New Florida Law Addresses Opioid Crisis
VOL. 30, NO. 4 • MAY/JUNE 2018
FLA-MOM Highlights
A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION
2018 Legislative Wrap-up
Dentist of the Year Meets FDA Legislator of the Year Dr. Irene Marron-Tarrazzi (left) and Rep. Colleen Burton
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HELPING MEMBERS SUCCEED VOL. 30, NO. 4 • MAY/JUNE 2018
DENTIST OF THE YEAR: Dr. Marron-Tarrazzi highlights
A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION
2018 LEGISLATIVE WRAP-UP PAGE 22
FDC2018 SPEAKER HIGHLIGHTS Taking the Fear Out of Debt
PAGE 30
5 Words You Never Want to Hear from Your Patient
PAGE 38 NEW! MANDATORY OPIOID COURSE!
PAGE 32
features
6
Things to Know Before You Go — 2018 Florida Dental Convention
28 Mandatory Opioid Course for All Florida-licensed Dentists
Are you registered with the U.S. DEA to prescribe controlled substances?
29 7 Steps to Prescribe Controlled Substances in Florida 36 Exhibitor Marketplace 46 What is the Gray Market, and Why Should You Care? 54 2018 Fort Myers FLA-MOM Impact! 55 Cover Story in JADA, FLA-MOM Impact Study 56 2018 FLA-MOM: A Special Thank You to Our 2018 Benefactors
2018 FLA-MOM • FORT MYERS
60 The Smile Was Free, But the Hug Was Priceless 61
FDA Member Helps Former NFL Player Regain His Confidence
in every issue PAGE 51
3 5 8 10 13
Staff Roster President's Message Legal Notes Did You Know? Information Bytes
16 news@fda 66 Compleat Dentistry 68 Diagnostic Discussion 74 Career Center 77 Advertising Index 80 Off the Cusp
TODAY'S FDA ONLINE: floridadental.org
FLORIDA DENTAL ASSOCIATION MAY/JUNE 2018 VOL. 30, NO. 4
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
FDA District Calendar
Dr. Michael D. Eggnatz, Weston, president Dr. Jolene Paramore, Panama City, president-elect Dr. Rudy Liddell, Brandon, first vice president Dr. Andy Brown, Orange Park, second vice president Dr. Dave Boden, Port St. Lucie, secretary Dr. William D’Aiuto, Longwood, 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. Rick Mullens, Jacksonville • Dr. Beatriz Terry, Miami Dr. Stephen Zuknick, Brandon • Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Spring Hill, treasurer • Dr. John Paul, Lakeland, editor
PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303 . FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2018 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication. POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 545 John Knox Road, Ste. 202, Tallahassee, Fla. 32303.
EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.
EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste 200, Tallahassee, Fla. 32303. FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; email address, fda@floridadental.org; website address, www.floridadental.org.
ADVERTISING INFORMATION For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113. For career center advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.
Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.
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TODAY'S FDA
MAY/JUNE 2018
WWW.FLORIDADENTAL.ORG
CONTACT THE FDA OFFICE 800.877.9922 OR 850.681.3629 545 John Knox Road, Ste. 200 • Tallahassee, FL 32303
EXECUTIVE OFFICE DREW EASON, Executive Director deason@floridadental.org 850.350.7109 GREG GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111 CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202 JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 ALEX LUISI, Leadership Concierge aluisi@floridadental.org 850.350.7114
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 DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 JAMIE IDOL, Commissions Coordinator jamie.idol@fdaservices.com 850.350.7142 ALLEN JOHNSON, Accounting Manager allen.johnson@fdaservices.com 850.350.7140 MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 STEPHANIE TAYLOR, Membership Dues Coordinator staylor@floridadental.org 850.350.7119
COMMUNICATIONS AND MARKETING JILL RUNYAN, Director of Communications jrunyan@floridadental.org 850.350.7113 LYNNE KNIGHT, Marketing Coordinator lknight@floridadental.org 850.350.7112 JESSICA LAURIA, Communications and Media Coordinator jlauria@floridadental.org 850.350.7115
FLORIDA DENTAL ASSOCIATION FOUNDATION (FDAF)
FLORIDA DENTAL CONVENTION (FDC) CRISSY TALLMAN, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 ELIZABETH BASSETT, FDC Exhibits Planner ebassett@floridadental.org 850.350.7108 KENLEE BRUGGEMANN, FDC Meeting Assistant kbruggemann@floridadental.org 850.350.7162 BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103 JENNIFER TEDDER, FDC Program Coordinator jtedder@floridadental.org 850.350.7106
GOVERNMENTAL AFFAIRS JOE ANNE HART, Chief Legislative Officer jahart@floridadental.org 850.350.7205 ALEXANDRA ABBOUD, Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204 COURTNEY THOMAS, Governmental Affairs Legislative Assistant cthomas@floridadental.org 850.350.7203
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
MEMBER RELATIONS KERRY GÓMEZ-RÍOS, Director of Member Relations krios@floridadental.org 850.350.7121 DESTINY SIMS, Member Access Coordinator dsims@floridadental.org 850.350.7100 ASHLEY MERRILL, Member Relations Coordinator amerrill@floridadental.org 850.350.7110 CHRISTINE TROTTO, Membership Concierge ctrotto@floridadental.org 850.350.7136
FDA SERVICES 800.877.7597 or 850.681.2996 545 John Knox Road, Ste. 201 Tallahassee, FL 32303 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat
SCOTT RUTHSTROM, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 CAROL GASKINS, Assistant Manager – Sales & Service carol.gaskins@fdaservices.com 850.350.7159 DEBBIE LANE, Assistant Manager – Service & Technology debbie.lane@fdaservices.com 850.350.7157 ALEX KLINE, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166 MARCIA DUTTON, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145 PORSCHIE BIGGINS, North Florida Membership Services Representative pbiggins@fdaservices.com 850-350-7149 MARIA BROOKS, SFDDA Membership Services Representative maria.brooks@fdaservices.com 850.350.7144 EBONI NELSON, CFDDA Membership Services Representative eboni.nelson@fdaservices.com 850.350.7151 MELISSA STAGGERS, WCDDA Membership Services Representative melissa.staggers@fdaservices.com 850.350.7154 TESSA DANIELS, Membership Services Representative tessa.daniels@fdaservices.com 850.350.7158 LIZ RICH, Membership Services Representative liz.rich@fdaservices.com 850.350.7171
CARRIE MILLAR Director of Insurance Operations carrie.millar@fdaservices.com 850.350.7155
YOUR RISK EXPERTS DAN ZOTTOLI Director of Sales — Atlantic Coast 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com DENNIS HEAD Director of Sales — Central Florida 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com MIKE TROUT Director of Sales — North Florida 904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com JOSEPH PERRETTI Director of Sales — South Florida 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com RICK D’ANGELO Director of Sales — West Coast 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com
To contact an FDA Board member, use the first letter of their first name, then their last name, followed by @bot.floridadental.org. For example, Dr. John Paul: jpaul@bot.floridadental.org.
R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117 AUSTIN MOSER, Coordinator of Foundation Affairs amoser@floridadental.org 850.350.7161
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The last four digits of the telephone number are the extension for that staff member.
TODAY'S FDA MAY/JUNE 2018
5
FDA - Awards Luncheon
2018 AWARDS LUNCHEON
FRIDAY • JUNE 22, 2018 11:30 AM-1 PM • OSCEOLA C BALLROOM FLORIDA DENTAL CONVENTION Gaylord Palms Resort & Convention Center Orlando, Florida
2018 AWARD RECIPIENTS PRESIDENT’S AWARD Dr. Michael Eggnatz
DENTAL TEAM MEMBER AWARD Ms. Elizabeth Martinez
FDA DENTIST OF THE YEAR Dr. Irene Marron-Tarrazzi
FDA PUBLIC SERVICE AWARDS Dr. Stephen Krist Dr. Harley Richards
J. LEON SCHWARTZ LIFETIME SERVICE AWARD Dr. James Antoon FDA LEADERSHIP AWARDS Dr. Christopher Bulnes Dr. Bertram Hughes NEW DENTAL LEADER AWARD Dr. Jordan Harper
DANIEL J. BUKER SPECIAL RECOGNITION AWARD Ms. Casey Stoutamire OUTGOING TRUSTEES Dr. James Antoon, CFDDA Dr. Stephen Cochran, NEDDA Dr. Richard Huot, ACDDA
LEADERSHIP
RELATIONSHIPS: FOCUS ON WHAT IS IMPORTANT Against the backdrop of our continuing caustic national discourse and polarizing politics, the Florida Dental Association (FDA) rose above the fray and was successful in meeting the challenges of a contentious legislative session (read the latest Capital Report at bit.ly/2KnwNui and “2018 Legislative Wrapup” (starting on page 22), while also protecting the public trust at the Florida Board of Dentistry. As the 2018 Legislative Session came to a close on March 9-10, the FDA Foundation held another successful Florida Mission of Mercy (FLA-MOM) in Fort Myers at the Lee County Civic Center. A huge thank you to FLA-MOM co-chairs, Drs. Chris Bulnes and Oscar Menendez, along with the entire 2018 FLA-MOM leadership team for executing our most efficient and organized event to date! Besides the obvious need for care, this annual event has turned into one of the most significant team-building occasions for the entire FDA! It’s rewarding to see members from every corner of our association come together for a common cause to personally touch and give back to our communities in need with the professional skills they possess and practice every day! My presidential visits have afforded me the unique opportunity to see the FDA thrive at the local level all over the state. To meet the significant challenges we will continue to face as a society and as a profession, we must debate our policies and core values with transparency and intellectual honesty to find the ethical and practical solutions to
the inequities that still exist in our great state. To eliminate internal conflicts and efficiently adapt to the demands of a rapidly changing world in which our members live, we must find solutions based on their merit that align with our association governance. I recently had an enlightening conversation with a young leader in the FDA about the value of membership beyond the tangible benefits and services that are highlighted in every issue of Today’s FDA and on our website. From experience, I’ve realized it’s difficult to gain knowledge when you are speaking, so it’s often better to speak less and listen more.
PRESIDENT’S MESSAGE MIKE EGGNATZ, DDS
Dr. Eggnatz is the FDA president and can be reached at meggnatz@ bot.floridadental.org.
This young leader communicated how a planned, short family trip outside the country to visit his parents turned into an unexpected two-and-a-half-week ordeal. He was trying to return to his private specialty practice while dealing with the bureaucracy of the federal government. Beyond the obvious frustration — disruption to his referral practice, loss of income and costs associated with this experience — he chose to find the silver lining and make the best of his circumstance. He relayed to me the generosity of fellow FDA member specialists who reached out to him to cover his practice and reassure his staff, patients and referrers of the quality and continuity of care that they were receiving. He shared this with his parents who asked, “Why would other dentists help him in his business when he was gone?” As he explained to them what being an FDA member means in our tripartite strucSEE PAGE 7
WWW.FLORIDADENTAL.ORG
TODAY'S FDA MAY/JUNE 2018
7
LEADERSHIP FROM PAGE 5
ture, he came to the realization that he would’ve never even met these dentists had he not been involved in the FDA. And, he would’ve never developed such close relationships with them had they not served together in multiple capacities at the local and state level of the FDA. I informed him that since he’d given so much to his local affiliate, district and the FDA over the years, and as a byproduct of his positive inclusive leadership, he was unconsciously building relationships while he was serving organized dentistry — never realizing the depths of the friendships he had made. Those relationships remained, even when he had finished serving in an official capacity. Serving in leadership for the last 30 years, I have experienced this dynamic multiple times in my career during times of illness, injury, personal loss and adversity. It’s those relationships that last and are most important, no matter what the current issue or controversy may be. We may disagree on policy, strategy or solutions to issues, but in the end, we are all FDA members volunteering our time away from our families and practices to make our profession better for our patients and those who follow us. So, when I heard this recent story from this young FDA leader, I reflected on my own relationships and the support I’ve received from people I would’ve never met or known, had it not been for my involvement in organized dentistry. It’s those relationships that have helped me focus on what’s most important and to draw strength from them in a difficult year! This year, three weeks after becoming your FDA president, my wife and I learned of the unexpected crushing news that our daughter, Kristina, was diagnosed with cancer. It has been the fight of our lives and she has been the most courageous warrior in a battle we are still waging! The support from family, friends, colleagues, FDA officers, Board of Trustees, delegation members and our great FDA and South Florida District Dental Association staff that I have served with over the years, has
WWW.FLORIDADENTAL.ORG
To meet the significant challenges we will continue to face as a society and as a profession, we must debate our policies and core values with transparency and intellectual honesty to find the ethical and practical solutions to the inequities that still exist in our great state.
been extraordinary and overwhelming! I could not have been there for my family if you had not been there for me! I thank you for your support and for the privilege of serving as your FDA president this past year. I’ve enjoyed it tremendously, but what I’ll always remember the most is the relationships and support that will last long after I’ve served. It has been an honor to lead this great organization! We must continue to work together to keep the FDA the proactive organization it needs to be, for us to meet the challenges ahead that will define the future of our profession. May we always be the collegial professionals we have devoted our careers to, and may we keep our focus on what is really important in our profession, with our patients and with our families.
TODAY'S FDA MAY/JUNE 2018
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LEGAL NOTES “YOU TAKE MY TEXT AWAY”: MOBILE DEVICES AND TEXTING FOR FLORIDA DENTISTS I’m sticking with my theme that health law is complicated and always changing, so here’s another example. On Dec. 28, 2017, the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Center for Clinical Standards and Quality/Survey and Certification Group issued a memorandum stating that “effective immediately … CMS does not permit the texting of orders by physicians or other health care providers.” This one sentence created confusion, as some construed it to be an absolute prohibition on texting.
GRAHAM NICOL, ESQ., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)
LEGAL CE 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! Expires 4/1/19
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TODAY'S FDA
So, right now, may a Florida dentist lawfully send appointment reminders via standard short message service (SMS) and instant messaging (IM) texts to a patient? The answer remains “yes,” unless you practice in a federally qualified health care center, treat Medicaid patients or participate in Florida Healthy Kids. More specifically, the CMS memo interprets the “conditions for coverage” for health care providers found in Title XVIII of the Social Security Act. But the CMS rules apply to dentistry only in those settings listed above. Moreover, the actual memo does not address texting patients. Rather, it addresses texting patient information among members of the health care team. If the CMS rules apply to you, then you must use a secure platform and texting patient orders is prohibited regardless of the platform used. Otherwise, the familiar and comforting HIPAA privacy and security standards apply to you if you are a covered en-
MAY/JUNE 2018
tity. At this point in the regulatory landscape, if you don’t know whether you are a covered entity or not, just assume that you are. While there is no blanket prohibition against Florida dentists texting patients, let’s take a few minutes to cover the basics of HIPAA and do some proactive risk management. Just because you can text, does not mean you should — the efficiency and ease of texting does not justify the substantial risk of violating the HIPAA Security Rule. The HIPAA Privacy and Security Rules do not specifically regulate texting, but they do set forth certain conditions that apply to all electronic communications in general. The Privacy Rule applies to all communications involving a covered entity and personally identifiable health information (PHI). The Security Rule applies anytime PHI is being transmitted electronically, also known as e-PHI. Therefore, both rules apply to texting between dentists and patients. Here’s what I see as the most common risks for dentists under the Privacy Rule: 1. Immediately stop texting and calling if the phone number changes or the patient “opts out” and withdraws consent to be contacted on their mobile phone. 2. Ensure your front office staff knows not to leave a message unless they have first confirmed that the patient’s identity and phone number are both accurate. WWW.FLORIDADENTAL.ORG
3. At the start of the text, identify yourself and your contact information.
9. Don’t use different messaging apps on different mobile devices!
4. Comply with the “minimum necessary standard” by limiting your texts to “This is Dr. Jones calling to confirm your appointment” or “This is Dr. Jones, please call me at ____.”
10. SMS and IM texts are obsolete! Stop sending e-PHI via Gmail, Yahoo or AOL!
5. Don’t message using the patient’s name! 6. Covered entities under HIPAA (most Florida dentists) have authorization through their Notice of Privacy Practices to make phone calls or send texts to patients about health care “payment,” “treatment” and “operations” (PTO). This means that you do not need express written consent to send a patient a text message or to call them on their mobile phone for the narrow purpose of appointment reminders, preoperative instructions, discharge or after-care instructions, and prescription notifications. Please note that the PTO rule is an exception to the general rule that you want your patient’s written authorization for methods of communication. Here’s what I see as the most common risks for dentists under the Security Rule: 1. You don’t ensure the confidentiality, integrity and availability of all e-PHI you create, receive, maintain or transmit. 2. “Confidentiality” means e-PHI is not available or disclosed to unauthorized persons. 3. “Integrity” means e-PHI is not altered or destroyed without your permission. 4. “Availability” means that e-PHI is accessible and usable on demand by an authorized person. 5. “Authorized person” doesn’t include your entire staff. It includes only those who must have access to the data to perform their jobs. 6. You don’t have a compliance policy in writing or you don’t routinely enforce it. 7. You don’t have cybersecurity coverage through your business owner’s or professional liability insurance. 8. Each time you or your staff access e-PHI, they must log in and log out, using a unique PIN and you need to “authenticate” their identity, i.e., keep track of which employee has which PIN.
WWW.FLORIDADENTAL.ORG
By this time, you should be using a secured, encrypted messaging app instead of SMS or IM; especially if you are using multiple phones, laptops, etc. Think about how easily your patients’ confidential records may be made public if one of the mobile devices is stolen or lost. This includes not just your personal cell phone, but also your patient’s phone and your staff ’s mobile devices. SMS and IM completely fail the confidentiality test. If you are sending e-PHI outside your internal firewalls, make sure it is encrypted so it is automatically rendered unusable if improperly accessed. With unencrypted messaging services, you have completely lost control over who sees your texts and e-PHI. For example, texts and emails remain on your internet service provider’s computers (do you really want to ask AT&T to sign a business associate agreement?); they’re often are unintentionally sent to a wrong number or intentionally intercepted while in route. Unencrypted texts also profoundly fail the integrity and accountability tests. For example, a stranger could send a message posing as you or modify data received on your patient’s mobile device and then forward it. Texting is convenient and many patients now rely on their cell phone as their primary means of communication. Please make sure to use a secure messaging app that keeps e-PHI private and restricts access to only authorized users. These private messaging apps are widespread and inexpensive. After logging in, you will enjoy the convenience of texting, but the app will encrypt your data, prevent e-PHI from leaving your private network, disable copy and paste functions, protect against someone saving it to an external hard drive, allow audit trails and automatically log you off if there is a period of inactivity. Florida Dental Association (FDA) members get a 35 percent discount on secure messaging apps available from FDA Services Crown Savings merchants, iMedicor and iCoreExchange. Learn more at fdaservices.com or contact FDA Services at 800.877.7597.
TODAY'S FDA MAY/JUNE 2018
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DIDYOU
BOD
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INFORMATION ABOUT THE FLORIDA BOARD OF DENTISTRY
DID YOU KNOW THERE ARE FOUR NEW MEMBERS ON THE BOARD OF DENTISTRY? Dr. Nicholas Kavouklis, of Tampa, was appointed in October 2017. Dr. Kavouklis received his doctor of dental medicine from the University of Florida and is the president and chief executive officer of Argus Dental & Vision Inc. He filled an open position on the board and his term ends Oct. 31, 2018, but he is eligible for reappointment.
DR. DON ILKKA FDA LIASON TO THE FLORIDA BOARD OF DENTISTRY
MS. CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS
Mr. Fabio A. Andrade, of Weston, also was appointed in October 2017. He is the managing director for FAAC Consulting, LLC. He succeeds Mr. Tim Pyle and his term ends Oct. 31, 2020, but he is eligible for reappointment.
If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@ floridadental.org or 850.350.7202, or FDA Liaison to the Florida Board of Dentistry Dr. Don Ilkka at donjilkkadds@aol.com or 352.787.4748.
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Dentistry and Orthodontics. He succeeds Dr. Robert Perdomo and his term ends Oct. 31, 2020, but he is eligible for reappointment. Dr. Nicholas White, of Longwood, also was appointed in March. He is the owner of Lake Mary Pediatric Dentistry. He succeeds Dr. William Kochenour and his term ends Oct. 31, 2021, but he is eligible for reappointment. The Florida Dental Association (FDA) looks forward to working with these new board members. Please join us in thanking them for their service to their profession. However, there is still one open consumer position on the board.
Dr. Matthew Freedman, of Naples, was appointed in March and is an orthodontist with Main Street Children’s
WWW.FLORIDADENTAL.ORG
The Doctors Company
FDA - Northeast District Dental Association
TECHNOLOGY
JUST THE FAX
We live in a time that’s like no other. Last
that VIP list. Obviously, not everyone can be a
night, I was trying to explain to my 11th grade
VIP. I went through my Facebook friends and
daughter how fax machines work. She asked,
designated whose posts I wanted see first in my
“Why do we still need to use those when we
feed. I did the same with Twitter.
have email?” With all the methods we have for communicating information, it’s a valid point. I remember a time when I was excited to get an email. That “ding” was exhilarating! I now have eight different email addresses — each with their own specific purpose. Every new “ding” could be important, but there is a 90 percent chance it’s irrelevant. I have six different “dings” just for email. I have different sounds for calls, texts, tweets, likes, posts and other requests, too. My Sunday afternoon nap was interrupted by one of those dings — and it wasn’t even mine. Information seems to come at us from so many different places, it’s like trying to get a drink of water from a fire hose. Yet somehow, we often complain that we didn’t get that email or see that text or notification you
You might say I’m simply prioritizing my communication. I realize that takes time, but it’ll save me valuable minutes every day from now on. Go through and unsubscribe from those useless emails you never read. Unfollow those “friends” on Facebook and Twitter who conmay be the most read communication available today, guard your personal text number for only those important communications. Use times I’ve texted back and forth with someone for 30 minutes when a five-minute phone call would have done the job. You know, I can pound a nail in with a screwdriver, but the hammer works much better.
overload?
or you will be overwhelmed and never get the message.
tion is truly important to you. If 90 percent of
n Decide what communication is important
those emails aren’t important, why do you still
point? Then, once you decide what’s important,
to you.
n Segment the important from the noise.
use the tools available to distinguish those
n Reduce the noise and clutter you receive.
from the “noise.” In my case, I have a VIP
n Be selective and guard certain
list for emails. I’m immediately notified with a sound and a notification that requires my response if I receive an email from someone on
WWW.FLORIDADENTAL.ORG
Mr. Darnell is the FDA director of information systems and can be reached at ldarnell@floridadental.org.
the right tool for the job at hand. There’s been
Take control of the information coming at you,
get them? If you never read them, what’s the
LARRY DARNELL, MBA, CAE
tribute to the “noise” in your life. While texts
called. So, what do we do with this information First, you need to decide what communica-
INFORMATION BYTES
communication methods.
n Choose the right communication method
to use.
TODAY'S FDA MAY/JUNE 2018
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FDA - Dentists' Day on the Hill 2019
MARCH 11-12, 2019 TALLAHASSEE floridadental.org/ddoh
Paragon
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TODAY'S FDA
MAY/JUNE 2018
WWW.FLORIDADENTAL.ORG
F L O R I D A D E N TA L C O N V E N T I O N : T H E O F F I C I A L M E E T I N G O F T H E F D A
O Y U R E T G A A V ME E LE
JUNE 2018 is| Still FLORIDADENTALCONVENTION.COM FDC21-23, - There Time to Register
GAYLORD PALMS RESORT & CONVENTION CENTER I ORLANDO, FLORIDA
THERE IS STILL TIME TO REGISTER! ONLINE REGISTRATION IS AVAILABLE 24/7 AT FLORIDADENTALCONVENTION.COM/REGISTRATION.
SAVE THE DATE
JUNE 21-23, 2018
UPDATES FOR MEMBERS *PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.
NEW! Mandatory Opioid Course for All Florida-licensed Dentists House Bill (HB) 21 states that all Florida-licensed dentists registered with the U.S. Drug Enforcement Administration to prescribe controlled substances must take a two-hour continuing education course on opioid training by Jan. 31, 2019. Take this course on Thursday at the 2018 Florida Dental Convention (FDC)! The course, “Opioid Use Disorder in Dental Patients” (C12 or C68), is approved by the Florida Board of Dentistry and will satisfy this requirement. Go to bit.ly/2rx81QJ to register for this course and learn more about the requirements for HB 21.
New Study Strengthens Evidence that Fluoride Safely Prevents Tooth Decay, But Critics Ignore the Study They Once Welcomed A study led by researchers at the federal government’s National Toxicology Program (NTP) found no link between elevated levels of fluoride and cognitive/ learning deficits. The American Fluoridation Society (AFS) reports that the recently released NTP study examined rats that consumed food and water with varying exposures of fluoride. The researchers “observed no exposure-related differences in motor, sensory, or learning and memory performance” for any of the nine tests they conducted.
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When the NTP study was first announced, an anti-fluoride group welcomed the news with a headline declaring that the study’s findings “could end fluoridation.” This group cited the NTP’s “cutting edge scientific tools” and wrote that the NTP’s decision to conduct a study “puts a lie to [proponents’] claims” about fluoridation. AFS noted that critics have been quiet since the NTP study results were publicly released. Go to https://bit.ly/2JNOmnk to read the full press release.
Have You Seen “Chew on This! 32 Questions”? Make sure to check out the FDA’s new video series, “Chew on This! 32 Questions.” Filmed in a single shot, the FDA asks intriguing people what they like, what they don’t and that fascinating middle ground that defines them. In our latest video, FDA Executive Director Drew Eason sits down to talk with American Dental Association Executive Direct Dr. Kathy O’Loughlin. Interested in taking part in “Chew on This! 32 Questions” or know someone who would make a great subject? Please send suggestions to communications@ floridadental.org — we’d love to hear from our members! Go to blog.floridadental.org/category/ chew-on-this/ to watch these entertaining videos.
Online Dispute Resolution Legitimacy Online dispute resolution (ODR) is a term used to describe a process in which parties use internet technology to facilitate the resolution of a dispute. It takes many forms, and can involve all sorts of disputes, including malpractice and other claims against dentists. ODR services often solicit comments or information for cases via the internet or email, and you should be careful about how you respond to such solicitations, if at all. Commenting on the merits of a claim through an ODR service is not unlike providing an expert opinion, and raises questions about who will be relying upon such commentary, and for what purpose; whether the ODR service is providing an accurate account of the facts giving rise to the claim; whether there are material facts and circumstances not accounted for by the ODR service; and, numerous other issues. Without questioning the legitimacy of ODR as a means by which to resolve disputes, it should be handled cautiously and comments given judiciously, if at all.
Helping Members Succeed: New FDA Career Center Find your next opportunity at the FDA Career Center! Job seekers can post their résumé for free. Employers can list jobs using an online management system, with résumé search included. Another exciting feature is the FDA Mentorship WWW.FLORIDADENTAL.ORG
Program — a resource to help dental students gain a practical and professional perspective of dentistry from established member dentists. Mentors can help facilitate their protégé’s transition from dental student to practicing dentist. To visit our Career Center, go to careers.floridadental.org.
Dilbone Appointed Chair of UFCD Department of Restorative Dental Sciences Dr. Deborah Dilbone was appointed permanent chair of the University of Florida College of Dentistry Department of Restorative Dental Sciences effective April 16, 2018. Dr. Dilbone has been serving as interim chair of the department since May 2016. She serves on many college committees and is the course director for Dental Anatomy and the Stomatognathic System. She is the college’s liaison for the American Dental Education Association’s (ADEA) Commission on Change and Innovation in Dental Education and serves on the Practitioner Advisory Committee for the National Dental Practice-based Research Network’s South Atlantic Region. She was a fellow of the 2017-2018 ADEA Leadership Institute and was recently named the 2017 ADEA/ADEAGies Foundation Drs. Connie L. and Richard R. Drisko Scholar in the ADEA Leadership Institute. She is an active member of many local, state, national and international dental organizations including the Academy of WWW.FLORIDADENTAL.ORG
Operative Dentistry, American Dental Association, Florida Dental Association, International Association for Dental Research, Omicron Kappa Upsilon and the Consortium of Operative Dental Educators. She is passionate about education and works diligently to improve the educational experience and learning outcomes of students. Her research interests focus on education, cariology and improving overall health assessments of patients. Go to bit.ly/2JPpmvI to read the full press release. Congratulations, Dr. Dilbone!
Welcome New FDA Members These dentists recently joined the FDA. Their membership allows them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry.
Atlantic Coast District Dental Association Mihika Ahluwalia, Boca Raton Thomas Balshi, Vero Beach Natalia Benda-Celenski, Fort Lauderdale Randall Cohen, Delray Beach Michelle Handel-Herman, Boca Raton Lee Herman, Parkland
In Memoriam The FDA honors the memory and passing of the following members: Roscoe P. Hylton Gainesville, FL Died: 1/16/18 Age: 95
Victor J. Beliveau Citrus Springs, FL Died: 3/4/18 Age: 65
Ralph C. Day Gainesville, FL Died: 1/24/18 Age: 70
Dwain F. Marquette Sarasota, FL Died: 3/30/18 Age: 88
Kevin Marvin Ormond Beach, FL Died: 2/17/18 Age: 48
James J. Lyons Neptune Beach, FL Died: 4/17/18 Age: 96
Richard A. France Ormond Beach, FL Died: 4/24/18 Age: 74
Lissette Bernal, Winter Garden Kerry Borer, Ormond Beach Serese Brooks, Longwood Manfred Buechele, Clermont Gary Cardoso, Merritt Island Hope Feldman, Palm Coast Cara Hill, Gainesville Judy Hsu, Orlando Yang Hua, Orlando Yomaly Kuhns, Oxford Satoko Matsumura, Gainesville Nishita Patel, Orlando Abdul Shaikh, Orange City Stephanni Terza, Gainesville
Hugues Jean, Parkland
Amaury Valle, Orlando
Ian Lieberman, Delray Beach
Northeast District Dental Association
Austin Mautner, Jupiter Rhonda Nasser, Palm Beach Iveliss Rodriguez, Davie Monica Weick, Deerfield Beach
Central Florida District Dental Association Maria Jose Abboud, Gainesville
Amy Addington, Green Cove Springs Joseph Boulter, Jacksonville Eric Broe, Ponte Vedra Beach John Della Porta, Ponte Vedra Beach
SEE PAGE 19 TODAY'S FDA MAY/JUNE 2018
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FDA Member Booth at FDC FDA Member Booth at FDC
UPDATES FOR MEMBERS FROM PAGE 17
Padmalatha Gottipati,
FDA Well Being Committee
Ponte Vedra Beach Craig Hadgis, St. Augustine Kathleen Hood, Jacksonville Hwang Marino, Orange Park April Stone, Green Cove Springs
Northwest District Dental Association Lindsay Fujawa, Seacrest Beach Douglas Fujawa, Seacrest Beach Benjamin Grooters, Panama City Beach
South Florida District Dental Association Lisset Arenas, Boca Raton Rony Arencibia, Miami Elsa Cortorreal, Miami Chandani Desai, Miami Beach Maria Feiz, Davie Natalie Guerra, Miami
Aftco
Yanet Jaime Garriga, Hialeah Janis Jeffers, Islamorada Christiane Murillo, Hollywood
West Coast District Dental Association Daniel Amyradakis, Lehigh Acres Renato Aves, Tampa Joanna Bala, Tampa Rosalie Brao, Naples Richard Burns, Davenport Maritza Castro Penalosa, Tampa Elizabeth Dy, Tampa Christopher Fall, Tampa Joel Garcia Boss, Sarasota Nilo Hernandez, Naples Zaid Hikmat, Pinellas Park Ivan Mericle, Tampa Louisa Sanders, Belleair Beach WWW.FLORIDADENTAL.ORG
TODAY'S FDA MAY/JUNE 2018
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FDAS - Workers' Comp
SAVE ON WORKERS’ COMP FOR YOUR PRACTICE EXPANDED ELIGIBILITY Practices with an annual Workers’ Compensation premium of $500 or more are now eligible (down from $1,000)! Available for dental offices that meet the following requirements: 1. Annual Workers’ Compensation Premium of $500 or more 2. Claims-free the past three years (current year plus two prior years) The carrier will immediately apply a 25 percent dividend of your earned annual premium to all new and existing policies that meet the program guidelines starting July 1, 2018.
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2018 LEGISLATIVE WRAP-UP This year’s legislative session was a very active session for organized dentistry. Between advocating for the dental student loan repayment program and opposing the creation of dental therapists in Florida, grassroots members of the Florida Dental Association (FDA) were an instrumental part of what passed and what was defeated this year. Below are summaries of issues addressed during the 2018 Legislative Session:
LEGISLATURE ADOPTS $89 BILLION BUDGET On Sunday, March 11, the 2018 Legislature officially adjourned and adopted the largest budget for the state of Florida, which totaled $89 billion. With the legislative session initially slated to end on Friday, March 9, the Legislature voted to extend session to have enough time to officially pass the state’s budget. Due to the tragedy in Parkland, the Legislature also had to reprioritize initiatives originally outlined in the budget and place additional focus on addressing issues surrounding school safety, mental health and gun regulations, which totaled $400 million. The state’s budget includes the $200,000 for community water fluoridation the FDA requested. This funding will be administered through the Department of Health (DOH). Unfortunately, the funding for Donated Dental Services ($150,000) did not make it into the final budget proposal. This funding would have been used to pay for two full-time coordinators and operating expenses for the program. The FDA will continue to seek state support
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for programs and initiatives like this one, which serves as a safety net program, providing donated dental care for those who are in need. The governor signed the budget (HB 5001) into law on March 16. The state’s budget for fiscal year 2018-2019 goes into effect on July 1, 2018.
DENTAL STUDENT LOAN REPAYMENT PROGRAM LEGISLATION NOT APPROVED THIS YEAR Legislation filed this year to help incentivize dentists to practice in underserved areas failed to pass the full Legislature. CS/HB 369 by Rep. Colleen Burton (R-Lakeland) and CS/SB 764 by Sen. Aaron Bean (R-Jacksonville) would have reinstated the dental student loan repayment program and provided up to $50,000 for dentists who worked full time in a rural or underserved area in a public health program. Dentists would have been able to participate in the program for a maximum of five years. CS/SB 764 was unanimously approved by all Senate committees and passed off the Senate floor; however, CS/HB WWW.FLORIDADENTAL.ORG
LEGISLATIVE WRAP-UP 369 only passed out of one committee and was never considered by the House Health Care Appropriations Subcommittee. The FDA will continue its support for this program, which in the past has proven to help increase quality dental care to people without routine access to dental care.
LEGISLATION TO CREATE DENTAL THERAPISTS IN FLORIDA FAILS TO GET SUPPORT This session proved to be a year where false comparisons and distortion of information took center stage as individuals and national organizations lobbied the Legislature to change Florida’s dental workforce. Individuals from within the dental profession, along with the Florida Dental Hygienists’ Association (FDHA), worked with lobbyists from the Pew Charitable Trusts and representatives from the James Madison Institute, to advocate for the creation of dental therapists in Florida. The FDA opposed this legislation because Florida has a sufficient dental workforce to address the dental care needs of this state. However, many dentists are challenged with a large amount of debt, which makes it difficult to set up a practice in a rural area and maintain a sustaining practice, especially with low Medicaid reimbursement rates. Furthermore, the FDA is concerned that this would lower the standard of care for dentistry — particularly among our state’s most vulnerable populations, who often suffer from the most complex problems and higher rates of tooth decay. The FDA is advocating for the return of the dental student loan repayment program to remedy this problem, which would provide qualified dentists with a salaried paying job in a community health center or a county health department, while the state pays at least $50,000 on their student loan for up to five years. WWW.FLORIDADENTAL.ORG
Sen. Jeff Brandes (R-St. Petersburg) filed SB 1498 and Rep. Danny Perez (R-Miami) filed CS/HB 683 to authorize a new licensed dental provider called a dental therapist, in which a high school graduate with three years of dental therapy training would be allowed to perform irreversible surgical procedures, such as extractions and partial root canals under the general supervision of a dentist — which doesn’t require the dentist to check the work or be in the building when the procedures are performed. The Senate Health Policy Committee did not consider SB 1498; however, the House bill did receive two committee hearings. CS/HB 683 was amended to conduct a study of dental therapists. The FDA also opposed a study of dental therapists because it’s unnecessary and the projected funding to conduct a study (ranging from $250,000 to $500,000) would be better used toward providing direct care to those in need.
JOE ANNE HART
Ms. Hart is the FDA chief legislative officer and can be reached at jahart@floridadental.org.
It is evident that these individuals and organizations are going to continue to travel all over the United States, hoping to convince legislators that dental therapists are the solution to addressing access to dental care. Our job is to show them that the FDA has always pursued ways to help increase access to dental care in Florida, but in ways that maintain the high standard of education and training dentists achieve to provide comprehensive dental care to all patients.
LIMITS ON PRESCRIBING CONTROLLED SUBSTANCES Earlier this year, the governor announced support for placing limits on prescribing opioids in response to the national attention brought on from the significant amount of deaths
SEE PAGE 24 TODAY'S FDA MAY/JUNE 2018
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LEGISLATIVE WRAP-UP FROM PAGE 23
recorded from opioid abuse and overdose. Legislation was filed by Sen. Lizbeth Benacquisto (R-Fort Myers) and Rep. Jim Boyd (R-Bradenton) to place limits on prescribing controlled substances, in addition to some other changes impacting health care providers. CS/CS/HB 21 requires all health care providers who are authorized to prescribe controlled substances to complete a board-approved two-hour continuing education (CE) course, if not already required by their practice act. All health care providers registered with the United States Drug Enforcement Agency (DEA) to prescribe controlled substances must complete the CE course by Jan. 31, 2019, and at each subsequent licensure renewal. The course will be offered by a statewide professional association of physicians in this state that is accredited to provide educational activities designated for the American Medical Association Physician’s Recognition Award Category I Credit or the American Osteopathic Category 1-A continuing medical education requirement. The course may be taken in a long-distance format (online) and must be included in the CE required for the biennial renewal of a health care provider’s license. The DOH may not renew the license of a prescriber who fails to complete this CE requirement. The FDA supported the two-hour CE training for controlled substances during session, but opposed the requirement that CE only be provided by one statewide professional association group. The FDA supported the original language in the bill that allowed each health care board to facilitate the CE course for controlled substances training. The FDA offered an amendment filed by Sen. Perry Thurston (D-Fort Lauderdale) to change the language back to the original language, but the amendment failed. CS/CS/HB 21 limits the prescribing of a Schedule II controlled substance to a three-day limit. However, health care providers will be allowed to prescribe up to a seven-day supply if they write “acute pain exception” on their patient’s prescription and adequately document the exception in their patient’s record and indicate the acute medical condition and lack of alternative treatment. The bill creates a definition for “acute pain” when prescribing controlled substances to mean “the
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normal, predicted, physiological and time-limited response to an adverse chemical, thermal or mechanical stimulus associated with surgery, trauma or acute illness.” The bill does delineate exceptions for acute pain to include cancer, a terminal condition, palliative care and traumatic injury, and directs the health care boards to adopt rules to establish guidelines for prescribing controlled substances for acute pain. The bill requires all health care providers to check the prescription drug database before prescribing or dispensing Schedules II, III, IV and V controlled substances for a patient who is 16 years old or older. The bill provides an exemption for checking the database when prescribing or dispensing a “nonopioid controlled substance” listed in Schedule V of s. 893.03 or 21 U.S.C. 812. The bill defines “nonopioid controlled substance” as a controlled substance that does not contain any amount of a substance listed as an opioid in s. 893.03 or 21 U.S.C. 812. The bill authorizes the DOH to issue a nondisciplinary citation to any prescriber or dispenser who fails to consult the prescription drug monitoring program database for the first offense and eliminates the requirement for the first offense be referred to the regulatory board for disciplinary action. The DOH is authorized to share and exchange database information with other states if certain conditions are met, and authorizes the database to interface with health care provider and facility electronic health records systems. Information contained in the prescription drug monitoring program database will be purged to eliminate information in the database that is more than four years old. Based on the significant number of anticipated inquiries to the database, the bill appropriates close to $1 million to revamp the prescription drug monitoring program database and potentially contract with a third-party vendor with experience administering these types of databases. CS/CS/HB 21 was signed into law by the governor on March 19 and becomes effective on July 1, 2018.
VETERAN AND MILITARY FAMILY OPPORTUNITY ACT Legislation passed this year to provide expanded opportunities for veterans and military families. CS/HB 29 by Rep. Mel Ponder (R-Fort Walton Beach) was cited as the “Don Hahnfeldt Veterans and Military Family Opportunity Act” in memory of former Rep. Don Hahnfeldt (R-The Villages), who passed away unexpectedly before the start of the 2018 Legislative Session. CS/HB 29 makes changes to professional licensing fees and WWW.FLORIDADENTAL.ORG
requirements for certain military members, veterans and their spouses. Specifically, the bill removes the dental exemption and allows for a person who is a member of the U.S. Armed Forces in good standing with the administrative board to be eligible for dental licensure in Florida. Additionally, the bill removes the dental exemption and allows for military spouses to go through the expedited licensure process to receive a temporary dental license by waiving applicable fees and removing the requirement to be supervised by a dentist. All other health care professions already are subject to these laws for veterans and military families, but the dental profession was exempted from having to comply in 2016. CS/HB 29 was signed into law by the governor on March 13 and goes into effect on July 1, 2018.
DIRECT PRIMARY CARE PASSES LEGISLATURE HB 37 by Rep. Danny Burgess (R-Zephyrhills) allows consumers to directly contract with a primary care provider. The legislation permits an agreement between the primary care provider and the patient for a specified list of services for a monthly fee. Primary care providers include physicians, chiropractors, nurses and advanced registered nurse practitioners, physician assistants and primary care group practices who provide medical services that are commonly provided without referral from another health care provider. The legislation outlines that this is not insurance and will not be regulated under the Florida Insurance Code. Additionally, this legislation does not satisfy the minimum essential coverage for health care as directed by the Affordable Care Act and is not considered worker’s compensation insurance. HB 37 was signed into law on April 5 and goes into effect on July 1, 2018.
DENTISTRY EXEMPTED FROM CLINICAL LABORATORIES CS/CS/SB 622 by Sen. Grimsley is the legislative package addressing many different issues involving the Agency for Health Care Administration (AHCA). Among several changes made to the regulation of clinical laboratories, the bill exempts from licensure persons engaged in testing performed by laboratories that are wholly owned and operated by one or more practitioners who are licensed under Florida law as allopathic or osteopathic physicians, chiropractors, podiatrists, optometrists
or dentists, and who practice in the same group practice, and in which no clinical laboratory work is performed for patients referred by a health care provider who is not a member of the same group. The bill also amends the definition for “clinical laboratory” to mean the physical location in which one or more of the following services are performed to provide information or materials for use in the diagnosis, prevention or treatment of a disease, or the identification or assessment of a medical or physical condition: n clinical laboratory services, which entail the examination of fluids or other materials taken from the human body. n anatomic laboratory services, which entail the examination of tissue taken from the human body. n cytology laboratory services, which entail the examination of cells from individual tissues or fluid taken from the human body. The governor signed CS/CS/SB 622 into law on March 19 and the bill goes into effect on July 1, 2018.
DEPARTMENT OF HEALTH LEGISLATIVE PACKAGE SHELVED THIS SESSION Typically, each state agency and department files legislation to clear up procedural and substantive issues relating to the different functions within their purview. This year, the DOH sponsored a legislative package that included numerous initiatives from various divisions within the department, including dentistry. CS/CS/SB 1486 by Sen. Denise Grimsley (R-Lake Placid) and CS/CS/HB 1047 by Rep. Julio Gonzalez (R-Venice) included dental-related provisions supported by the FDA. The bills would have clarified a provision on dental examiners, removing the requirement that only Florida-licensed dentists could serve as proctors for dental licensure exams and would have codified in statute a Board of Dentistry (BOD) rule relating to the reporting of adverse incidents when using anesthesia. Additionally, the bills would have changed the inspection of dental laboratories from once a year to once every two years, and revised the definition for dental laboratory to include individuals who received onsite consultation from a dentist during dental procedures.
SEE PAGE 26 WWW.FLORIDADENTAL.ORG
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Unfortunately, both bills died this session without being considered on the floor of either chamber.
FLORIDA NO-FAULT MOTOR VEHICLE LAW Florida’s No-fault Motor Vehicle Law, also known as personal injury protection (PIP) coverage, continues in law. For years now, the Legislature has filed legislation to eliminate PIP coverage and move to replace it with mandatory bodily injury coverage. CS/SB 150 by Sen. Tom Lee (R-Brandon) and CS/ HB 19 by Rep. Erin Grall (R-Vero Beach) attempted to make changes to PIP laws with very different approaches. CS/SB 150 would have replaced PIP with a medical payment coverage mandate of $5,000. Medical payment coverage would provide substantially similar coverage as current PIP medical benefits, except that it provides reimbursement for 100 percent of covered medical losses, whereas PIP provided 80 percent of medical losses. The repeal of PIP would have eliminated the limitations on recovering pain and suffering damages from PIP insureds, which currently requires bodily injury that causes death or significant and permanent injury. The bill created financial responsibility requirements for damages for liability on account of accidents arising out of the ownership, maintenance or use of a motor vehicle: n Beginning Jan. 1, 2019 through Dec. 31, 2020, $20,000 for bodily injury or death of one person in any one crash, and subject to that limit for one person; $40,000 for bodily injury of death of two or more people in any one crash. n Beginning Jan. 1, 2021 through Dec. 31, 2022, $25,000 for bodily injury or death of one person in any one crash, and subject to that limit for one person; $50,000 for bodily injury or death of two or more people in any one crash. n Beginning Jan. 1, 2023 and thereafter, $30,000 for bodily injury or death of one person in any one crash, and subject to that limit for one person; $60,000 for bodily injury or death of two or more people in any one crash.
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The bill would have retained the $10,000 financial responsibility requirement for property damage. CS/HB 19 also would have repealed PIP and would have required mandatory bodily injury coverage. Bodily injury coverage limits would be $25,000 in damages due to bodily injury or death of any one person and $50,000 for bodily injury or death to two or more persons. The $10,000 financial responsibility for property damages remained the same. In the end, neither bill passed and PIP coverage remains intact.
HELP PROTECT FLORIDIANS — REPORT UNLICENSED ACTIVITY The DOH has an Unlicensed Activity (ULA) division that investigates and refers for prosecution all unlicensed health care activity complaints and allegations in the state. The division has one of the utmost important missions in the DOH: to protect all Floridians from the serious and potentially lifethreatening consequences a person could have from receiving medical care from an unlicensed practitioner. Unfortunately, many bad actors in the state practice dentistry without a license. In order to help protect Floridians and visitors to our state from these individuals who practice without a license, the ULA needs your help! The ULA has an updated website solely dedicated to reporting the practice of unlicensed activity. If you are suspicious of anyone practicing dentistry — or any other medical profession — without a license, please file a complaint online at flhealthcomplaint.gov. You also can email the ULA program at HALTULA@flhealth.gov or contact them at 877.425.8852. You can make the complaint anonymously, but please note that email addresses are public records in Florida. The ULA investigators work with law enforcement and the state attorney’s office to prosecute those found practicing without a license. Many times, this can result in the bad actor receiving a felony level criminal conviction. In order to increase public awareness of the persistent and dangerous problem of individuals practicing unlicensed, the ULA has increased their education campaigns across the state. Please take a moment to view the updated videos, articles and other information the ULA has put online at flhealthsource. gov/ula. As a profession that values quality education and training, it’s important for dentists to be involved in the safety of citizens receiving dental care.
WWW.FLORIDADENTAL.ORG
FDA 2018 LEGISLATIVE AWARDS This year, two legislators took on reinstating the dental student loan repayment program to help encourage dentists to practice in rural and underserved areas. As each legislative session presents with its own set of challenges, this year was no different. Although the legislation failed to pass the full Legislature, they never gave up on the possibility of getting it to the finish line. For their unwavering dedication and commitment, Sen. Aaron Bean and Rep. Colleen Burton are the FDA’s 2018 Legislators of the Year. Sen. Bean is known among his colleagues as someone who always exudes positive energy, even at the end of a long day in session. He’s passionate about every bill he files each year and presents each one before committees with excitement. He displayed that same passion for CS/SB 764 and was able to get it approved by the full Senate. He unSEN. BEAN derstands the value and importance of being able to access quality dental care from a highly trained and educated dentist. Sen. Bean is a true advocate for dentistry. Rep. Burton was more than willing to take on the task of creating opportunities for patients in underserved areas to receive dental care, while incentivizing dentists who are struggling with excessive student loan debt. She is committed to working with the FDA on supporting policies and legislation that ensure public safety in all settings. By REP. BURTON sponsoring CS/HB 369, Rep. Burton believes that the dental student loan repayment program is an important part of Florida’s Action for Dental Health, which is the FDA’s initiative designed to improve the oral health and resulting overall health of all Floridians. The FDA looks forward to working with Rep. Burton next year on this issue. The FDA would like to recognize and congratulate the recipients of the FDA’s 2018 Dr. Lewis Earle Legislative Service Award. The seven legislators pictured on the right have been supportive of the FDA’s legislative agenda throughout their tenure in the Legislature:
WWW.FLORIDADENTAL.ORG
SEN. ANITERE FLORES (R-MIAMI)
SEN. BILL GALVANO (R-BRADENTON)
SEN. BILL MONTFORD (D-TALLAHASSEE)
SEN. JOE NEGRON (R-PALM CITY)
SEN. OSCAR BRAYNON (D-MIAMI GARDENS)
REP. TRAVIS CUMMINGS (R-ORANGE PARK)
REP. SHEVRIN JONES (D-WEST PARK) TODAY'S FDA MAY/JUNE 2018
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MANDATORY OPIOID COURSE
Mandatory Opioid Course for Florida-licensed Dentists To ensure your license stays active, you must take a twohour continuing education (CE) course on opioid training by Jan. 31, 2019. During the 2018 Legislative Session, the Legislature approved House Bill 21 (HB), which requires each person registered with the United States Drug Enforcement Administration and authorized to prescribe controlled substances to complete a board-approved two-hour CE course on prescribing controlled substances. Additionally, health care practitioners are required to use E-FORCSE, the Florida Prescription Drug Monitoring Program (PDMP), prior to prescribing controlled substances. For additional information on E-FORCSE, please visit flhealthsource.gov/FloridaTakeControl/pdmp. To help you comply with this new requirement, the Florida Medical Association (FMA), in partnership with the Florida Dental Association (FDA), is jointly sponsoring the course, “Opioid Use Disorder in Dental Patients,” on Thursday, June 21 at the 2018 Florida Dental Convention (FDC).
Opioid Use Disorder In Dental Patients (C12 or C68) Speaker: Dr. Jason Portnof Date: Thursday, June 21 Time: 9:30-11:30 a.m. or 12:30-2:30 p.m. CE Credits: 2 Cost: Only $65!
Course Description The opioid crisis is a public health emergency in the U.S., with a severe impact in Florida. In this course, Dr. Portnof will review the current standards and the new Florida laws and rules related to the prescribing of controlled substances. Attendees will leave the course able to define acute and chronic pain and opioid addiction, and know when to consider non opioid and non pharmacological alternatives for treating pain.
Learning Objectives Participants will be able to: n understand the scope of the opioid program and the current situation in Florida. n learn the best practices for safe prescribing of controlled substances, including emergency opioid antagonists and monitoring patients. n identify the risk of addiction and the best practices for safe and effective treatment of acute pain with opioids. n overview Florida laws and rules related to the prescribing of controlled substances and Florida’s PDMP (E-FORCSE) and instructions regarding usage, with an emphasis placed on the recent modifications made to improve safety. n discuss the non opioid and non pharmacological alternatives for treating pain. Go to bit.ly/2HYWNff to register for FDC2018 and the course, “Opioid Use Disorder in Dental Patients.” Go to bit.ly/2rx81QJ to find more information on the course offered at FDC, or please contact the FDA at 850.681.3629. For more information on HB 21 visit flhealthsource.gov/FloridaTakeControl/.
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Taking the Fear Out of Debt: Financing a Dental Practice After Student Loans The landscape for new dentists can be quite scary. For example, the average dental student graduates with more than $240,000 in student loan debt. This amount represents an increase of more than 66 percent over the last decade. This debt load can jeopardize the aspiring business owner’s motivation to purchase their first dental practice. After all, is it smart to take on an additional $450,000 in practice loan debt? Let’s take a different approach to looking at debt. When a person buys a business — in this case, a dental practice — the business pays the debt, not the individual. Even though almost all dental practice loans require a personal guarantee, the borrower of the money is the actual business. JONATHAN BURNS VICE PRESIDENT, BANK OF AMERICA PRACTICE SOLUTIONS
Making loan payments on a new car, taking on credit card debt to pay for an expensive vacation or even purchasing a new home can be troubling when a person is saddled with high student loan debt. Why? None of these outcomes actually make the borrower money. Borrowing money to purchase a dental practice can actually create a better cash flow position, even after adding debt. Also, 100 percent financing to purchase a dental practice is readily available, so there is no need to invest current liquidity — and that protects the dentist’s current personal financial statement. Here’s an example: Let’s assume a dentist has been working as an associate for three years and has made an average annual salary of $100,000. The associate is now interested in buying a practice for $450,000. Historically, this practice generates revenue of $600,000. On average, a dental practice nets 40 percent profit to the owner. So in this scenario, the practice net income would be $240,000. A 10-year loan for $450,000 requires roughly $4,700 monthly payments, or $56,400 annually. After the dental practice pays the loan, the net income to the owner is $183,600 ($240,000 original net minus the $56,400 debt payments). We can see that the associate in this example will actu-
JASON NUNEZ VICE PRESIDENT, BANK OF AMERICA PRACTICE SOLUTIONS
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ally increase their annual income by $83,600 even though they took on an additional $450,000 in debt. Let this way of looking at debt — and the example above — serve as motivation to fulfill your dream of owning a practice.
MAY/JUNE 2018
WWW.FLORIDADENTAL.ORG
Making loan payments on a new car, taking on credit card debt to pay for an expensive vacation or even purchasing a new home can be troubling when a person is saddled with high student loan debt.
The current student loan situation can be overwhelming, so most new dentists will graduate with a goal to pay off all of their debt as quickly as they can, and they’ll be prudent about borrowing more money. They will work as associates in practices for longer periods of time than necessary because they fear acquiring additional debt. But buying a practice could be a way to pay off the debt more quickly. By purchasing a business and allowing it to pay the practice debt first, a dentist can increase income and improve cash flow. Borrowing money is intimidating, and so is taking the leap from associate to practice owner — but the additional debt can actually be worth it in the end. This article is for informational purposes only. Please consult your tax advisor, as neither Bank of America, its affiliates, nor their employees provide legal, accounting and tax advice. Bank of America is a trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America Corporation. ©2016 Bank of America Corporation. Mr. Burns and Mr. Nunez are speaking at FDC2018 and presenting two courses. “Preparing to Purchase a Dental Practice: Finding a Diamond in the Rough” will be on Thursday, June 21 at 10 a.m., and “Life After Dental School: I’m Ready to Own My First Dental Practice” will be later that day at 2 p.m.
WWW.FLORIDADENTAL.ORG
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SPE
W E I V E R P AKER
5 Words You Never Want to Hear from Your Patient: “You Never Told Me That!”
MITCHELL GARDINER DMD, FAGD, FACD, FICD
Dr. Gardiner is an assistant clinical professor in restorative dentistry at Rutgers School of Dental Medicine and has a private practice in Shrewsbury, N.J. He can be reached at mgardiner155@gmail.com.
I’ve just completed work on a dental malprac-
8 and 9 that were beginning to stain and be-
tice lawsuit, working as an expert witness for
come noticeable to the patient. The dentist told
a defendant dentist. The lawsuit didn’t go well
his patient that he could improve her smile
for him, as I expected it wouldn’t. This case
by placing conservative porcelain veneers on
brought back memories of another lawsuit that
teeth Nos. 7–10. The patient was told that she
was like this one. It was one of my first dental
wouldn’t even need to be anesthetized for the
malpractice lawsuits when I began my work
procedures, and that it required conservative
as an expert witness for another defendant
tooth preparation. There was no documenta-
dentist. This took place 25 years ago, but the
tion in the record concerning any conversa-
similarities in these lawsuits were striking. It’s
tions between the patient and the dentist as it
my opinion that sharing the important infor-
related to the treatment plan or the promises
mation from these lawsuits can help my fellow
made by the dentist concerning no tooth prep-
professionals understand where the dentists
aration. The dentist proceeded to minimally
made mistakes and to prevent them from mak-
prepare the four anterior teeth and within two
ing the same mistakes in the future.
weeks, four veneers were permanently bonded
Both aforementioned lawsuits centered on general dentists performing veneer procedures on the anterior teeth. And both plaintive patients
into place. Both the patient and the dentist were pleased with the results. Is this the end of the story? Not quite!
who sued their dentists were young, attrac-
When the young woman’s husband observed
tive females who weren’t satisfied with the
her veneers, his initial comment was now
appearance of their smiles. Both patients were
she had horse teeth and the teeth appeared
told that conservative veneers would greatly
like chicklets. Her friends confirmed her new
enhance their smiles with minimum teeth
smile appeared toothy. When the patient im-
preparation, or in the case of the most recent
mediately returned to discuss these newfound
lawsuit, with no tooth preparation. In both
complaints, the dentist was upset and told her
clinical cases, things went badly shortly after
that he did not agree with her husband and her
completion. This can happen to any of us.
friends. He told her his work was impeccable
Let me begin by summarizing the cogent facts from the lawsuit that took place 25 years ago. The 26-year-old female patient presented with
and beautiful. She demanded that the veneers be removed and replaced. This is where the case quickly went south.
two small composite restorations in teeth Nos.
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It’s my opinion that sharing the important information from these lawsuits can help my fellow professionals understand where the dentists made mistakes and to prevent them from making the same mistakes in the future.
The angry dentist rescheduled his patient for a longer appoint-
she could not get further dental treatment. She was forced to
ment and while using local anesthesia and nitrous oxide, he
leave her job as a hairdresser due to her dental problems. She
proceeded to remove the veneers and more aggressively pre-
also stated the dentist never told her what he had to do, and if
pare the four teeth for veneers again. This time, however, he
she had been informed, she would’ve told the dentist to leave
prepared the teeth so that the porcelain technician would have
her teeth alone. The discussion of a lack of informed consent
much more room to place porcelain. A mistake that he made
became a critical focus in the trial. After a full day of delib-
during this appointment was that he let his patient get up
erations, the jury returned with the verdict against the den-
and go to the bathroom during the appointment. The patient
tist. Damages for the four veneers amounted to a staggering
looked in the mirror, saw that her four teeth were aggressively
$500,000. This case was an eye-opener, to say the least.
prepared, and she furiously accused the dentist of damaging her perfectly healthy teeth. Veneers were ultimately placed and shortly thereafter a malpractice lawsuit was filed.
For some reason, which I sometimes still cannot fathom, I have stayed in this business of dental malpractice, working as an expert witness. It can be frustrating. I lecture around the
I represented the dentist as an expert witness. My responsibil-
country to dentists on various issues of dental malpractice,
ity was to explain the acceptable standards of care to the jury.
which I enjoy and makes it all worthwhile.
I examined the patient and found the veneers to be beautiful and in excellent function. As a clinician, I knew that for veneers to be placed by the dentist so that they would not appear bulky, more tooth structure would need to be removed. The jury understood this concept. The records supported this by way of the clinical documentation. Unfortunately, he was a bitter, angry dentist on the stand and he berated the patient for
So here I am, 25 years later with another porcelain veneer lawsuit against a dentist filed by another pretty, young patient unhappy with her smile. However, this case is different in certain respects. I’m representing the dentist as an expert witness, but I don’t like what I see in this case and I think it’s important for my readers to understand what I’m seeing.
having the audacity of suing him. He considered himself the
Early on in this lawsuit, I advised the lawyers and the malprac-
best dentist in the area, or so he told the jury.
tice insurance carrier to settle this case, and to do so quickly.
In her testimony, the patient claimed that ever since her teeth
Let me explain why I thought this case was indefensible.
were mutilated, they have become exquisitely sensitive to
The dentist defendant told his 30-year-old patient that he
hot and cold, but that due to a dental phobia she now had,
could place no-preparation veneers on her maxillary six SEE PAGE 35
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FDC - Exhibitor Coupons
FROM PAGE 33
anterior teeth. He told her that if she did not like them he could easily take them off. He told her it was a reversible procedure. He also told her for half the cost, he would cover her lower six interior teeth the same way. The patient readily agreed to this treatment plan. The dental history for this patient documented a history of bruxism, clenching and teeth chipping. An appointment was scheduled and teeth preparations and impressions were done. Shortly thereafter, 12 veneers were bonded into place. It didn’t take that long for the veneers to break, chip and delaminate. The patient went to another dentist who claimed to be a specialist in cosmetic dentistry. He stated that all the laminates needed to be removed and replaced. This dentist also told the patient that all the teeth were prepared for the veneers when they were initially done. When the patient left the first dentist, she contacted the office and requested a copy of her records, which were promptly sent to her. A year later, the patient filed a malpractice lawsuit against the first dentist. When the dentist received a lawsuit, he reviewed his records and he added the following documentation: Patient warned about veneers due to bruxism habit, patient insists on doing veneers anyway. During discovery, the period when records and information is gathered prior to trial, this record showed up with the altered addition that was placed in the record but not dated by the dentist. The problem here was that the original record without this alteration was already in the hands of the patient and her lawyer. The dentist did not realize this when he altered the records after the lawsuit was filed. As a defense expert, I realized that this case was lost before it started and was indefensible. The problem was that the demand by the patient and her lawyer kept going up. The records, however, were altered and the credibility of the defendant dentist was now the focal point of the lawsuit and not the dentistry itself. This case was settled on the day of the trial for $187,500. Two areas made these similar malpractice lawsuits indefensible and lost: informed consent and altered patient records. I will be speaking about these issues and many others at the 2018 Florida Dental Convention in June. See you there! Dr. Gardiner will be speaking at FDC2018 and presenting four courses. On Friday, June 22, “Complete and Honest Medical History and Valid Informed Consent Discussion and Documentation — You Cannot Practice Without Them” will be at 9 a.m. and “Changing Standards of Care in 2018” will be later that same day at 2 p.m. On Saturday, June 23, “Everything You Never Wanted to Know About a Malpractice Trial” will be at 9 a.m. and “Dental Injuries and Mishaps: What are Dentists Being Sued for Today?” will be later that same day at 2 p.m.
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TODAY'S FDA MAY/JUNE 2018
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FDC Exhibitor Marketplace
DENTIST OF THE YEAR 40
1.
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2. MAY/JUNE 2018
3. WWW.FLORIDADENTAL.ORG
“
Dentistry offers the unique opportunity to combine my artistic ability and passion for knowledge with the desire to care for my patients.
DR. IRENE MARRON-TARRAZZI
TFDA: Tell us about your family. IMT: I was born and raised in Caracas, Venezuela. I graduated from dental school at the age of 22 from the Universidad Central de Venezuela. My next challenge was coming to the U.S. to continue my education and training with my specialty and master’s degree in periodontics at the University of North Carolina-Chapel Hill. Upon graduation, I moved to Florida to attend Nova Southeastern University where I completed my American dental degree. While I was starting to practice, I met Francisco, who is a thoracic surgeon. Now, we’re happily married and have two wonderful children who are 7 and 9. We are fortunate to come from a typical Hispanic household with strong family values where our parents are very involved with helping us raise our children. With the support of Francisco and our family, I can balance my professional career as well as my personal life.
IMT: My family is the center of my life, and when I’m not working, teaching or studying, we focus on doing activities that bring us closer together. Weekends are spent with my children and friends. My favorite times are when Francisco and I sneak away for date nights, and it’s even better when we get to fit in the time to travel together. Also, when I can find a quiet moment, I enjoy reading.
”
TFDA: How did you end up in dentistry?
IMT: My mother was a dentist in Venezuela, and as a child watching her care and treat her patients, I was surrounded with inspiration and the environment to grow into the woman I am now. She showed me that dentistry offers the unique opportunity to combine my artistic ability and passion for knowledge with the desire to care for my patients. One of my hopes for the future is to inspire my children to see the world the same way.
TFDA: How did you get involved in the Florida Dental Association (FDA)? IMT: Upon graduating from Nova, I joined our local dental society, the Greater Miami Affiliate, and started attending the monthly meetings. I was one of the youngest in the room, and it seemed to me that the existing members had developed strong friendships, so I unfortunately felt like an outcast. My first reaction was to not return, but instead I brought a friend who later became a member. Ironically, it was at this meeting when the question was raised regarding the lack of new members becoming part of the affiliate. I scanned the room, and a little nervously expressed what my first experience was like, which led me to suggest having a more welcoming atmosphere to new members. That same day, I was offered a position on the board.
SEE PAGE 41
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5. 4. 6. 7. 8.
10. 7. 9.
10.
12.
11. 42
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FROM PAGE 39
I’m the type of person who leaves things better than the way I found them, and I became fully engaged toward improving our local affiliate. Since then, I have served in multiple capacities at the component, state and national levels.
TFDA: How has your involvement in organized dentistry influenced your own practice and commitment? IMT: I’ve been a member of the American Dental Association, FDA and South Florida District Dental Association since I began to practice. These associations have introduced me to new colleagues, new science and new ways to manage my practice. I enjoy exposing myself to the current trends, technology and the issues that affect our profession. I feel that it has made me a more well-rounded person, since it has opened my eyes beyond the culture of my practice. It has allowed me to evolve as a practitioner and be open to change. My involvement has given me the opportunity to voice opinions of those who are not heard and to think of my patients first. It has taught me to challenge myself and to challenge the status quo.
TFDA: What are your predictions for dentistry? IMT: This is an exciting time for the dental profession, beginning with the patients’ greater awareness of the importance of oral health and the ability of the dentist to solve complicated problems and meet the patients’ cosmetic demands.
Dentistry is uniquely positioned to allow for small independent boutique practices as well as the ever-growing corporate and group practices. While rapidly evolving, motivated and caring practitioners will only have a wonderful career and bright future.
TFDA: What advice would you give to dental students? New dentists? IMT: One of my greatest attributes is my continued quest for self-improvement. I was lucky to participate in the ADA Institute for Diversity in Leadership and was taught how to harness this desire and self-drive. My advice to new dentists is not to be afraid to ask for help and to seek mentors. One of the beautiful things during my tenure with leadership in the ADA is that I both sought out mentors early in my career and now have become a mentor myself. New dentists will be leaders within their practices and their communities. Leadership concepts are necessary and can be learned, and it’s inevitable that opportunities will arise in their personal and professional life. I would like them to know that they should be involved early and take a chance. A common complaint from dental students is the shortcoming in their education concerning the business or economic side of dentistry. New dentists need to learn to develop a sound business understanding. They must have the tools to manage their personal debt, scan the practice environment to identify risks and opportunities to create the greatest value for their business and employees — but most importantly, creating value for their patients.
Advancements and implementation of technologies are quickly becoming the basis of our everyday dental procedures, and will continue to improve the experience and outcomes for our patients. SEE PAGE 43
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3RENEW WAYS TO
1 2
ONLINE CREDIT CARD PAYMENT
pay your dues FDAVisit-floridadental.org/dues 3 Ways totoRenew
FDC - ADA Photo Booth
3
in full or set up a dues installment plan with a credit card.
CREDIT CARD PAYMENT VIA PHONE OR MAIL Call the member relations team at 800.877.9922 to make a credit card payment in full over the phone or use the self-addressed yellow envelope to submit your payment in full, or enroll in the dues installment plan by submitting your dues statement with your credit card information. Don’t forget your signature!
CHECK BY MAIL Use the self-addressed yellow envelope for a onetime payment in full by check. Make your check payable to the Florida Dental Association. HAVE QUESTIONS ABOUT YOUR DUES STATEMENT? Go to www.floridadental.org/dues for answers to frequently asked questions! NEED MORE HELP? Our FDA Member Relations Department is always ready to help with any questions. Call 800.877.9922 or email membership@floridadental.org.
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FROM PAGE 41
TFDA: How has dentistry changed since you began practicing? What’s improved? IMT: Since I began practicing 15 years ago, the dental profession has experienced an exciting amount of technological growth. I can’t imagine practicing dentistry without a CBCT and an intraoral scanner. This integration of digital dentistry into our practices has allowed us the ability to better diagnose, communicate with our referral base and treat our patients with a wider array of options. Our focus has evolved into a patient-centered care.
TFDA: What is your dental philosophy? IMT: Making a difference in my patients’ lives by providing high-quality, comprehensive implant and periodontal care allows me to improve their overall general health. This patient-centered philosophy enhances my relationship with my patients and referring doctors. I believe that listening and understanding the needs of the patient is the cornerstone to delivering the best outcome in a caring environment.
TFDA: What has been the most challenging aspects of your job? The most rewarding? IMT: In addition to being a dentist, I am a wife, a mother of two young children, a business owner and a volunteer. Like many women, I struggle with achieving work-life balance. I admit that I have encountered many crossroads and challenges throughout my professional life. As women, we naturally carry many varied responsibilities, especially when you are the type of person who passionately strives to improve and love what they do. The idea that “women can have it all” is what I hope to cultivate in my 9-year-old daughter, Victoria.
It’s also been my honor to have encouraged my staff to pursue their dreams. I am so proud that two have become nurses, one a hygienist, one a dentist, and another an oral and maxillofacial radiologist. Training the next generation of caregivers is one of my proudest achievements. Dr. Marron-Tarrazzi is a periodontist in Miami and can be reached at imarron@bot.floridadental.org.
Photos: 1. Family time with Francisco, Daniel & Victoria. 2. 2018 Dentists’ Day on the Hill, Tallahassee (Dr. Michael Ragan, NSU and UF Students) 3. UF College of Dentistry Commencement in 2016 4. ADA New Dentist Committee 5. Dr. Marron-Tarrazzi and her staff during the 2018 Florida Mission of Mercy in Fort Myers. 6. Dr. Marron-Tarrazzi with Nobel Prize winner Malala Yousafzai 7. Dr. Marron-Tarrazzi is a board certified periodontist. 8. ADA Board of Trustees 9. With her UF Hialeah AEGD Residents 10. Ready for surgery 11. Receiving the 2017 Lucy Hobbs “Woman to Watch Award“ with (l to r) Drs. Carol Summerheys and Maxine Feinberg (former ADA presidents) and Kathleen Bird 12. Selfie after lecturing to dental students at the University of Puerto Rico.
It also has been incredibly rewarding to have opened my own practice, serve my patients, help my profession by volunteering and use my personal creativity in all aspects of my profession.
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FDASUPPLIES.COM
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WHAT IS THE
GRAY
MARKET,
AND WHY SHOULD
YOU CARE BY AHMED SHAMS, SOURCEONE DENTAL INC., ON BEHALF OF FDASUPPLIES.COM
Sometimes, we receive questions about how FDASupplies.com can offer such large discounts on dental supplies. And many times, dentists either wonder if or are told that our products might be unsafe gray market items. We get questions like: “Aren’t those products old or expired?” “Are the products from outside the United States?” “Are they safe?” It’s clear that many practices don’t know what the gray market is, or how we know the products you find on FDASupplies.com are the same quality products from authorized distributors that you’re accustomed to — but for a much lower price.
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So, what is the gray market? And, how can you avoid purchasing inferior products? Not to be confused with the black market — which is typically counterfeit or stolen products and completely illegal — the gray market is the “unauthorized” reselling of products. This includes different forms of unauthorized reselling. A simple version of a gray market could be a dentist selling items online. Maybe he/she bought an item with a buy-oneget-one special at a tradeshow and sold the free one via an online auction site. Technically speaking, the dentist is not authorized to resell this product from the manufacturer, so this is a gray market resell.
The more common contributor to the gray market is an authorized distributor from another country (who purchases products at lower cost than a U.S.-based distributor) exports those authorized products back to the United States for resale. You can easily find these on large resell and auction websites. A seller might be authorized to sell in Brazil, for example, but once that item is brought back into the U.S., it becomes unauthorized for resell and a gray market item.
WWW.FLORIDADENTAL.ORG
Risks of Gray Market Items The most important reason to avoid a gray market product is because the warranty is void. You will have no support from the manufacturer if a product does not perform as advertised. A second risk of gray market products is potentially poor-quality control. An unauthorized reseller doesn’t have to ensure any quality control of the products during storage and shipping. Finally, black market (e.g., counterfeit, stolen) items often find their way into gray market sellers’ inventories. It can be difficult to know the difference and impossible to know if what you are buying is safe for you and your patients.
Avoid the Gray Market with FDASupplies.com There are NO gray market products on FDASupplies.com. Every company we work with is either an authorized distributor of the products offered on the site, or they are the manufacturer with products shipped direct from those warehouses. FDASupplies.com can offer products at discounted prices to Florida Dental Association (FDA) members because we have removed outside sales representatives from the equation and are leveraging the buying power of thousands
WWW.FLORIDADENTAL.ORG
PRICES ARE LOWER BECAUSE OF MEMBERSHIP POWER!
of member dentists in multiple states. While a trained outside sales rep can be useful to a practice, many of the supplies a dental office orders on a regular basis don’t require a commissioned representative’s assistance. Do you need to pay a commission on cotton rolls, patient bibs, gloves, Lidocaine, etc.? Some national suppliers have implied the products offered by SourceOne Dental through FDASupplies.com are gray market. This is not true. Prices are lower because of membership power! Additionally, all FDASupplies.com products include free ground shipping direct from a supplier or the manufacturer. On average, Florida dentists can expect delivery within three to five
business days for any in-stock item, and typically one to two weeks for any special-order items. Several hundred FDA members have taken the FDASupplies.com challenge and are now saving an average of 10-30 percent on more than 60,000 brand name dental supplies without sacrificing quality. Our customer support specialists can answer your questions and provide a custom price comparison based on your recent invoices. Or, visit FDASupplies. com for a list of frequently asked questions and answers and helpful videos. NOTE: FDASupplies.com is available only to FDA member dentists.
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FLOOD INSURANCE GET YOUR COVERAGE IN PLACE WITH TO SPARE. FDAS TIME - Flood Insurance
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FDA - Helping Members Succeed
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FDA - Emerald Club
Check the FDA Foundation box on your FDA dues statement or go to DONATE.FLORIDADENTAL.ORG.
Your tax-deductible gift to the Foundation supports these life-changing programs: Florida Mission of Mercy, Donated Dental Services and Project: Dentists Care. 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 545 John Knox Road, Ste. 200, Tallahassee, FL 32303. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL IN-FORMATION 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.
2018 FLA-MOM
ANOTHER SUCCESSFUL FLORIDA MISSION OF MERCY! In March, more than 1,300 volunteers from across the state participated in the Florida Dental Association (FDA) Foundation’s signature event, the Florida Mission of Mercy (FLA-MOM). In its fourth year, the 2018 FLA-MOM event was hosted by the West Coast District Dental Association and was held on March 9-10 in Fort Myers.
BY R. JAI GILLUM FDA FOUNDATION DIRECTOR OF FOUNDATION AFFAIRS
Ms. Gillum is the FDA Foundation Director and can be reached at rjaigillum@floridadental.org.
The FLA-MOM is a large-scale, two-day, professional dental clinic that provides care to any patient at no cost to them, with the goal of serving the underserved and uninsured in Florida — those who would otherwise go without care. The FLA-MOM seeks to have a positive impact on those who attend by relieving dental pain and infection, restoring smiles and dignity, and educating patients about the importance of obtaining and maintaining optimal oral health. Patients at the FLA-MOM received treatments that ranged from extractions and fillings to cleanings and restorative therapy. Additionally, each FLA-MOM patient receives oral health education provided by More Health Inc., a full panoramic X-ray for their records, and a resource guide of local Project: Dentists Care clinics to use for follow-up treatment or to establish a dental home. The 2018 FLA-MOM attracted dentists from all over the state and as far away as New York. Many FDA members brought their entire office to volunteer for the event. With the help of our volunteers — dentists, hygienists, dental assistants, students (including volunteers from all three Florida dental schools) and general community volunteers — we provided about 11,900 procedures to more than 1,900 patients, resulting in a value of care of approximately $1.75 million! At the Fort Myers FLA-MOM, data was collected for the third and final year of the FLA-MOM Impact Study. The first of its kind, the FLA-MOM Impact Study will analyze patient data from the Jacksonville, Pensacola and Fort Myers events to investigate the impact that dental outreach programs like the FLA-MOM have on local communities’ emergency department use. An article on preliminary results from the 2016 Jacksonville FLA-MOM has been published as the feature story in the May issue of the Journal of the American Dental Association. We’ve seen the positive impact that this program has had on various communities across the state, and the FDA Foundation is excited to host the next FLA-MOM in conjunction with the Central District Dental Association on March 22-23, 2019 in Orlando. Please visit flamom.org for more information, to register to volunteer or to make a donation in support of the 2019 FLAMOM.
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2018 FLA-MOM • 2018 FLA-MOM • 2018 FLA-MOM • 2018 FLA-MOM • 2018
WWW.FLORIDADENTAL.ORG
TODAY'S FDA
MAY/JUNE 2018
2018 FLA-MOM • 2018 FLA-MOM • 2018 FLA-MOM • 2018 FLA-MOM • 2018
Join the FDA Foundation on March 22-23, 2019 in Orlando. Please visit flamom.org for more information, to register to volunteer or to make a donation in support of the 2019 FLA-MOM.
55
2018 FORT MYERS*
FLA-MOM IMPACT! PATIENTS TREATED
MORE THAN 1,900 VOLUNTEERS
1,300+
WITH CARING HEARTS
VALUE OF CARE
APPROXIMATELY
$1.75 MILLION PROCEDURES
ABOUT 11,900 * These are preliminary figures. Look for the complete FLA-MOM story in the May-June issue of Today’s FDA.
SAVE THE DATE! 2019 FLA-MOM • ORLANDO • MARCH 22-23 GO TO WWW.FLAMOM.ORG OR CALL 800.877.9922.
CONGRATULATIONS! DR. ANDY BROWN DR. JOLENE PARAMORE
T
COVER STORY IN JADA, MAY 2018 FLA-MOM IMPACT STUDY
he Florida Dental Association (FDA) Foundation is excited to announce the May cover story of the Journal of American Dental Association (JADA) is “Mission of Mercy Patient Characteristics and Dental-related Emergency Department Use,” co-authored by Drs. Jolene Paramore and Andy Brown. Although dental Mission of Mercy (MOM) events have existed for more than two decades and are held in more than 30 states, systematic data collection and reporting on patient characteristics, oral health care use patterns and oral health care needs are lacking. In 2016, the FDA Foundation Board of Directors decided to conduct a scientific research study about the Florida Mission of Mercy (FLA-MOM) to determine the impact of the event on addressing the needs in the communities we serve, with a special interest on the effect on hospital emergency department (ED) use. ED visits for dental-related problems have skyrocketed in the last decade. Florida alone had 163,906 dental-related ED vis-
WWW.FLORIDADENTAL.ORG
its at a cost of more than $234,000,000 in 2014!1 The Impact Study’s goals are to identify the characteristics, reasons for seeking care, dental needs, dental use patterns and barriers to access for people who seek care at a MOM clinic. Additionally, does the definitive care provided at a MOM clinic affect hospital ED use for non-traumatic dental problems? Written in coordination with Dr. Jill Boylston Herndon of Key Analytics and Consulting, the JADA article presents the methods and results for the first phase of the Impact Study based on patients surveyed at the 2016 FLA-MOM in Jacksonville. Additional surveys have been done with the patients at the 2017 FLA-MOM in Pensacola and the 2018 FLA-MOM in Fort Myers with data analyses currently underway. The FLA-MOM Impact study provides a better understanding of a community’s needs and how safety net programs impact a community’s overall health — which affects dental, medical
and behavioral health. The valuable and relevant results give us insight into factors that must be addressed as we collaborate with community leaders and stakeholder groups. Our ultimate goal is to use the data to develop communityspecific programs aimed at alleviating the numbers of patients who use EDs for dental problems and improving the oral health of our citizens. The FDA Foundation looks forward to sharing the results of the Impact Study with all interested partners across the state, as well as with other state dental organizations. We are committed to making a lasting difference in the communities we serve by creating awareness about local community oral health care needs and promoting efforts to develop sustainable strategies to improve oral health care outcomes.
C.A. Serna, O. Arevalo, S.L. Tomar. Dental-related use of hospital emergency departments by Hispanics and non-Hispanics in Florida. Am J Public Health, 107 (S1) (2017), pp. S88-S93.
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A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS
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A SPECIAL THANK YOU TO OUR 2018 BENEFACTORS (cont.)
BRONZE BENEFACTORS CENTRE MANAGEMENT CHARLOTTE COUNTY DENTAL SOCIETY PROJECT DENTISTS CARE OF SOUTHWEST FLORIDA INC. SOUTHWEST ENDODONTICS – DR. GUSTAVO FUENTES DR. JAMES ANTOON MR. JACK BOSWELL DR. ANDY BROWN DR. JOHN CONTINO & DR. ERIC REED DR. NATHAN DEWSNUP DR. WAYNE DUBIN DR. STEVE FONTANA DR. STEVEN FREY
DR. RITA HURST DR. MICHELE LABODA DR. IDALIA LASTRA DR. OSCAR & MRS. DENISE MENENDEZ DR. RICHARD MULLENS MR. LUIS PEREZ DR. BARBRA REED DR. JOHN RICHARDS
DR. SCOTT SCHWARTZ DR. SCOTT SCHWEDEL & DR. TIMOTHY TALBOTT DR. BARRY & MRS. ELLEN SETZER DR. RICK STEVENSON DR. FRANK SZOT DR. JAMES WALTON
PATRONS AFFORDABLE CARE INC. CARE CREDIT DR. DAVID BODEN DR. SOL BROTMAN DR. TOM BROWN THE BULNES FAMILY DR. DAVID CLARY & DR. BARBARA FUEREDI
DR. LEO CULLINAN DR. JEREMY DAVEY DR. TIMOTHY DAVIS FLORIDA ASSOCIATION OF PERIODONTISTS DR. RUDY LIDDELL DR. VINCENT LOVETTO MORGAN STANLEY NAI TALCOR
DR. DAVID O’SULLIVAN DR. ROBERT PAYNE DR. JUAN RODRIGUEZ SOUTHERN DENTAL REFINING ST. WILLIAM CATHOLIC CHURCH DR. JUAN TEODORO DR. LAURA VAN VARICK
CHAIR SPONSORS DR. NOLAN ALLEN MS. JERILYN BIRD DR. ALBERTO BOLANOS DR. TERRY & MRS. KAREN BUCKENHEIMER DR. SEAN CARR DR. STEPHEN COCHRAN
DR. NICHOLAS DUNDEE MR. DREW EASON DR. MICHAEL EGGNATZ DR. TOD FAWCETT GOSTOUT DENTAL LLC MS. JUDITH MACY
DR. EDDIE MARTIN DR. JOHN PAUL DR. HEATHER SARKODIE DR. JEFFREY SKUPNY TOMOKA PERIODONTICS & IMPLANT DENTISTRY
FRIENDS OF FLA-MOM SPECIALISTS IN PERIODONTICS LLP DR. WILL ABRAHAMS DR. MICHAEL ADAMS DR. PANKAJ AGRAWAL DR. RICHARD ANDOLINA DR. WILLIAM AUGHTON DR. SEEMA BADVE MR. MIRASLOV BECK MS. ANJU BHASKAR BRIAN SIMON – ALLIANCE FINANCIAL GROUP MR. HARVEY BUDD MR. BAO CAO MR. KHANH CAO MR. SEBASTIAN CASTALDI DR. KIRAN CHAVDA
MS. CINDA COLLMER DR. CHRIS CONNELL DR. JOHN CRAIG DR. GRACE DAI MS. TARA DEILY DR. NORMA FERRER MS. ANN FOSTERIS MS. CHARLENE FOSTERIS MR. HARRY FOSTERIS MS. LILLIAN FOSTERIS MS. CORAZON GEMARINO MR. RAVINDER GHATAHORA DR. KAREN GLERUM DR. MADHU GOYAL THE GOZON FAMILY DR. CECILIA HINES
MR. SIDI HUANG MR. KUNAL JAIN MS. LISA LA MONICA MS. HANNA LEE DR. CORNELIOUS LYNCH DR. ELIZABETH JOHN DR. BERNARD KAHN DR. ROBERT KLEMENT DR. GEORGE KOLOS MS. MIN JUNG LEE MS. WANDA LEE MS. REBECCA LEFORT MS. TERRI LEWE MR. QIAOQI LU DR. SANJAY MADAN MR. DON MCNAB
DR. PAUL MILLER MS. HEATHER MINSKY NOTTINGHAM DR. RICHARD OLITSKI DR. JEFFERY OTTLEY DR. MUKESH PATEL MS. NGUYET PHAM DR. QUEANH PHAN DR. PATRICIA PRIMERO MR. JEFFERY RENFROE MR. JASON RIOS DR. CARLOS SANCHEZ MR. SYDNEY SHAW DR. SATINDERPAL SONDHI MS. SARA MOGHUL MS. CORAZON YAP
FLA-MOM LEADERSHIP A tremendous thank you to the amazing leaders who contributed their time and talents to make the 2018 Florida Mission of Mercy a great success! 2018 FLA-MOM LEADERSHIP
Mr. Bill Minor Parking/Security Manager
Dr. Chris Bulnes 2018 Local Co-Chair
Dr. Craig Oldham Clinical Co-lead
Dr. Oscar Menendez 2018 Local Co-Chair
Dr. Paul Palo Dental Triage Co-manager
Dr. Nolan Allen Statewide Co-Chair
Dr. Jolene Paramore Impact Study Lead
Dr. Andy Brown Statewide Co-Chair, Impact Study Manager
Mr. Geoff Parsley Central Supply Manager
Dr. Leo Cullinan Statewide Co-Chair
Dr. John Paul Routing Co-manager Dr. Mike Pikos Oral Surgery Co-manager
2018 FLA-MOM COMMITTEE
Dr. Rick Stevenson Safety Officer
Dr. Brandon Alegre Patient Entry Manager
Dr. Bruce Tandy Patient Registration Exit Manager
Mr. Clay Archer Data Services Lead
Ms. Susan Tandy Hospitality Co-manager
Ms. Jessica Barnhart Hospitality Co-manager
Dr. Bill Truax Volunteer Lead
Dr. Tom Brown Endodontics Manager
Dr. Billy Truax Facilities Lead
Ms. Karen Buckenheimer Oral Health Education Lead
Ms. Kathie Truax Volunteer Recruitment Manager
Ms. Kelsey Bulnes Patient Ambassador Co-manager
Dr. Cecil White Patient Registration Lead
Dr. Natalie Carr Bustillo Pediatrics Manager
Dr. Steve Zuknick Clinical Co-lead
Dr. Susan Byrne Sterilization Manager
Ms. Lissette Zuknick WCDDA Executive Director
Dr. Cindi Deragon Donor Manager Dr. Sam Desai Fundraising Lead
STATEWIDE FUNDRAISING COMMITTEE
Dr. Marcos Diaz Oral Surgery Co-manager
Dr. Nolan Allen
Dr. Don Ilkka
Ms. Linda Dundee Volunteer Registration Co-manager
Dr. James Antoon
Dr. Bernie Kahn
Dr. Nick Dundee Volunteer Registration Co-manager
Dr. Andy Brown
Dr. Lee Anne Keough
Dr. Monica Franklin Hygiene Manager
Dr. Chris Bulnes
Dr. Oscar Menendez
Dr. Leo Cullinan
Dr. Jolene Paramore
Dr. Sam Desai
Dr. Howard Pranikoff
Dr. Brian Gear Local Clincal Lead Dr. Fred Grassin Routing Co-Manager Ms. Milly Grey Hospitality Co-Manager Ms. Colette Hawkins Setup/Tear Down Manager Dr. Reza Iranmanesh Prosthodontics Manager Dr. Zack Kalarickal Communications Lead Dr. Lee Anne Keough Dental Triage Co-manager Dr. Phil Kraver Hospitality Lead Dr. Pat Lepeak Restorative Manager Dr. Larry Leventhal Medical Triage Manager Dr. Rudy Liddell Radiology Manager Ms. Denise Menendez Patient Ambassador Co-manager
Dr. Cindi Deragon Dr. Beau Biggs Statewide Committee Ex-officio Dr. Terry Buckenheimer Statewide Committee Ex-officio Dr. Kim Jernigan Statewide Committee Ex-officio
STAFF Ms. R. Jai Gillum Director of Foundation Affairs Mr. Austin Moser FDA Foundation Coordinator Mr. Drew Eason FDA Executive Director Mr. Greg Gruber Chief Financial Officer/Chief Operating Officer
2018 FLA-MOM
THE SMILE WAS FREE, BUT THE HUG WAS PRICELESS As I stood with a badly aching back and feet that felt as if they had been beaten from continuously standing for 12 hours two days straight on a concrete floor, a woman appeared and briskly walked toward me. Her look was determined and a little concerned.
BY DR. PAUL PALO
Dr. Palo is a member of the FDA Board of Trustees and an alternate to the American Dental Association 17th District Delegation. He is a general dentist in Winter Haven, Fla. and can be reached at ppalo@bot.floridadental.org. This article originally appeared on Beyond the Bite on March 16, 2018.
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First, let me explain my location: I was at the Lee County Civic Center Arena. This is where I’ve just spent three days volunteering for the Florida Dental Association (FDA) Foundation’s fourth annual Florida Mission of Mercy (FLAMOM) dental clinic. Last weekend, my fellow dentists and I, hygienists, assistants, laboratory technicians and community volunteers provided nearly 2,000 patients with more than $1.7 million worth of dentistry at no charge to them. Hard work? You bet it is. But worth every ache and blister. So, back to the distressed woman who approached me. I was the lead volunteer in charge of overseeing dental triage, so I was frequently singled out by many people with questions and concerns. This young woman certainly looked concerned. She introduced herself as an advocate for a group of people staying in a drug addiction treatment facility in Naples. Dr. Leo Cullinan had arranged to bus them over to our event to take advantage of the treatment we were providing. She explained that one of her charges, a 24-year-old young woman, had come in the day before with many painful, bad teeth. It was determined that her remaining teeth were so badly decayed, none could be saved. She was taken to oral surgery
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where a skilled surgeon removed her remaining teeth. The caregiver’s reason for concern was because she could sense the despair in this young woman’s eyes at now not having any teeth to present herself with for future employment. I calmly explained that our clinic had no provisions to make immediate dentures, but she was not deterred. So, at this point, I brought in Dr. Cullinan to see if there were any available resources in Naples to help this young woman out. And that’s where I left her — in Dr. Cullinan’s capable hands. I moved on to other problems that needed to be solved and completely forgot about the situation. Fast-forward 24 hours to Saturday afternoon, when I was helping break down the clinical equipment and box it up to transport out when again, who do I see but the advocate bounding straight for me — this time with a huge smile on her face. She thanked me profusely for helping the young woman the day before, and told me that due to Dr. Cullinan’s persistence, she was fitted for a same-day denture courtesy of Dr. Reza Iranmanesh, our wonderful lead prosthodontist. “This will change her life!” she proudly exclaimed as my eyes began to mist over. She then embraced me in a wonderful heartfelt hug of thanks — more payment than I ever expected, but so gladly accepted. If you want to help change the lives of so many in need, as well as receive much more payment than you would ever get in a typical week at the office, I urge you to join us in Orlando in March 2019 for the FDA Foundation’s next FLA-MOM. It will change your life, too. WWW.FLORIDADENTAL.ORG
DONATED DENTAL SERVICES FDA Member Helps Former NFL Player Regain His Confidence
By Dental Lifeline Network
Dental Lifeline Network (DLN) recently partnered with the NFL Alumni Association to keep alumni and their families healthy, productive, and connected to the league and their former teammates by providing treatment through the Donated Dental Services (DDS) program. Through this partnership, volunteer dentists provide free dental treatment to former players and their family members who meet the same criteria as other DDS patients — have a permanent disability, are over the age of 65 or are medically compromised, and cannot otherwise afford treatment. Florida Dental Association (FDA) member Dr. Holly Hamilton, of Sebastian, and a DDS volunteer since 2008, had the opportunity to help Craig, a former NFL player. Craig played in the 1980s for the Buccaneers and Colts.
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After his NFL days, he worked odd jobs and volunteered for the Boys and Girls Club, but has not been able to do so since 2013 due to numerous orthopedic issues. He had to have both hips replaced and used a cane to walk. His dental health had deteriorated and he had several decayed and missing teeth, which took a toll on his mood. “Before, my kids always told me, ‘Dad, you’re always grumpy,’” said Craig. Sadly, he was unable to afford the dental treatment he needed. He was approved for Social Security disability benefits, but didn’t receive any assistance that could help with his dental needs. After being referred to Dental Lifeline Network’s DDS program by the NFL Alumni Association, Craig was matched with two volunteers who agreed to help. Dr. Hamilton (a Steelers fan) restored two teeth, provided a full-mouth cleaning and with the help of NDX Florida, donated upper and lower partial dentures. “Craig was a great patient, super humble and extremely grateful,” said Dr. Hamilton. With the help of these volunteers, Craig had uplifted spirits after receiving his new set of teeth. “Now I smile
Craig with Dr. Holly Hamilton
more — my kids see me and that’s all I do, I smile. When they first saw my new teeth, they couldn’t believe it!” said Craig. “What [Dental Lifeline Network] did with giving me my smile back, was giving me my life back.” Since 1997, Florida DDS volunteer dentists and labs have provided more than $8 million in treatment to more than 1,800 people. DLN • Florida thanks the FDA and the FDA Foundation for their long-time support of DDS. Will you see one patient this year? Visit willyouseeone.org to sign up online or contact Florida DDS Coordinator Megan Manor at 850.577.1466 or mmanor@DentalLifeline.org.
TODAY'S FDA MAY/JUNE 2018
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Mentorship WHAT IS THE FDA MENTORSHIP PROGRAM? 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 of dentistry from established member dentists in an effort to facilitate the transition from dental student to practicing dentist.
WHO PARTICIPATES? The mentors are member dentists from the FDA 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 of the three Florida dental schools: LECOM, Nova and UFCD will be able to participate as protégés.
HOW CAN I BECOME MENTOR? Volunteering is easy! Complete and submit a profile by visiting careers.floridadental.org/ementor. For additional information, please contact Kerry Gómez-Ríos at membership@floridadental.org.
COMPLEAT DENTISTRY
COMPUTERS ARE USELESS
DR. EDWARD HOPWOOD
Dr. Hopwood is restorative dentist in Clearwater and can be reached at edwardhopwood@gmail.com.
Compleat dentistry is a slower-paced, deliberate style of dentistry, espoused by Pankey, Dawson and so many others, in which the dentist knows the patient well, knows the work, knows their own abilities and limitations, and uses this knowledge to take care of the patients who trust them with their care. The world will change, but the principles of compleat dentistry will remain the foundation of an exceptional practice. The spelling is an homage to Isaak Walton, whose book, “The Compleat Angler,” was about so much more than fishing.
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There seems to be a real and constant threat of jobs disappearing because computers are getting so good that they’re doing jobs where people used to be needed. They’re not swooping in and taking them away quickly — rather, they are slowly trickling into our lives until we realize that certain things we used to rely on other humans to do, we now rely on computers. For example, cars are becoming autonomous right now. Most of us have a car that will apply the brakes for us if we’re about to back into something. Some of us have cars that will steer for us. And, after a few more incremental steps, we will find ourselves in a showroom questioning, why wouldn’t we pay a little bit more for a car that will be fully autonomous, and then whether to buy an autonomous car or rideshare it. Soon thereafter, autonomous cars will prove that they are safer than regular cars and regular cars will be outlawed. What will the Uber drivers do then? If a recent high school graduate were to tell me he planned to start a job as an Uber driver, I’d tell him he’d better hurry up, because it seems as if it will be a short career. But it isn’t just Uber drivers who are under threat. Google’s artificial intelligence software now is better at speaking than a human, so call center workers are going to find their careers shortened. And now, computers are better than humans at reading radiographs, so radiologists … And on it goes as advances in technology result in jobs becoming a commodity and then the price for the job drops to nothing. How much would you pay for a road map today?
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I recently went to a fantastic lecture where a dentist, Dr. Mark Setter said, “The greatest threat to our profession is commoditization.” Many of us share the same concern that technology will advance to the point where our jobs can then be done by computers (maybe with a tech assisting), and then we’re no longer needed. The perfect example is the clear aligner trays: First they were marketed to orthodontists where great movement could be accomplished and refined on patients who otherwise wouldn’t have put up with braces. But, too many orthodontists just took the impression and let the computers do the work. So, the general dentists figured they could make impressions as well as the orthodontists and if the computers were doing all the work, then the “professionals” simply became tray dispensers. The companies making the trays figured they could dispense the trays and the patients can make their own impressions, and now we have a home ortho kit and orthodontic storefronts in the shopping malls. So, what is an orthodontist to do? Well, the answer comes from the second half of the quote that is the title of this column: “(Computers) are useless. They can only give you answers.”
– Pablo Picasso, 1964
Fifty-four years ago, one of the world’s greatest artists gave us some insight into our world today. What an orthodontist needs to do is use their training to ask the right questions —
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the questions that computers would never think to ask. The questions that a tech who is only trained to make impressions would never comprehend. Then, it’s OK to use the computers to find the answers. In other words, computers are great at finding the solution to a problem, but not so great at finding the cause of the problem. If we want to protect our profession from becoming a commodity, then as the professionals, we need to get better at finding the causes of the problems we face. So, what is an orthodontist to do? They should use their skills and training so it’s impossible for a computer to do a better job. That means doubling down on the human side of their profession, which requires understanding the problems each patient presents, solving them and doing it better for each individual patient than any computer ever could, such as: n learning why a tooth may not be moving for a patient (physiology of movement or psychology of compliance) n learning the limitations of the computers, then working to add the human touch to provide proper intercuspation until it feels right (equilibration, perhaps)
In other words, computers are great at finding the solution to a problem, but not so great at finding the cause of the problem. If we want to protect our profession from becoming a commodity, then as the professionals, we need to get better at finding the causes of the problems we face.
n learning to bring the bite in harmony with the joints (centric relation) n working to make sure the completed case is as stable as possible (follow-up and retention) In other words, all the things that won’t be done in a shopping mall storefront. Sure, this is hard work. Sure, this means constantly learning new techniques and knowing the patient, and applying all that has been learned over the course of a career. And that means giving all of yourself to help the person who sat down in your chair and trusts you to take care of them, and doing it in a way that no algorithm ever could. It means serving another person in a way that you use all your skills to improve their life — which is pretty much the definition of a professional. We give of ourselves to help another. And, if we are good at it, then we reap the rewards, some of which are financial.
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We are in control over whether our profession becomes a commodity, but it is bigger than that. You see, Picasso recognized that even if a computer could replicate his work — brush stroke for brush stroke — the final product would not be art. There is something magical that happens when the human side interacts with the technical side, and true art requires both. If we preserve the human side of our profession, then it could never become a commodity. We can do this by dedicating ourselves to truly serving our patients: constantly pursuing new knowledge, taking the time to know our patients and using our talents — the very same things that L.D. Pankey argued for 50 years ago when he was trying to save the profession from the greatest threat of his age.
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BY DRS. JASBIR UPADHYAYA*, FARAJ ALOTAIBY*, DONALD M. COHEN, NEEL BHATTACHARYYA AND NADIM M. ISLAM
A 22-year-old male was referred to the University of Florida Oral Medicine Clinic for evaluation of oral ulcers of more than two weeks’ duration. The patient presented with a history of painful recurrent oral ulcers and reported onset of ulcers mainly during stressful times in his life. This was the third recurrence and each year, the ulcers presented during the summer. Associated symptoms included mild sinus congestion and a sore throat. No fever or cough was reported. The patient denied any rashes or joint swelling, or painful lesions on the hands or feet. During each recurrence, the sores lasted three to four weeks. The patient reported a weight loss of 30 lbs. due to his inability to eat appropriately because of intense pain associated with the ulcers. He didn’t remember taking any medications that could have triggered the outbreak of ulcers. He
Intraoral examination revealed diffuse large, shallow erosions and ulcerations surrounded by irregular erythematous borders on the lateral and ventral surfaces of the tongue (Fig. 1a), soft palate, buccal mucosa (Fig. 1b) and labial mucosa (Fig. 1c). The dorsal surface of the tongue was covered by a thick white coating (Fig. 1d). Hemorrhagic crusting of the vermilion zone of the lips also was noted (Fig. 1a). The patient then received treatment at the UF Oral Medicine Clinic without any further biopsy and reported remarkable resolution of ulcerations within the next two weeks.
Question: Based on the clinical findings and medical history, what is the most likely diagnosis? A. Recurrent aphthous ulcers
also denied any changes in lifestyle or habits that might have
B. Behçet’s disease
precipitated their onset. At the time of presentation, he was on
C. Recurrent or secondary herpes
a liquid diet comprised of protein and milk shakes. The patient had a history of depression and anxiety for which he had seen a therapist in the past, and a family history of heart disease. He
D. Pemphigus vulgaris E. Erythema Multiforme
was a former smoker who had quit smoking three years ago. His medication history included Percocet, lidocaine 2 percent viscous solution (swish and spit every four hours) and nystatin, which were prescribed by the closest health care center.
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SEE PAGE 70
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b.
a.
c.
d.
Fig. 1: Diffuse large ulcerations and erosions surrounded by irregular erythematous borders noted on the ventral surface of tongue (a), buccal mucosa (b) and labial mucosa (c). A thick white coating was present on the dorsum of the tongue (d). Hemorrhagic crusting of vermilion border of lips also is seen in Fig. 1a.
a.
b.
c.
d.
Fig. 2: Disappearance of ulcerations and erosions on the ventral tongue (a), buccal mucosa (b) and labial mucosa (c) after valacyclovir administration and topical application of clobetasol ointment (0.05 percent). (d) The dorsum tongue showing complete resolution of lesions.
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DIAGNOSTICS FROM PAGE 68
Diagnostic Discussion A. Recurrent aphthous ulcers Incorrect, but a great choice. Aphthous ulcers usually are seen in young individuals and are very painful. Patients usually report a history of similar outbreaks in the past, as reported by this patient. The ulceration demonstrates a yellowwhite, fibrinopurulent membrane that is surrounded by an erythematous halo as seen in our patient. The ulcers may be preceded by an erythematous macule in association with prodromal symptoms of burning, itching or stinging. Aphthous ulcers arise exclusively on nonkeratinized mucosa and almost never affect the bound down or masticatory mucosa such as the palate, which is unlike in our patient who also had ulcers on the palate. Recurrent aphthous ulcers involving the gingiva or hard palate more commonly are seen in herpetic lesions. And, most importantly, aphthous ulcers do not last for more than two weeks, unlike this patient whose sores lasted almost four weeks or more during each recurrence. B. Behçet’s disease Incorrect, but a good guess. Behçet’s disease (BD) is a vasculitic disorder occurring in the third decade of life and is characterized by episodic aphthous ulcers, as seen in our patient. It is most common in Turkey, Japan and the Eastern Mediterranean countries. The etiology is unknown, but environmental and genetic factors are implicated in its pathogenesis. The HLA-B51 allele is a
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strongly associated risk factor for the disease and is highly prevalent among individuals of Asian descent. Oral ulcers occur in 92–100 percent of patients and are painful. They are similar to the aphthous ulcerations occurring in otherwise healthy individuals and demonstrate the same frequency and duration. Most commonly, the ulcers manifest on the tongue, buccal and labial mucosa, and hard and soft palate, as seen in this patient. They typically heal within 10 days, which was unlike our patient, where the ulcers did not heal earlier than three to four weeks. Most importantly, patients with BD also have skin, genital and ocular lesions, which were not present in this patient. The diagnosis of BD is based on the presence of recurrent oral ulceration (as seen in our patient), plus two of following: recurrent genital ulcers (not seen in this case), eye lesions or skin lesions (again, not seen here) and a positive pathergy test (not done in this case). C. Recurrent or secondary herpes Incorrect, but an excellent choice. The most common site of recurrence for herpes simplex virus-1 is the vermilion border and adjacent skin of lips, which also is known as herpes labialis. The lesions present as multiple small, erythematous papules that may form clusters of fluidfilled vesicles. The vesicles rupture and crust within two days, and healing usually takes place within seven to 10 days, which is very much unlike our patient. The majority of the affected patients experience approximately two recurrences annually, but few may experience outbreaks more frequently. Patients with
rapidly developing recurrences tend to respond less favorably to treatment. In the immunocompetent patient, recurrent herpetic lesions almost always are limited to keratinized mucosa bound to the bone like the gingiva and hard palate, which again does not fit the pattern of distribution seen in our patient. In immunocompromised patients, intraoral lesions may spread to unbound mucosa, but this is not the scenario in this case. Moreover, these lesions begin as small vesicles that collapse to form clusters of erythematous macules, and do not present as large ulcerations as seen in this patient. D. Pemphigus vulgaris Incorrect, but a good option in the differential diagnosis. Pemphigus vulgaris (PV) is an immune-mediated condition with an estimated incidence of one to five cases per million people diagnosed each year in the general population. It results from immunoglobulin G (IgG) autoantibody production towards the desmosomal proteins desmoglein-1 and desmoglein-3. It often is seen in young to middle-aged adults. The condition seems to be more common in persons of Mediterranean, South Asian or Jewish heritage. Oral lesions often are the first sign of the disease in 70-90 percent of cases, and are the most difficult to resolve with therapy. Areas subjected to frictional trauma like the buccal mucosa, palate, lower lip and tongue are most affected, as seen in our patient. However, any area of the oral cavity may be involved. Patients usually complain of oral soreness because of superficial, ragged erosions and ulcerations on WWW.FLORIDADENTAL.ORG
DIAGNOSTICS the oral mucosa. Rarely, patients may report vesicle or bullae formation, which rupture quickly, producing nonhealing ulcerations, but were not noted in this patient. Desquamative gingivitis also is a common feature, which is another feature not seen in our patient. A characteristic feature of PV is the positive Nikolsky’s sign when a bulla can be induced on normal-appearing skin by application of firm lateral pressure. No bulla formation or Nikolsky’s sign was noted in this case. The oral lesions in PV are diffuse and persistent and do not heal in four weeks unless treated, which is unlike the lesions noted in our patient. Oral lesions of PV do not recur periodically (annually in the summer) as seen in this patient. Moreover, he did not present with any cutaneous lesions that are commonly seen in PV patients in the form of flaccid bullae and vesicles. Infrequently, ocular involvement in the form of bilateral conjunctivitis may be seen in PV, which was not present in this patient. E. Erythema multiforme Correct. Erythema multiforme (EM) is a blistering, ulcerative mucocutaneous condition of uncertain etiopathogenesis. It probably represents an immunologically mediated process, which is triggered in about 50 percent of the cases — especially in younger individuals — by a preceding herpes simplex infection, and in older individuals by an exposure to a variety of medications. EM typically has an acute onset and usually affects young adults in their 20s or 30s. Men are affected more frequently than women. The condition usually is self-limiting, lasting WWW.FLORIDADENTAL.ORG
two to six weeks. Prodromal symptoms, like fever, malaise, headache, cough and sore throat, occur about one week before onset. Our patient complained of sore throat and mild congestion. Oral lesions are very painful and begin as round, dusky erythematous patches that ulcerate and evolve into large, shallow erosions and ulcerations with irregular borders, like the ones seen in this patient. Hemorrhagic crusting of the vermilion zone of the lips is common, another feature seen in this patient (Fig. 1a). EM presents with a wide spectrum of clinical diseases ranging from ulcerations, erythema, bullae, erosions or nonspecific erythematous changes. Even though the disease is self-limiting, about 20 percent of patients may experience recurrent episodes, just as seen in this patient. In cases of recurrent episodes of EM, initiating factors like recurrent herpes infection or drug exposure should be considered. Patients with EM may develop skin lesions that appear as concentric circular erythematous rings resembling a target or bull’s-eye (target lesions). Cutaneous lesions were not present in our patient. When EM is restricted to the oral cavity, it can be mistaken for other inflammatory, vesiculobullous and dysplastic conditions. Patients may be dehydrated because of the inability to ingest liquids because of mouth pain. Conjunctival, genitourinary and respiratory mucosa may be affected, but was not seen in this case. Involvement of extraoral mucosa usually is associated with a more severe form of the condition, EM major.
Diagnosis of EM often is clinical. Histology and immunofluorescence can help distinguish oral EM from other vesiculobullous conditions. EM and lichenoid drug eruptions may be virtually indistinguishable, except lesions seen in EM lack the characteristic peripheral striae that are seen in lichenoid drug eruption. Also, lesions in chronic EM usually heal only to recur, unlike those in lichenoid drug eruptions, which usually never completely heal. Management includes the use of topical or systemic corticosteroids, especially in the early stages of the disease, along with antiviral therapy if herpetic infection is considered a triggering factor. If a causative drug is identified or suspected, then it should be discontinued immediately. Steroids tend to show a striking resolution of lesions. In this case, the patient was prescribed valacyclovir (1,000 mg) and clobetasol ointment (0.05 percent). He was advised to take 1,000 mg valacyclovir twice daily for the first 10 days, followed by 1,000 mg once daily for the next 80 days. In addition, he was instructed to apply clobetasol ointment to the affected areas twice daily after use of a chlorhexidine rinse. At his threeweek follow-up appointment, we noted that his oral lesions had disappeared with complete healing (Fig. 2). The patient was happy and had started to have his normal diet back. This suggests that his EM was triggered by recurrent herpes simplex infection.
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on common, important, new and challenging oral diseases.
References: Cizenski JD, Michel P, Watson IT, Frieder J, Wilder EG, Wright JM, Menter MA. Spectrum of orocutaneous disease associations: Immune-mediated conditions. J Am Acad Dermatol. 2017; 77(5):795-806.
DR. COHEN
Thete SG, Kulkarni M, Nikam AP, Mantri T, Umbare D, Satdive S, Kulkarni D. Oral manifestation in patients diagnosed with dermatological diseases. J Contemp Dent Pract. 2017; 18(12):11531158.
Lerch M, Mainetti C, Terziroli BerettaPiccoli B, Harr T. Current perspectives on Erythema Multiforme. Clin Rev Allergy Immunol. 2018; 54(1):177-184.
Diagnostic Discussion is contributed by UFCD professors, Drs. Nadim Islam, Indraneel Bhattacharyya, and Don Cohen, who provide insight and feedback
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The dental professors operate a large, multi-state biopsy service. The column’s case studies originate from the more than 12,000 specimens the service receives every year from all over the United States.
DR. BHATTACHARYYA
Clinicians are invited to submit cases from their own practices. Cases may be used in the “Diagnostic Discussion,” with credit given to the submitter. Drs. Cohen, Islam and Bhattacharyya can be reached at oralpath@dental.ufl.edu.
Conflict of Interest Disclosure: None reported for Drs. Cohen, Islam and Bhattacharyya. The Florida Dental DR. ISLAM Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/goto/cerp. *Residents in Oral and Maxillofacial Pathology University of Florida College of Dentistry
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General Dentist: Bradenton, FL— Full Time. If you’re looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community of Bradenton, FL while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success. You’ll enjoy the following: Base salary with performance incentives to earn more; Sign-on bonus of $5000; Relocation package; Full time benefits include CE allowance, professional liability, 401K and group health/wellness plans; Practice 4-5 days per week with family friendly days/hours. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues and have a valid DEA license. Please apply at www.dental-partners.com. Endodontist. General practice is seeking a part-time Endodontist. Locations on Florida’s West Coast include Clearwater, Largo, St. Petersburg, and Bradenton. Established in 1981. No capitation. Send CV to CorpOffice@ FloridaDentalCenters.com, fax: (727) 445-8382 or call: (723) 461-9149. Endodontist – Melbourne Supplement your Schedule! Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/Fee for Service dental group practice with 16 locations serving communities across central Florida. We are interested in speaking with Endodontists to join our team one day a week in Melbourne. This is a great opportunity to supplement your schedule. We are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Social responsibility is one of Christie Dental’s core values. Whether it is partnering with the Brevard County Schools Supply Zone, participating in the Making Strides against Breast Cancer Walk, sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard and Osceola communities. DDS/DMD/BDS, Certificate in Endodontics, FL State Dental License or Eligibility. Contact Kate Anderson at Kateanderson@amdpi.com or 781-213-3312. General Dentist – Sebastian. Christie Dental is a PPO/FFS multi-specialty dental group with 16 practice locations in the Brevard and Ocala Florida area. Christie Dental offers individuals and families a full range of dental care, including general dentistry, hygiene and specialty care, such as pedodontics, oral surgery, endodontics, orthodontics and periodontics. We currently have a wonderful opportunity for an General Dentist to join our growing team in a prime Sebastian practice. Contact Kate Anderson at kateanderson@amdpi.com or 781-213-3312. Endodontist – Supplement your Schedule in Ocala! Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/Fee for Service dental group practice with 16 locations serving communities across central Florida. We are interested in speaking with Endodontists to join our team one day a week. This is a great opportunity to supplement your schedule. Our specialists enjoy a built-in referral system from our general dentists. We are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our be-
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havior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Social responsibility is one of Christie Dental’s core values. Whether it is partnering with the Brevard County Schools Supply Zone, participating in the Making Strides against Breast Cancer Walk, sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard and Osceola communities. DDS/DMD/BDS, Certificate in Endodontics, FL State Dental License or eligibility. Contact Kate Anderson at Kateanderson@amdpi.com or 781-213-3312. Part-Time Oral Surgeon, Sebastian. Christie Dental is a multi-specialty dental group with 16 practice locations in the Brevard and Ocala Florida area. Christie Dental offers individuals and families a full range of dental care, including general dentistry, hygiene and specialty care, such as pedodontics, oral surgery, endodontics, orthodontics and periodontics. 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 the Christie Dental group. Contact Kate Anderson at Kateanderson@amdpi.com or 781-213-3312. General Dentist – Full time in Melbourne! Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/Fee for Service dental group practice with 16 locations serving communities across central Florida. We’re interested in talking with Doctors to join our team in the Melbourne area. We are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Doctors are supported with a network of resources and support, including mentor programs, leadership opportunities, continuing education and even a clear path to ownership. New dentists are able to shadow and learn from experienced professionals in their field, and seasoned professionals appreciate the camaraderie and collaborative environment. Social responsibility is one of Christie Dental’s core values. Whether it is partnering with the Brevard County Schools Supply Zone, participating in the Making Strides against Breast Cancer Walk, sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard and Osceola communities. DDS/ DMD/BDS, FL State Dental License or eligibility. NOTES: Additional Salary Information: Christie Dental is proud to provide a competitive compensation package, including comprehensive health benefits (Health, Vision, Dental), Life Insurance, Long Term Disability, Professional Liability Insurance, a 401(k) program with employer matching, and established mentor programs and leadership opportunities. Contact Kate Anderson at Kateanderson@amdpi.com or 781-213-3312. GENERAL DENTIST OPPORTUNITY: Pinellas Park, FL — Sign on bonus! If you’re looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community of Pinellas Park, FL while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success.
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You’ll enjoy the following: Base salary with performance incentives to earn more; Sign-on bonus of $5,000; Relocation package; Full time benefits include CE allowance, professional liability, 401K and group health/wellness plans; Practice 5 days per week with family friendly days/ hours. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues and have a valid DEA license. www.dental-partners.com. NOTES: Employer will assist with relocation costs. abrooker@ dental-partners.com. General Dentist. General Dentist needed for 2 days a week with potential for more depending on patient base. inievesdmd@gmail.com. General Dentist. The General Dentist that joins our team will be responsible for performing dental examinations and treatment in a collaborative, patient centric practice environment. Continuing education and leadership development opportunities are available and encouraged for this role. Excellent communication skills are required to maintain our group’s mission of providing the highest quality of patient service, and asserting our position as a provider of choice in the communities we serve. Job Duties: Examine, diagnose, prescribe, and carry out (or direct others in carrying out) oral health care services that are in the best interest of the patient; Contribute towards a team oriented and collegiate environment by working with other clinical and non-clinical staff members as necessary; Uphold the policy, protocol, and procedures which are in compliance with the most current accepted professional standards; Improving your clinical skills and acumen through participation in continuing education and training opportunities (continuing education support is available); Participate in various community outreach initiatives as necessary. Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/Fee for Service dental group practice with 13 locations serving communities across central Florida. We are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Doctors are supported with a network of resources and support, including mentor programs, leadership opportunities, continuing education and even a clear path to ownership. New dentists are able to shadow and learn from experienced professionals in their field, and seasoned professionals appreciate the camaraderie and collaborative environment. Social responsibility is one of Christie Dental’s core values. Whether it is partnering with the Brevard County Schools Supply Zone, participating in the Making Strides against Breast Cancer Walk, sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard and Osceola communities. Christie Dental is proud to provide a competitive compensation package, including comprehensive health benefits (Health, Vision, Dental), Life Insurance, Long Term Disability, Professional Liability Insurance, a 401(k) program with employer matching, and established mentor programs and leadership opportunities. DDS/DMD from a dental education program accredited by the Commission on Dental Accreditation. Current, valid license to practice dentistry in state where providing care (License must be in good standing) or eligible for licensure. Other certifications as required by state to include- CPR, DEA, etc. Christie Dental is a multispecialty group practice, founded in 1999. Since
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our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/Fee for Service dental group practice with 16 locations serving communities across central Florida. Come join our thriving group practice! Contact Kate Anderson at Kateanderson@amdpi.com or 781-213-3312. Associate Dentist in Jacksonville — Great area, Great team, Busy practice! Harbour Dental Care is growing by leaps and bounds and is looking for an amazing general dentist. This is a privately held office, not corporate, not DSO. At HDC, you will be provided with mentoring, training and development, continuing education, and a very competitive compensation package. We take great pride in what we do, and how we do it! If you love to make patients happy, be empowered to perform at your peak, use the highest technology available, and deliver premium service then you are going to love it here! This is a privately owned office, not corporate. 3D CBCT, CEREC, All digital, Brand new office environment, Great location, huge new patient flow! Please contact us if you are ready for an amazing opportunity to jump start your career! Sincerely, Kevin W. Snyder DDS. drsnyder@harbourdental.care. www.harbourdental.care. Private practice experience recommended. GPR/AEGD a plus. Florida License. GREAT ATTITUDE, HARD WORKING, SELF MOTIVATED, RESPONSIBLE, AND THE ABILITY TO DELIVERY 5 STAR CUSTOMER SERVICE. General Dentist Associate for a Private Office in Orlando FL. ORLANDO FLORIDA Dentist, Immediate Opening. An Excellent opportunity for a General Dentist to join an Upscale Private Established Dental Office North of Downtown Orlando, providing excellent patient care with the latest State-of-the-Art technology including Digital Paperless records, Digital x-rays, Intraoral Camera, Cerec, Laser, Invisalign. And doing ALL aspects of dentistry including Cosmetic, Ortho, Surgery and Dental Implants. we are 100% FFS/PPO. — (No HMO/No Medicaid). Our practice has grown immensely throughout a short period of time and we are looking to continue moving forward. We are a very successful dental health model designed to help our patients and the community achieve a healthy and beautiful smile by providing great dental care and excellent customer service. We offer superior quality and excellent patient care, provide attention to details and our patients love us. Great compensation plus base salary with a huge potential for the right person, in addition to the on-the-job experience, mentoring and clinical support. If you have GPR-AEGD Residency it is a Plus ...This is a FullTime position, but willing to discuss Part Time if requested. Please Fax Resume to Fax 407-327-1018 or Email: Doctor@ OrlandoDentalCenter.Com. FL Dental License, DEA, NPI, Malpractice Ins. Ability to start soon. NOTES: Additional Salary Information: Full Time/Part Time. Amazing Associate Opportunity. This is an opportunity for the right dentist to join one the fastest growing dental practices in Florida. A chance to get in now and enjoy the continued rapid expansion of our office. We have moved our almost 50 year established practice into a brand new state of the art facility on the same site as the old building. This allowed us to maintain our entire patient base and referral sources and at the same time become the best place to go for dentistry in the County. Our new patients have skyrocketed over the past year and we need a talented general dentist to join our team and help us keep up with demand. You will have plenty of new patients and hygiene exams from your very first day allowing you to ramp up your monthly production extremely fast. We are strictly Fee For Service and PPO only, no managed care,
discount plans, or Medicaid of any sort. That translates into being well compensated for each and every procedure you perform or supervise. Use our proven systems to help maximize your case acceptance and production, and therefore your income. Our current associates are taking home over $300k working only 4.5 days a week. This allows them time to enjoy all the wonderful activities that the Beautiful Florida Panhandle has to offer. Sign on/ Relocation bonus available to those who qualify. Medical insurance, 401k, disability available to full time providers. Call or e-mail today to take advantage of this tremendous opportunity. Florida Dental License is required to practice. NOTES: Additional Salary Information: $600 daily guarantee or 30% of collections whichever is greater. smilemaker80@gmail.com. Associate Dentist. Looking for a great opportunity to practice in Central Florida? Our well-established, privately owned practice in Saint Cloud has a position for an outstanding Associate Dentist. We offer an excellent earnings potential for the individual who is dedicated to providing high quality, compassionate care for our growing patient base. Key tasks include: Examination and treatment planning; Providing appropriate care for patients ages 6 and up; Being a friendly, professional practice ambassador both within and outside of the office; Being receptive to mentoring when needed and appropriate; Being dedicated to professional growth; Four (4) Day practice week to include 2 early evenings. Compensation includes: Base salary to start and incentives for exceeding production goals; Malpractice insurance, CE allowance and Retirement contribution is also provided. Would you like to be considered as a member of our friendly, professional, and dedicated team? If so please send us your CV along with a brief paragraph explaining why you should be considered. Lakeshore Dental Care, PLLC. info@mylakeshoredental. com. Fax: 407-957-6762. DMD/DDS degree from an accredited dental school. Current Florida Dental License, 2 years clinical experience or graduate of an Advanced GPR program. Pediatric Dentist — Tampa, FL. Available Spring/Summer 2018. Private Pediatric dental practice — Non-corporate. Two office locations in the Tampa bay area. One office has 8 chairs and is 5 days a week. 2nd office has 6 chairs and is a couple of days per week, with potential for growth. The ideal candidate I am seeking is full time, 5 days per week. PPO insurance and fee-for-service patients in both practices. High-income potential approximately, can easily clear $300,000 in the first year with our compensation structure. Both offices have digital radiographs and digital charting. In office IV-sedation provided on a monthly basis with a certified Anesthesiologist. Fully trained and certified pediatric dental staff in place. Orthodontic treatment is provided in both locations by an orthodontist in our practice. Full autonomy over treatment plans. Position is available starting Spring/Summer of 2018. Must have a current Florida dental license, previous experience in private practice is preferred but not necessary. Must have graduated or soon to graduate from a certified pediatric dental residency program. Candidate should have excellent communication skills and enjoy a fast pace, fun work environment. We are now interviewing qualified candidates so if interested please email current CV to, sugarbugdude@gmail.com. Prior to interviewing we ask you to sign a non-disclosure agreement in order to protect our practice information. We are looking forward to speaking further about this amazing opportunity with an interested candidate. CV to sugarbugdude@gmail.com. Requirements: Must have a current Florida dental license. Previous
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CAREER CENTER FROM PAGE 75 experience in private or corporate offices is preferred. Must be a pediatric dental specialist. No general dentist limited to children. Excellent communication and people skills. Must enjoy a fast-paced work environment. Associate Dentist — Melbourne. Viera Modern Dentistry is currently looking for a full-time Associate Dentist to add to our successful and growing practice in Melbourne, Florida. This office is fully digitized and equipped with SiroLaser, CEREC® CAD/CAM, intraoral cameras, VELscope®, and digital X-rays. Dr. Pham offers: Competitive earning potential, with no earning cap; Benefits, including: Medial, Dental, Vision, 401K; Dr. Pham pays all lab & Supply fees, malpractice insurance, and any CE credits taken through the PDS institute®; Mentorship and training; Great working environment, with a fun, friendly, and supportive team. Full-time General Dentist Needed. Veteran (10-30 years’ experience) Full-time general dentist needed to join our rapidly growing practice. High tech offices with well trained staff await you. Medical insurance and mal- practice insurance paid by the office. We offer a 401K match program and profit sharing. We have 6 offices surrounding the Tampa area, with 2 new offices opening soon. Unlimited salary potential, with a first-year guarantee. Only serious, experienced dentists please apply. 10-30 years of general dentistry experience. Active Florida License. NOTES: 2 openings. Additional Salary Information: Medical, mal-practice, 401K, profit sharing. vmonti@happydentistry. com. Part Time/Full Time Pediatric Dentist. Our thriving Orlando, FL private practice office is seeking a part time associate to join our busy practice. We have a modern office, a wonderful patient base, and a loyal and committed team. We are looking for a fun, caring, compassionate individual committed to providing excellence in total oral health care to our little patients (and big ones). Our office creates an environment that encourages family-centered preventative care and a team approach with our parents and children. Our practice is committed to excellent service that exceeds the expectations of our patients and their parents. Our goal is to build trust with our patients and parents and make each and every visit a positive experience. We are located in a very desirable area of sunny Orlando, FL. This opportunity is perfect for the individual interested in working part time with the potential for full time. We offer a competitive compensation and benefits package including health insurance and 401k. To become part of our outstanding team email your C.V. to mlkdentistry@ icloud.com. General Dentist Opening — South Florida and Orlando Markets. Looking for an opportunity with a successful and growing company? Sage Dental currently has opportunities for qualified General Dentists & Specialists at our South and Central Florida practices. Sage Dental offers you: Excellent Earning Potential – Sage Dental operates more efficiently and we share the results with our doctors through a higher compensation model; Ability to Focus on Patient Care – By delegating all the management and administrative stresses to us, our doctors can focus on
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providing the best patient care possible; State-of-the-Art Facilities – Our dentists enjoy working in state-of-the-art facilities with the latest dental technology and equipment; Quality of Life – Since you don’t have to worry about insurance claims, payroll, staffing, accounting and marketing, you have the time to enjoy everything Florida life has to offer, including our many golf courses and beautiful beaches. If you are ready to take the next step in your career as a General Dentist or Specialist and want a position with excellent earning potential, Sage Dental has what you are looking for. Apply today! Contact: Bradford Cabibi - Doctor Recruitment. Email: bcabibi@mysagedental.com; careers@mysagedental.com. website: http:// www.mysagedental.com/; https://www.mysagedental. com/career-opportunities/. Phone: 561-999-9650 Ext. 6146, Fax: 561-526-2576. Florida Dental License. NOTES: Additional Salary Information: Highly Competitive. General Dentist ‑ Spring Hill, FL Part Time. f you're looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community of Spring Hill, FL while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success. You'll enjoy the following: Base salary with performance incentives to earn more. Sign-on bonus of $3000. Practice part time, 1-2 days per week with family friendly days/hours (Fridays and one other day if desired. Part time benefits package to include 401K and CE allowance. Apply via this posting or send resume to abrooker@dental-partners.com. www. dental-partners.com. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues and have a valid DEA license. Prefer 3+ years of general dentistry experience with the ability to perform molar endodontics and implants. Associate general dentist. I have a small, personal, general dentistry fee for service office and am looking for the right associate to add to my team. The perfect candidate has a passion for dentistry but does not care for the administrative duties and responsibilities of owning an office. Your mission should be to provide the best dental care that modern medicine has and to provide it with compassion and caring. We want the office to be a dental home where our patients feel they are part of a family. You should have 3+ years of experience and be willing to travel for training provided by the office. DDS/DMD, FL license, 3+ years’ experience. Ability to do molar RCT and/or place implants a plus but not required. jlm144@cfl.rr.com. General Dentist Opportunity (4 Days/Week) – Stuart, FL. Dr. Rick Woodward has an immediate opening for a fulltime, lead General Dentist (4 days/1 Saturday) to join our digital, high production, multi-specialty Stuart, FL practice located at : 2410 NW Federal Highway Suite A-110 Stuart, Florida 34994. Enjoy a rewarding role with a dedicated and experienced staff (including hygienist) with an established patient base in gorgeous Stuart, FL just 3 miles from the beach! Be able to focus on providing excellent patient care with treatment autonomy (we handle the rest)! High Compensation Opportunity: Unlimited Earning Potential: Production % vs. Six Figure Annual Amount. Benefits/Perks: Practice Leadership: Clinical Freedom; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty, Digital Practice w/13 Ops! Pediatrics and Oral Surgeon in Office; Partnership Model – Investment Opportunities / Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term / Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues;
Group Practice Camaraderie – Technique Development assistance, Study Clubs, Chairside Mentoring, GEDC University Courses; Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. 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; phone 678-836-2226 | fax 678-836-2144; |web www.greatexpressions.com; email Ross.Shoemaker@ greatexpressions.com. “Look for the Smile Above Our Name!” Must Have Active/Clear Florida Dental License (or Eligible to Attain One), U.S. DMD or DDS. Experienced General Dentist (High Income)- Jacksonville, FL. Dr. Rick Woodward is seeking a full-time Experienced General Dentist to lead our established dental practice in Jacksonville, FL (Normandy). Office Details: Single Doctor Practice Located at 7909 Normandy, Jacksonville, FL 32221, just off 295 and 10 minutes west of Downtown Jacksonville! Outstanding Current Full-Scope Provider Relocating Out of Area; Seeking a 3-5 year (Preferred) Experienced General Dentist with Strong Focus on Quality Patient Care; Fully Digital; 6 Operatory Setting; Healthy Production $50,000k/month (avg); High Compensation Opportunity: Strong Six Figure Annual Amount vs. Percent of Production; *Sign-On or Relocation possible. Benefits/Perks: Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term / Long Term Disability, Time Off; Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Partnership Model – Doctor Care Path/Investment Opportunities; Malpractice Coverage Assistance; Paid ADA & State Society Dues; Continued Education Reimbursement/Support. For more Information, please contact: Hannan Ayad| Doctor Recruiter | Great Expressions Dental Centers; phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. Job Requirements: Must have a DDS/DMD from an accredited University and active State Dental Board license. Experienced Dentist ($215k+ Annually)- Jacksonville, FL. Dr. Rick Woodward is seeking a full-time General Dentist to lead our established dental practice in Jacksonville, FL (Northside). Office Details: Single Doctor Practice: Located at 1403 Dunn Avenue, Jacksonville, FL 32218, off I-95 and roughly 9 miles from Downtown Jacksonville! Current Provider Relocating; Seeking a 3-5 year (Preferred) Experienced General Dentist with Strong Focus on Quality Patient Care; Fully-Digital Practice With 6 Operatories; 2 Dental Assistants and 1 Hygienist (all full-time); Current Provider Averages $60,000 in Production/Monthly. High Compensation Opportunity: Strong Six Figure Annual Amount vs. Percent of Production; Outgoing Doctor Earned $18,000 Monthly ($216,000 Annually) With Office Growth Potential. Benefits/Perks: Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Partnership Model – Doctor Care Path/Investment Opportunities; Malpractice Coverage Assistance; Paid ADA & State Society Dues; Continued Education Reimbursement/Support. For more Information, please contact: Hannan Ayad| Doctor Recruiter | Great Expressions Dental Centers, phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions. com. Job Requirements: Must have a DDS/DMD from an accredited University and active State Dental Board license.
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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.
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OFF THE CUSP IT'S BETTER TO BE HOPEFUL THAN TO BE WORRIED
JOHN PAUL, DMD DR. PAUL IS THE EDITOR OF TODAY’S FDA. HE CAN BE REACHED AT JPAUL@BOT. FLORIDADENTAL.ORG.
Worrying about the future is starting to seem like a worthwhile use of our time. Now that we have 24/7 access to news or gossip that’s packaged to look like news, you wonder how tomorrow can possibly be as good as today. Can our children end up better off than us if they let someone talk them into eating a Tide Pod or burning themselves with deodorant? On top of the general craziness, being part of the Florida Dental Association’s (FDA) leadership means a steady stream of information on who wants to make dentistry better by adding more legislation to distract you from the actual practice of dentistry. Can you say mandatory opioid course that by law must be provided by a group that doesn’t really know what you do for a living? The Florida Medical Association is trying to work with us even if more than 50 percent of our legislators don’t really get it. Other groups are willing to spend millions of dollars and several years in a campaign to legitimize a new provider because they think we have a pretty cool job but don’t see the need to spend all that time in school to do it. We have a saying in our office, whether you think you’ll have a good day or a bad one, you’re right. You don’t always get to decide what each day will offer, but you’re in complete control of whether you see the day as full of obstacles or opportunities. It’s a little easier to be an optimist when you know who has your back. Take the time to meet some of them at the Florida Dental Convention. More than a hundred of your volunteer leaders will be gathered in one room. If you’re an FDA member, then you have the right to be in that room and meet the people who feel it’s important to give their time to make sure our profession stays among the finest in the nation. There’s a building full of folks in Tallahassee who really believe “Helping members succeed” is the reason they come to work each day. Look back a few pages — if you want to feel like the king and queen of the world, volunteer for the Florida Mission of Mercy (FLA-MOM). If we missed you this March, it’s not too late to volunteer for the next FLA-MOM on March 2223, 2019 in Orlando. At the end of the day, there are a lot more reasons to be hopeful than to be worried.
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DENTAL SCHOOL GRADUATES. THE FDA HAS YOU COVERED! All new dental school graduates who become FDA members and practice in Florida will have their first year of professional liability coverage from The Doctors Company completely paid for by their FDA colleagues!
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