the teeth do not need veneers, have you done the right thing? Bleaching teeth is one of the many treatments that everyone should have in their treatment options in order to do the right thing at the right time. Once you have determined to do the right thing, then you need to do the thing right (according to the wisdom of my late esteemed colleague, Dr. Dick Tucker). When considering bleaching, the most cost-efficient, safe and efficacious technique for both the dental office and the patient is generally recognized as tray bleaching using a 10 percent carbamide peroxide (CP). The following checklist on tray bleaching may be helpful.
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1. Everybody’s teeth respond differently, both in how white they get and how quickly that whitening occurs. Tray bleaching expectations include: Normally discolored teeth can take three days to six weeks.
identifying the existing restorations revealed in a full smile because the restorations do not change color.
evaluating the results of the periodontal conditions because exposed roots do not bleach.
Nicotine-stained teeth can take one to three months.
Tetracycline-stained teeth can take two to 12 months or longer. The average for tetracycline-stained teeth is three to four months to get lighter, but not necessarily white.
recording all existing decay, gingival disharmony, history of sensitivity or occlusal problems.
Once teeth reach their maximum whiteness, further treatment or different products or concentrations will not improve that shade. Teeth look the best when they match the color of the sclera of the eyes. 2. Prior to bleaching, the dentist should conduct a proper examination and analysis of the smile. This examination should include: evaluating how much of the teeth are showing in a full smile because the gingival area of teeth does not bleach as well as the incisal portion.
identifying the gummy smile because whiter teeth make the gummy smile more noticeable. Periodontal therapy for altered passive eruption may be first indicated.
3. The dentist should take a screening radiograph of the anterior teeth to be bleached and any single dark tooth to determine the cause of the discoloration. That cause could include: an abscessed tooth.
internal or external resorption.
calcific metamorphosis (the pulp chamber obliterated by secondary dentin).
different size pulp chambers.
caries.
cysts or tumors.
4. There are two different bleaching materials that require different instructions for the patients. CP is composed of hydrogen peroxide and urea. CP is best worn overnight, as it is active for six to 10 hours. Hydrogen peroxide (HP) is only active for 30-60 minutes, so it is applied during the day. A 10 percent CP product is comparable to a 3.5 www.floridadental.org
percent HP product. Because CP has a long activity time, it takes fewer nights to reach the same shade as HP worn during the day. Conversely, HP worn during the day will take more days of less wear time to equal the nighttime bleaching with CP. 5. The pH to get tooth decay on dentin is below 6.8 and in enamel is below 5.5. Because CP has urea, the pH of the mouth and in the tray is elevated above 8 within five minutes of insertion, such that patients cannot get tooth decay while wearing the bleaching tray with CP. Hence CP in a tray may be used for caries control when fluoride in a tray is not working. HP has a pH of 5, so does not favor tooth protection for long-term wear. 6. Different tray designs are important for different products, different concentrations and different patients. Ten percent CP originally was designed to treat the gingivae as an oral antiseptic (Glyoxide), so trays can be made that extend onto the tissue 1-2 millimeters for a more comfortable, better seal. The gingival health in research projects always improves during bleaching. Concentrations higher than 10 percent require scalloping the tray, such that there is no tissue contact, to avoid tissue burning. 7. Spacers or reservoirs are not needed to bleach teeth, as only a thin film of material is required with tray isolation, but reservoirs account for tight or ill-fitting trays. A proper alginate impression (where the adhesive has set for 10 minutes in the tray before use, the impression is held in the mouth for one minute past tacky and poured within 15-45 minutes without bubbles) creates an excellent fitting non-scalloped, no reservoir tray for 10 percent CP.
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“While there is much more information about how to do the thing right with bleaching, these points provide a starting point for good quality patient care.�
8. Tooth sensitivity is a result of the easy passage of peroxide through intact enamel and dentin to the pulp in five to 15 minutes. This easy passage changes the color of the dentin as well as the enamel. Sensitivity is a transient pulpitis, and the higher the concentration, the greater the sensitivity. 9. In addition to a proper fitting tray and low concentration of CP, the best treatment for sensitivity involves the tray application of 5 percent potassium nitrate for 10-30 minutes prior or after bleaching. Potassium nitrate is found in most desensitizing toothpastes in the U.S. Professional products also are available, as well as bleaching products, which contain potassium nitrate. 10. Bleaching should not be started immediately after a prophylaxis. Before initiating bleaching and to reduce sensitivity issues, it is best to wait two weeks, during which time the patient should brush with a desensitizing toothpaste to further reduce the chance of sensitivity.
11. Because bleaching materials penetrate the tooth and release oxygen, the bond strengths of composite to enamel are reduced by 50 percent if bonding is performed immediately after bleaching. The dentist should wait two weeks after bleaching for the oxygen to dissipate before initiating bonding procedures. 12. The oxygen released during bleaching also affects the shade of the tooth, so the patient should not be bleaching for two weeks prior to a shade being taken for a crown or composite. Since some patients may be using over-the-counter products unknown to the dental office, it is important that the receptionist question the patient before scheduling an appointment that involves bonding or shade matching. 13. Restorations will not change color from any type of bleaching. While the surface will be cleaned, which may result in a more favorable-appearing restoration, the color is the same. Patients need to be informed of Please see BLEACHING, 43
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THE FDA COUNCIL ON THE NEW DENTIST PRESENTS
WHERE THE NIGHT COMES ALIVE! DANCE THE NIGHT AWAY @ WRECKERS FRIDAY, JUNE 23 FROM 10 PM – 1 AM
FDC2017 SPEAKER PREVIEW BLEACHING from 41
the cost of replacing unaesthetic restorations as a separate fee from the bleaching fee. 14. A single dark tooth is best treated with a single tooth bleaching tray rather than a full-mouth tray. This allows the single tooth to reach its maximum whitening before changes are attempted on the adjacent teeth. A single-tooth tray is fabricated by taking a full-mouth tray extended further onto the tissue, and removing the tooth molds so that the bleaching material only contacts the single dark tooth.
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While there is much more information about how to do the thing right with bleaching, these points provide a starting point for good quality patient care. Haywood VB. Tray Tooth Bleaching. Dental Practice Success. Posted online April 18, 2016 at https://success.ada.org/en/practice/ dental-practice-success/spring-2016/traytooth-bleaching. Copyright © 2016 American Dental Association. All rights reserved. Reprinted with permission.
Dr. Van Haywood is a professor at the Dental College of Georgia at Augusta University and can be reached at vhaywood@gru.edu. He will be speaking at FDC2017 and presenting two courses. On Thursday, June 22, “Tooth Bleaching of All Types — From the Youngest to the Oldest Patient,” will be at 9 a.m. and “Bleaching Tips and Pearls: Single, Dark Teeth, Sensitivity and Caries Control” will be later that same day at 2 p.m.
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FDC2017 SPEAKER PREVIEW
What Big Teeth You Have
Images That Get Your Patient’s Attention By Dr. Mark Kleive
It was the night before a treatment consultation when I recognized that I was feeling unusually nervous. I was presenting a treatment plan to a patient and feared they might not be prepared to hear it. This was contrary to my learning. Although I had heard the advice many times, “Mark, present a plan to the patient when they are ready to hear it,” I didn’t think that my patient, Sharon, was ready. However, she and I had to move forward with a plan soon because she wanted to maintain her remaining teeth. Sharon and I had spent much of the last four years getting to know each other better. Simultaneously, we were watching her periodontal situation deteriorate. I did not think that Sharon really understood the complexity of her situation and the possibilities that she had. It was a difficult conversation that I’d have to lead. I began our consult appointment by asking Sharon what questions she had from her previous visit with me. Without hesitation she said that she was excited to see her
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photographs, the first of which was already on the consult room computer screen. Sharon said she anticipated that she would get a “better perspective” of her current condition. Before we began to look at her photographs and the models that I had prepared, I shared with Sharon my feelings of nervousness. I shared with her that I was fearful that the best opportunity that I saw for her might be more than she anticipated. I wanted permission to share a plan with her, but I didn’t want her to be overwhelmed, never to return. Sharon chuckled with glee at my honest concern. She knew that extensive measures were necessary to get what she wanted. I could immediately feel my own tension disappear as we looked at her first photograph together. I have discovered that I am most successful in helping patients move from a crisis orientation to a health orientation when they have ownership in their current condition. Although it sometimes takes many “touches” in order to earn the right to care for people, the tools that I use to develop this ownership can influence this timeline. Beginning in the year 2000, I incorporated digital intraoral photography into my practice. I have found its use to be my most powerful tool for increasing patient awareness and developing that ownership.
With correct technique, nearly every area of the mouth can be clearly viewed with as few as six images. I still remember trying to show a patient a shadow of decay under a silver filling of a posterior tooth with a hand-held mirror. The patient obviously could not see what I was trying to describe. Not only was the patient frustrated that he couldn’t see it; I was frustrated that I couldn’t show it to him better. Of course, with excellent photographic images, this experience is now infrequent. Additionally, an image helps people see things in the way that I see them. That truly is my goal: to help patients see their mouth in a way that will both enlighten them and prompt them to ask about what could be different. Let me share with you how I facilitate that happening. The typical workflow for a comprehensive exam for a new or existing patient in our practice is this: 1. The patient is engaged in a preclinical interview by the assistant or doctor. 2. Six digital photographic images are taken of the patient’s mouth (smile, lips retracted, upper occlusal, lower occlusal, left buccal retracted and right buccal retracted) then printed (Figs. 1-6).
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Fig. 1
“That truly is my goal: to help patients see their mouth in a way that will both enlighten them and prompt them to ask about what could be different.�
Fig. 2
Fig. 5
Fig. 3
Fig. 6
Fig. 4 www.floridadental.org
Please see TEETH, 47
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FDC2017 HIGHLIGHTS LASERS IN DENTISTRY WITH DR. DAVID ROSHKIND LASERS IN DENTISTRY: A BASIC COMPETENCY WORKSHOP W25 SATURDAY, JUNE 24 9 AM-5 PM LASER CE CREDITS: 6 AUDIENCE: DENTISTS REGISTRATION CATEGORY
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This workshop is designed to introduce the novice laser user or potential user to the basic scientific principles involved with laser dentistry, the safety concerns that go with lasers, the potential uses of a laser in the dental practice, and provide a hands-on experience using one or more lasers. The workshop will not be an exhaustive education in the technological developments, nor in the most current research findings. It is intended to give the attendee a basic understanding of the principles necessary to assure safe and efficacious use of lasers for the health and welfare of the patient, as this should be the first step toward becoming clinically proficient. This full-day workshop includes both a lecture and a hands-on portion with a short multiple-choice group examination, which covers a comprehensive overview and basic understanding of all dental laser devices, laser tissue interactions, and safety and operation of dental lasers. A variety of dental lasers will be used with support from dental manufacturers. A letter of successful completion of a Basic Competency Course in Lasers will be provided by the Academy of Laser Dentistry (ALD). The letter will be emailed after successful completion of the course. This course fulfills the prerequisite for the ALD Standard Proficiency Certification. A two-hour lunch break will be provided during this course. Only 20 seats remaining! Participant Requirements: Loupes and an extracted tooth
DR. DAVID M. ROSHKIND has been involved in laser dentistry since 1990. He has held positions as President of the Academy of Laser Dentistry, Chairman of Regulatory Affairs, Chairman of Scientific Sessions, and Chairman of Certification. Dr. Roshkind has held many appointments, such as: Senior Clinical Instructor at the Institute of Laser Dentistry; Certified Laser Educator; Instructor at the University of Pennsylvania School of Dental Medicine and assistant professor at Nova-Southeastern University College of Dental Medicine. He is a charter member of the Academy of Laser Dentistry, received the Academy’s Outstanding Service Award in 1998, holds the Master of Laser Dentistry designation and is an associate of Laser Education International, LLC. He currently is an assistant professor at the University of Florida College of Dentistry. Dr. Roshkind has practiced general, cosmetic and laser dentistry in West Palm Beach, FL for more than 32 years and practiced for eight years in Gainesville, FL.
FDC2017 SPEAKER PREVIEW TEETH from 45
3. The appropriate radiographs are taken. 4. The patient and doctor review the photographic images. 5. The extraoral and intraoral exam is completed. Please note that the photographs are reviewed prior to the clinical examination. This allows a higher level of engagement and understanding by the patient. It’s exciting to see the light bulb go off and to hear the patients claim their comprehension. Almost every patient expresses appreciation for seeing their mouth in a way that makes sense to them. As you take a photographic tour, I do not suggest that your focus be narrowed to only pathology; the opportunity exists to compare areas of health with areas of concern. If you are concerned about a patient’s periodontal situation, for example, show him/her an area that they are maintaining well and compare it to an area that could be improved. Help the patient understand that your intention is to partner with them so that all areas of their mouth will have the opportunity to be just as healthy. Some dentists can get engagement with a still image from an intraoral video camera. However, typically an image from an intraoral camera shows detail of usually one tooth. Let’s assume your goal is to move from single-tooth dentistry
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to a more comprehensive approach. An image that visualizes a quadrant, or better yet an entire arch, is more helpful in this regard. A patient can more easily see how different areas of their mouth relate to each other if we help them see a “bigger picture” perspective. Considerable emphasis in dental marketing is based upon using the right scripts to “sell” dentistry. I realized early that this mentality did not fit with my temperament or my values. I do not want to be a salesman. I do not want to be guilty of being one of those people who tells patients what they “need.” My role as a dentist has become clearer because I want to be a partner with my patients, a facilitator. I have learned from Frank Spear that three concepts must be addressed for any person to commit to care: 1. They must be aware of their current condition. 2. They must be aware of the consequences of doing nothing. 3. They must be aware of the benefits of treatment. Experience is showing me that this process cannot be rushed. Patient commitment to care often does not follow a linear path or timeline and is rather a developmental process. It is our responsibility to pace with the patient and continue to hold up possibilities for them.
Sharon guided the rest of our time together. We paid attention to the photographs that she thought best showed her current condition while talking about the opportunities that I thought were possible. Our plan developed during our conversation to include a multi-disciplinary approach to her care with orthodontics, perio-aesthetics, and implant and restorative dentistry. At no time did I feel like a salesman “selling” dentistry. My feelings were more about pride in my team’s ability to partner with Sharon. From our first contact with Sharon more than four years ago to the present, our team has helped her to create ownership for herself, and she has now truly developed an appreciation for what is possible. Dr. Mark Kleive has a restorative and cosmetic dental practice in Ashville, NC and can be reached at mark@blackmountaindentist. com. He will be speaking at FDC2017 and presenting three courses. His workshop, “The Fun Way to Proficiency with Digital Photography,” will be on Thursday, June 22 at 9 a.m. and his course, “A Picture is Worth Two Words: Case Acceptance,” will be later that same day at 2 p.m. On Friday, June 23, he will be presenting, “Successful Hiring, Team Development and Retention” at 9:30 a.m.
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CORPORATE CLASSROOMS
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THE EPIDEMIC OF DENTAL EMBEZZLEMENT — DIAGNOSIS, TREATMENT & PREVENTION NC15 MR. MICHAEL DEMEOLA 2-5 PM FINANCIAL CE CREDITS: 0 This lecture is fully sponsored by Berryhill, Hoffman, Getsee & DeMeola, LLC.
SIMPLIFYING COMPUTER-GUIDED SURGERY: MAXIMIZING SUCCESS WHILE MINIMIZING COMPLEXITY FOR THE DENTIST & PATIENT W18 DR. RICK FERGUSON
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PEMPHIGUS AND PEMPHIGOID — THE UNIQUE ROLE OF THE DENTAL PROFESSIONAL C66 DR. PAUL EDWARDS MS. HANNAH HEINZIG 2-4 PM ORAL MEDICINE CE CREDITS: 2
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DOUBLE YOUR PRODUCTION TOMORROW NC23 MS. WENDY BRIGGS
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FDC2017 SPEAKER PREVIEW
Opportunity is Rocking at Your Door … Will You Answer the Call?
By Marvelless Mark Kamp, The Business Rock Star
Have you ever thought of your dental practice as a concert hall? That every day, you’re putting on the performance of a lifetime? And, all of those screaming fans outside (your patients), are there for a reason? Your fans (patients) do business with you because: someone referred them to you.
a neighbor or friend told them about your music (dental practice).
your dental team exceeds their expectations with the products or services that you provide.
your band (team) rocks and over-delivers by providing an exceptional customer experience every time.
No need to worry about social media — because when the above happens, your patients will take care of it for you! Music is a business, just like yours. Turns out, neither the music business nor your business is rocket science — they are rock-it science.
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Do you know what Steve Job’s business model was? His business model wasn’t Thomas Edison, Andrew Carnegie, Warren Buffet or Jack Welch. His model for business was The Beatles. He said, “They were four guys who kept each other’s negative tendencies in check, they balanced each other and the total was greater than the sum of their parts. And that’s how I see business, no great things are done by one person; they’re done by a team of people.” You see this in music, too, like Fleetwood Mac. The band formed in 1967, but it wasn’t until Lindsey Buckingham and Stevie Nicks came on in 1975 that they really hit it big. And then later on, they all had successful solo careers. But, to this day, they all agree that when they came together, they were greater than the sum of their parts. That’s what happens when you have the right members: Focus on the dream, the hours of rehearsal and giving an all-out effort. That’s when the magic happens! So, who’s in your band? First, let’s talk about the requirements that it’s going to take to be in your band. Musicians talk about those moments where the sound is “tight” and everything just came together to create something greater than any one of them could create alone. And while it may seem that way, that kind of synergy does not happen by accident. It is the result of getting the right people in the band, having a tight common focus and of course, hours of rehearsal, then absolutely going for it.
In translation, that means: If you want to achieve your goals or your dreams, you have to surround yourself with the right people, and create the right kind of culture and relationships that allow you to work effectively together. Let’s get specific. When Don Henley and Glenn Frey were putting together The Eagles, they would not audition anyone unless each person could play multiple instruments, sing leads, do solos and write songs. Then they would never step out on stage until they could rehearse their playlist 100 times in a row perfectly. So, what can we learn from these famous bands about working together that we can apply to what we do? 1. Put the band first. Aerosmith’s Steve Tyler once said, “As good as I am, I’m nothing without my band.” He knew he had to put the band first. So always default to: What’s best for the band? What’s best for the team? 2. Honor everyone’s unique abilities. In a band, some people are up front and are noticeable. Others, like the bass player, barely get noticed at all. But a smart rock star makes sure everyone gets honored. Let me ask you this: Have you ever gone to a concert and wondered why all the band members usually get a solo in the show? It’s not so everyone else can get a beverage break. It’s so that everyone can be honored for his or her unique abilities. The same is true in business. You need to allow each and www.floridadental.org
every person play his or her part and honor that person’s contribution. It’s been said about The Rolling Stones that Mic Jagger makes them famous, but their guitarist Keith Richards makes them a band. And some of your people make your company famous while others make the company work on a day-by-day basis. There needs to be a realization that everyone contributes to the success of your practice. We all have a critical part to play, and everyone needs to be recognized for the part that they play. Stephen Covey says, “Always treat your employees exactly as you want them to treat your best customers.” Are you treating them like that? Are you constantly feeding them praise, honoring their abilities, empowering them to make decisions on their own, mentoring them, helping them grow as a person, a role model and as a business associate? The more you can get your people feeling they like they are invested or have ownership in your company or business, the more mileage you will get out of them and the better they will treat your patients. 3. This may sound weird concerning rock bands, but check your ego at the door. Some bands like U2 endure and become legendary. But other bands — in fact, most bands — break up. What is the reason most bands break up? Yoko Ono (just kidding). It is almost always ego. Check your ego at the door and put on your team player hat; no matter what, none of us is as smart as all of us (your team). What keeps a band together is humility, a humble spirit, and a bandleader that isn’t overcome with an ego and knows the band is better together. A great band has members with outstanding talents with a clear leader who celebrates everyone’s talents as they are each contributing to the team (band). www.floridadental.org
“Focus on the dream, the hours of rehearsal and giving an all-out effort. That’s when the magic happens!”
In conclusion, but certainly not in conclusion, is it going to be easy taking a little extra time to screen people your interviewing? Yes. Will it take a little extra time for a little extra training? Yes. Is it a risk to empower your employees to make decisions on their own and let them learn from their mistakes? Yes. Is your competition doing these things? Yes. If they are a smart business rock star. It’s going to be far more profitable to start thinking proactively toward your business instead of reactively. Taking time out to leave little post-it notes of thanks, celebrating someone’s birthday or a great job they did, or giving someone a pat on the back or announcing over the loudspeaker that someone did a great job today. And, how about just listening when someone has an idea or challenge. That’s what rock stars do. They get everyone excited and on board with their dream or mission statement. Speaking of, is your mission statement something that excites everyone on your team? Is it something that they want to share with their friends and makes them excited to come to work? The Beatles’ mission statement was to be “Bigger then Elvis,” and Kiss said they want
to be “the biggest and most raucous band in the world.” Now that’s exciting, simple and clear. Then, you celebrate your successes — we all know rock stars like to celebrate (but that’s a different story)! So for now, “crank up your speakers” and hear the message of these songs: “There’s Always Something There to Remind Me” that we possess “The Power” so “Don’t Stop Believing,” even “Living in a Material World.” “We Built This City on Rock ‘n Roll,” so we will “Fight for Our Right to Party” even if the “Girls Just Want to Have Fun.” Always honor your band (your team), so they are not a “Band on the Run.” Jerry Garcia of the Grateful Dead said, “You do not merely want to be considered the best at what you do, you want to be considered the only one who does what you do.” Boom … (microphone drops). “Now Excuse Me, While I Kiss the Sky.” Marvelless Mark (Mark Kamp) is the author of the acclaimed book, “Opportunity Rocks” and can be reached at cindy@marvellessmark.com. He will be speaking at FDC2017 and presenting his keynote session, “Opportunity Rocks!” on Friday, June 23 at 8 a.m. March/April 2017
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All Aboard
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A big part of team chemistry is building great relationships with each other by having fun together outside of the office.
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All Aboard
By Dr. Edward Hopwood
“What a great team you have here!” We consistently hear this refrain from the patients in our office, and we smile graciously and say, “Thank you.” It is a point of pride that we are members of a great team. It affects every part of our practice and it allows us to have fun while we are there. We work together, have fun together, learn together and we have each other’s backs. Because of this, we are able to enjoy the time we spend in our practice. But wait, isn’t staff management supposed to be one of the “headaches” that the large corporations are supposed to “free us” from? One of the big concerns from my residents every year is: How am I going to manage a staff? To me, I don’t look to manage anyone; I point our practice in the direction it’s going, then we all get to work to push it to get there. And that is why we will be attending the Florida Dental Convention (FDC) together as a team.
Have You Seen the List of CE This Year? It used to be that state dental meetings simply were speakers giving watered-down versions of the courses they were trying to get you to pay big money to attend. I would leave the meetings feeling like there was not a lot of substance in the lectures. But in recent years, all that has changed. Great speakers are presenting their best stuff at these meetings, and we can drive to them, rather than having to fly there.
Dr. Hopwood and Michele take care of a patient.
The list of courses this year is simply amazing. Dr. Sandy Rosenberg has arranged to get the best speakers from all over the country to come to us. I paid a lot of money and gave up weeks of my life to hear Dr. Lee Brady speak when she was with Pankey — now I can see her in Orlando. Drs. Harald Heymann and Van Haywood are legends in the field of dental materials, and I can see them both at FDC. Our very own Dr. Sam Low is a perio maestro. People fly from all over the world to see Dr. DeWitt Wilkerson — we just need to drive to our state meeting. The days of watered-down courses with little substance are gone. The lectures will be great, and I can count on them to provide our team with first-class, quality continuing education (CE) that is easily accessible. Sure, I would like to fly us all over the place for these meetings, but the bang for the buck at FDC is unbeatable. Donna and Angie work on a treatment plan. Please see ABOARD, 57
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Grab your cowboy hat, slip on your boots and join us for live music from the Tobacco Rd Band, southern fixins’ and entertainment for all ages! Name badges are required for entry for all attendees over 12 years of age. Request your ticket when registering. Preview the band at tobaccordband.com.
All Aboard ABOARD from 55
The Secret to a Great Team One of the big reasons our team is so great is that we have fun together. In fact, when we listed our core values, a cornerstone value was that we maintain the ability to have fun while we are at work. We all know that it is impossible to have fun if each member of the team is not working together. A big part of team chemistry is building great relationships with each other by having fun together outside of the office. I have many great memories from dental meetings we have attended as a team: Like the time I got back to work on Monday morning after a meeting and found my team in my back office all dressed up like the people from the movie, “The Hangover” — one was sunburned, one was missing a tooth and one was carrying a baby (doll). I can’t imagine what happened after we had dinner together that previous Friday night. Another time, we went to a fancy meeting at a fancy hotel. I was the only dentist who brought his whole team and everyone kept saying to me, “I can’t believe you brought your staff.” But to me, it was only natural and expected that they would enjoy the meeting like I did. However, when they pulled up to the hotel, they circled around once or twice before getting out of the car, and later told me, “We can’t believe you brought us to this place.” The Gaylord Palms is a fantastic facility for fun and recreation. It is a great setting with an unbelievable pool, unique restaurants and fun things to do together. The Florida Dental Association throws a party and there are a lot of great opportunities to spend some non-dental time together. We always enjoy dinner together when we are at a meeting. That time together and away from the office helps to build and maintain those
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relationships. A great team is connected by more than work, and a weekend away is a perfect time to establish and strengthen those connections.
Six is Better Than One “What is this?” I asked as I was handed a new type of scrubby with an odd cone shape (we call them “scrubbies,” but their real name is “end-tufted brush”). “Isn’t it great, I found them and thought they would be more effective for placing the bonding agent in the post space,” replied Donna, my long-time assistant. And she was exactly right. You see, we are always looking for ways to take better care of our patients and that extends to every member of our team. I work hard to keep up with all the advancements in dentistry and so does my team. When it comes to keeping up with rapid advancements, six is better than one. So, I am glad that all six members of our team are constantly looking for ways to take better care of our patients. And that is another reason why we all are planning to go to FDC. The Exhibit Hall is an enormous display of all the latest and greatest things in dentistry. Any one person who walks through there is bound to find many things that they will take back to their office and try out the following Monday. Six people are likely to find even more. And our patients will get better care because of the time we spend looking for the latest and greatest technology, materials and supplies. The Exhibit Hall is a great way to casually interact with the reps and a wonderful opportunity to ask those questions that you may not otherwise ask. I expect that each of my team members will have various questions about the equipment or materials that
they will find out about at the meeting. It’s not just about finding new things; it’s also about finding better ways to use the technology we already have. Connecting with reps on an informal level is an excellent way to expand our knowledge base.
Colleagues in Care As you can tell, I do not look at my team as people to be managed. I look at them as colleagues who work with me to take care of our patients. As an employer, it is important to recognize that even though my name is on the side of the building, my employees have dedicated their lives to their careers. They are proud of their careers and they work hard at what they do. Part of my job as the dentist is to get out of their way and allow them to shine. Part of my job is to help them to realize their full potential and use their God-given talents every day. So, it is only logical that I would bring them with me to the biggest dental meeting in our state. I expect my fellow dentists to be there advancing their knowledge. I expect the specialists I work with to be there learning and improving their practices. And, I expect my colleagues in my office to be there — growing and learning and finding new ways to shine.
Photos: All photo credits go to Bob Colmer. 1. Angie, Michele, Donna, Lou and Jen. 2. Michele and Lou work together in sterilization. 3. Jen takes an X-ray.
Dr. Hopwood is a restorative dentist in Clearwater and can be reached at edwardhopwood@gmail.com.
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EXHIBITOR MARKETPLACE Exhibitors as of March 14, 2017
#3D Diagnostix Inc. 3M Oral Care
AA-dec A. Titan Instruments Accutron Inc. ACTEON North America ADS Florida | Henry Schein Professional Practice Transitions Advantage Technologies Advice Media AFTCO Air Techniques Inc. AMD Lasers Anutra Medical Inc. Argen Refining ArtCraft Dental Inc. ASAP Dental Care Aseptico Aspen Dental Atlanta Dental Supply Atlantic Dental / Brewer Design AXA
B
These exhibitors have made a commitment to attend the FLORIDA DENTAL CONVENTION (FDC). Not only do these companies exhibit the latest in technology, materials and equipment, but many sponsor events and continuing education programs at the FDC. Look to see if your supplier is on the list. Make an effort to stop by their booth in the Exhibit Hall in June for exclusive show specials. Support these companies that support the Florida Dental Convention.
FDA SERVICES INC. IS A MAJOR SPONSOR OF THE FLORIDA DENTAL CONVENTION.
Bank of America Practice Solutions Banyan Bayshore Dental Studio Belmont Equipment Benco Dental Berryhill, Hoffman, Getsee & DeMeola LLC Bien-Air Dental Bioclear Matrix BioHorizons BIOLASE Biotec Inc. BirdEye Bisco Dental Products Black Tie Digital Marketing BQ Ergonomics LLC Brasseler USA
C CareCredit Carestream Dental Carr Healthcare Realty Centura Pharmaceuticals Inc. Certol International Christian Dental Society Citibank Healthcare Practice Finance Classic Craft Dental Laboratory ClearCorrect Coast Dental Colgate COLTENE
Cool Jaw by Medico International Inc. Crest + Oral-B Curaprox USA CUTCO Cutlery
D Dansereau Health Products Dear Doctor Inc. Demandforce DenMat Dental Care Alliance Dental Equipment Liquidators Inc. Dental Temps Staffing Solutions DentalEZ Integrated Solutions DentalOne Partners / DentalWORKS DentalPC DentaSpa Seminars Dentegra Insurance Company Dentsply Sirona Designs For Vision Inc. DEXIS Diatech Inc. Digital Doc LLC Digital Resource Doctor Multimedia Doctor’s Choice Companies Inc. Doctor.com Doctors Disability Specialists DoctorsInternet.com Doral Refining Corporation Dr. Fuji / ACIGI Relaxation
E-F Easy Living Products Eclipse Loupes and Products Elevate Oral Care LLC Envolve Benefit Options Essential Dental Systems FDA Supplies / SourceOne Dental Inc. Fidelity Bank First American Dental Finance First Citizens Bank First Home Bank Florida Academy of General Dentistry Florida Baptist Convention Florida Board of Dentistry Florida Combined Life Florida Dairy Farmers / Dairy Council of Florida Florida Dental Association Florida Dental Association Foundation Florida Dental Association Services Florida Probe & VoiceWorks Forest Dental Products Inc. Fortress Insurance Company Fortune Management
Fotona / Lasers4Dentistry Fuze Care System
G Garfield Refining Company Garrison Dental Solutions GC America Inc. GlaxoSmithKline Glidewell Dental Global Expo Great Expressions Dental Centers Greater New York Dental Meeting Greenberg Dental & Orthodontics
H Halyard Health Hawaiian Moon HealthLink / Clorox Heartland Dental Henry Schein Dental Henry Schein Practice Solutions Heraeus Kulzer HIOSSEN Hu-Friedy Manufacturing Co. LLC Hunza Dental
I I.C. System Inc. ICW International iMedicor Implant Direct Implant Educators Infinite Trading Inc. Insurance Credentialing Specialist integrated dental systems International Pemphigus & Pemphigoid Foundation Ivoclar Vivadent Inc.
K Karl Schumacher Dental KaVo Kenwood / CGX Radios Kerr Kettenbach LP Knight Dental Group Komet USA Kuraray America
L Lares Research Lending Club Patient Solutions LIBERTY Dental Plan Lighthouse 360 Live Oak Bank LumaDent Inc.
M MacPractice maxill MCNA Dental Plans Medidenta Meisinger USA LLC MHM Services Inc. / Centurion Microcopy
Microflex / Ansell Midmark Corporation Millennium Dental Technologies Inc. MIS Implants Technologies Modular & Custom Cabinets Ltd. More Health Inc. My Computing RX Myofunctional Research Co.
N-O National Dental Association Nature Hill NV New Image Dental Laboratory Nova Innovations NSK America Corporation NSU — College of Dental Medicine Officite On the Map Marketing OraPharma Inc. Orascoptic Ortho-Tain / Healthy Start
P Pacific Dental Services Panoramic Corporation Patient News Patient Prism LLC Patterson Dental PDT Inc. / Paradise Dental Technologies Pelton & Crane PerioChip By Dexcel Technologies Ltd. PeriOptix Peter J. Freuler Jr., PA, CPA Philips Sonicare & Zoom Whitening Planmeca USA Inc. Porter Instrument Co. Inc. Power Dental USA Prestige Products Direct Professional Sales Associates Inc. Proma Inc. Prophy Magic Prophy Perfect / PHB Pulpdent Corporation
Summitt Dental Systems Sunrise Dental Equipment Inc. Sunset Dental Lab Sunshine Health Sunshine State Credit Superior Dental Design Services & Upholstery SurgiTel
T-U TD Bank The Dental Assisting National Board The Doctors Company The Online Practice Thommen Medical Tokuyama Dental America TriNet HR III Inc. U.S. Navy Recruiting UF College of Dentistry Ultradent Products Inc. Ultralight Optics Inc.
V-W Vatech America VIAX Dental Technologies Video Dental Concepts VOCO America Inc. Walla International / Click Heaters Wand Dental Inc. (Milestone Scientific) Water Pik Inc. WEAVE Wells Fargo Practice Finance
X-Y-Z i XPdent Corporation Zimmer Biomet Dental ZOLL Medical
Exhibitors in blue are FDAS Crown Savings Merchants.
R-S Real Time CPAs RF America IDS Inc. RGP Dental Royal Dental Manufacturing Sage Dental Salvin Dental Specialties Inc. SciCan Inc. SDI (North America) Inc. Serve First Solutions Inc. Shamrock Dental Co. Inc. Shofu Dental Corporation Sierra Dental Products LLC SmileFaith Foundation Inc. Snap On Optics Solutionreach Special Olympics Florida St. Renatus LLC Straumann USA
EXHIBIT HALL HOURS
THURSDAY • JUNE 22, 2017 9 a.m. – 6 p.m.
FRIDAY • JUNE 23, 2017 9 a.m. – 6 p.m.
SATURDAY • JUNE 24, 2017 9 a.m. – 2 p.m.
YOU are NUMBER
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YOUR COLLEAGUES ARE “HELPING MEMBERS SUCCEED” EVERY DAY!
DEDICATED VOLUNTEERS HELP YOU SUCCEED My participation in organized dentistry began in dental school, like many others. I was involved with the American Student Dental Association at the University of Florida. Through that experience, I realized how important being involved in organized dentistry is to protecting our profession and maintaining ethical standards. The Pinellas County Dental Association and West Coast District Dental Association have welcomed new graduates with open arms. I have been fortunate to help involve new dentists in our local dental association as a resident and now as I practice.
DEBORAH LOWRY, DMD
A goal of serving on the New Dentist Committee is to maintain the integrity of our profession by active involvement of new dentists, as well as to aid each other’s success through fellowship. The initial transition into practice can be overwhelming, but with the support of other experienced and knowledgeable dentists in organized dentistry it becomes simplified. Ultimately, through relationships with our colleagues and specialists, our common goal is to provide high quality dentistry to our communities. — Deborah Lowry, DMD New Dentist Committee, West Coast District Dental Association dlowry05@gmail.com
Interested in opportunities to get involved? Simply email the FDA’s Membership Concierge and she’ll put you in touch with your local dental society. Contact Christine Mortham at cmortham@floridadental.org.
FDA CHAT online member support NEW! Chat with FDA Member Relations staff and get answers fast. Go to the Members page at www.floridadental.org. FDA CHAT is available weekdays from 8 a.m. to 5 p.m.
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OPTIMIZE your ce earning
AUTOMATIC CE VERIFICATION CE verification is automatically provided for all attendees. To receive CE Credit:
» Scan your badge upon entering and exiting a course. » Attend 50 of the 60 minutes of a course to receive one hour of CE credit.*
» Example: if your course is three hours, you may be out of the course for a maximum of 30 minutes to receive full credit.
* In order to stay compliant with the Florida Board of Dentistry’s time
CE REPORTING MADE SIMPLE » All verified course attendance for Florida licensed
dentists and hygienists will be submitted to CE Broker no later than July 22, 2017, excluding NC (non-credit) courses.
» Your CE certificate will list all courses with verified attendance; however, CE credit* will not be reported for NC course codes.
» NC courses will be listed as zero hours on your CE certificate.
requirements for CE credit, you will be scanned in-and-out each time you enter and exit a course to verify course attendance.
* Each state varies on what is accepted for CE and those courses can
CONVENIENT CE CERTIFICATES
KNOW YOUR CODES
» Your CE certificate will be emailed to you on June 26, 2017.
» Or, print your certificate during FDC2017 at the CE stations. CE Stations are located:
» in the Exhibit Hall through Saturday at 2 PM. » on the classroom level on Saturday from 2-6 PM. » or, print your certificate at home or the office for free
until Sept. 1, 2017 at www.floridadentalconvention.com
* Only credit for full course attendance will be automatically added to
your CE certificate. Credit for partial course attendance will be added to CE certificates no later than July 22, 2017.
be self-reported to your reporting entity after the event, should your organizing Board of Dentistry accept those courses.
» C: Clinical Lecture, CE approved* » W: Hands-on Workshop, CE approved** » PM: Practice Management, CE approved** » MR: Hands-on Mini-residency, CE approved** » NC: Non-clinical, non-credit * CE approved refers to Florida Board of Dentistry (BOD) statutes. ** The Florida BOD specifies that approved Practice Management courses include “principles of ethical practice management, provides substance abuse, effective communication with patients, time management, and burnout prevention.” FS 466.0135(c)
QUESTIONS? CONTACT BROOKE MARTIN AT 850.350.7103 OR BMARTIN@FLORIDADENTAL.ORG
Plan to attend this very special celebration honoring our FDA President, Dr. Bill D’Aiuto, as well as the 2017 award recipients, including the FDA Dentist of the Year.
2017 FDA Award Recipients
J. Leon Schwartz Lifetime Service Award Dr. David Russell Dr. David Russell is a life member of the American Dental Association (ADA) and the Florida Dental Association (FDA). He has been a member of the ADA for more than 50 years and a member of the FDA for more than 30 years. During his time in the FDA, he has served as the Northwest District Dental Association (NWDDA) delegate to the FDA House of Delegates (HOD); a member of the Committee on Conventions and Continuing Education; president of the FDA Foundation; and served on the board of the FDA Political Action Committee. Dr. Russell served as professor and chair of the Department of Pedodontics at the University of Alabama School of Dentistry for 17 years, and has practiced pediatric dentistry in Fort Walton Beach for more than 30 years. Dr. Russell’s commitment to his many NWDDA and FDA activities over the past 30 years has been consistently positive and associated with the significant growth, including the development of the Florida Dental Convention and the FDA Foundation. He is known as personable, dedicated and humble.
FDA Dentist of the Year Dr. Elizabeth Gesenhues Dr. Elizabeth Gesenhues was born in Munich, Germany and then moved to Louisville, Ohio where she experienced small-town life with her parents and siblings as a young child. She earned her dental degree at Case Western Reserve University School of Dentistry, followed
by a post-doctoral certificate in pediatric dentistry at the Children’s Hospital Medical Center (CHMC) in Cincinnati. Dr. Gesenhues’ years at CHMC sparked her interest in craniofacial growth and development. With this interest in mind, she moved to Germany to study the European approach to orthodontics at the University of Cologne, where she received the German orthodontic specialty certification. She then returned to the United States and earned certification in orthodontics from the University of Florida College of Dentistry (UFCD). Dr. Gesenhues currently has a private orthodontic practice in St. Augustine, Fla. Dr. Gesenhues has volunteered at various free dental clinics, served as the Project: Dentists Care coordinator for the Northeast District Dental Association (NEDDA), and was a delegate to the FDA HOD and an alternate delegate to the FDA HOD, as well as Reference Committee chair. She currently is a member of the FDA Leadership Development Committee. She claims her greatest accomplishment is becoming a pediatric and orthodontic dentist, as well as honoring her parent’s commitment to education and maintaining family ties across two continents.
President’s Award Dr. Bill D’Aiuto Dr. Bill D’Aiuto began his service to organized dentistry as the chair of Florida’s New Dentist Committee. In 1992, he was the ADA’s New Dentist chair for Mississippi, Alabama, Georgia and Florida (the old ADA 5th District). New dentist and student issues have been the foremost concern of his dental career. Dr. D’Aiuto was instrumental in bringing the American Student Dental Association (ASDA) student vote to the ADA HOD as part of his 26 years serving Florida’s delegation to the ADA. Dr. D’Aiuto has been the chair
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of the Florida National Dental Congress (now the Florida Dental Convention) and the president of the Florida Dental Health Foundation (now the FDA Foundation). As the FDA’s appointee to the ADA Council on Dental Practice, he has seen firsthand the trends that face the dental profession. Dr. D’Aiuto has been honored for his service in dentistry by receiving many awards, including the 1989 ADA Outstanding Young Dentist Leader Award and 1993 FDA Dentist of the Year. Dr. D’Aiuto is a general practitioner in the Orlando area and has maintained a solo practice there since 1982.
President’s Choice Award Dr. Suzi Theims-Heflin Dr. Suzi Theims-Heflin is a UFCD graduate and received her certification in pediatric dentistry from the Medical College of Georgia. She has a solo private practice in Ocala, and until recently, in Gainesville, Fla. Dr. Theims-Heflin is a fellow of the American College of Dentists, and serves as an alternate delegate to the ADA HOD, chair of the FDA Leadership Development Committee and member of the FDA HOD. Dr. Theims-Heflin also has been active in the Alachua County Dental Association where she has served as secretary/treasurer, vice president and president, as well as the chair for Children’s Dental Health Month.
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Dr. Theims-Heflin and her husband, Phillip, live in Gainesville. She enjoys reading, playing the piano, traveling and volunteering for the Junior League of Florida and Gainesville.
Daniel J. Buker Special Recognition Award Ms. Kerry Gómez Ríos A Florida State University graduate, Ms. Kerry Gómez-Ríos is the FDA’s Director of Member Relations and has led our membership and recruitment efforts for the last three years. Under her direction and vision, the FDA experienced its first gain in market share and member growth since 2004. Since that initial gain in 2014, membership has continued to grow each year under her leadership. The FDA has been recognized at the ADA Recruitment and Retention Awards Ceremony for the last three years, and the FDA’s growth contributed to 10 percent of the ADA’s overall member growth in 2016. As part of her responsibilities, Ms. Gómez-Ríos serves as staff support to the FDA Council on Membership and the Council on the New Dentist. She has been instrumental in revitalizing both councils as well as strengthening our bond with the three Florida dental schools and their ASDA chapters, while increasing student involvement with the FDA. She maintains that the absolute favorite part of her job is forging relationships with dentists and students,
and being able to put a smile on members’ faces while helping them succeed. Ms. Gomez-Rios has been married to her college sweetheart, Julio, for 18 years. Together, they have an 11-year-old daughter, Bella, and a three-year-old rescue puppy, Benji. They enjoy traveling to Panama, where she and her husband were both born, so they can participate in their family-created charity, Panama Pantry, which provides basic food items to the community of La Mesa de Santiago.
FDA Leadership Award Dr. Michael Eggnatz Prior to becoming the FDA’s president-elect, Dr. Michael Eggnatz has held leadership positions at every level of the tripartite. On the national level, Dr. Eggnatz has served as 17th District delegate, alternate delegate to the ADA HOD and on two reference committees. At the state level, he has been an FDA trustee, Governmental Affairs Committee member, Legislative Contact Dentist, Donated Dental Services board member and FDA Board of Trustees (BOT) liaison to the Committee of Conventions and Continuing Education, where he assisted with the new general chair’s transition into the current format. At the local level, Dr. Eggnatz is past president of the South Broward Dental Society (SBDS) and the South Florida District Please see AWARDS, 66
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Dental Association (SFDDA), and also served as the general program chair for the Miami Winter Meeting for nine years. He also served as the president of the Greater Miami Chapter of Alpha Omega and as deputy and state regent. Dr. Eggnatz has been on the FDA HOD since 1997, and is a fellow of the American College of Dentists and the International College of Dentists. Dr. Eggnatz is a native Floridian and in 1988, he became a third-generation dental graduate from the University of Maryland (UMD). He is most proud of his beautiful grown children, Kristina and David, his wife, Marian, and his family legacy in dentistry.
FDA Leadership Award Dr. Rodrigo Romano Dr. Rodrigo Romano is a board-certified periodontist who specializes in periodontal disease and dental implants, and is a diplomate of the American Board of Periodontology. He earned his dental degree at the Universidad Autonoma de Guadalajara in Mexico and then completed an internship in oral and maxillofacial surgery at Hospital General de Zapopan, Jalisco. He continued his postgraduate education in periodontology at Tufts University School of Dental Medicine
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where he received his master’s degree, and presented his research on the “Distribution of Oral Bacterial Species in the Atheromas and Dental Plaques of Cardiovascular Disease subjects: A Pilot Study” during the Bates-Andrews Research Day presentations. In 2013, Dr. Romano became a fellow of the International College of Dentists for his outstanding contributions and dedication to dentistry, and in 2015 he became a fellow of the Pierre Fauchard Academy. As a proud member of the ADA, he stays active in organized dentistry at the local, state and national levels. Dr. Romano currently is a member of the ADA Council on Membership; SFDDA delegate to the FDA HOD; alternate delegate to the ADA HOD; alternate trustee to the FDA BOT; and, chair of the FDA Council on Financial Affairs. In the past, Dr. Romano served as the SFDDA treasurer; clinical instructor at the UF-Hialeah campus; president and treasurer of the Miami Dade Dental Society; representative of the Tufts Alumni Admissions Program; periodontology department chair at Community Smiles Dental Clinic; and, secretary of the Community Smiles Dental Clinic BOT. Miami has been Dr. Romano’s home since moving to the United States from Mexico in 1985. He stays active by running with his team, “SoleRunners,” and enjoys attending the Florida Dental Convention.
New Dental Leader Award Dr. Mark Limosani Dr. Mark Anthony Limosani received his dental degree from the University of Montreal in 2007. Since then, he completed a one-year multi-disciplinary residency at the Queen Elizabeth Oral Health Center, a McGill University affiliated program. Following one year of private practice and many hours of continuing education, he then followed his dream and attended the specialty program in endodontics at Nova Southeastern University, where he also received his master’s degree in dental science. He won the Robert A. Uchin Endodontic Award for his presentation during Nova’s Endodontic Alumni Day. He currently is the SFDDA president and is a past president of the SBDS and Nova’s Alumni Association. He also has held the positions of the SFDDA secretary and president-elect, SBDS president-elect, and the Miami Dade Dental Society secretary and treasurer. Dr. Limosani is a former adjunct faculty member at Community Smiles and Nicklaus Children’s Hospital. He also is a Baptist Bus participant.
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Dr. Limosani has lectured locally and internationally on many topics in endodontics including: dental traumatology, the restoration of endontically treated teeth, restoratively minded endodontics, diagnosis and treatment planning, and cone beam computed tomography use in endodontics. Dr. Limosani enjoys family time, competitive running and traveling.
FDA Public Service Award Dr. Sol Brotman Dr. Sol Brotman is a general dentist with a private practice in Jacksonville. Dr. Brotman attended Washington and Lee University and received his dental degree from UMD in 1980. He earned his post-doctoral certificate in comprehensive general dentistry from UFCD in 1990. He has served on the faculties of both UMD, which opened the Brotman Facial Pain Center in 1999, and the University of Florida. Dr. Brotman’s commitment to the community is evident with the numerous honors and awards he’s received over the last 10 years, including: the OneJax Silver Medallion Humanitarian Award in 2012; the Bank of America Local Hero Award in 2007; and, as a member of the Notable Alumni of Washington and Lee University in 2004. Dr. Brotman has served in many positions: founding chair of OneJax; Florida Board of Dentistry (BOD) chair; HandsOn Jacksonville president; Jewish Family and Community Services president; Mental Health
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Foundation of Jacksonville Community Board chair; and, Jacksonville Lacrosse Club president. He also has been a Stein Fellow Mentor for United Way of Northeast Florida; member of multiple governing boards and committees of the Dana-Farber Cancer Institute, Jacksonville Human Rights Commission and various other nonprofit boards, including the Founding Board of Gulf Coast Dental Outreach; and, as a trustee of the Community Foundation of Northeast Florida. His most notable achievements include serving as chair of the committee that rewrote and streamlined three chapters of the Jacksonville city ordinance that deals with housing, employment and public accommodations. He oversaw BOD initial rules that increased access to care for low-income Floridians. Dr. Brotman has been married to his wife, Leslie, for 37 years.
FDA Public Service Award Dr. Barry Setzer Dr. Barry Setzer graduated from the UMD School of Dentistry and completed his residency in pediatric dentistry at the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Dental Medicine. He also served as captain in the U.S. Air Force Dental Corps. Dr. Setzer is a fellow of the International College of Dentists, American College of Dentists, Pierre Fauchard Academy, Academy of Dentistry International and the American Academy of Pediatric Dentistry. In 2016, Dr. Setzer
received the Sally D. Ott Memorial Award for Outstanding Service to the NEDDA, as well as the FDA Foundation Humanitarian Award for his exemplary humanitarian service to the state of Florida. Dr. Setzer currently is a member of the FDA BOT and the Council on Dental Education and Licensure; consultant to the FDA Committee on Conventions and Continuing Education; member of the UFCD Strategic Planning Committee; and, chief of the pediatric dentistry section of Wolfson Children’s Hospital. Dr. Setzer was instrumental in the success of the 2016 Florida Mission of Mercy (FLAMOM) as the fundraising lead. Under his leadership, the FLA-MOM received more than $590,000 in donations and in-kind revenue, with a net income of more than $130,000 to support the 2017 FLA-MOM. Dr. Setzer and his wife, Ellen, have one daughter, Dena, and a grandson, Adam Shepherd “Shep.” He currently is the founder and partner of Drs. Setzer, Cochran and Soares, PA in Jacksonville.
FDA Public Service Award M s. Diana (Chris) Phillips In 2005, Ms. Chris Phillips took over as the adult volunteer clinic director at the Brevard County Health Department (BCHD), which
Please see AWARDS, 69
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THURSDAY, JUNE 22 • 8-11 PM • OSCEOLA C BALLROOM Show us what you’ve got! Step into the spotlight and jam with a live band that makes even a novice sound like a rock star! Come enjoy sweet treats, live music and entertainment for all ages. Everyone is invited. Badges are required for entry. Children under 12 years of age do not need a badge.
2017 Awards AWARDS from 67
is housed at three different facilities in Titusville, Rockledge (now Viera) and Melbourne. Over the past 11 years, she has visited nearly every office in the county, attended every Brevard County Dental Society (BCDS) meeting, volunteered in several capacities and also solicited volunteers to treat patients in the volunteer clinic. Ms. Phillips also participates in the BCDS annual “Tooth Trot,” usually dressed as the Tooth Fairy with gifts for kids and fairy dust for all. This past year, she helped organize two “Dental Day” events in collaboration with the Space Coast Health Foundation, which involved a multi-chair clinic where more than 200 adults received approximately $100,000 in dental care. During her personal time, Ms. Phillips helps transport homebound patients to the clinic, attends volunteer dental events at the community college, helps BCDS raise money for Give Kids A Smile events and finds care in the dental community for patients who might not qualify for the clinic or Medicaid, or who might need services not available in those programs. She also works with organizations such as the National Veterans Homeless Support, which provides dental screenings and supplies to homeless veterans in Brevard County. Over the past few years — representing the BCHD and the volunteer clinic — Ms. Phillips established emergency department referral programs with two of the area’s largest hospitals. Both have renewed agreements and have shown a significant reduction in dental emergency department visits. Her programs serve as a model for other counties and have been recognized by the state and the governor.
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Dental Team Member Award Ms. Becky Drone Ms. Becky Drone has worked in the dental field — for the same dental family — for nearly 30 years. She is a past member of the American Association of Dental Office Managers, where she assisted in scheduling events for the association. Ms. Drone volunteered for the 2016 and 2017 FLA-MOM events where she assisted with registration. She is highly involved in her community and currently volunteers at the Gulf Coast Kids House and at the Schnauzer Rescue Group. She has been a member of many civic associations that aid the community and help grow her county’s economy. She also has served as a guardian ad litem for the past six years and has been the voice for 13 children. Ms. Drone claims her greatest accomplishments as being part of the 2016 and 2017 FLA-MOMs, being the voice for children through the Guardian ad Litem Program, assisting in several adoptions to ensure that children got into loving homes, as well as working with FDA member Dr. Jeff Ottley for the past 19 years.
Celebrate These Award Winners Purchase your tickets for the FDA Awards Luncheon in your FDC registration. Tickets are $40 each, or purchase a table of 10 for $350. For more information, contact Brooke Martin at 850.350.7103 or bmartin@floridadental.org.
Ms. Drone is a longtime resident of the Pensacola/Milton, Fla. area. She and her husband, Tim, have one son. When not working, she keeps herself busy by volunteering in the community, water skiing and spending time with her family at the beach. She enjoys dentistry as much as any dental professional and takes pride in helping patients achieve excellent dental health.
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SHARPEN YOUR
SKILLS THURSDAY, JUNE 22 BEACH, DR. DAVID
Cutting-edge Endodontics: Advances in Biomechanical Preparation • W05
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Positioning for Life: Ergonomic Advancements in Dentistry • NC05
BERRIOS, MR. LUIS • GILBERT, MR. ROGER • SANCHEZ, MR. ROBERT Preventive Equipment Maintenance • W04
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Immediate Implants, Immediate Provisionalization • W02
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A to Z of Mini Dental Implants: A Two-day Mini-residency • MR01
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The Fun Way to Proficiency with Digital Photography • W03
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Predictable Polishing Techniques for All Dental Ceramics • W07
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The Art and Science of Provisional Restorations for Natural Teeth • W08 • Dental Assistants Only
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ALONGE, DR. JOHN
Cutting-edge Endodontics: Advances in Biomechanical Preparation (Repeat) • W10
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Smarten Up and Sharpen Up — It’s The Right Thing to Do • W15 • Hygienists Only
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Minimally Invasive Exodontia Techniques Workshop • W20
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The Direct Posterior CompositeAesthetic Restoration: Hands-on Workshop • W26
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Anterior Preparation Design Workshop • W11
Precise Preliminary Impressions and Accurate Bite Registrations: It’s All About Technique (Repeat) • W22
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Posterior Preparation Design Workshop • W16
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Keys to Successful Endodontics • W17
DEVILLA, DR. EGDAR
Implant Training: A Hands-on Implantology Workshop • W12
FERGUSON, DR. RICK
Keys to Successful Endodontics (Repeat) • W27
DEVILLA, DR. EDGAR
Bone Grafting and Suturing Techniques as Related to Implant Dentistry • W23
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Regenerative Options in the Compromised Implant Site: Predictable Guided Bone Regeneration • W28
Simplifying Computer-guided Surgery: Maximizing Success While Minimizing Complexity for the Dentist and Patient • W18 • SOLD OUT! FREE to FDA member dentists during pre-registration!
RAWAL, DR. SUNDEEP
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Using Lasers in Managing Periodontics, Implantitis and Aesthetic Crown Lengthening • W13
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Predictable Polishing Techniques for All Dental Ceramics (Repeat) • W14
Digitally Driven Dentistry: Using Science and Technology to Advance Restorative Therapies Through Hands-on Experience • W24 Lasers in Dentistry: A Basic Competency Workshop • W25
SHAW, DR. TRACY
Dermal Fillers: How andWhy to Incorporate it into Your Dental Practice • W21
ROSHKIND, DR. DAVID
Lasers in Dentistry Introductory Workshop • W19
SHAW, DR. TRACY
Botulinum Toxin: How & Why to Incorporate it into Your Dental Practice • W09 • SOLD OUT!
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FDC2017 HIGHLIGHTS MINI DENTAL IMPLANTS WITH DR. RAYMOND CHOI A TO Z OF MINI DENTAL IMPLANTS: A TWO-DAY MINI-RESIDENCY MR01 THURSDAY, JUNE 22 & FRIDAY, JUNE 23 9 AM-5 PM RESTORATIVE CE CREDITS: 14 AUDIENCE: DENTISTS REGISTRATION CATEGORY
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understand indications and contradictions of mini implants. learn case selection and treatment strategy for mini implants. become familiar with both removable and fixed applications of mini implants.
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DR. RAYMOND CHOI is a graduate of University of Southern California (USC) School of Dentistry and is in private general practice in Tustin, CA. He has served 10 years at USC as an Assistant Clinical Professor in the department of Dental Medicine. He has been placing and restoring implants for over 20 years and has been teaching implant dentistry since 2001. He is a Fellow of International Congress of Oral Implantologists, an Associate Fellow of American Academy of Implant Dentistry and a graduate of Misch International Implant Institure.
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I work with a vast array of dental companies and am always searching for new companies to fill the Exhibit Hall at the Florida Dental Convention so you can find the latest and greatest products for your dental office. — Elizabeth Bassett, CMP Exhibits Planner Have a question about FDC Exhibitors? 800.877.7597 • 850.350.7108 • ebassett@floridadental.org www.floridadental.org
Digitization
The Digitization of Dental Education By Dr. C.J. Henley
Technology, namely the internet, has forever changed the landscape of education in both medicine and dentistry. Gone are the days of pulling a reference text off your bookshelf to refresh your memory on a topic. Gone are the days of sifting through old journals and putting money into a copy machine so you can take the clinically relevant articles home with you to read at your leisure. Gone are the days of the card catalog. (Millennials, imagine every possible Google search typed onto an index card, and then looking through all the index cards to find the article you are looking for — that is what a card catalog is like.) Technology has simplified the search for information and made the dissemination of new, clinically relevant information a breeze. Dentists can read articles and quickly share that information in a matter of seconds to an audience worldwide. Social media sites such as Twitter and Facebook have allowed the creation and distribution of medical media to become quick, simple and often free to the end user. Rapidly, technology has made a deep impact in both the
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training and continuing education (CE) of dentists. From the palm of your hand, you can access thousands of lectures and videos on YouTube that give precise instructions on virtually every clinical technique imaginable. The wealth of information available on crowdsourced sites such as Wikipedia is unbelievable. As of this writing, Wikipedia has roughly 140,000 regular contributors who post information on virtually any topic.1 Groups of physicians and dentists have even started journal clubs to discuss the most relevant and up-to-date information regarding their respective specialties through sites like Twitter. The ease with which we now can find and share information is unprecedented in history, and this can be a great benefit to our careers, our skill sets and our patients. However, our new online lives have come at a cost. Have we replaced the personal relationship with the on-demand relationship? A recent study shows a steep decline in empathy, as measured by standard psychological tests, among college students of the smartphone generation.2 In an article published in 1997, it was found that empathy and effective communication skills increase patients’ satisfaction, improve patients’ compliance, and enhance the clinician’s ability to diagnose and treat their patients. Additionally, clinicians who exhibit empathic behavior have a significantly reduced risk of malpractice litigation.3
“
The ease with which we now can find and share information is unprecedented in history, and this can be a great benefit to our careers, our skill sets and our patients.
”
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While the internet age has impacted the bedside manner of providers today, it also has had an impact on how patients approach their health care. In 2013, one in three American adults have gone online to diagnose a medical condition.4 Patients rely on internet resources to research diseases, understand the viewpoints of patients with similar diseases, review therapeutic and side effect profiles of therapy, and view rankings of medical providers. According to one study, 69 percent of surveyed patients used online health information as a second opinion, and 11 percent solely relied on internet sources instead of visiting a physician.5 Many clinicians today have had the experience of a patient doing “research on the internet” on how to treat condition “X.” Oftentimes, the “cut-and-paste” internet article leads to a misguided understanding of the clinician’s treatment recommendations and fosters doubt in the doctor-patient relationship. Moreover, the accuracy of information on the internet is poor. The literature is littered with study after study that shows the medical information posted on many websites is inaccurate.6 This is especially true in the case of information that is intended for patient consumption. So, what can we do to improve empathy and patient education in the digital age? It’s essential to ensure that our patients have access to high-quality, patient-centered information. Share information on your website and social media to help empower patients
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with knowledge about their diagnoses and treatments so that they can be more active in their own care. And more importantly, when the information comes from you, it gives your patient someone they can directly access with their questions and comments, as opposed to a forum that may not even have a dentist among the group. A recent paper published by the United Kingdom Department of Health stated that there are social and health benefits of an internet-savvy health care workforce, and that social media can help foster professional development and lifelong learning.7 Lastly, what can we do to maintain the personal relationships within our profession and caution ourselves against the convenient trend of on-demand CE? Use technological resources only as a supplement to your CE. I am a child of the internet era. Like most of my contemporaries, I love the convenience the internet offers to my daily life. I use the internet for everything from banking to opening my garage door to changing the thermostat in my home. Because our lives are so busy, often a quick online CE course that can be done in the convenience of your home is preferred over a long-winded lecturer late on a Tuesday night. However, when I attend my local dental association meetings, it always seems that attendance is in decline. I imagine this is true in Florida and elsewhere in the United States. Our generation within the dental profession needs to guard against this trend. We are social beings. Often, a deep understanding of certain topics only
comes from a thoughtful discussion among colleagues as opposed to a cursory read of information online. “When you speak to people in person, you’re forced to recognize their full human reality, which is where empathy begins.” References: 1. https://en.wikipedia.org/wiki/Wikipedia:Statistics 2. Konrath SH, O’Brien EH, Hsing C. Changes in dispositional empathy in American college students over time: a meta-analysis. Pers Soc Psychol Rev. 2011 May;15(2):180-98. 3. Neuwirth ZE. Physician empathy: should we care? Lancet. 1997;350(9078): Article 606 4. http://www.pewinternet.org/2013/01/15/ health-online-2013/ 5. Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW. Patients’ Use of the Internet for Medical Information. Journal of General Internal Medicine. 2002;17(3):180-185. doi:10.1046/j.15251497.2002.10603.x 6. John AM, John ES, Hansberry DR, Lambert WC. Assessment of Online Patient Education Materials from Major Dermatologic Associations. The Journal of Clinical and Aesthetic Dermatology. 2016;9(9):23-28. 7. https://www.gov.uk/government/uploads/system/uploads/attachment_data/ file/213222/final-report1.pdf Dr. Henley is a general dentist in Jacksonville and can be reached at DrHenley@HenleyandKelly.com.
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MEMBER IN GOOD STANDING
FLORIDA DENTAL ASSOCIATION
C. William D’Aiuto, DDS 2017 Florida’s Advocate for Oral Health CENTRAL FLORIDA
D I S T R I C T D E N TA L A S S O C I AT I O N A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS
By Drs. Jasbir Upadhyaya, Indraneel Bhattacharyya, Nadim M. Islam and Donald Cohen
A 12-year-old female was referred by her general dentist to Dr. Alex Podaru, a periodontist at the Lakeland Periodontics and Implant Dentistry in Lakeland, Fla. The patient presented for evaluation of an anterior maxillary red, spongiotic gingival lesion (Fig. 1). Extraoral examination revealed perioral dermatitis with multiple vesicles, and angular lacerations of the commissures (Figs. 2a-b). A generalized puffiness also was noted. The periodontist’s clinical impression was localized juvenile spongiotic gingival hyperplasia, a fungal infection or an allergic/autoimmune condition. The patient’s medical history was significant for crusted, swollen and fissured lips, which started five years ago (Fig. 3). The condition was unresponsive to antifungal medications and was positive for Staphylococcus aureus. Intraoral examination revealed multiple nodules in the cheeks near the occlusal plane (Fig. 4a). The anterior facial gingiva, limited to the pre-maxilla, was red and
spongiotic. No lesions were seen on the tongue. The patient experienced a burning sensation with baking soda toothpaste, and was possibly a mouth breather. She had no lesions on other parts of the body, had no previously diagnosed autoimmune conditions and no significant allergies were reported. Her blood work values were normal, and she was currently taking Zyrtec and using a steroid cream on her face. Dr. Podaru biopsied the lesion on the anterior facial gingiva, and the tissue was submitted to the University of Florida College of Dentistry Oral Pathology Biopsy Service for histopathologic examination and interpretation.
Question: Based on the clinical findings, what is the most likely diagnosis?
Fig. 2b. Angular cheilitis, which appears as a fissured, erythematous alteration of the skin at the corners of mouth. The lesion is crusted and demonstrates scaling of lips.
Fig. 3. Clinical presentation of the fissured and crusted lips with scaling. This image represents the lesion seen five years ago.
A. Heck’s disease/multifocal epithelial hyperplasia B. Gingival fibromatosis C. Impetigo D. Sarcoidosis E. Crohn’s disease Please see DIAGNOSTIC, 84 Fig. 4a. Nodular swelling of the buccal mucosa (black arrows) demonstrating cobblestone appearance of the mucosa.
Fig. 1. Clinical presentation of the anterior maxillary gingival lesion. The image is the pre-biopsy presentation of the erythematous spongiotic gingival lesion.
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Fig. 2a. Multiple erythematous papules of the skin surrounding the vermilion border of the lips. The lesion denotes perioral dermatitis and extends to the area around the nasal orifices.
Fig. 4b. Mucosal tag seen on the labial/buccal mucosa (black arrow). Also seen in the image is angular cheilitis at the corners of mouth. March/April 2017
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Diagnostic Discussion A. Heck’s disease/multifocal epithelial hyperplasia Incorrect, but an excellent choice. Heck’s disease presents with multiple papillomatous and papulonodular lesions throughout the oral mucosa. It predominantly arises in children and in most cases, the lesions resolve as the child ages. It is a rare squamous epithelial proliferation caused by human papillomavirus 13 and 32. The condition initially was described in Native Americans and Inuit, but subsequently has been reported in many populations and ethnic groups. Multifocal epithelial hyperplasia often affects multiple members of the same family; this familial tendency may be related to either genetic susceptibility or to close proximity between individuals of the same family. The condition is characterized by multiple smooth-surfaced papules and nodules of the oral mucosa. The color varies from white to pale pink and the lesions are commonly seen on the labial and buccal mucosa, lower lip and the tongue. Individual lesions are small and well-demarcated, but may coalesce to produce a cobblestone or fissured appearance, just as seen in this patient (Figs. 3 and 4a). The main differentiating factors are the papillomatous appearance of the lesions in Heck’s disease versus the nodular/diffuse swellings seen here and the swelling/fissuring prominently seen in this patient, but not in Heck’s disease. The condition may last for several months or years before running its course, as is inferred from the rarity of the disease in adults. Some authors have
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related a low-functioning immune system in children to the onset of the disease, and later as the individuals develop, better immunity resolves the lesions over time. Since the lesions can resemble other conditions such as inflammatory fibrous hyperplasia, inflammatory papillary hyperplasia, Cowden disease and focal dermal hypoplasia (Goltz-Gorlin syndrome), diagnosis is made on the basis of clinical observations and biopsy. The condition requires no treatment, but conservative surgical excision may be performed for diagnostic or aesthetic purposes, or for lesions subject to recurrent trauma. B. Gingival fibromatosis Incorrect, but a good differential. Gingival fibromatosis presents with slowly progressive gingival enlargement, which begins before age 20 and often is correlated with the eruption of the deciduous or permanent teeth. The gingiva is firm, normal in color, and appears smooth or finely stippled. In older patients, the surface may develop numerous nodular or papillary projections as seen in our patient (Fig. 1). Gingival fibromatosis is a rare condition and may be familial or idiopathic. The familial variations may occur as an isolated finding or in association with one of the several hereditary syndromes. In most cases of isolated gingival fibromatosis, an autosomal dominant pattern of inheritance is seen; however, autosomal recessive examples also have been noted. Other findings sometimes seen in conjunction with gingival fibromatosis include hypertrichosis, generalized aggressive periodontitis, epilepsy, mental retardation, sensorineural deafness, hypothyroidism and growth hormone deficiency. While the gingival changes in our patient are compatible with gingival fibromatosis,
the chronic profound lip swelling/fissuring is not seen. The gingival changes may be generalized or localized to one or more quadrants. Either jaw may be involved, but the maxilla is affected more frequently and demonstrates a greater degree of enlargement. In localized cases, the hyperplasia may involve a group of teeth and remain stable or, later may extend to other segments of one or both jaws. Associated clinical problems include poor aesthetics, prolonged retention of deciduous teeth, inadequate lip closure, and difficulty in eating and speaking. Mild cases respond to scaling and root planing, whereas conservative surgical excision is indicated for advanced gingival enlargement. C. Impetigo Incorrect, but a good guess. Impetigo is a superficial infection of the skin that is caused by Staphylococcus aureus, alone or in combination with Streptococcus pyogenes. The facial lesions usually develop around the mouth and nose, as seen in our patient. They have a linear pattern and the infection is more prevalent in school-aged children, another similarity to our patient’s case. Impetigo initially appears as red macules or papules, with the subsequent development of fragile vesicles. These vesicles quickly rupture and become covered with a thick crust. Some cases may be confused with exfoliative cheilitis and recurrent herpes simplex infection. Pruritis is common, and scratching often causes the lesions to spread. This is the main differentiating feature as impetigo patients can get lesions that spread far from the perioral region and our patient’s lesions are limited to this area. Clinical presentation usually is supportive in making a strong presumptive diagnosis. When diagnosis is not obvious clinically,
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Diagnostic
the definitive diagnosis requires isolation of S. aureus or S. pyogenes from cultures of involved skin. Topical mupirocin or fusidic acid have been shown to be effective. D. Sarcoidosis Incorrect. Sarcoidosis is a multisystem granulomatous disorder, and has a worldwide distribution. It affects adults between 20 and 40 years of age, and exhibits an increased prevalence in females and blacks. Sarcoidosis usually is associated with the formation of non-caseating granulomas in the affected tissues and organs. It can affect multiple organs, especially the lungs, lymph nodes, skin, eyes and salivary glands. It usually presents with bilateral hilar lymphadenopathy, pulmonary infiltrations, eye and cutaneous lesions. Oral involvement may be the initial manifestation of the disease in one-third to two-thirds of patients. An oral lesion appears as a submucosal mass, an isolated papule, an area of granularity or ulceration. The most frequently affected intraoral soft tissue is the buccal mucosa, followed by the gingiva, lips, tongue and the palate. The buccal mucosa lesions appear as non-tender, well-circumscribed brownish-red or purplish papules, or as submu-
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cosal nodules. The lesions are most often solitary, but may be multiple in 10 percent of cases. Gingival involvement leads to varied clinical presentations, including gingival hypertrophy (similar to what is seen in our patient, Fig. 1), gingivitis or periodontitis. Also importantly, chronic progressive lip swelling is the hallmark of sarcoidosis involving the oral cavity. However, fissuring of the lips has not been reported in sarcoidosis patients. Sarcoidosis also is less likely to occur in a 12-year-old. To completely rule out sarcoidosis in this patient, elevated serum angiotensin-converting enzyme levels and/ or documentation of pulmonary involvement (hilar lymphadenopathy) would be required to support the diagnosis.
E. Crohn’s disease Correct! Crohn’s disease is an immune-mediated granulomatous inflammatory condition that primarily affects the distal portion of the small bowel and proximal colon. The oral lesions are significant because they may precede the gastrointestinal lesions by months or years in 30 percent of cases that have both oral and gastrointestinal involvement. The condition is more common in teenagers, although it also occurs in patients more than 60 years of age. Gastrointestinal signs and symptoms usually include abdominal cramping and pain, nausea and diarrhea, occasionally accompanied by fever. Weight loss and malnutrition may develop.
In cases of isolated oral manifestations, the literature reveals no consensus concerning differential diagnosis with orofacial granulomatosis (OFG). The histological features of OFG are indistinguishable from sarcoidosis or Crohn’s disease. The diagnosis of sarcoidosis is established by the clinical and radiographic presentations, the histopathological features and the presence of negative findings with both special stains for fungus and cultures for organisms, such as Mycobacterium tuberculosis.
The range of oral lesions seen in Crohn’s disease includes diffuse or nodular labial and buccal mucosa swelling, cobblestone appearance of the mucosa and deep granulomatous appearing ulcers in the buccal vestibule. Cobblestoning usually is located on the posterior buccal mucosa and may be associated with succulent mucosal folds (Fig. 4a). Soft tissue swellings that resemble Please see DIAGNOSTIC, 86
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denture-related fibrous hyperplasia, and mucosal tags may be seen. Mucosal tags more commonly are found in the labial and buccal vestibules as well in the retromolar region (Fig. 4b). Many of these lesions may be preceded by painless gingival enlargement, as is seen in our patient (Fig. 1). Others may have persistent gingival lesions manifesting as pustular ulcerations (pyostomatitis vegetans), erythema, swelling and cobblestoning. Ancillary oral lesions include angular cheilitis and scaly perioral erythematous rashes, again findings prominently displayed in this patient (Figs. 2a-b). The patient in our study was applying steroid cream on her face, which might be a causal factor for her perioral dermatitis lesions (Fig. 2a). Studies have reported a higher prevalence of caries and periodontal disease in these patients than noted in the normal population. Higher levels of cariogenic bacteria, such as Streptococcus mutans and Lactobacillus also have been observed in the saliva of these patients. Importantly, approximately 60 percent of patients with oral Crohn’s disease also show evidence of cheilitis, labial and tongue fissuring, glossitis and aphthous stomatitis (Fig. 3). Oral lesions can be painful and can impede speech and food ingestion, decrease self-cleaning mechanisms of the oral cavity and contribute to diet modifications. Microscopic examination of the lesional tissue obtained from the intestine or the oral mucosa reveal the presence of non-necrotizing granulomas within the subcutaneous connective tissue. The treatment of Crohn’s disease of the oral cavity focuses on reducing inflammation, relieving pain and preventing secondary infections. Due to the increased risk of
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caries, patients need more advice on oral hygiene and prophylaxis, dietary education and regular dental checkups. Oral lesions have been reported to clear with treatment of gastrointestinal lesions in many cases. For persistent oral lesions, steroids (topical, intralesional or systemic) are the first line of treatment. Systemic thalidomide and infliximab have been used successfully to manage refractory oral ulcers of Crohn’s disease.
Drs. Bhattacharyya, Islam and Cohen can be reached at ibhattacharyya@dental.ufl.edu, MIslam@dental.ufl.edu and dcohen@dental. ufl.edu, respectively. Conflict of Interest Disclosure: None reported for Drs. Bhattacharyya, Cohen and Islam.
References: Halme L, Meurman JH, Laine LP, von Smitten K, Syrjänen S, Lindqvist C, Strand-Pettinen I. Oral findings in patients with active or inactive Crohn’s disease. Oral Surg Oral Med Oral Pathol Aug 1993; 76(2):175-81.
The Florida Dental Associa-
Dr. Cohen
tion is an ADA CERP Recognized Provider. ADA
Rowland M, Fleming P, Bourke B. Looking in the mouth for Crohn’s disease. Inflamm Bowel Dis Feb 2010; 16(2):332-7.
CERP is a service of the American
Ojha J, Cohen DM, Islam MN, Stewart CM, Katz J, Bhattacharyya I. Gingival involvement in Crohn’s disease. J Am Dent Assoc Dec 2007; 138(12):157481. Zbar AP, Ben-Horin S, Beer-Gabel M, Eliakim R. Oral Crohn’s disease: Is it a separable disease from orofacial granulomatosis? A review. J Crohns Colitis March 2012; 6(2): 135-42.
Dental Association to assist dental professionals in identifying
Dr. Bhattacharyya
quality providers of continuing dental education.
Diagnostic Discussion is contributed by
ADA CERP does
UFCD professors, Drs. Don Cohen, Indraneel
not approve or en-
Bhattacharyya, and Nadim Islam provide
dorse individual
insight and feedback on common, important,
courses or instruc-
new and challenging oral diseases. The dental professors operate a large, multistate biopsy service. The column’s case studies originate from the more than 10,000 specimens the service receives every year from all over the United States. Clinicians are invited to submit cases from
tors, nor does it
Dr. Islam
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 www.ada.org/goto/cerp. This course will expire 02/01/2018.
their own practices. Cases may be used in the “Diagnostic Discussion,” with credit given to the submitter.
www.floridadental.org
COMMUNITY IMPACT
COMMUNITY IMPACT
THANK YOU TO THE VOLUNTEERS AND SPONSORS THAT MADE THE 2017 FLA-MOM A SUCCESS! SEE YOU NEXT YEAR AT the 2018 FLA-MOM! March 9-10, 2018 • Fort Myers, FL • Lee Civic Center
DON’T GET CAUGHT WITHOUT
EPLI COVERAGE! DEFINITION
LEGAL COUNSEL
Employment practices liability insurance (EPLI) is a type of liability insurance covering wrongful acts arising from the employment process. The most frequent types of claims covered under such policies include: wrongful termination, discrimination, sexual harassment, and retaliation.
“From my perspective, employment practices liability presents an equivalent, if not greater, risk to Florida doctors than malpractice. Dentists are well-trained on patient care responsibilities but there is no similar education on rapidly changing employment law.” – Graham Nicol, FDA Chief Legal Counsel
EPLI COVERAGE PREMIUM ESTIMATES (Coverage w/ 3rd Party)* Option 1
Option 2
Limit: $250,000 Retention: $5,000 Estimated Premium: $814
Option 3
Limit: $500,000 Retention: $5,000 Estimated Premium: $949
Limit: $1,000,000 Retention: $5,000 Estimated Premium: $1,356
* Premium estimates are non-binding and are based on dental practices with 10 or fewer employees in your mailing ZIP code.
CLAIM EXAMPLE The call comes in… “I am being sued! Help!!! An employee quit and they now allege that I systematically campaigned to force them to resign. Am I covered?” Agent’s Perspective … These situations are hit and miss and can come down to “he said, she said.” Unfortunately, this scenario is quite common. An employee is terminated or quits. They are unhappy. They sue. Who’s right? Who’s wrong? Most importantly, can you prove it? These claims are significant and very costly to defend. In the example above, the following amounts were paid: $150,000 Defense | $100,000 Lost Income to Plaintiff | $110,000 Mental Anguish to Plaintiff
Call us at 800.877.7597 to learn more and apply for coverage.
CDT 2017 Code Check App
iOS & Android
This handy, searchable app contains the new dental procedure codes, including 11 new codes and five revised codes. Features include: A complete listing of 2017 CDT Codes New and revised codes listed with tracked changes Searchable code number, keyword & category
Chairside Instructor App
iOS
Includes video clips, Spanish text, WiFi printing, and ability to upload photos from your own camera roll. You also can draw on a picture, add a comment, email it to a patient, and save for future use.
Toothflix 2.0 App
iOS
The ADA Toothflix 2.0 DVDs look better, sound better, and now include Spanish. The videos are shorter and snappier to hold patients' attention. And, three allnew videos are included: TMJ, Tooth Decay, and the animated hit, Dudley's Grade School Musical.
Oral Pathologist App
iOS & Android
ADA Oral Pathologist is a chairside reference of oral pathology conditions that can assist dentists with formulating diagnoses. Dr. Michael Kahn, of the Department of Oral and Maxillofacial Pathology at Tufts University School of Dental Medicine, wrote and developed content for the app. Search more than 200 conditions or search by entering clinical observations.
Florida Dental Convention
iOS & Android
Everthing thing you need to know about the FDA's official annual meeting — maps, course listings, speaker profiles, and scheduled events. Come for the CE. Stay for the fun! Available June 2017 at www.floridadentalconvention.com.
Ways to Get Involved 1.
Become a Legislative Contact Dentist.
2.
Support pro-dental candidates through the FDAPAC.
3. 4.
Attend Dentists' Day on the Hill.
5.
Serve on an FDA or district council.
6.
Volunteer for Peer Review in your district.
7. 8.
Write articles for Today's FDA.
9. 10.
Offer pro bono care through the FDA Foundation: PDC, DDS, and FLA-MOM.
Become a mentor in the new FDA Mentorship Program. Volunteer for Give Kids a Smile.
Train as an FDA spokesperson. BONUS! Be an FDC speaker host. (See page 22.)
HELPING MEMBERS SUCCEED QUESTIONS ABOUT YOUR MEMBER BENEFITS?
ADA APP ORDERING: iOS – Order from adacatalog.org, and then complete your download in the App Store. Android: Order from adacatalog.org, then complete your download from the Google Play store.
www.floridadental.org
Find more information at www.floridadental.org. Contact us at membership@floridadental.org or 800.877.9922.
March/April 2017
Today's FDA
89
C lassified A dvertising
Opportunities
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Today's FDA
The FDA’s online classified system allows you to conveniently browse, place, modify and pay for your ads online, 24 hours a day. Our intent is to provide our advertisers with increased flexibility and enhanced options to personalize and draw attention to your online classified ads! As an added benefit, we will continue to publish the basic text of paid, online classified ads in Today’s FDA, at no additional cost to you. All ads posted to the online classified system will be published during the contracted time frame for which you have posted your online classified advertisement. Today’s FDA is published bimonthly; therefore, all active ads online will be extracted from the system on roughly the following dates of each year:
Issue
Extracted Date
Jan/Feb March/April May/June July/Aug Sept/Oct Nov/Dec
Jan. 15 March 15 May 15 July 15 Sept. 15 Nov. 15
Please visit the FDA’s classified website at www. floridadental.co/classifieds.
March/April 2017
Dentist Needed (FT Summer Opening) - Fort Myers, FL. Come lead our established dental team in Fort Myers, FL! Great Expressions Dental Centers has a 2017 summer opportunity for a fulltime General Dentist to join our College practice located: (9250 College Parkway, Unit 1 Fort Myers, FL 33919). Enjoy a rewarding role with a dedicated and experienced staff in this productive practice with an established patient base! Compensation: Competitive Compensation: 150K Salary vs. Percent of Production! Sign-on Bonus (Up to 10K) possible as well! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road Roswell, GA 30076 USA phone 678-836-2226 | ext 47629 | fax 770-242-3251 |web www.greatexpressions.com. “Look for the Smile Above Our Name!” http://www. Click2apply.net/nsmwyfj3h4#sthash.JjlTfmYG.dpuf. General Dentist – Florida. Tampa Bay. Experienced General Dentist wanted full-time for wellestablished group. Mon - Fri. Non-corporate. $180,000 - $220,000 guaranteed salary plus bonus program, sign-on bonus, 3 week paid vacation, paid holidays. CE and health insurance. Email resume to: hr.cobbedental2@verizon.net or call: (727) 446-3259. FLORIDA—Dentist. Dentist wanted who enjoys treating children. Well established non-corporate group practice. Mon. - Fri. $180,000 - $220,000 guaranteed salary plus bonus program, sign-on bonus, 3 week paid vacation, paid holidays, CE and health insurance. Email resume to: hr.cobbedental2@ verizon.net or call: (727) 446-3259. Dentist. With over 30 years of experience with correctional healthcare, MHM Centurion of Florida is now the new provider for dental care with the Florida Dept. of Correction. We are in 15 states, in over 350 facilities and 6,000 employees strong. We are staffed by a mission oriented, multi-disciplinary team of dentists, physicians and nurses. Correctional dentistry offers regular hours and no managed care hassles. Come find a rewarding career in an unexpected place! We are currently seeking Dentists for positions in Northern FL, Central FL and the Pan Handle: Sneads, Chipley, Lake Butler, Live Oak, Ocala, Orlando, Blountstown, Wewahitchka, Perry, Jasper. We offer: competitive comp, health, dental, vision, ST disability, paid malpractice, 401k match, CME reimbursement, generous paid days off in addition to holidays, and more. *F/T and P/T schedules available. To learn more or apply, contact: Diana Connerty - diana@mhmcareers.com - 844475-8042. www.mhm-services.com EOE.
www.floridadental.org
Endodontist Opportunity (Part Time) - Treasure Coast + WPB, FL. Come join our South Florida specialty team as a part-time (8 days/month) Endodontist in the Treasure Coast and West Palm Beach, FL! Aggressive compensation package (production based percent), dedicated staff, consistent schedule with a strong referral network of local offices. Compensation: Percentage of Production. Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office Setting(s); Malpractice Coverage Assistance. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road, Roswell, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions.com, email Ross.Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!”
State Society dues. *Malpractice coverage assistance. *Mentorship through our National Doctor Panel and regional clinical leaders, chair side mentoring and study clubs. *GEDC University keeps dentists up-todate in the newest clinical advances and operational best practices. *Community services that makes a difference from annual donations to dental schools to participation in community events to Free Dentistry through Missions of Mercy to making meals for local kids through Feeding the Children Everywhere. *Superior administrative support in areas such as accounting, billing, insurance, human resources, information technology, accounting and more. **Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road Roswell, GA 30076 USA phone 678-836-2226 | ext 47629 | fax 770-242-3251 |web www.greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply.net/65xcn2p4bq.
Pediatric Practices offer specialized career paths and practice support solutions for Pediatric dentists committed to making kids smile! Work with a great team that places quality of care at the top of their list. Our large well established practice enjoys a high level of success and it is a result of just the right combination of excellent staff, marketing plan and a practice philosophy of patient first. It has taken years of development of systems and practices that have elevated us to where they are today and that is being ready to add an additional pediatric dentist to our top-notch team. Offering: Generous guarantee salary with production based bonus; Full schedule from day one; State of the art facilities with top of the line equipment; Excellent benefits package Great Earnings Opportunity! The successful candidate will be a licensed DMD or DDS and must have completed Pediatric Dentist Residency and should be licensed or qualified to obtain license in the FL. Experienced Specialists or New Licensees are welcome! Interested Pediatric dentists should respond with resume/cv to bames@dentalcarealliance.com. Learn more @ www. dentalcarealliance.net.
ORLANDO - PRIVATE FFS/PPO OFFICE - General Dentist Full Time. An Excellent opportunity to join an Upscale Private Established Dental Office Near Downtown Orlando, providing excellent patient care with the latest State-of-the-Art technology including Digital x-rays, Intraoral Camera, Cerec, Laser, Invisalign. Doing ALL aspects of dentistry including Ortho, Cosmetic, Surgery and Dental Implants. 100% PPO/FFS. (No HMO/ No Medicaid). We offer superior quality and excellent patient care, provide attention to details and our patients love us. Great compensation, with a huge potential for the right person in addition to the on-the-job experience and mentoring. If you have GPR-AEGD Residency, it is a Plus. Please Fax 407-327-1018 OR e-mail: Doctor@ NewSmileDentistry.Net.
Melbourne, General Dentist--Part Time, Friday Preferred Want to supplement your income in a 5 Star office? If you like working in a great environment, maybe even want to learn some practice management skills in an office that consults nationally, and you do top-notch restorative dentistry, this could be a great opportunity for you. Please call Dr. Lee Sheldon at the office, 321-259-8000 or mobile, 321-258-7467. I look forward to speaking with you. http://drleesheldon.com.
General Dentist Opportunity Private Practice in North Port Florida Brand New Fully Equipped Operatories Located in existing Private Multi Specialty Practice. Generous Percentage of Collections. Daily minimum guaranteed. Latest Technology: Paperless, CT scanner on site. 941.223.7228.
Full-Time Associate Dentist Opening - Jensen Beach, FL If you are looking to be a clinical leader in your own office, where the patient’s disease dictates the treatment, and a trained staff handles payroll, information technology and other administrative duties, join Great Expressions Dental Centers in Jensen Beach, FL. We are seeking a full time General Dentist to lead our established, 7-op, multi-specialty, digital practice in Jensen Beach, FL located: 3251 NW Federal Highway Jensen Beach, Florida 34957. You will join an expanding dental group that provides high-quality lifetime patient care with a consistent schedule leaving time for life at home. We are innetwork with all PPO plans, have in-house discount dental plan and are the preferred provider for Great Expressions and non-Great Expressions orthodontists and specialists. Why Great Expressions Dental Centers? *Work with a full office staff (including Hygienist) in a state-of-the-art office. *Diagnose and treatment plan your own cases. *Opportunity to build rewarding career through our industry leading Doctor Career Path. Grow from an associate doctor to a senior doctor to clinical partner based on your career goals. *Built-in referral and resource network with more than 300+ colleague dentists. *Excellent income: Six-Figure Draw vs. Percent of Production and Benefits. *Competitive Benefits Offered: Healthcare & dental benefits, 401K, short/long-term disability, 6 paid holidays, potential for 2 weeks’ vacation. *Fully paid American Dental Association &
www.floridadental.org
Full-Time Dentist Opportunity: Coconut Creek + Fort Lauderdale, FL Come be a clinical leader for both our Coconut Creek, FL + Fort Lauderdale, FL dental team(s)! Great Expressions Dental Centers has an immediate, select opening for a full-time (5 days/ week) General Dentist to join both our established, high production, multi-specialty practice in Coconut Creek, FL located at 4660 W. Hillsboro Boulevard, Suite 7 Coconut Creek, Florida 33073 and our Fort Lauderdale, FL office location. Compensation: Six Figure Draw vs. Percent of Production. Benefits/ Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Practice Setting; Full Benefits Offered for Full Time - Healthcare & Dental Benefits, 401k, Short Term/Long Term Disability, Time Off; Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road Roswell, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions.com. “Look for the Smile Above Our Name!” http://www.Click2apply. net/59jsnt33mc#sthash.VB7oRKR6.dpuf. Pediatric Dentist Full-Time or Part-Time! Ocala, FL. Formed in 1991, Dental Care Alliance is a Dental Support Organization with over 200 affiliated dental practices in 13 states. Our affiliated Mainstreet
Part-Time (2+ days) Endodontist - Fort Myers, FL. Come lead our specialty team as a part-time Endodontist in Fort Myers, FL! Great Expressions Dental Centers has a current, select opening for a part-time (2-3 days/week) Endodontist to join our Fort Myers, FL multi-specialty practice in Page Field. We offer an aggressive compensation package, dedicated staff, consistent schedule with a strong referral network of local offices. Compensation: Six Figure Annual Base vs. Competitive Percent of Production! Attractive Sign-on or Relocation possible as well. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office ; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration! Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248686-0170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/ DMD from an accredited University and active State Dental Board license, Endodontist Dental License and certifications.
Please see CLASSIFIEDS, 92
March/April 2017
Today's FDA
91
Your Classified Ad Reaches 7,000 Readers! CLASSIFIEDS from 91 JOB SEEKER. ENDODONTIST AVAILABLE, EXPERIENCED, FT/PT, FOR SO. FLA. EAST COAST. IV SEDATION TRAINED. CALL 239-2899336. Part-Time Dentist (2 days/wk) - Tampa, FL. Great Expressions Dental Centers has an immediate opening for a part-time (2 days/wk) General Dentist to join our Carrollwood Commons practice located: (15148 N. Dale Mabry Highway). Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competitive Compensation! Dependent on Experience. Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Dentist Opening - Port Richey, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Port Richey, FL practice located: (11116 U.S. Hwy. 19 Port Richey, Florida 34668). Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competitive Compensation: Six Figure Annual Draw vs. Percent of Production! Sign on Bonus or Relocation Assistance possible! Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Solo office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. http://www.Click2apply. net/8fdcjcnf86#sthash.fTJWMX7b.dpuf. Dentist Opening - Seminole County, FL. Great Expressions Dental Centers has an upcoming opportunity for a full-time General Dentist to join
92
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March/April 2017
our recently affiliated practice located in Seminole County, FL. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competitive Compensation: Six Figure Annual Draw vs. Percent of Production! Sign on Bonus or Relocation Assistance possible! Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Solo office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-6860170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here: http://www.Click2apply. net/s2xkq5fb5g. Dentist Opportunity - Lake Mary, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Lake Mary practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production; Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Solo office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Dentist Opportunity - Port Richey, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Port Richey, FL practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw vs. Percent of Production; Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Solo office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare
& Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions. com “Look for the Smile Above Our Name!” http:// www.Click2apply.net/rq9xng9zkc. Dentist (Full-Time) Opportunity - The Villages, FL. Great Expressions Dental Centers has an immediate opening for a full-time Associate Dentist to join our solo, practice in The Villages, FL! The office is located at 11962 County Rd 101, Ste 304 and is golf cart accessible! Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competitive Six Figure Annual Draw vs. Percent of Production; SignOn Bonus or Relocation Assistance possible.** Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Solo office with 4 ops (room to add); Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. *Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-6860170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Dentist (Full-Time) Opening - Tampa, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Tampa practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw vs. Percent of Production. Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext.
www.floridadental.org
Your Classified Ad Reaches 7,000 Readers! 72467| fax 248-686-0170 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Part-Time Oral Surgeon for busy group practice! Christie Dental is a multi-specialty dental group with 13 practice locations in the Brevard and Ocala Florida area. We currently have a wonderful opportunity for an Oral Surgeon to join our team in our Merritt Island and Palm Bay specialty practices, on a part-time basis. This is an opportunity that provides a high number of referrals from inside and outside Christie Dental. https://www.christiedental. com/781.213.0289. General Dentist or Specialist Wanted. If you are a General Dentist or a Specialist, and are looking for a quality large private practice full of integrity that feels like your own, then you should join Regency Dental of Port Saint-Lucie. We have been serving the local community since 1993 with a great reputation. Please send your CV to Jenn@regencydental.org, or call 772-785-9515 ext. 113. Full Time Dentist Opportunity: Jensen + Port St. Lucie, FL Full Time Dentist Opportunity: Jensen + Port St. Lucie, FL. Great Expressions Dental Centers has an immediate, select opening for a full-time (5 days/split offices) General Dentist to join both our established, high production, Jensen and Port St. Lucie practice(s)! Enjoy a rewarding career with a full office staff (including HYG), a strong schedule and the ability to focus on quality patient care. Compensation: Six-Figure Draw vs. Percent of Production. Benefits/Perks: Leaders in the Practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office(s); Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Roswell, Norcross, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions. com email Ross.Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!” Associate Dentist. As one of the country’s largest dental support organizations, we have more than 200 affiliated dental practices in 13 states. For more than twenty years, we’ve taken great pride in our revolutionary approach to dentistry. Dental Care Alliance was created by dentists and our focus has always been on improving the well-being of both patients and dentists. Our platform is powerful and cultivates lasting relationships. Experienced, licensed Clinical Directors ensure superior standards of care, and our affiliated dentists share our commitment to practicing with honesty, integrity and compassion. The future is now. We currently have an outstanding Full-Time Associate Opportunity for an experienced General Dentist to join one of our highly successful affiliated practices in Jupiter, FL area. State of the
www.floridadental.org
art practice facilities. Strong commitment to longterm dental care for the whole family. Be chair side and make money from day one. Highly trained and dedicated staff to support you. No Day-toDay headaches of Managing a Practice. Excellent compensation pkg. with performance based incentives. Well-established and growing patient base. Full Time Dentist Benefits Package: Company paid professional liability insurance; DCA sponsored continuing education; Medical Insurance Dental Plan Life Insurance Vision Insurance; Long Term Disability Section 125 - Flexible Spending Account; 401K; DCA Voluntary Supplemental Insurance Products. Requirements: 5+ years’ experience preferred. Licensed to practice dentistry in the State of FL. Email resume to bames@dentalcarealliance. com. Learn more @ www.dentalcarealliance.net. Dentist Opportunity (Full Time): Rockledge, FL. Full time General Dentist needed for a 100% fee for service private practice on the beautiful space coast in Rockledge, FL (just south of Cocoa Beach and Merritt Island & minutes from Melbourne, Viera & Satellite Beach). Our modern, state-of-the-art practice is located in a free-standing building, is digital & paperless. The ideal candidate must be capable of both simple and surgical extractions, molar endo and be proficient in all other areas of general dentistry. Compensation is commission based with a guaranteed minimum. You would be joining a well-trained, experienced, highly motivated team. Please send your CV and contact info to molardoc2@ gmail.com. All inquiries will be strictly confidential. We look forward to hearing from you. Hiring Dental Specialists. Kool Smiles is hiring PT or FT for all Dental Specialties: Oral Surgery, Orthodontist, Endodontist, Pedodontist (in office Gen Anes) and Dental Anesthesiologist in SC/GA/ MS/LA/AR. For more information, please apply online at koolsmilesjobs.com or contact Emily Platto @ 770-508-6810. Part-Time (2+ days) Endodontist - Fort Myers, FL. Dentist Needed (FT Summer Opening) - Fort Myers, FL. Come lead our established dental team in Fort Myers, FL! Great Expressions Dental Centers has a 2017 summer opportunity for a full-time General Dentist to join our College practice located: (9250 College Parkway, Unit 1 Fort Myers, FL 33919). Enjoy a rewarding role with a dedicated and experienced staff in this productive practice with an established patient base! Compensation: Competitive Compensation: 150K Salary vs. Percent of Production! Sign-on Bonus (Up to 10K) possible as well! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777
Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-4305528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Dentist Needed (FT Summer Opening) - Fort Myers, FL Come lead our established dental team in Fort Myers, FL! Great Expressions Dental Centers has a 2017 summer opportunity for a fulltime General Dentist to join our College practice located: (9250 College Parkway, Unit 1 Fort Myers, FL 33919). Enjoy a rewarding role with a dedicated and experienced staff in this productive practice with an established patient base! Compensation: Competitive Compensation: 150K Salary vs. Percent of Production! Sign-on Bonus (Up to 10K) possible as well! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-4305528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Associate Position available Now- FFS office. Permanent 3 day a week solo Doc position. 1 year contract after 60 day trial/temp. Generous compensation. Must do Molar Root Canal and 90% of extractions. Cosmetic and Invisalign a plus, as well as Spanish speaking. Office is well managed, you only need to step in and do Dentistry in the relaxed and cordial small town environment. Commute is 45-60 min. from Fort Lauderdale zone, about an hour from West Palm. 954.557.2901. Endodontist (full-time) - Tampa, FL. Great Expressions Dental Centers is seeking an Endodontist to join our established and highly productive dental practices located in Tampa Bay, FL: Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect: Compensation: High Income Opportunity: Six Figure Annual Base Salary vs. a Competitive Percent of Production! Attractive Sign-on or Relocation possible as well! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; MultiSpecialty and Digital offices; Doctor Career Path – Partnership/Investment Opportunity available! Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State
Please see CLASSIFIEDS, 95
March/April 2017
Today's FDA
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Bring your most current dental supply invoice to the FDASupplies.com booth for a price comparison and we’ll give you a $10 Starbucks gift card.
Contact FDASupplies.com Phone: 888.325.2808 | Fax: 877.376.0062 | Email: support@fdasupplies.com Customer Support M-F 9am-6pm | Your ADA membership number will be required to access FDASupplies.com or to speak with customer service staff.
Your Classified Ad Reaches 7,000 Readers! CLASSIFIEDS from 93
WHAT’S YOUR STATUS? AS LIFE EVENTS OCCUR, don’t forget to notify the FDA of any changes to your contact information. READY TO RETIRE or have questions about your membership status? Contact the FDA Member Relations department to learn about retired membership or eligibility for other membership incentives. CALL OR EMAIL the FDA at 800.877.9922 or fda@floridadental.org. * Florida licensed dentists must notify the Florida BOD with any new information. Go to floridasdentistry.gov or call 850.488.0595.
Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. *Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration! Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license, Endodontic Dental License and certification. Dentist (4 days/wk) - Tampa, FL. Great Expressions Dental Centers has an immediate opening for a full-time (4 days/wk) General Dentist to join our Carrollwood Commons practice located: (15148 N. Dale Mabry Highway Tampa, Florida 33618). Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competi-tive Compensation: Six figure draw vs. Percent of Production. Sign on Bonus or Relocation assistance possible! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Part-nership/Investment Opportunities; Full Benefits Offered - Healthcare & Dental Benefits, 401K Short term/Long Term disability, Time off; Malpractice Coverage Assistance; Continued Education Reim-bursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC Uni-versity Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license.
For Sale/Lease Office for sale in Panama City, FL. For sale, Panama City, FL. 1933 sqft. Stand alone building. 4 equipped ops with room for 2 more ops; Lab, etc. Plenty of parking. Superb location in professional office park on major street on best side of town. Does not include practice, already sold that when dentist recently retired. 850-2715612. INTRAORAL X-RAY SENSOR REPAIR. We specialize in repairing Kodak/ Carestream, Dexis Platinum, Gendex GXS 700 & Schick CDR sensors. Repair & save thousands over replacement cost. We also buy & sell dental sensors. www. RepairSensor.com/919-924-8559. http://www.repairsensor.com/. DOWNTOWN ORLANDO Beautiful, architecturally designed office for lease in professional building; 2410 sq. ft. with 5 plumbed operatories with built-in cabinets. There are built-in planters, sky-lights and many other features. Great location in rapidly increasing residential community (90,000 residents within 3 miles) as well as 74,000 daily downtown office workers. Owner dentist retired and left office ready for occupancy. Ideal for specialist; must be seen to be appreciated. Call 321-277-7663.
www.floridadental.org
March/April 2017
Today's FDA
95
OFF THE CUSP
JOHN PAUL, DMD, EDITOR
Smiles from MOM The Florida Mission of Mercy (FLA-MOM) in Pensacola is packed away and we are basking in our success. I’m not gonna lie and say any of it was easy. My back hurts, my feet feel like they were beaten with a bamboo rod, my voice is gone and my face is sore from smiling. The FLA-MOM is a great place to learn the meaning of “It’s better to give than to receive.”
“
Dentistry is what we do, but caring is what makes the difference.
”
The most popular question was, “How do you do this? How do you turn a gym into a dental clinic?” It’s simple: Take about 100 of the Florida Dental Association Foundation’s dedicated volunteers, and have them round up maybe 2,000 more. Find a place with a big enough room and turn the volunteers loose. Slide Tab A into Slot B — maybe 10,000 times — and it’s a clinic. “How do you find all these people willing to do so much?” Also simple — this one may be easy — this is who we are. All we need is a place to be who we are, a fistful of instruments (none of them exactly what you want) and a lot of people get helped in two days. We have fun doing what we do well. The sherriff ’s deputies were amazed and jealous. One said to Dr. Andy Brown, “We don’t get this kind of respect. There is a patient, you just pulled out all her front teeth,
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March/April 2017
her mouth is full of bloody gauze, and she’s hugging and thanking all the volunteers! Why does that happen?” It happens when one person shows another person they care. Dentistry is what we do, but caring is what makes the difference. People rarely remember what you did for them but they always remember how you made them feel. I made a point of thanking those deputies, too, because they made me feel safe to put my attention on the job I knew how to do. If you haven’t been to a FLA-MOM yet, you are missing out. You’ll save your shirt as a badge of honor and you’ll consider burning the rest of your clothes. Your heart will grow three sizes. You’ll meet people that will be family for the rest of your life. Your pride in yourself, your profession and all the people who make up the Florida Dental Association will swell. Whether your part is administrative, technical, clerical or clinical, there will be no doubt in your mind: Dentistry is the greatest profession possible.
Dr. Paul is the editor of Today’s FDA. He can be reached at jpaul@bot.floridadental.org.
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H Y O UR P P A H FDC
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THURSDAY, JUNE 22 M 5-6 PM WRECKERS SPORTS BAR Dentists and spouses welcome Presented by