2017 - Nov/Dec TFDA by Florida Dental Association

DENTAL LICENSE RENEWAL DEADLINE: FEB. 28, 2018

VOL. 29, NO. 7 â&#x20AC;¢ NOVEMBER/DECEMBER 2017

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

6 Places to hang your dental hat District Dental Associations Offer Local Events And Support

10 MILLION HITS! FDA builds patient awareness with digital campaign

THE SCOOP ON FDA PRESIDENT Dr. MICHAEL EGGNATZ

MS. ARIA SHARMA DENTAL STUDENT

DR. DEMETRICK LECORN MID CAREER DENTIST

O YOU N D T YOUR

D? EE

DR. KAYCEE WILCOX NEW DENTIST

WH A

FOUR MEMBER DENTISTS TALK ABOUT THEIR DENTAL CAREER

BENEFIT

FIT W

! T E H AV E I

DR. STEVE TINSWORTH EXPERIENCED PRACTIONER

Dr. rick huot elected ADA 2nd vice president !

TRY OUR AGENT “The best thing about Dennis and his team at FDA Services is their ability to respond quickly to any little question or request that I give them. Sometimes a transaction requires a random proof of insurance or some other detail, and it’s been no problem to acquire that when needed.” - Dr. Ryan C. Customer Since 2013

“Dennis Head has been extremely helpful with all of our needs since we started practicing 13 years ago.”

“The office has been a member with FDA Services since 2005. Dennis Head has provided us with all required coverages till today. He works around a practice’s needs and is not there to “sell” their products. He always provides prompt service and they are only a phone call away. We have also ordered supplies through FDA. They are a good resource for all dental practices.”

- Dr. Jason S. Customer Since 2005

Dennis Head

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Director of Sales Central Florida Phone: 407.359.9700 Email: dennis.head@fdaservices.com

HELPING MEMBERS SUCCEED VOL. 29, NO. 7 • NOVEMBER/DECEMBER 2017

cover story

PAGE 33

WHAT DO YOU NEED? WE HAVE IT!

PLUS PROFILES OF CAREER STAGES & INTERVIEWS WITH FOUR MEMBERS DENTAL OFFICE

— Graham Nicol

highlights GET THE SCOOP ON FDA PRESIDENT DR. MICHAEL EGGNATZ PAGE 44

FDC2018 SPEAKER HIGHLIGHTS

XEROSTOMIA IN PATIENTS LIVING WITH HIV PAGE 50 FORENSIC ODONTOLOGY PAGE 54 GET RESULTS WITH MAGIC COMMUNICATION PAGE 60

DELTA DENTAL: NEVER A DULL MOMENT PAGE 14

features Realize there are no hard and fast answers to disciplining staff who use medical marijuana in Florida right now…

TIPS ON HOW TO DEAL WITH MEDICAL MARIJUANA AND YOUR STAFF, Page 72

Keys to Buying Your Own Dental Practice

PAGE 66

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

HOD to Consider Bylaws Change 13 Third-Party Payers: An Update on Delta Dental Concerns 14 10 Million Hits: FDA's Successful Digital Advertising Campaign 16 Issues to Watch During the 2018 Session 21 Member Milestones 26 Congratulations, Dr. Huot 29 License=Livelihood 32 Your FDA Member$hip Value 43 Team Building in a Great Learning Environment 49 FDC Exhibitors 62 New! FDA Career Center 70 How a Random Act of Kindness Opens Doors 79 6 Places to Hang Your Dental Hat 82 The FDA District Flow Chart 86 District Presidents Q & A 94 Can Insurance Companies Make Life Easier? 100 Oral Health Disparities: Alachua County Fluoridation 103

in every issue Staff Roster 3 President's Message 5 Legal Notes 8 Information Bytes 17 Legislative Corner 19

news@fda 22 Did You Know? 12 Diagnostic Discussion 105 Classified Listings 110 Off the Cusp 112

TODAY'S FDA ONLINE: floridadental.org

FLORIDA DENTAL ASSOCIATION NOVEMBER/DECEMBER 2017 VOL. 29, NO. 7

EDITOR Dr. John Paul, Lakeland, editor

3RENEW WAYS TO

1 2 3

ONLINE CREDIT CARD PAYMENT Visit floridadental.org/dues to pay your dues 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.

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

BOARD OF TRUSTEES 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 2017 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication. POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 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 classified advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.

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

TODAY'S FDA

NOVEMBER/DECEMBER 2017

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

EXECUTIVE OFFICE DREW EASON, Executive Director deason@floridadental.org 850.350.7109 GREG GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111 GRAHAM NICOL, Chief Legal Officer gnicol@floridadental.org 850.350.7118

AUSTIN MOSER, Coordinator of Foundation Affairs amoser@floridadental.org 850.350.7161

FLORIDA DENTAL CONVENTION (FDC) CRISSY TALLMAN, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105

CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202

ELIZABETH BASSETT, FDC Exhibits Planner ebassett@floridadental.org 850.350.7108

JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123

BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103

ALEX LUISI, Leadership Concierge aluisi@floridadental.org 850.350.7114

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

ACCOUNTING

GOVERNMENTAL AFFAIRS

JACK MOORE, Director of Accounting jmoore@floridadental.org 850.350.7137

JOE ANNE HART, Chief Legislative Officer jahart@floridadental.org 850.350.7205

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 ANGELA ROBINSON, Insurance Clerk angela.robinson@fdaservices.com 850.350.7156

LEONA BOUTWELL, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138

ALEXANDRA ABBOUD, Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204

DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165

COURTNEY THOMAS, Governmental Affairs Legislative Assistant cthomas@floridadental.org 850.350.7203

JAMIE IDOL, Commissions Coordinator jamie.idol@fdaservices.com 850.350.7142

PORSCHIE BIGGINS, North Florida Membership Services Representative pbiggins@fdaservices.com 850-350-7149

INFORMATION SYSTEMS

MARIA BROOKS, SFDDA Membership Services Representative maria.brooks@fdaservices.com 850.350.7144

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

WWW.FLORIDADENTAL.ORG

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 MARIAH LONG, Member Access Coordinator mlong@floridadental.org 850.350.7100 ASHLEY MERRILL, Member Relations Coordinator amerrill@floridadental.org 850.350.7110

MARCIA DUTTON, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145

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

CHRISTINE TROTTO, Membership Concierge ctrotto@floridadental.org 850.350.7136

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.

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

TODAY'S FDA

NOVEMBER/DECEMBER 2017

TOP 10

WAYS TO GET INVOLVED 1. Become a Legislative Contact Dentist.

2. Support pro-dental candidates through the FDAPAC.

3. Attend Dentists' Day on the Hill.

2018 FLORIDA MISSION OF MERCY March 9-10, 2018 Lee Civic Center Fort Myers, FL

4. Offer pro bono care through

the FDA Foundation: PDC, DDS, and FLA-MOM.

5. Serve on an FDA council or district council.

6. Volunteer for Peer Review in your district.

7. Write articles for Today's FDA. 8. Become a mentor in the new FDA Mentorship Program.

9. Volunteer for Give Kids a Smile. 10. Train as an FDA spokesperson. BONUS!

Be an FDC speaker host.

HELPING MEMBERS SUCCEED QUESTIONS ABOUT YOUR MEMBER BENEFITS? Find more information at floridadental.org. Contact us at membership@floridadental.org or 800.877.9922.

TODAY'S FDA

NOVEMBER/DECEMBER 2017

YOU CAN MAKE A DIFFERENCE! � � � �

dentists, hygienists, dental assistants lab technicians physicians, nurses, pharmacists, EMTs general community volunteers

WWW.FLORIDADENTAL.ORG

HOW WORKING TOGETHER TO EMBRACE CHALLENGES LEADS TO SUCCESS It has been an extraordinarily busy but rewarding few months serving as your president! Many of you received the previous impressive opioid issue of Today’s FDA (TFDA) many weeks after the rash of hurricanes in Texas, Florida, Puerto Rico and the Caribbean Islands, and the historic fires that ravaged many areas of California. That issue was packed with an extraordinary amount of the most current information and articles we all need to know for our everyday practice and to protect our patients. It was produced prior to the president and governor’s proclamation of a national and state opioid crisis. Kudos to our editor, Dr. John Paul, and the TFDA staff for being ahead of the curve and highlighting this crisis that affects us all. They have already been recognized by the Florida Surgeon General as a model for associations across the state for educating their members and the public on this insidious national problem that crosses all cultural, religious, geographic and socio-economic barriers. They are likely to be recognized for another well-deserved publishing award! My previous “President’s Message,” which challenges all of us to engage in the imminent legislative process to protect the sanctity of the doctor-patient relationship, was submitted prior to the above natural disasters in September, and did not address the Florida Dental Association’s (FDA) role prior to, during and after those natural disasters. I reference this because I have never been so proud to be an FDA member — we worked on a daily basis for weeks with leadership, volunteers and professional staff across the state to make sure our members were constantly informed and supported through these scary and frenetic events! WWW.FLORIDADENTAL.ORG

We wanted you to know that you were not alone and that we could be a resource for you and your family. We sent hurricane preparedness emails prior to the storm; set up phone trees during the slow-moving monster; and, followed up for weeks after the event to assess damage and provide financial relief through our FDA Foundation and in conjunction with the ADA Foundation. This was a herculean group effort from volunteer leadership and the incredibly capable professional staff at the FDA. It was a time when we all needed to pull together, so we could lean on each other as we all experienced this huge event in different ways. Sometimes, the worst events bring out the best in all of us! Please join me in thanking the members of the Board of Trustees (BOT), the FDA/ADA delegation members and council chairs/members from across the state who took the time to make sure our members received the help and encouragement they needed to weather the storm. An additional thank you to our ADA trustee, Dr. Cesar Sabates, and the out-going ADA first vice president, Dr. Irene Marron, for encouraging and voting for additional funding and relief from the ADA Foundation and BOT, and streamlining the seamless tripartite cooperation in getting funds to those who applied and were in need.

LEADERSHIP

PRESIDENT’S MESSAGE MIKE EGGNATZ, DDS

Dr. Eggnatz is the FDA president and can be reached at meggnatz@ bot.floridadental.org.

The FDA Foundation received unsolicited funds from across the country from eight different states totaling $87,000, and we processed $93,000 in Emergency Disaster Assistance Grants. One of those states was Texas, who was recovering from their own hurricane and flooding disaster. I visited Houston three weeks after their hurricane and fortunately, they had the resources to recover from SEE PAGE 7 TODAY'S FDA

NOVEMBER/DECEMBER 2017

IT’S EASY! JUST CHECK THE FDA FOUNDATION BOX ON YOUR FDA DUES STATEMENT.

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.

LEADERSHIP

FROM PAGE 5

their widespread flooding. They shared some important recovery experiences that would prove invaluable to our recovery efforts here in Florida. We are fortunate that we weren’t hit with a Category 5 hurricane in the metro Miami-Dade, Broward and Palm Beach counties area as forecasted. Although the Florida Keys were hit hard, they were evacuated and are not a major population center. They will be rebuilt to once again become one of the jewels of Florida, and they are ready for visitors. Their close proximity to Miami led to the largest utility repair effort in our nations’ history, with the help from utility companies from the northeast to California. The Miami Metro Zoo parking venue served as a giant staging area. Unfortunately, our brothers and sisters from Puerto Rico were not so fortunate! We have and will continue to pay it forward by sending them financial resources from the FDA Foundation, under Dr. Bob Payne’s leadership. We are continuing to support Puerto Rico in many ways from the mainland. The dean of the dental school and the delegation leadership from Puerto Rico were extremely appreciative of the support you have provided. They personally thanked our delegation and many others at the ADA national meeting in Atlanta this past October. Dr. Payne and I personally visited the states that gave funds to Florida and thanked them for their generosity in our time of need. It was truly rewarding to see and feel the generosity from across the country at the ADA national meeting. We not only survived the storms, but flourished at the ADA meeting with an informed delegation representing you! This is why we belong to organized dentistry and the tripartite — to help each other in times of need. Huge congratulations to our very own Dr. Rick Huot, of Vero Beach, for being elected the ADA’s new second vice president! Having a vice president with his expertise and experience to be a voice of knowledge at the ADA BOT is invaluable. We are entering unprecedented territory in dentistry in the areas of: dentistry as a part of Medicare; electronic health records; medical/dental integration; specialty recognition; and, the discussion of mid-

level providers. New business and delivery of care models are all national issues that Dr. Huot can speak to with his 30 years of experience in the Air Force, private practice, federally qualified health centers, dental service organizations and as a consultant. He has worked in all these environments. Florida should be proud that the ADA has elected two consecutive vice presidents from the same state. We bring special knowledge and experience from Florida in many areas that are controversial national issues. We can inform and help influence policy at the ADA. We thank Dr. Irene Marron, as she leaves office for representing Florida across the country and for sacrificing more than 120 days away from her practice to serve with distinction as the ADA first vice president. Many people ask me why I spend so much time and effort in organized dentistry. I tell them the same thing I said when I eulogized one of our great mentors, past FDA president and trustee, Dr. Clifford Marks this past summer: “Through organized dentistry, I have met some of the smartest and most generous people I know, who I would not have otherwise ever met or had influence my life. I am thankful for those relationships and it makes me a better dentist, professional and person.” These last few months have only reinforced those concepts and ideals. I hope you also will take the opportunity to shape your profession, expand your horizons, help others in the profession and be influenced by some of the same type of generous people who I have had the privilege to meet in organized dentistry. Throughout the challenges of these last few months, working with so many talented and caring professionals, I have never been so proud to be an FDA member! Working together, we can be proud of our state and the role the FDA plays in it as the expert in oral health in Florida. It is my that hope that you feel the same way. Again, if I have not met you, I look forward to doing so in the near future so we can improve the oral health for all Floridians.

FLA-MOM WAS A HIGHLIGHT! 1. BEST TIME: Attending FLA-MOM this year in Pensacola was a highlight for me. The event was close to my home and allowed me to give back in an organized, group setting. FLA-MOM was a great way for me to join with other dentists around Florida and to give back to those truly in need. I am thrilled that the FDA has provided an outlet for this type of fun, rewarding, service for its members. — Dr. Jenna Pascoli • FDA Services Board of Directors, Panama City

WWW.FLORIDADENTAL.ORG

TODAY'S FDA

NOVEMBER/DECEMBER 2017

HOW WELL DO YOU KNOW THE BOARD OF DENTISTRY DISCIPLINARY PROCESS? PART 7

LEGAL NOTES

This is Part 7 of a continuing series.

STEP 13: Your Election (or Waiver) of Rights GRAHAM NICOL, ESQ., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

Graham Nicol is the FDA chief legal officer.

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

TODAY'S FDA

All Administrative Complaints (ACs) end with two notices. The first is known as “Notice Regarding Assessment of Costs” and basically says, as we’ve seen before, that the board will assess costs and attorney hours against you under section 456.072(4), Fla. Stats. The second is far more important and is known as “Notice of Rights” or “Election of Rights.” Read this very carefully. It says: Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. This is one of the most important decisions you will make in the case and in your career: whether to choose an “informal hearing” under section 120.569 or a “formal hearing” under section 120.57. It is crucial that the health care professional understand the significance of this seemingly innocuous decision. TIP: Think of the Election of Rights form as you waiving all your rights. You may have viable defenses that you don’t even know about. If you make the mistake of electing an informal hearing, you have agreed that all the allegations made against you are true and you have admitted you are guilty. The only issue remaining is what your punishment will be. TIP: The difference between an informal and formal hearing is whether or not you “dispute material facts.” In other words, if you disagree with the allegations made against you, or you simply want the government to prove the allegations, you

NOVEMBER/DECEMBER 2017

must choose a formal 120.57 hearing. If you want to waive your rights to challenge the allegations against you, that is what you have done by choosing an informal 120.569 hearing. TIP: An informal hearing does not mean that it will be relaxed and casual; rather, it means that the licensee waives all rights to challenge the facts underlying the AC. As a prerequisite to a so-called “informal hearing,” the respondent admits that the facts alleged in the complaint are true, thereby waiving the right to challenge the complaint. TIP: Think of the Elections of Rights as more of a “Waiver of Rights.” You never elect an informal hearing without advice from competent legal counsel. It is like settling a case without getting “your day in court.” It should be done only after you understand what sanction the agency will recommend as punishment and a settlement stipulation or consent order to that effect has been agreed to by the agency and the regulated party. In other words, with an informal hearing, the violation has already been established and the only substantive issue for the Board of Dentistry (BOD) is what the appropriate penalty should be. Section 120.57(4), Fla. Stats. allows for the parties to dispose of the AC via stipulation, consent order or agreed settlement. TIP: Even if you’re ready to retire anyway, think carefully before voluntarily relinquishing your license to make it all go away. Once you have received notice that you are being investigated, a voluntary relinquishment has the same practical effect as having your license revoked for cause. You will be reported to the National Practitioner Data Bank; the disciplinary record will be permanent and there is literally nowhere in the U.S. where you can practice like you did before because every state board treats a voluntary relinquishment after you’re on notice of an investigation as a licensure revocation. If you are going to use the “run away and hide” strategy, make sure you do it before you are put on notice of the investigation.

WWW.FLORIDADENTAL.ORG

TIP: One way to assess a stipulation or settlement offer (or even the penalty recommended by the administrative law judge [ALJ] if you opt for a formal hearing) is to review the disciplinary guidelines required under s. 456.079, Fla. Stats. The BOD’s disciplinary guidelines are analogous to sentencing guidelines in criminal matters and are mandated by legislation to “specify a meaningful range of designated penalties based upon the severity and repetition of specific offenses.” Sentencing guidelines put licensees on notice of minimum and maximum penalties for each violation and ensure the BOD is consistently applying the penalties. If the BOD finds several aggravating circumstances, expect the discipline to be on the high end of the scale and vice versa for mitigating circumstances.

to by the dentist, an informal hearing leaves the professional facing some very real dangers. Dentists should not take comfort in the erroneous belief that, “The board is comprised of practicing dentists, they are on my side, they know what the pressure is like, they will understand and forgive what happened in my practice.” The board members (many of whom are not dentists) were appointed by the governor to protect public safety, not to advocate for or protect the interests of individual dental professionals.

TIP: Another way to assess settlement offers is to review the “subject matter index” required under section 120.53, Fla. Stats. This statute requires governmental agencies to organize and index public disciplinary orders. Until the early 1990s, many licensure boards relied upon their newsletters, which outlined the disciplinary violation and the penalty assessed, to serve as a subject matter index. In Gessler, the 4th District Court of Appeal (DCA) found that the medical board’s failure to maintain a subject matter index was presumptively prejudicial to the respondent and the case was ultimately dismissed by the Florida Supreme Court. The sentencing guidelines have largely replaced the subject matter index, but both should be consulted to compare discipline imposed based on similar violations.

Mediation

TIP: Even if both parties agree to the settlement, the BOD can nevertheless reject the settlement and impose its own sanction. If licensees knowingly waive their rights by electing an informal hearing, they nevertheless are required to appear, usually through counsel but sometimes in person, before the full BOD. The board may question respondents under oath about their conduct and comment on the inappropriateness of the behavior previously admitted to by the licensee. Respondents will be allowed to present only mitigating circumstances and appeal to the board for mercy. No facts or law may be argued and no new evidence may be introduced, unless it is relevant to mitigating (or aggravating) the sanction to be imposed.

Because the board has the unilateral right to accept, reject or modify the punishment recommended by the Department of Health (DOH) and agreed WWW.FLORIDADENTAL.ORG

Under section 120.573, Fla. Stats., the DOH may offer mediation. Choosing mediation does not affect your right to an administrative hearing. If the agency and respondent agree to mediate, in writing, within 10 days after the time period stated in the election of rights, then time limitations imposed for formal and informal hearings are tolled. TIP: You probably want the allegations against your license resolved as soon as possible. However, mediation is one way to slow down the process while remaining at work.

Parties have 60 days to conclude the mediation. If mediation results in settlement of the administrative dispute, the agency shall enter a final order incorporating the agreement of the parties. If mediation terminates without settlement of the dispute, the agency shall notify the parties in writing that they may still choose an informal or formal hearing.

STEP 14: The Informal Hearing Under 120.569

party are to be determined by a government agency, the respondent has the right to an administrative hearing in front of — not the BOD or DOH — but the Division of Administrative Hearings (DOAH). “Substantial interests” include your license to practice your chosen profession unencumbered with restrictions, probation, suspension or revocation. If you elect an informal 120.569 hearing, the case is resolved before the BOD. Only by electing a formal 120.57 hearing in front of the DOAH, will the licensee be permitted to dispute the factual allegations made by the DOH, thereby forcing the government to prove its allegations to the satisfaction of an impartial ALJ. Formerly known as hearing officers, their title was changed in 1996 to ALJs to more properly describe their non-adversarial function in the system. As there are no disputed issues of material fact, the agency itself will conduct an informal hearing pursuant to the procedures set forth in section 120.57(2), Fla. Stats. and will issue a final order that is directly appealable to the 1st DCA or the district court where the doctor resides.

STEP 15: The Formal Hearing Under 120.57 The BOD conducts 120.569 hearings. In contrast, formal hearings are conducted by the ALJ assigned by the DOAH. Under section 456.073(6), Fla. Stats., board members who served on the Probable Cause Panel (PCP) for your case will recuse themselves should the matter come up for hearing before the full BOD.

Section 120.569, Fla. Stats., provides that when the “substantial interests” of a TODAY'S FDA

SEE PAGE 10 NOVEMBER/DECEMBER 2017

LEGAL NOTES FROM PAGE 9 FROM PAGE 9 TIP: That being said, don’t be lulled into thinking the BOD is completely independent and will guarantee an objective review. They care passionately about these cases or else they wouldn’t be on the BOD.

Initiating the Hearing TIP: Election of a formal hearing does not lead inexorably to the expense and emotional distress of a full-blown trial. First, the summary hearing process is explained below. Second, there is no right to a jury trial in a DOAH proceeding. Third, requesting a formal hearing initiates negotiations with the prosecutor from a position of strength, not weakness. Fourth, you can still negotiate a settlement with the prosecuting attorney while the DOAH proceeding is pending.

If you want to dispute the facts or challenge the AC in front of an independent judge, then you must opt for a formal 120.57 hearing. Within five business days following the DOAH’s receipt of a petition or request for hearing, the division shall issue and serve on all original parties an initial order that assigns the case to a specific ALJ and provides general information regarding practice and procedure before the division. TIP: Once you’ve initiated a hearing, the BOD can take no further action against your license. In other words, once the case is under DOAH jurisdiction, the BOD has lost jurisdiction (other than to act as a litigant in the DOAH process).

There are two ways to initiate a 120.57 formal hearing. First, your lawyer may file a petition or a request for a hearing with the agency (BOD) in question, and

TODAY'S FDA

the agency will refer the matter to the DOAH. Second, some lawyers choose to initiate formal administrative proceeding by filing their own Petition for Formal Hearing directly with the DOAH rather than the BOD. This alternative disputes all the government’s factual allegations and should be accompanied with filing a Notice of Appearance with the DOAH. TIP: The Notice of Appearance means investigators and the prosecutor for the department may no longer communicate with you directly. Instead, they must communicate with defense counsel. TIP: Because DOAH hearings proceed rapidly, defense counsel also should consider filing Requests for Admission and Requests for Production at the same time as the Petition and Notice of Appearance. TIP: Ask for costs and attorneys’ fees in your pleadings and at trial. Florida case law is split between whether you waive your right to seek reimbursement if you fail to raise it at trial, with other cases saying it may be raised for the first time on appeal. TIP: Under section 120.574, Fla. Stats., if the parties agree, you can fast-track the case even further with a summary hearing.

Summary Hearings When your case gets assigned to an ALJ, you will get an initial order that will briefly describe the expedited time sequences, limited discovery and final order provisions of a summary procedure. You have 15 days after service of the initial order to file a motion for summary hearing. If all parties agree, in writing, to the summary proceeding, then the

NOVEMBER/DECEMBER 2017

hearing will occur within 30 days of the agreement and the ALJ’s decision will occur within 30 days from the conclusion of the final hearing or the filing of the transcript thereof, whichever is later. If you opt for a summary hearing, you must file your witness list no later than five days before the final hearing. TIP: The witness list contains the names and addresses of witnesses who may testify at the hearing and identifies documentary evidence that may be introduced at the hearing. If a witness is not listed, they cannot be called at trial. Thus, witness lists contain many names and if you don’t know why the person is listed, your lawyer needs to find out immediately. TIP: Summary hearings are so quick because discovery and motion practice is severely limited.

Pre-trial Conference The ALJ usually will schedule a telephone conference in close connection to the final hearing. At the pre-trial conference, the legal and factual issues to be considered at the final hearing are made explicit; the witnesses and documentary evidence that will be offered at the final hearing are identified; and, the range of penalties that may be imposed are clarified.

The Final Hearing All parties shall have an opportunity to respond, to present evidence and argument on all issues involved, to conduct cross-examination and submit rebuttal evidence, to be represented by counsel or another qualified representative, to

WWW.FLORIDADENTAL.ORG

propose findings of fact and conclusions of law, and to file exceptions to the ALJ’s recommended order (more on this later). TIP: Some lawyers think the ALJs bend over backwards to accommodate parties who are not represented by legal counsel (“pro se”); however, you do not want to represent yourself on a licensure matter.

The hearing is conducted like a bench trial, meaning there is no jury in the room and both arguments of fact and law are directed at the ALJ. Compare this procedure to that of circuit court where facts are decided by a jury and only legal matters are controlled by the judge. TIP: You can waive both opening and closing arguments — and that often happens — but a good lawyer will both open and close in order to persuade the ALJ of the facts and the applicable law.

The records in a DOAH case consist only of: q notices, pleadings, motions and intermediate rulings. q

evidence admitted.

those matters officially recognized.

q proffers of proof and objections, and rulings thereon. q

proposed findings and exceptions.

q any decision, opinion, order or report by the presiding officer. q

all staff memoranda or data submitted to the presiding officer during the hearing or prior to its disposi- tion, after notice of the submission to all parties, except communica-

tions by advisory staff as permitted under s. 120.66(1), if such communications are public records. q all matters placed on the record after an ex parte communication. q

the official transcript.

Look for Part 8 of this series in the next issue of Today’s FDA. This article is for informational purposes only and is not intended to be a substitute for professional legal advice. If you have a specific concern or need legal advice regarding your dental practice, you should contact a qualified attorney.

DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS LOOKING FOR HELP? We can address your concerns in the complex arena of managed care. We also can gather data on problems and create momentum for finding solutions. Contact the FDA Director of Third Party Payers & Professional Affairs Casey Stoutamire: 800.877.9922; 850.681.3629; cstoutamire@floridadental.org

MEMBERS ONLY!

TOP 5 LEGAL RESOURCES

YOU WANT ME TO SIGN WHAT? A Florida Dentist’s Handbook on Managed-care Contracts is a comprehensive reference including information on reimbursement, risk, negotiating, and rights and duties of both parties.

HIPAA & FLORIDA PRIVACY LAW Being fully HIPAA-compliant does not guarantee compliance with Florida law. FDA members have a comprehensive collection of FREE forms that comply with federal and Florida law.

FDA LEGAL FAQS The FDA website houses the answers prepared by the FDA’s experienced legal counsel to our members’ legal FAQs, including: patient records, patient abandonment, advertising and more.

For more information: fda@floridadental.org or call 800.877.9922

ADA CONTRACT ANALYSIS SERVICE This service analyzes third-party contracts, including contracts from

managed-care companies. This service is available at no cost to FDA Find FDA legal resources online at: www.floridadental.org/member-center/member-resources/legal-resources. members. Simply call the FDA for this free service.

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NOVEMBER/DECEMBER 2017

DIDYOU

REMEDIABLE TASKS

INFORMATION ABOUT THE FLORIDA BOARD OF DENTISTRY

Did you know that you will need to register a new user account on the new, upgraded Florida Department of Health, Division of Medical Quality Assurance online licensing and renewal system before you renew your license this biennium?

Your Portal. On Demand. The Florida Department of Health, Division of Medical Quality Assurance (MQA) has launched an upgraded online licensing and renewal system.

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

Step 1 >> Register for a New User Account Visit www.FLHealthSource.gov/mqa-services, select No and click Register to begin the registration process.

Step 2 >> Log into your New Account Check your email INBOX, JUNK, SPAM, CLUTTER and TRASH folders to locate your new account user ID and temporary password. Using your temporary password and user ID provided via email, log into your account. You will be prompted to create a new password for your account.

Step 3 >> Add your License/Application or Apply for a License After you Sign In with your new user ID and password, you will then be prompted to add your license to your account before you can renew. If you are a new applicant, follow the instructions to apply for a license. If you have a current license or pending application, you will need three (3) items:

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

Your social security number

Your date of birth

Your mailing address zip code on file with the Department of Health (Please note that your mailing address zip code can be found on your renewal postcard or your physical license)

Once you have successfully added your license to your account, you will see the Manage My License section on your dashboard. From your dashboard, you can:

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 Illka at donjilkkadds@aol.com or 352.787.4748.

TODAY'S FDA

add additional licenses or applications request a name or status change update your address and add a secondary practice location upload your documents start a new application complete an application you have already started renew your license

Learn from an expert who will walk you through the process of registering for an account and adding your license to your dashboard during a free informational webinar. To register for an upcoming webinar, go to www.FLHealthSource.gov/webinars.

NOVEMBER/DECEMBER 2017

For questions, contact the MQA Customer Contact Center at MQAOnlineService@flhealth.gov.

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Books SHELF

NOW AVAILABLE ONLINE! An FDA-members only benefit! Read reviews of the latest scientific and clinical information, or choose a book from the shelf and write a review. And, keep the book at no charge!

floridadental.org/member-center/publications/books-on-the-shelf

BYLAWS CHANGES HOUSE OF DELEGATES TO CONSIDER BYLAWS CHANGES Following the recommendation of the Florida Dental Association (FDA) Council on Ethics, Bylaws and Judicial Affairs, chaired by Dr. Drew Johnson, the House of Delegates (HOD) will be asked to consider two proposed bylaws changes. The first change would prohibit FDA line officers, trustees and alternate trustees from serving on the FDA HOD. Currently, the FDA Bylaws prohibit FDA line officers and trustees — but not alternate trustees — from serving on the FDA HOD. The text of the first proposed bylaws change is as follows: 2017H-006 [Policy] RESOLVED, that the FDA Bylaws, Chapter VI, House of Delegates, Section 20, Representation, be amended as follows:

Overstrike = Deletion Underline = Addition

SECTION 20. REPRESENTATION The HOD has 103 certified delegates: 100 delegates from the components and one student delegate from each of the three accredited Florida dental schools. FDA line officers, trustees and alternate trustees may not be delegates or alternates to the FDA HOD. The second proposed bylaws change is intended to address contested elections for line officers at the HOD. Last session, the secretary position had an additional nominee, who ran from the floor. The proposed bylaws change will codify the procedures used at that session and incorporate them into the bylaws. The text of the proposed change is too lengthy to include in this notice, but it will be presented in full in the agenda for the next HOD session. The HOD will hold its semi-annual session Jan. 26-27, 2018 at the Tampa Airport Marriot, 4200 George J. Bean Parkway, Tampa, FL 33607. The FDA encourages all members to seek information about this important matter from their district’s delegates to the HOD and their trustees to the Board of Trustees. WWW.FLORIDADENTAL.ORG

TODAY'S FDA

NOVEMBER/DECEMBER 2017

THIRD PARTY PAYER

THIRD-PARTY PAYERS: AN UPDATE ON DELTA DENTAL CONCERNS

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

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

TODAY'S FDA

I always like to say there is never a dull moment when dealing with third-party payers, and I’m sure you would agree with me! Lately, there have been many updates and issues regarding Delta Dental Insurance. First, you may have heard that the California Dental Association (CDA) reached a settlement agreement with California Delta Dental. The CDA initiated the suit about three years ago when California Delta Dental attempted to reduce reimbursement rates without complying with a provision of its contract that required an advance notice and review of any such actions. As a result of this settlement news, the Florida Dental Association (FDA) started receiving many calls and emails asking when the FDA would be filing a lawsuit against Delta. FDA staff researched the issue and reviewed the Delta contracts in Florida, but unfortunately, the contracts in our state are not susceptible to the same claim as the CDA because our contracts do not include the same contractual situations as those in California.

ence. Delta Dental then sent a “very nice response” in which it threatened anti-trust litigation. This was not a veiled threat, and instead should be a cautionary tale to other dental associations, including the FDA. As a result of the FTC v. North Carolina Board of Dental Examiners Supreme Court case, the legal landscape is ripe for anti-trust litigation against state associations. When a group of practitioners gets together to set parameters and influence competitively sensitive decisions (such as dental plan fees, bylaws, etc.) there is a significant anti-trust issue. Dentists cannot engage in “concerted action” to increase or maintain high prices. Now, you might be asking why the dental plans are not subject to the same restrictions. Well, insurance plans are exempt from the requirement. Over the past several years, dentists have been lobbying Congress to repeal the McCarran-Ferguson Act, which allows the insurance plans to potentially overcharge and discuss pricing among themselves in the industry.

Second, the Washington State Dental Association (WSDA) signed a petition to require Delta Dental of Washington to call special meetings of its member dentists to consider and potentially adopt a variety of proposed bylaw amendments that would make Delta more patient and provider driven. The proposal was brought forward at the WSDA’s 2017 Pacific Northwest Dental Confer-

The FDA also has been receiving calls about Delta Dental of Illinois not paying its claims. As you might have heard, the state of Illinois is bankrupt. Delta Dental of Illinois is a self-funded plan, which is funded by the state, and since Illinois is bankrupt, Delta Dental of Illinois hasn’t been paying claims because there is no money to pay the claims with. However, the latest information the

NOVEMBER/DECEMBER 2017

WWW.FLORIDADENTAL.ORG

We can help our members succeed by addressing their concerns individually and getting a resolution for them and their patients.

FDA received is that Illinois now has a budget, and the Illinois State Dental Society (ISDS) executive staff has met with the director of Central Management Services (CMS) and key insurance staff members working with Delta Dental of Illinois. Delta Dental has been processing claims and they are around 15-18 months in arrears. The backlog of reimbursement that is due to dentists and medical providers is far exceeding what the comptroller for the state has in reserves. Therefore, the governor and the comptroller will be having further discussions to determine where this excess money will come from, e.g., other funds/bonds/taxes. Upon a final decision, communications will be made from the governor and comptroller offices to the director of CMS, Delta Dental and ISDS. CMS/Delta Dental has made it clear that they are still currently paying on the backlog of claims and some dental offices have received payments from Delta Dental of Illinois. Please note, if you are in network and have been turning patients away from treatment, you may be in breach of your

WWW.FLORIDADENTAL.ORG

contractual agreement, so please review your contracts. CMS also has made it clear that they would like to have a budgetary amount to distribute soon so that the claim backlog processing can advance. Delta Dental is hand adjudicating the claims, so this backlog will take some time to process and eliminate. Unfortunately, this will be a long process — but there has been some movement. It also was recently announced that Delta Dental launched new plans called the Delta Dental PPOSM Basic Plan and the Delta Dental PPOSM Premium Plan in Pennsylvania, Florida and Texas. If you are a current Delta Dental provider, please make sure you review any correspondence from Delta Dental, as you could be added as a network provider for these new plans. Now time for some encouraging news — in response to the flood of calls from members to the FDA and other state dental associations, the American Dental Association (ADA) recently sent a letter to Delta Dental Plans Association directing them to stop objection-

able practices in explanation of benefits (EOBs) that threaten the doctor-patient relationship. In case you haven’t seen it in your practice, Delta was providing a list of Delta Dental network-participating dentists who might charge less than the nonparticipating dentist they recently sought treatment from, and including unsolicited and unsupported medical opinions from insurance company dentists who were not involved in the treatment. The ADA is working with Delta on this issue, but in the meantime, please let the FDA know if you are still seeing this type of information on your Delta EOBs. At this point, you might be asking, “Well, what can we do to address the Delta issues in our practices?” As the FDA’s director of third party payer and professional affairs, we encourage you to reach out to me to address your issues. While we cannot completely change the insurance industry structure, we can help our members succeed by addressing their concerns individually and getting a resolution for them and their patients.

TODAY'S FDA

NOVEMBER/DECEMBER 2017

10 MILLION HITS! HIGHLIGHTS FROM THE FDA’S SUCCESSFUL DIGITAL ADVERTISING CAMPAIGN

CONNECTING PROSPECTIVE PATIENTS WITH FDA MEMBERS In September 2016, the Florida Dental Association (FDA) and Moore Communications Group launched a successful year-long, statewide digital advertising campaign to support these goals:

targeted prospective patients in Flor Educate ida on how to find an FDA-member dentist and the value of choosing an FDA dentist.

awareness of the FDA and FDA-member  Build dentists among patients. patients to find and see an  Engage FDA-member dentist.

REACHING KEY CONSUMER AUDIENCES During this campaign, we successfully reached and engaged key consumer audiences with multiple ad campaigns featuring targeted creative content and messaging. These ads ranged from the benefits of seeing an FDA dentist to tips for consumers without dental benefits to see FDA dentists. Based on the success of this campaign, the FDA and Moore Communications will continue digital advertising efforts to support our goals:

 reaching targeted prospective patients  connecting them with FDA-member dentists.

150K AD CLICKS

10 MILLION IMPRESSIONS

CLICKING THROUGH TO YOU VISITS to the FDA WEB 107,000 SITE and “FIND AN FDA DENTIST”

WOW! 10.3 % CONVERSION RATE*

90K VIDEO AD VIEWS

landing page (an increase of more than 180 PERCENT in traffic to the FDA website from Facebook). VISITS to Spanish language  21,000 “Find an FDA Dentist” landing page



13,785 CLICKS to the ADA/FDA “Find a Dentist” search

MORE THAN

2 MILLION PEOPLE

REACHED ON FACEBOOK

percentage of people who went to an FDA website or landing page and clicked to “Find a Dentist”

The FDA’s conversion rate, which is one of the most important metrics in gauging a campaign’s success, is better than 90 percent of health care industry organizations. A conversion of more than 5 percent is generally considered good for this industry, while the FDA achieved a 10+ percent conversion.

5 GREAT FDA WEBSITE ENHANCEMENTS It seems that the older I get, the more I try to simplify tasks that can overwhelm me. You almost need a degree to change the radio in your car, make a phone call with a “smartphone” or find your favorite show on TV. I want simple. A Google search page: simple. Ordering necessary items with Amazon, use a dash button or tell Alexa to do it: simple. That was our goal in our website redesign. We listened to members who struggled to find information. We noticed we had an overwhelming amount of information available, yet you couldn’t get what you needed when you needed it most. So, we set out to redesign the website with simplicity and efficiency in mind for the sake of our members. We decided to bring our website in line with the American Dental Association and use a branded web template (BWT) system, which more than 30 states and constituencies are using. What that means: if you look at several states’ websites like North Carolina, South Carolina or Georgia, they all share a common style and structure with our website. That’s where the ease of use, familiarity and simplicity comes in. It also adds the ability of our districts to use this BWT system. Two of them do now — Northeast and Central Florida — with others considering it. It increases brand awareness and consistency. We now can share content between three (and even four — I see you, affiliates) levels of the tripartite more easily.

TECHNOLOGY

INFORMATION BYTES LARRY DARNELL, MBA, CAE

Mr. Darnell is the FDA director of information systems and can be reached at ldarnell@floridadental.org.

I realize this sounds like web-speak and techno-babble, but let me simplify. As a member, you get: q

a unified single-sign on process, one username and one password for three websites.

new features, like a streamlined event calendar, blog and a career center (January 2018)

better visibility for the public to find you using “Find-a-Dentist” features from anywhere

minimal clicks needed to renew, join or donate.

integrated leadership features to make agendas and minutes available quickly.

In short, we’ve made our website simple for everyone. If you use a tablet, a phone or your desktop computer, it all looks and works the same. Advanced search features, streamlined menu structure and one-click options for the most requested information are now available. We know that the public also visits our website, so we have something just for them, too. Take another look at our website at www.floridadental.org and tell me how it can be even simpler for you.

WWW.FLORIDADENTAL.ORG

TODAY'S FDA

NOVEMBER/DECEMBER 2017

PROTECT

YOUR

PATIENT S PROTECT Y

Registration now open: floridadental.org/ddoh

OUR

DENTAL

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2018 DENTISTS’ DAY ON THE HILL MONDAY, FEB. 5

TUESDAY, FEB. 6

Legislative Briefing 6 p.m. • Aloft Hotel, Tactic 3

Capitol Visits Lunch Provided

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A L L I A N C E HOTEL ROOM BLOCK ALOFT HOTEL 200 N Monroe St. • Tallahassee, FL 32301 • Phone: 850.513.0313 Room Block Deadline: Jan. 6, 2018 (rate: $224 with complimentary parking) For more information, contact the FDA Governmental Affairs Office at 800.325.0051 or gao@floridadental.org.

LEGISLATIVE CORNER IS TELEDENTISTRY TELEHEALTH?

Teledentistry is not new. It has been around for many years and has been used in Florida in many of our rural and underserved communities. The most prevalently used terminology for this method of care is telemedicine. So, what is teledentistry? Teledentistry is the modality of linking dental providers to patients remotely through telecommunication technology, digital imaging and electronic health records. This modality of providing care remotely to patients has proven to be beneficial to many groups and individuals who are limited in their ability to access care. Some challenges to accessing care are a lack of reliable transportation to go see a dentist or a physician, or physical restrictions that limit a person’s mobility to go to a dentist’s office for care. Teledentistry is working to address these issues in some areas around the state the way telemedicine has done so with physicians and hospital settings. Even though Florida’s health care system has been actively involved in the field of telemedicine or telehealth, there are no universal standards outlined in statute that govern telemedicine or telehealth and how it has evolved over the years. Even now, there is a growing consensus among health care groups in Florida to start using the terminology “telehealth” as a more universal way to address the variety of health care specialties that could be provided remotely.

LEGISLATIVE CORNER JOE ANNE HART

Ms. Hart is the FDA chief legislative officer and can be reached at jahart@floridadental.org.

To view a copy of the FDA's recommendations for the Telehealth Advisory Council, go to http://bit.ly/2xzaqvX.

During the 2016 Legislative Session, the Legislature authorized the creation of the Telehealth Advisory Council. The council consisted of 15 members, including the Agency for Health Care Administration Secretary Justin Senior and the Department of Health Surgeon General Dr. Celeste Philip. The council was directed to make recommendations intended to increase the use and accessibility of services provided via telehealth. The FDA submitted a letter to the council to help provide guidance as it relates to teledentistry, which can be found at http://bit.ly/2ziWn2e. A full report on the recommendations of the Telehealth Advisory Council was released mid-October. To review a copy of the council’s recommendations, go to http://bit.ly/2xzaqvX. As Florida continues to address innovative ways to help increase access to dental care, teledentistry is a tool that can be used in a meaningful way to help address issues for Florida’s rural and underserved areas.

WWW.FLORIDADENTAL.ORG

TODAY'S FDA

NOVEMBER/DECEMBER 2017

2018 LEGISLATIVE SESSION

ISSUES TO WATCH DURING THE 2018 SESSION The Florida Dental Association (FDA) has filed legislation to reinstate the dental student loan repayment program that started back in the early 1990s. Sen. Aaron Bean (R-Jacksonville) and Rep. Colleen Burton (R-Lakeland) have agreed to file this legislation on behalf of the FDA. SB 764 and HB 369 will create a dental student loan repayment program to encourage dentists to work in underserved areas around the state as a Medicaid provider and be eligible to receive no less than $50,000 per year (up to five years). This legislation is a great opportunity to ensure that qualified dentists are providing dental care to Floridians who may suffer from other medical conditions and may present at a higher risk as opposed to a less trained individual. The FDA also will seek funding for Donated Dental Services (DDS) and community water fluoridation. During the 2017 Session, the FDA was successful in securing $100,000 for DDS and $200,000 for community water fluoridation under the Department of Health’s budget. The funding for DDS is allocated to hire two part-time coordinators (including operation expenses) to coordinate patients’ approval for services and matching them with a volunteer dentist. The funds for community water fluoridation would be used by local governments (cities and WWW.FLORIDADENTAL.ORG

counties) in their efforts to start, maintain or update their systems to supply fluoridation to their water. These funds were approved for only one fiscal year (July 1, 2017 through June 30, 2018); therefore, the FDA will request funding for both programs during the 2018 Session. The funding request for DDS will be $170,000 and the funding request for community water fluoridation will be $200,000. A hot topic that has captured the headlines with national and state attention is prescription drug usage — in particular, opioid abuse. The president of the United States has appointed an opioid commission that has been meeting this summer to recommend strategies to combat the opioid crisis. Additionally, Gov. Rick Scott announced that he will seek $50 million this session to address this issue and has recommended limits on prescribing opioids, in addition to continuing education training on prescribing. Legislation will be filed this session to provide additional controls to help address the concerns around overprescribing by health care providers. The FDA will be monitoring this legislation and any impact on organized dentistry. Another issue gaining attention in Florida is the establishment of a den-

tal mid-level provider, called a “dental therapist.” There are out-of-state foundations and individuals targeting states to push this model. Because the FDA feels strongly that all Floridians deserve the highest standard of dental care from a fully trained dentist, we do not support this well-intentioned but misguided approach to improving access in Florida. Unfortunately, these groups and individuals often distort and criticize the position of the FDA, as well as the American Dental Association, for not supporting dental therapists. However, as a membership organization, the FDA supports and promotes evidence-based policies proven to achieve positive health outcomes for our patients and all Floridians. From the list of issues outlined in this article, legislators will have their hands full with many important decisions to make. As the state recovers from all the damages from the recent hurricane, the state’s budget will be challenged and every item will be carefully scrutinized. This session will have several items that will take center stage. FDA staff will be at the Capitol monitoring all activities and will keep you up to date on issues impacting dentistry.

TODAY'S FDA

NOVEMBER/DECEMBER 2017

UPDATES FOR MEMBERS *PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.

FDA Past President Died Dr. Charles W. Fain Jr., 95, of Daytona Beach, died Sept. 8, 2017. He attended The Citadel, University of Georgia and graduated from Emory University School of Dentistry in 1945. He immediately entered the U.S. Navy Dental Corps. Upon release from active duty, he practiced dentistry in Winter Haven, Fla., for three years before being recalled to military service in 1950 and assigned as a dental officer to the First Marine Division in Korea. For his participation, Dr. Fain received two Presidential Unit Citations, the Bronze Star and a Gold Star in lieu of the second Bronze Star, five Battle Stars, Korean Service Ribbon and the Korean Presidential Unit Citation. In 1952, he returned to Daytona Beach and established a dental practice limited to pediatric dentistry. In addition to his growing practice, he was active in local, state, national and international dental societies, and was a member of most of the associations related to his professional field. He is a past president of the American College of Dentists, Florida Dental Association, Central Florida District Dental Association, Volusia County Dental Association, Florida Society of Dentistry for Children, Florida Society of Pedodontists and Southeastern Society of Pedodontics. He also was a fellow for the International College of Dentists, American Academy of Pedodontics and the Royal Society of Health (England), and was a director for the Florida Academy of Dental Practice Administration,

TODAY'S FDA

and the Florida Dental Political Action Committee. Dr. Fain retired from dental practice in 1987.

Volunteers Needed To Help Change a Life Florida Donated Dental Services (DDS) program, is a program of Dental Lifeline Network • Florida. The program helps provide comprehensive dental treatment for people who are elderly, have a disability or are medically fragile, and is operated in partnership with the Florida Dental Association (FDA). Join other FDA DDS volunteers to help some of Florida’s most vulnerable residents who have no access to dental care. More than 583 people statewide are waiting for treatment and DDS is unable to accept any more applications in most Florida counties because of the long waitlist. You can help by treating one patient per year or as many as you choose. Volunteering is easy. You review the patient profile in advance, choose to see or decline any patient, and determine your own treatment plan. You see patients in your own office and never pay lab costs. DDS Coordinator Megan Manor screens patients to determine eligibility, handles the paperwork, serves as liaison between your staff and the patient, and arranges for assistance from specialists and laboratories. You can help change a life. To volunteer visit: WillYouSeeOne.org.

NOVEMBER/DECEMBER 2017

Health Insurance Open Enrollment Began Nov. 1: The FDAS Health Care Enrollment Center Can Help You Sign Up for Health Insurance! Do you need to buy health insurance for yourself, your family or your practice during the 2017-2018 open enrollment period? The FDA Services Health Care Enrollment Center is here to walk you through the process and make signing up for health insurance easy and painless. Our insurance experts will lead you through the often-confusing landscape of the open enrollment period and help you find the coverage that is right for you at the best possible price. You can purchase coverage with a Jan. 1 effective date from Nov. 1 to Dec. 15, 2017, so give us a call at 800.877.7597 to speak to one of our licensed agents about your health insurance needs!

Save the Date for FDC2018! Join us June 21-23 for the 2018 Florida Dental Convention (FDC) at the Gaylord Palms Resort and Convention Center! We are excited to bring you distinguished speakers and courses for the entire team on hot topics including special needs patient care, dental coding, ethics in treatment planning and much more! Remember, being a Florida Dental Association (FDA) member has its perks — pre-registration is FREE and there are more than 18 hours of

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FREE continuing education (CE) to take advantage of. Stay in the middle of the action and reserve your room early for FDC2018 at the Gaylord Palms Resort and Convention Center! The room rate is $196 per night, including free self-parking. Go to http://bit.ly/2yHwFUw or contact the hotel directly at 407.586.2000 to make your hotel reservations today.

Gov. Scott Appoints Three to Board of Dentistry On Oct. 25, Gov. Rick Scott announced the reappointment of one and the appointment of two to the Board of Dentistry. Dr. Nicholas Kavouklis, 58, of Tampa, is the president and chief executive officer of Argus Dental and Vision Inc. Dr. Kavouklis received his doctor of dental medicine from the University of Florida. His appointment fills a vacant seat for a term beginning Oct. 25, 2017 and ending Oct. 31, 2018. Catherine Cabanzon, 56, of West Palm Beach, is a dental hygienist at Advanced Dentistry South Florida. Cabanzon received her dental hygiene degree from Palm Beach Community College and her bachelorâ&#x20AC;&#x2122;s degree from Saint Petersburg College. She is reappointed for a term beginning Oct. 25, 2017 and ending Oct. 31, 2020. Fabio A. Andrade, 58, of Weston, is the managing director for FAAC Consulting, LLC. He succeeds Tim Pyle and is appointed for a term beginning Oct. 25, 2017 and ending Oc. 31, 2020. These appointments are subject to Senate confirmation.

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Books on the Shelf Take advantage of this FDA memberonly benefit! Review the latest scientific and clinical information for us and keep the book at no charge! If you are interested in reviewing a book, go to floridadental.org/member-center/publications/ books-on-the-shelf to choose a book or read a review.

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 Mihran Asinmaz, West Palm Beach Lloyd Beaufils, Davie Vibhor Bidkar, Royal Palm Beach Summer Borges, Coral Springs Denise Brady, Margate Harold Brooks, Vero Beach Robert Cherry, Sunrise Sharon Davis-Browne, North Palm Beach Uttma Dham, Plantation Allison Driscoll, Jupiter Michelle Emile-Naguib, Lake Worth Jeremy Farbman, Boynton Beach Miguel Ferrer, Greenacres Robert Fish, Tamarac Seth Gilson, Pompano Beach Anthony Gragg, Fort Lauderdale Ina Griffin, Davie Yousaf Gul, Coral Springs Jaclyn Harden, North Palm Beach Michael Hennessy, Boynton Beach Manal Hilali, Sunrise Patrick Hoy, Sebastian Julia Joh, Pompano Beach Elizabeth Kossak, Plantation Jack Krauser, North Palm Beach Rachel Kwal, Boca Raton Rene Landa, Plantation Raymond Lee, Boca Raton Randi Levine, Pompano Beach Fabiola Liendo, Coral Springs Kevin McCaffrey, Plantation Aysha Momin, Lantana Janise Morales, Miami

TODAY'S FDA

In Memoriam The FDA honors the memory and passing of the following members: James A. Harrison Pagosa Springs, CO Died: 8/29/17 Age: 70 Armando Blardonis Weston, FL Died: 9/7/17 Age: 52 Charles W. Fain Jr. Holly Hill, FL Died: 9/8/17 Age: 95 Christina M. Martin Tampa, FL Died: 9/12/17 Age: 57 James A. Taylor Ormond Beach, FL Died: 9/30/17 Age: 81 Liliana Mosquera, Davie Tahimara Perez, Lake Worth Amjad Pirzada, Wellington Carly Polin, Boca Raton Jason Portnof, Davie Sharon Robinson, Plantation Mayra Rodriguez, Boca Raton Nohora Rodriguez, Sunrise Michael Rowe, Sebastian Ronald Rubin, Boca Raton Marisol Ruiz, Boca Raton Tatiana Santiago Herzog, Fort Lauderdale Emon Skaff, Plantation George Soropoulos, Boca Raton David Sutton, Wellington Burak Taskonak, Fort Lauderdale Ronald Taylor, Boca Raton Tamara-Kay Tibby, Boca Raton Lewis Towsky, Delray Beach Mark Turner, West Palm Beach Jenee Ware, Vero Beach Vanessa Watts, Davie Jennifer Westcott, Palm Beach Gardens Sasha Winderbaum, Delray Beach Max Zaslavsky, Fort Lauderdale

SEE PAGE 24 NOVEMBER/DECEMBER 2017

UPDATES FOR MEMBERS FROM PAGE 23

Central Florida District Dental Association Maria Aguilar, Gainesville David Akkara, Orlando Luis Alcalde Presedo, Winter Garden Ludmics Antonos, Winter Garden Susanne Baaqee, Ocoee Eleonora Bakiri, Gainesville Monique Belin, Ocala Paayal Bhakta, Brooker Mauricia Brown, Gainesville Troy Brown, Coleman Shaun Bullard, Ocala May Chen, Kissimmee Andrew DaCunha, Winter Park Joseph Delmond, Gainesville Richard Donatelli, Gainesville Cassandra Dorsey, Merritt Island Mark Falco, Lake Mary Stephanie Ferreira, Orlando Desmond Foster, Gainesville Erik Garcia-Aranguren, Inverness Susan George, Oviedo Emilia Godoy, Windermere Alyson Golomb, Orlando Diana Gomez, Orlando Eliana Grady, Maitland David Hernandez, Melbourne Susan Jacquot, Orlando Mitesh Jivan, Mount Dora Carlos Johary, Longwood John Kim, Ocoee Thomas Kim, Lady Lake Daniel Koren, Orlando Sadesh Kumar, Melbourne James Logsdon, Oviedo Juan Lopez, Orlando Bruna Lounsberry, Orlando Jeffrey Mabry, Melbourne Asma Mamsa, Clermont Kevin Marvin, Port Orange Ramzi Matar, Winter Park

Clarissa Morales, Melbourne Ammar Mousa, Wildwood Michael Murphy, South Daytona Chitra Nagaraj, Ocala Vivek Nerikar, Newberry Sonia Nguyen, Orlando David Nguyen, Altamonte Springs Rosana Nikfar, Orlando Christopher Nowacki, Melbourne Beach Justin Palmer, Orlando Thomas Parham, Ormond Beach Jesus Perez, Clermont Marco Pinto, Melbourne Anitha Prasanna, Titusville Lauren Price, Clermont Sandra Puerto, Leesburg Will Ratliff, Newberry Leidy Riano, Winter Springs Margarita Rivera, Orlando Jose Rodriguez Lantigua, Oviedo Ashley Romine, Eustis Camille Rose, Orlando Monica Ross, Orlando Richard Rozensky, The Villages Glenn Rudolph, Gainesville Stephen Ruso, Melbourne Kimberly Service, Orlando Janice Sistrunk Carlton, Kissimmee Derek Slosser, Winter Park George Sonbol, Orlando Molly Stanford, Ocala Kenya Storr-Jones, Fruitland Park John Thousand, Palm Coast Jessica Trombetta eSilva, Ocala Mark Tuberoso, Daytona Beach Abigail Tubio, Altamonte Springs Monica Varela, Kissimmee Stephanie Vinokur, Orlando Sandra Wasif, Oviedo Charles Widmer, Gainesville Elsa Wittbold, Ormond Beach

Northeast District Dental Association Kathryn Antony, Jacksonville Andrew Calhoun, Jacksonville Naderge Chery, Jacksonville Lauren Crawford, Jacksonville David Donelson, Marietta Alexander Fetner, Jacksonville Steven Freeman, St. Augustine Jeannette Hanna, Jacksonville Ashley Harris, Jacksonville Matthew Henry, Jacksonville Beach John Joyner, Jacksonville Stephanie Mapp, Orange Park Adam Morrell, Jacksonville Tuyet-Minh Nguyen, Jacksonville Jong-Yun Park, Jacksonville Renee Schulte, Fleming Island Eric Serrano, St. Augustine Camden Smith, Yulee Jason Speigel, Jacksonville Frederico Tepedino, Jacksonville Qi Wang, Ponte Vedra Beach Scott Yorko, Jacksonville

Northwest District Dental Association Briano Allen, Tallahassee Julia Baty, Broken Arrow Chinara Garraway, Havana Nicklaus Heath, Pensacola George Jusu, Tallahassee Marcial Lopez, Monticello Viraj Manocha, Tallahassee Patricia McKie, Pace Gina Nicoloso, Tallahassee Trae Pappas, Panama City Patricia Salter, Bonifay Kevin Sanders, Tallahassee Rajiv Tuladhar, Navarre

A GREAT TIME WITH GREAT MUSIC! 1. BEST TIME: The Tobacco Rd. band at the last Florida Dental Convention at the Gaylord was a great time with great music. The bourbon tasting fundraiser in Tampa for the FDA Foundation was a blast. I now know our delegation knows it’s bourbon!

2. MOST VALUE: FDA annual meeting in Orlando! 3. SAVINGS: About $2,500. — Dr. Craig Kara • Vice chair of FDA Council on Dental Benefits and Care, Indian Harbour Beach

TODAY'S FDA

NOVEMBER/DECEMBER 2017

WWW.FLORIDADENTAL.ORG

Timothy Vola, Tallahassee Connie Vu, Tallahassee Rachelle Wells, Monticello

South Florida District Dental Association Enrique Acosta, Miami Isabel Acosta Valdes, Miami Lina Aguilar, Miami Jossue Alfonso, Miami Anna Aller, Coral Gables Jenny Bello, Davie Eduardo Cabrera Viera, Miami Angela Cala Morales, Miami Helen Carmenate, Hialeah Rene Cedeno, Miami Coral Cohen, Cooper City Mehrdad Daneshgar, Coral Springs Sofia Fontecilla, Miami Luz Franco Taveras, Coconut Creek Liscary Fuertes-Rufin, Miami Lakes Jans Gandul-Cabrera, Miami Delia Garcia Pino, Doral Daniela Gomez, Coral Gables Susana Gonzalez, Miami Lakes Sutnamis Gonzalez, Miami Aixa Guzman, Hollywood Azin Haghighi, Pembroke Pines Norys Hayes, Key Largo Jared Helfant, Hollywood Liliam Hernandez, Pembroke Pines Seanica Howe, Key West Adel Khatib, Davie Hakan Kinaci, Pembroke Pines Robert Liebler, Hialeah Maribel Lopez, Miami Grace Lopez, Fort Lauderdale Amy Martinez, Miami Karen Martinez, Miami Vivian Menendez-Llera, Hialeah Sandra Miller-Sheriff, Hollywood Moneeze Mujtaba, Pembroke Pines Mustafa Naif, Miami Melissa Obrochta, Hialeah Paulo Oliveira, North Miami Beach Fabiola Ortega, Miami Carrigan Parish, Miami Lidia Paz, Homestead Fred Pedroletti, Miami Ravi Ramjit, Miami Cecilia Rey, Miami Christina Reyes, Hialeah

Omarys Reyes Velazquez, Miami Sandrine Riboul, Miami Lindsay Ringdahl, Miami Valeria Roa Canal, Coral Gables Yailin Rosario Orellana, Miami Springs Julian Ruiz Rodriguez, Miami Eddy Sedeno, Miami Springs Maria Segrera, Pembroke Pines Martin Swartz, Hallandale Beach Myriam Taveras, Weston Violeta Trenkova, Homestead Lisset Valdes Castellanos, Miami George Vazquez, Miami Rafael Vera, Miami Michelle Webb, Miami Tosha Williams, Pembroke Pines Thomas Zurfluh, Davie

West Coast District Dental Association Kathryn Aasen, St. Petersburg Archana Antony, Winter Haven Eleanor Apodaca, Lutz Nahal Azizkhani, St. Petersburg Andre Bandeira, Palm Harbor Marnie Bauer, Tampa Christopher Beach, Dunedin Roberto Bellegarrigue, Tampa Magied Bishara, Tampa Catalina Botero, New Port Richey Walter Bowlin, Tampa Joseph Breig, Tampa Carlos Breton, Tampa Angela Butala, Tampa Jade Carter, St. Petersburg Cesar Chilmaza, Tampa Caroline Dau, Seminole Alexsa Davila, Winter Garden Houman Dehdashti, Punta Gorda Vivian DeLuca, Lutz Michael Derakhshan, Brandon Jeffrey Dolle, Tampa Frederick Eck, Bonita Springs Paul Erben, Bradenton Chelsea Farrell, Sun City Center Danielle Fernandez, Tampa Xhoana Gjelaj, Trinity Gary Gordon, Naples Adam Gromak, Brandon Steven Guelff, Sebring

Dylan Hagerty, Tampa Ioannis Helidonas, Port Richey Jordan Hester, Naples Alison Heusner, Sarasota Viet Ho, Lakeland Zahida Iqbal, Oldsmar Jaih Jackson, Bradenton Jonathan Johnson, Lakeland Danielle Jones, Tampa Francis Lugo, Tampa Jason Mach, Lutz Mauricio Martinez, Cape Coral Ashley Massey, Spring Hill Nathan Miller, St. Petersburg Nausheen Mirza, Tampa Ramy Mousa, Bushnell Omar Mubarak, Zephyrhills William Mueller, Brandon Jennifer Naoom, Land O’ Lakes Leslie Nevarez, Riverview Yen Nguyen, Lutz Eunice Nieves Vachet, Bradenton, Maidelys Oliva, Naples Marc Ottenga, Bradenton Heather Palmer, Cape Coral Ami Patel, Tampa Remal Patel, St. Petersburg Phong Phane, St. Petersburg Krystal Reyes Viruet, Fort Myers Jaclyn Rivera, Tampa Walter Robison, Naples Peter Rodenbostel, St. Petersburg Manu Sachdev, New Port Richey Shahab Samimi, Tampa Pooja Sandesara, Bradenton Neil Seaver, Tampa Kim Shaw, Bradenton Omari Sheehy, Seffner Anna Simeoni, Tampa Sarah Soltau, Plant City Douglas Stilian, Port Charlotte Sheetal Suryawanshi, Tampa Jason Swartz, Sarasota Shabnam Tehrani, New Port Richey Edgardo Toro, Tampa Kevin Van, Clewiston Karen Varone, Lakewood Ranch James Vellis, St. Petersburg Joseph Vu, Parrish Brant Wade, New Port Richey Chad Waltz, Tampa Edward Williams, Lakeland

ALL THE FREE CE! 1. MOST VALUE & SAVINGS: There are so many benefits to being an FDA member! If I had to pick the one that I value the most, it would be all the free continuing education we can access — whether it is online at the FDA website or free CE classes offered each year at FDC in Orlando. — Dr. Susan Byrne • FDA House of Delegates;Vice Chair,FDA Council on Membership; Tallahassee

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TODAY'S FDA

NOVEMBER/DECEMBER 2017

Member Milestones 26

TODAY'S FDA

The Florida Dental Association (FDA) would like to recognize its life members and those who have belonged to the association for 60, 50, 35 and 25 years. Each member listed below has been mailed a special membership pin. The FDA congratulates these members and thanks them for outstanding personal commitment to the association and the dental profession. Please note: The names listed below are those who have reached the milestone during the current membership year.

Life Members Marc Alfant Gary Alvo Satish Ankalikar Howard Bell William Belton Antonio Benitez Denton Birch Dayn Boitet Victoria Bong-Krueger Robert Bousquet Florian Braich Eugene Brinkley Leonard Britten Randall Brown Kent Brown Frank Cervone Timothy Chatterley William Clement Dennis Dalton John Darby Edwin Delz Glenn Dibartolomeo W. Padge Dorne Stuart Dropkin Brendan Dwyer Lindsay Eastman Claude Edwards Jeffrey Eisner Polly Eldridge Donald Elsman Robert Farbman Geraldine Ferris Phillip Forbes Charles Ford Patricia Francisco Tomas Frankel Lee Friedel Joel Garblik D. Georgina Garcia Craig Gassett Elizabeth Gesenhues Michael Gioia Michael Gmitruk Franklyn Gober Bruce Goldman Francisco Granda James Haddix Robert Hawkins Thomas Hills William Holth Fahey House Alfred Huber

NOVEMBER/DECEMBER 2017

Harry Insko Brian Jacobus Gary Kaplan Suraiya Kasu Stephen Katz Thomas Klement William Kochenour Samuel Kretzschmar Robert Lalane E. Joseph LeCompte Mark Levinsky Gary Lind Deborah Lubell Richard Lubell John McCombs Michael McRoyan James Melzer Lina Miranda Yolanda Mitchell Arthur Molzan John Murrell Robert Murrell James Nabors Roy Nakaiye Alexander Nurell Gary Ozga Timothy Parker Marshall Pepper Donald Picard Thomas Porter Gerald Pyser Subhash Rege Charles Reinertsen David Rockey Harvey Rosa Paul Rubenstein John Salatino Elias Sargi Bruce Schaeperklaus Blair Scharf Bradley Schiff Steven Serkin Tommy Sexton Surendra Solanki Carol Stewart Neil Stringer Henry Sweeny Elijah Tillman Curt Urban Undavadi Vasudev Daniel Velinsky Kerry Waldee Michael Walker Franklin Watson

Peter Weaver David Weiner Steven Weissman Paul Werner Gary Yanowitz Thomas Yoho J Zerulik Arnold Zusselman

60-year Members Kermit Adkins Edward Anderson Gilbert Bardfeld John Beane William Brodie George Brooks Livia Buck Deuel Christian Robert Cornfeld Donald Crawford Richard Ehlers Irwin Ennis Robert Foster Jack Giles Robert Iler William Jacobs Albert Jordan Richard Karlson Don King Conrad Kusel Olga Lujan Jacob Maldonado Carl Mallick John Marshall Malcolm Meister Robert Miessen Samuel Miller M Paul Nestor Thomas Parker Harvey Peretz Richard Powell Vincent Puleo Ronald Ridge Carl Rosebrough James Ross Richard Smith Robert Uchin Eddie Waldheim Isadore Weinstein Richard White Robert Yackee

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50-year Members Richard Adams Carlos Baro Albert Bauknecht Howard Berman Richard Bostyan Robert Bowman Norman Browner Lawrence Cook George Dorris Leonard Efrom Richard Gray John Griffin Stephen Grussmark Ben Hargett Robert Hart William Hill William Johnson William Kent Leonard Kessler Benjamin Lacy Harold Levine Jerry Linder Frank Lombardi Paul Marchand Roberto Perdomo Samuel Perlman William Peterson Raymond Pirino Wayman Price Joseph Rosaler Wayne Shepherd Gerald Springstead Melvyn Taylor Franklin Ward Robert Watkins John Williams George Woodruff

35-year Members Mark Abood Douglas Andrews Bradley Bartel Charles Beck John Belcher Joseph Bender Gery Benza Stephen Blank Terry Blanks Gabor Bodnar Pearl Burns Stephen Carpenter Michael Chanatry Sidney Christie Milton Clement Edward Cronauer

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Charles D’Aiuto Matthew Davis Leonard Drazek Robert Ettleman Randy Feldman Mark Fowler Faustino Garcia Jay Garlitz William Glenos Laurie Gordon-Brown Shaun Graser Mark Grumet Randy Guelpa William Hale John Haley Michael Harper Charles Hoffman Timothy Hope Thomas Hunter John Hyatt Don Ilkka Robert Karol Robin Katzman Marian Keefe Paul Kennedy Dan Knellinger Ira Lelchuk Jose Lopez-Lloreda Mark Luger Gregg McNeal Rita Medwid Arturo Mosquera Basappa Mruthyunjaya Matthew Nieber Gary Palsis Stanley Parker Charles Peter Martin Polin Louis Popiel Edward Quinn Paul Rang Angela Rasmussen Richard Rasmussen Steven Reynolds Michael Robbins Michael Rosengarten Andrew Ross Hermann Schulze Seth Shapiro Alan Slootsky Robert Smith Jeffrey Smith Robert Spoont Richard Staller Christopher Starr Gary Stevens Charles Thomas Marc Tindell Dieu Tran-Hoang Manuel Vilaret Bruce Waterman Willard Watson Sterling Watson Richard Westberry

Dewitt Wilkerson Craig Wood Davis Yates

25-year Members Gilda Alonzo Michael Andersen Maria Aragon Deborah Austin-Brown Gregory Bello Mayra Betancourt Jeffrey Bilotti Katie Boehly John Bonner Debra Bowers Janice Brand Lisa Brewer Bruce Buhrow Evelyn Caballero Jack Campbell Jacqueline Canizales John Capriccio James Carreiro David Carroll Alicia Carroll Frank Casella Oscar Castro Richard Caudill Joseph Chasko Rashmi Chhadva Leo Chin Stephen Cochran Jacqueline Cogan David Cohen Brian Coleman Ralph Collazo John Conti Andrew D’Amelio James Davis Margaret Dennis Todd Denson Phillip Drlicka Paul Eckstein Jeffrey Ellenberg James Frazier Jay Gelman Craig Georgiades Ira Goldman Christine Grant Mark Greskovich Gregory Groshan Sharon Haas Mark Halek Richard Hall Jon Hall Lawrence Handley Mitchell Hantman Claude Harris Rex Harrison Alan Hecht

TODAY'S FDA

Manon Hutchison Scott Imray Mary Isaacs Richard Jackson Lucien Johnson Philip Jones Mitchell Josephs Larry Kawa Terry Kelly Loyd Kiernan Peter Krimsky Gary Lease Theodore Lerner Margaret Lessig Stephen Lester Vagn Lindhardt Joan Lynch Susan Mackenzie Jose Martinez Peggy Mason Steven Mautner William McGrady Dan McSherry Maria Mezcua Azita Moosavi Steve Neyer Thomas O’Connell Craig Oldham Richard Oliver Ramon Ortiz Roberto Perdomo David Petrik Thomas Plunkett Elisa Ramirez Susan Rand Clive Rosenbusch Eric Ross John Russo George Sanchez Paul Schloth Craig Segal Ann Setkowicz Dennis Sevel Jeffrey Sevor Randall Shults Thomas Silver Jay Singer Kirk Solberg Louis Spelios Barry Stevens Neil Stevenson Hani Tadros Suzanne Thiems-Heflin Leslie Thompson Dorothy Tiberii Kathy Tyler Barry Weber Nancy Wiley T. Merrell Williams Shirin Yasrebi Alida Zayas

NOVEMBER/DECEMBER 2017

ON THE

MOVE! DECEMBER 2017

NEW ADDRESS

SAME PHONE NUMBERS

NEW ADDRESS FDA Services 545 John Knox Road, Ste 201 Tallahassee, FL 32303 800.877.7597

NEW ADDRESS Florida Dental Association Headquarters & FDA Foundation 545 John Knox Road, Ste. 200 Tallahassee, FL 32303

SAME ADDRESS Florida Dental Association Governmental Affairs 118 E. Jefferson St. Tallahassee, FL 32303 800.326.0051

800.877.9922

DENTAL LICENSE RENEWAL DEADLINE

New! Mandatory Survey Complete the surveys!  Telehealth Survey — Mandatory: No License will be issued without it!  Dental Workforce Survey — Voluntary: Provides valuable information

about the state’s dental health needs. QUESTIONS? CONTACT THE FDA AT 800.877.9922 OR FDA@FLORIDADENTAL.ORG. 28

TODAY'S FDA

NOVEMBER/DECEMBER 2017

WWW.FLORIDADENTAL.ORG

DR. RICK HUOT

Dr. Rick Huot and wife, Joanne, attend the American Dental Association National Convention in Atlanta, Georgia.

CONGRATULATIONS, DR. HUOT! Florida Dentist Elected ADA’s Second Vice President Dr. Rick Huot, a general dentist and practice management consultant in Vero Beach, Fla., was elected second vice president of the American Dental Association (ADA) during a meeting of the ADA House of Delegates (HOD) in Atlanta. The ADA Board of Trustees (BOT) formulates and reviews policies and programs, and makes recommendations to the members of the ADA HOD. As a member of the ADA BOT, Dr. Huot will play a major role in the ADA’s efforts to be America’s leading advocate for oral health. An ADA member for 35 years, Dr. Huot has served in many leadership positions within the association, including 21 years as a delegate to the ADA HOD. After three years of active duty in the U.S. Air Force Dental Corps, he spent the initial years of his career in Maine, and is a past president of the Maine Dental Association. He later relocated to Florida, where he practiced dentistry for 14 years. He has served as president of the Atlantic Coast District Dental Association, and currently is on the Florida Dental Association BOT.

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TODAY'S FDA

NOVEMBER/DECEMBER 2017

No One Pays Greater Tribute

TO DENTISTS. Program Highlights

Exclusive credit for your first 3 years of practice!

▸ 5% FDA Member Discount ▸ 5%-10% No Loss Discount ▸ Cyberguard included at $50,000 of coverage ▸ Dividend Plans - For the past 5 years, The Doctors Company has rewarded eligible members with a 5 percent dividend each year. Members receive dividends on their annual premiums. ▸ Occurrence and Claims-Made Policies now available!

Call us at 800.877.7597 to get started with Professional Liability Coverage from The Doctors Company.

www.fdaservices.com

REWARDING DENTISTS IS ONE WAY WE’RE TAKING THE MAL OUT OF MALPRACTICE INSURANCE The Doctors Company is committed to transforming the malpractice insurance industry. That’s why we’re evolving our role to become an entirely new kind of partner, thought leader, and relentless defender. One that’s dedicated to helping our members focus on what they do best— delivering care. That’s what we call dental malpractice insurance, without the mal.

10937A_Tribute-10th_InfoG-WHITE_PartialOutline_Dental_082917m2.pdf

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2:56 PM

TRIBUTE BALANCE FOR FLORIDA DENTISTS.

$7 MILLION

to dentists.

AVERAGE ANNUAL TRIBUTE BALANCE INCREASE.

10 PERCENT

are not offered by any other dental malpractice insurer.

LICENSE = LIVELIHOOD At the FDA, we know how important maintaining your dental license is to your livelihood. The biennium deadline for renewing your license is Feb. 28, 2018.

Top 3 ways we safeguard

your license

1. BOARD OF DENTISTRY (BOD) LIAISON AND STAFF SUPPORT – Dr. Don Ilkka and Casey Stoutamire, Esq., Director of Third Party Payers and Professional Affairs, are your direct connection to the BOD by attending all the BOD meetings and working closely with BOD members and staff. 2. CE BROKER – Any CE earned from the FDA is automatically reported to CE Broker on your behalf. The basic CE Broker account is free, but FDA members may upgrade at reduced rates using a Crown Savings special code obtained by calling 850.681.3629. 3. LICENSE EXPIRATION REMINDERS – Here’s one right now! Between now and Feb. 28, 2018, we will be pushing out constant reminders to members who have not yet renewed their license.

NEW! FOR 2018 RENEWAL

2 SURVEYS RENEW!

1. DENTAL WORKFORCE SURVEY – Although voluntary, please complete this important survey that captures critical workforce data regarding the state of the profession. 2. TELEHEALTH SURVEY – For your license to be renewed, YOU MUST COMPLETE THIS MANDATORY TELEHEALTH SURVEY.

THE ONLINE LICENSE RENEWAL opened at the end of November.

Visit http://www.flhealthsource.gov/mqa-services.

WHAT DO YOU NEED? DENTAL STUDENT

NEW DENTIST  

 

Help finding a job after graduation Advice from experienced dentists

Help with student loans Help with insurance

DENTAL OFFICE

A voice in the legislature  Advice about patient issues OFFICE  DENTAL High-quality, low-cost CE  Ways to give back  Low cost dental supplies  Leadership opportunities 

ECIFFO LATNED

ALONG THE WAY

DENTAL OFFICE

MID CAREER DENTIST  

EXPERIENCED PRACTIONER

 

Advice about third party payers Free patient mediation DENTAL OFFICE

Financial planning Financial security

DENTAL OFFICE

FDA MEMBER BENEFITS THAT FIT!

WE HAVE IT! 

    

Advocacy for student loan repayment options FDA Mentorship Program ADA Student Loan Refinancing Peer Review ADA Ethics Hotline Dentists’ Day on the Hill



FDA Director of Third Party Payers



Free Pre-registration & CE at 2018 FDC FDA Career Center FDA Foundation volunteer opportunities Leadership in FDA, ADA & local level



FDA Services insurance products

 

What concerns you the most about your future? The short answer is everything – residency, finding a job, and where I will live, to mention a few. Since I only have four years in dental school, I’m trying my best to take advantage of every opportunity to learn, whether through research, volunteering, or investing in clinical time and academics. Overall, I think there are a lot of unknowns in my future and dental school is flying by so quickly that I feel as though all thoughts towards my future have been put on hold while I engage in the present.

What is your best patient interaction, so far?

ARIA SHARMA Dental school/class: University of Florida Class of 2019 Hometown: McLean, Virginia Undergrad school: Barnard College of Columbia University Hobbies/Interests: Reading, baking, and doing the New York Times crossword daily

y interest in dentistry was first piqued by an observership at the UF College of Dentistry Pediatric Dental Clinic during my winter break of my second year of undergrad. A pediatric resident I knew had worked with Dr. Leda Mugayar during medical school and mentioned how working with her might be a fun thing to do over break, since Dr. Mugayar is well-known for being both an excellent clinician and a kind and engaging professor who is always up for a laugh. By the end of my first week, I was hooked on dentistry. Since starting dental school, I’ve worked hard to become an active member of the school community. I am serving my second term as our class Vice President and am the current President of the UF ASDA chapter.

What is the favorite part of your day at dental school? I love our morning huddles. It’s wonderful to get to start each day with my peers and the great faculty leading our TEAM program. Our team leaders relate what we see in the student clinic to their countless years of experience working in the real world. We share what we learned from yesterday’s patients, tips for difficult procedures, celebrate one another’s birthdays, and extol the Gators for their latest victory. I value the opportunity to step back from the early morning rush of preparing for patients and ground myself.

TODAY'S FDA

NOVEMBER/DECEMBER 2017

My first day of clinic, I felt like a fish out of water; taking radiographs, talking to professors, and navigating the organizational system of the stock room verged on being more stress-inducing than taking the NBDE Part 1. My first patient was nothing but kind and encouraging, understanding of the teaching environment of which they had agreed to be part. While the appointment ended up going fine and the patient’s attitude was wonderful, I finished that clinic session feeling unsuccessful and embarrassed. However, I recently saw this same patient back for a second time and they commented on how much I had grown and learned in just a few months — specifically that even the way I held my instruments was more relaxed and confident. That has been the nicest compliment and I’m incredibly grateful to have started my clinical experience with a patient with such an great and supportive attitude.

What kind of practice/residency are you planning on after graduation? I hope to pursue a residency in endodontics and possibly pursue a career in academia. The most important consideration as I progress in my career is to maintain a tie to mentorship and helping others succeed. Science is at its best when there is collaboration and I strive to foster a sense of community and support in helping move our field further.

What is the impact of organized dentistry on your school experience? As someone who started dental school knowing no one in the dental field, organized dentistry has been my lifeline thus far. I rely heavily on the connections made through organizations such as ASDA and the FDA for mentorship and advice. Being part of ASDA and having the opportunity to interact with the FDA regularly have been my most rewarding experiences of dental school. I’m honored and privileged to learn from those who have been in my shoes before.

WWW.FLORIDADENTAL.ORG

DENTAL STUDENT YOUR

BENEFIT

FIT

FDA Mentorship Program

FDA Career Center

FDA campus events

FDA pays for your dental exam professional liablity insurance

FDA Foundation Florida Mission of Mercy

WWW.FLORIDADENTAL.ORG

WHO ARE YOU (ON AVERAGE)?  Millenial generation: one-in-three American workers today are Millennials (adults ages 20 to 36 in 2017)  Gender (Class of 2020): 50.8% female; 49.1% male  Heavy social media user & tech savvy  Single with no children  Excited about doing work that makes a difference  Thinks quality dental care should be expanded to benefit all Americans  Looking forward to a profession of working with hands as well as mind and heart  Work/life balance is important Free

ADA Student Loan Refinancing Program

ADA Success Series

pre-registration & CE at the Florida Dental Convention Advocacy for student loan repayment options

FDA Foundation free & reducedfee patient care

Dentists’ Day on the Hill

TODAY'S FDA

NOVEMBER/DECEMBER 2017

Do you have an important mentor? Dr. Al Tillman was my mentor throughout dental school and continues to give me guidance on a daily basis. I was blessed to be able to join his well-established practice after dental school and could not be anymore pleased with my transition from school to practice. The patients in his practice have graciously accepted me as their new dentist thanks to the way he has reassured them. One of the biggest challenges I have faced in private practice is having to make on-the-spot decisions when treatment planning. Knowing I am working with an experienced practitioner who is there to back me up eases a lot of my stress.

What has been your best patient interaction, thus far?

DR. KAYCEE WILCOX Dental School/Year: LECOM School of Dental Medicine, Class of 2016 Hometown: Bonifay, Fla. Undergraduate school: University of West Florida Hobbies/Interests: Kayaking, going to the beach, antiquing, college sports, and spending time with friends and family

am a Florida native. I have lived less than an hour from the beach my whole life and cannot imagine living in any state but the beautiful Sunshine State. I am known as Kiki to seven energetic nieces and nephews who keep me on my toes. Recently, I got engaged and am currently in full wedding planning mode! After graduation, I joined a private practice in Crestview, in the Florida Panhandle. I grew up nearby and it has been a pleasure serving my community. Growing up in a small town allowed me to understand, first hand, the challenges people have with receiving affordable, comprehensive dental care. Private practice has given me the freedom to be selective with care and to give back through charity cases at my discretion. In addition to private practice, I am a part-time preceptor at LECOM’s outreach clinic in Defuniak Springs. Remaining involved with my dental school enables me to keep informed on the the changes that are occurring yearly.

What is the favorite part of your day in your practice? My favorite part of the day in my practice is when my cases succeed on the first try. Case in point: my crown patient walks in, the temporary crown is removed and the permanent crown is cemented with no adjustments.

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One of my most memorable moments in practice thus far is the fabrication of my first immediate denture for a 65-year-old female patient who wanted to replace missing teeth and restore her smile. All of her remaining maxillary teeth were mobile with most of the teeth non-restorable. We decided an immediate maxillary denture would be the best treatment for now, and she could revisit the idea of implants later. I extracted all of her maxillary teeth and delivered the immediate denture. After her last adjustment appointment, she told me how excited she was to be able to show off her new smile for her son’s college graduation.

Where do you see yourself in 10 years? Ultimately, I see myself as a practice owner of a thriving private practice and free of student loan debt! By this point, I also hope to have established a yearly mission trip event, whether it is within or outside of the country. Perhaps, I will have even met my goal of visiting all 50 states.

How has organized dentistry impacted your first five years of practice? I have greatly benefited from the FDA’s hard work to prevent insurance companies from dictating non-covered procedure prices. Additionally, I enjoy participating in FDA events such as Florida Mission of Mercy. I continue to be amazed at the outcomes after each event. By being involved in organized dentistry, I also am able to unite with dentists from all over the state to stand up for what is right for our profession and make our voices heard. Overall, having the support of the FDA has made me feel less alone in my experience as a new dentist. I have personally called the FDA office about day-to-day practice questions. I feel fortunate to have such a great support system at my fingertips. Organized dentistry has so much to offer! I would encourage any new dentist to join and help make dentistry the best profession. WWW.FLORIDADENTAL.ORG

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NEW DENTIST WHO ARE YOU (ON AVERAGE)? • Out of dental school less than 10 years • Member of Generation X (ages 37 to 52 in 2017) or Millenial generation (ages 20 to 36 in 2017) • Likely married, may have young children • Takes a lot of pride in doing quality work. • Enjoys a dentist’s independence/flexibility • Concerned about student debt • Values advocacy for increased reimbursement rates from dental insurers • Wants ongoing education on new techniques Advocacy for student loan repayment options

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school to help pay for my braces. I was intrigued by the work I saw Dr. Stephen Paige (my orthodontist) do (pouring and trimming models and bending wires) — so much so that he began to show me how to do these things. By the end of the summer, I had progressed to chairside assisting. My fate was sealed from then on! I remained committed to dentistry, although later my interest grew from orthodontics to endodontics during undergrad dental school. I practiced general dentistry for one short year before being accepted to the endodontic program at UFCD. Currently I have three endodontic practices — Ocala, Lecanto and The Villages.

What is your favorite part of your day?

DR. DEMETRICK LECORN Dental school/year: University of Florida College of Dentistry, Class of 2002 Hometown: Ocala, Fla. Undergrad school: University of Miami Hobbies/Interests: singing, running and exercise, traveling, dental mission work locally as well as abroad. (I lead two dental teams per year to Honduras and Jamaica and monthly free clinics in Ocala and the surrounding areas); and teaching. Leadership: American Board of Endodontics Board Certification, 2011; Omicron Kappa Upsilon; Pierre Fauchard Academy of Dentists, Assistant Clinical Professor at the University of Florida College of Dentistry Department of Endodontics, Dental School Admissions Committee at University of Florida College of Dentistry, Faculty Advisor of the Student National Dental Association, former President and membership/recruitment chair for the Marion County Dental Association; member of the American Dental Association, the Florida Dental Association, the Marion County Dental Association and the American Association of Endodontists.

am 41 years old, married with no children but hope to adopt some day soon. I grew up in Ocala, Fla. and was introduced to dentistry at a very early age (16) by my orthodontist who hired me to clean his dental lab after

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The favorite part of my day is meeting each new patient and easing their minds about root canal therapy. My happiest day in practice was when I hired my first associate. I also most enjoy the flexibility of being in a private practice with associates.

Who were your mentors when you were a new dentist? My mentor when I was a new dentist was Dr. Frank Vertucci (the director of my endodontic program at the University of Florida when I was a resident) and Dr. Leandro Britto (my endodotic faculty during my residency, who now is in private practice in Jacksonville, Fla.)

What is your most memorable experience at the Florida Dental Convention? My most memorable experience at the Florida Dental Convention was attending a lecture given by an endodontic classmate of mine (Dr. David Beach, “Endodontics Gone Wild”). It was at that moment I realized we had made it and were legit! We were still students but also now teachers.

What do you wish for/foresee for the future of dentistry? I forsee nothing but great things in the future for dentistry. With all the new advancements in our field, we are saving more teeth than ever before. Specifically, in my field of endodontics — with the microscope and cone beam CT scans, I am now able to save teeth that previously would have been lost. We will continue to learn to save more teeth and I feel before my career in dentistry is over, we will be growing teeth from stem cells.

What member benefit do you value most? The member benefit I most value is the Peer Review process.

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WHO ARE YOU (ON AVERAGE)? • Graduated from dental school before 2007 • Member of Generation X (ages 37 to 52 in 2017) • Likely married with children at home • Strives to do quality work without compromise • Enjoys a dentist’s independence/flexibility • Concerned about student debt • Values advocacy for increased reimbursement rates from dental insurers • Wants ongoing education on new techniques

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Dentistry has provided so many opportunities to be involved and give back in resources, talent, and time. It is truly rewarding. Dentists have such good analytical training that they can assist in areas outside their professional life with their friends, their kids, and the world at different levels.

What is the favorite part of your day with patients?

DR. STEVE TINSWORTH Dental school/year: University of Kentucky College of Dentistry, 1970 Hometown: Bradenton, Florida (raised in Murray, KY) Undergrad school: Murray State University Hobbies/Interests: Golf, fishing, community service and supporting professional organizations Leadership: past president of Southern Association of Orthodontists, Florida Association of Orthodontics and Manatee Dental Society; FDA Legislative Contact Dentist; served as chair of Peer Review; President of Manatee Symphony Guild; President of American Cancer Society Manatee Chapter Honors: 2014 SAO Oren Olivier Distinguished Service Award; FAO Distinguished Service Award 2012; Leadership Spirit Award-2016 from Manatee Community Foundation Spirit of Manatee

have had six different dentists in my extended family. One sister is a dental hygienist and another is a pharmacist. I have enjoyed being involved in my community and giving input to the development of community and professional organizations over the years. Recently I assisted our local Bradenton Kiwanis to provide funding for a dental unit at the homeless clinic named after our local Senator Bill Galvano. We have instituted a Christmas in August program to help homeless kids get backpacks and school supplies along with dental, medical and vision screening. I have lead the dental component since its inception. We now serve more than 400 kids each year.

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The best part of the day is when we get a very positive emotional response to a patient’s treatment. Joy, tears of happiness, shared smiles with a parent and child for the services we have provided as an orthodontic team. Daily we share riddles and jokes with patients, parents and staff to make the day fun.

What advice do you have for a new dentist? The same advice that Bill Gates, Warren Buffet, Steve Jobs use: “Don’t spend more than you make.” Budgeting and saving for the future is very important for the practice and your family.

Most memorable experience at the Florida Dental Convention? Hearing Lee Greenwood sing “I am Proud to be an American” after 2001.

What do you wish for the future of dentistry? I hope that dentists maintain autonomy to practice with their ethics and the best interests of patients foremost in their treatment plan while offering respectful care using evidence-based dentistry for long-term benefits and economic balance.

Which member benefit do you value most? I value the opportunity to meet and share the experiences of practice. Our future will need a factor of positive professional support and reminders about our obligation to society for the privilege of being a dentist. Also, I think the Peer Review resource will be increasingly beneficial to our members. It is economically smart to be an FDA member.

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WHO ARE YOU (ON AVERAGE)? • Graduated from dental school after 1970 • Member of Baby Boom generation (ages 53 to 71 in 2017) • Likely married with no children at home • Strives to do quality work without compromise and maintain high ethical standards • Enjoys a dentist’s independence/flexibility • Concerned about the future of dentistry and how new dentists will manage student debt • Values advocacy for increased oral care for the underserved • Wants advocacy for higher reimbursement rates from dental insurers to continue • Interested in ongoing education on new techniques

FDA Mentorship Program offers an opportunity to create a legacy.

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Quick Email Tips 5 to Keep You Out of Trouble 1.

Never assume that an email is from whom it says it is from. Email can be — and is — easily “spoofed.” A spoof is an email that looks like it came from someone you likely know.

Never blindly click links in any email. No matter if it is from someone you know, your bank, Apple, UPS, FedEx or even your system administrator, you can hover over the link and likely see it is not what it seems to be. If you have a question, call the person or use a separate method to communicate with a company to verify before taking any action. Attachments also can be corrupted, so be extremely cautious of those as well.

Never send information like passwords, your Social Security number, bank information or any other personal data via email. You don’t know who sees it on the other end and potentially while in transit. Unencrypted email is easy to access, even without your email being hacked. Suffice it to say, your email can be “overheard” — similar to someone standing at your door while you are on the phone.

Be extremely cautious when using “Reply All” and forwarding email strings. There may be conversations in the thread that others don’t need to see or may be proprietary. It also may have unintended consequences for other users who use “Reply All” back and didn’t notice all the people on the email.

Often, email can carry a certain tone even if you didn’t mean for it to, so take great consideration before clicking send. It is the same as what you say out loud — once it’s out there, you can’t take it back — and in electronic form, it lives forever.

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PRICELESS Your prestige and credibility are enhanced by your membership in organized dentistry. A unified profession can pool resources to benefit members with services that would be very expensive for individual dentists to pay for on their own. A professional staff works on your behalf full time, providing countless services to help you succeed.

YOUR SIX DISTRICT DENTAL ASSOCIATIONS FOR A COMPLETE LISTING OF YOUR MEMBER BENEFITS, GO TO FLORIDADENTAL.ORG.

Working together, we can be proud of our state and the role the FDA plays in it as the expert in oral health in Florida. â&#x20AC;&#x201D; Dr. Michael Eggnatz

dentistry is A family tradition

GET THE SCOOP ON …

Dr. michael eggnatz fda president, 2017-2018 3

Dr. Eggnatz was born and raised in Hollywood, Fla. and is one of six children born over a period of nine years to Marian and Lee Eggnatz. The fourth child of three boys and three girls, his parents had their hands full raising six children in the 60s in the small beach town of Hollywood. Nestled between Miami and Fort Lauderdale, it was a great place to grow up. He is a third-generation dentist. His grandfather, Meyer, was one of the first orthodontists in Miami Beach and worked with L.D. Pankey. His father was the first pediatric dentist in Hollywood, and spent his career promoting water fluoridation throughout Broward County. Dr. Eggnatz’s siblings are all leaders in their fields. His sister is a hygienist in St. Petersburg in a prosthodontist’s office. Another sister is the clinical director of social work at a large non-profit foundation, also in St. Petersburg. His little sister is a lead CMS investigator for a large company and is tasked with investigating medical fraud.

His older brother is a retired deputy chief of the Davie Fire Department. He was responsible for assisting Homeland Security/fire rescue for Port Everglades and the Fort Lauderdale Airport. His younger brother is a successful commercial painting contractor and community leader, currently serving as president of his Temple in Tampa, one of the largest in the southeastern United States. Dr. Eggnatz received his Bachelor of Science degree from Florida State University and his Doctor of Dental Surgery degree from the University of Maryland. He completed his general practice residency at the Veterans Administration Medical Center and Jackson Memorial Hospital in Miami. He is a Fellow of the American College of Dentists sponsored by past FDA president Raymond Klein, who was the president of the

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PHOTOS

1. Three generations of dentists – University of Maryland School of Dentistry — Meyer Eggnatz ’28, Lee Eggnatz ’58, Michael Eggnatz ‘88 2. Celebrating his FDA Presidency at the FDC Convention 2017 3. Visiting the ADA – Presidents Leadership Conference – Chicago, 2017 4. Dr. Eggnatz, his son, David, at his FSU graduation with his grandfather, Papa Lee Eggnatz, 2013 5. His beautiful children: David & Kristina 6. His dedicated and outstanding staff – Nora, Ayli, Maureen, Laura & Kristina 7. His spouse and best friend for 32 years, Marian 8. His daughter, Kristina at her FSU graduation, 2011 9. Marian & Michael, Wedding Day, 1985

FROM PAGE 45 American College of Dentists at that time. He also is a fellow of the Pierre Fauchard Academy and the International College of Dentists. He is a member of the Academy of General Dentistry and the Florida Academy of Cosmetic Dentistry. He is a past president of the Greater Miami Chapter of the Alpha Omega International Dental Fraternity and past Florida Regent of Alpha Omega. He is a past president of the South Broward Dental Society and the South Florida District Dental Association. He was the general and scientific chair of the Miami Winter Meeting from 2007-2014. He has been a delegate to the Florida Dental Association (FDA) since 1996 and to the American Dental Association (ADA) since 2002, where he represents the 17th District (Florida) to the ADA. Currently, he serves as the President of the Florida Dental Association, and has a private practice in aesthetic, implant and restorative dentistry in Weston, Fla. Dr. Eggnatz has been married for 32 years to his wife, Marian and they have two children, Kristina and David. He enjoys the outdoor Florida lifestyle, which includes the beach, boating and is an avid sports fan.

PRESIDENTIAL FAVORITES HOBBIES: boating, beach , sports, family, collecting old family photos FAVORITE FOOD: shrimp and scallop scampi FAVORITE MEMORY: Hollywood Beach in high school FAVORITE GUILTY PLEASURE: eating vanilla ice cream (lactose free) with chocolate syrup FAVORITE SPORT/SPORTS TEAM: FSU Seminoles, Miami Heat, Miami Dolphins FAVORITE LEISURE ACTIVITY: live sports or concerts FAVORITE VACATION DESTINATION: British Virgin Islands FAVORITE BOOK: The Greatest Generation FAVORITE FLOWER: yellow roses FAVORITE DESSERT: brownies FAVORITE CANDY: Baby Ruth bar FAVORITE DRINK: pineapple juice FAVORITE MOVIE: The Godfather FAVORITE MUSIC: classic rock FAVORITE ARTIST: Eagles FAVORITE PET: our family Maltese dog, Woody

Eggnatz Family Reunion Cruise, 2013

We are entering unprecedented territory in dentistry, in the areas of: dentistry as a part of Medicare; the electronic health record; medical/ dental integration; specialty recognition; and, the discussion of midlevel providers. — Dr. Michael Eggnatz

2018 AWARDS LUNCHEON Join in the recognition of your colleagues. FRIDAY • JUNE 22, 2018 11:30 AM-1 PM FLORIDA DENTAL CONVENTION Gaylord Palms Resort & Convention Center Orlando, Florida

2018 AWARD RECIPIENTS PRESIDENT’S AWARD Dr. Michael Eggnatz

NEW DENTAL LEADER AWARD Dr. Jordan Harper

FDA DENTIST OF THE YEAR Dr. Irene Marron-Tarrazzi

DENTAL TEAM MEMBER AWARD Ms. Elizabeth Martinez

J. LEON SCHWARTZ LIFETIME SERVICE AWARD Dr. Jim Antoon

FDA PUBLIC SERVICE AWARDS Dr. Stephen Krist Dr. Harley Richards

FDA LEADERSHIP AWARDS Dr. Chris Bulnes Dr. Bert Hughes

DANIEL J. BUKER SPECIAL RECOGNITION AWARD Ms. Casey Stoutamire

Individual tickets are $40 or table of 10 for $350 Deadline to purchase: June 1st. Purchase your tickets with your FDC2018 registration beginning March 1st.

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 21-23, 2018

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GAYLORD PALMS RESORT & CONVENTION CENTER I ORLANDO, FLORIDA FDC2018 KEYNOTES  Thursday, June 21  Tom Morrison What’s Your UBER … Are You Ready for 2020?

SAVE THE DATE

JUNE 21-23, 2018

 Friday, June 22  Monica Wofford Make Difficult People Disappear™

FREE PRE-REGISTRATION FOR FDA MEMBERS

BRING YOUR TEAM TO FDC2018

TEAM BUILDING IN A GREAT LEARNING ENVIRONMENT BY DRS. MARY PORTER, TODD McCABE AND IVAN ZAMORA

TFDA: Is this the first year you have taken your entire team to the Florida Dental Convention (FDC)? What made you decide to take them? MP: No, we have taken them many times. The FDC is always informative, fun and extremely important for staff/ team bonding. TFDA: What was the experience as a team at FDC? MP: It was a wonderful team-building experience. TFDA: Did everyone attend the same courses or did you “divide and conquer” what was offered? Why did you feel this was best? MP: We divided and conquered — this way more information is gathered and shared amongst us all.

TFDA: What do you feel was most beneficial at FDC for your team? MP: The team-building aspect in a great learning environment. TFDA: How will you implement what was learned at FDC in your office on a daily basis? MP: We try to review the information learned in our morning huddles. Educating and treating our patients according to the new standard of care is our top priority. TFDA: Would you take your team back next year and if so, why? MP: Definitely! The staff always comes back with a positive and motivated attitude, which benefits the practice and our patients. Drs. Porter, McCabe and Zamora are general dentists in Sarasota and can be reached at MeadowsFront@gmail.com.

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SPE

W E I V E R P AKER

Xerostomia in Patients Living with HIV

MARK SCHWEIZER, DDS, MPH;

Dr. Schweizer is an assistant professor and the director of Development and Special Projects, and the program director for Ryan White HIV Programs at Nova Southeastern University College of Dental Medicine. Dr. Schweizer also is the dental director for the Southeast AIDS Education and Training Center.

GEORGE KOLOS, DMD

Dr. Kolos is an assistant professor at Nova Southeastern College of Dental Medicine. Dr. Kolos is a Florida Dental Association Trustee and a member of the International College of Dentists.

TODAY'S FDA

In the United States, it’s estimated that 1.1 million people are living with HIV. Of those, 1 in 7 do not know they are infected.1 The number of new HIV diagnoses fell 19 percent from 2005 to 2014.1 Because HIV testing has remained stable or increased in recent years, this decrease in diagnoses suggests a true decline in new infections. The statistics in the southern United States are not as promising. In 2015, the South accounted for 52 percent of the 18,303 new AIDS diagnoses in the United States, followed by the Northeast with 18 percent, the West with 17 percent and the Midwest with 12 percent.1 In 2015, the rate of new AIDS diagnoses was 7.9 in the South, 5.9 in the Northeast, 4.1 in the West and 3.4 in the Midwest.1 Of the 6,721 deaths attributed directly to HIV or AIDS in 2014, 53 percent were in the South, 19 percent were in the Northeast, 17 percent were in the West and 11 percent were in the Midwest.1 Florida statistics are more alarming, being ranked first among the 50 states in the number of HIV diagnosis in 2015.2 This year, the number of reported HIV cases in Florida has jumped 23 percent — the biggest increase in a continuing upward trend that began in 2012 after several years of decline. The proportion of Floridians infected with the disease is at its highest in seven years.3 Increases in new infections are present in almost all counties of the state. A review of all counties in Florida shows that the highest new infection rates are in Miami-Dade County with 47 percent, followed by Broward with 41.5 percent, Orange with 35.5 percent and Hillsborough with 30 percent.4

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For the dental profession, the state statistics are of particular importance. In the absence of antiretroviral therapy (ART), oral manifestations are the earliest significant indicators of HIV infection.5 Oral lesions are common (30-80 percent) in patients infected by the HIV virus and may indicate an impairment in the patient’s general health status.6 With new advances in ART, clinical and epidemiological observations have shown a considerable decline in the morbidity of HIVpositive patients. There has been a significant shift in both the type and frequency of oral lesions present in patients living with HIV/AIDS (PLWHA). Patients on ART show a lower incidence of oral lesions including candidiasis, oral hairy leukoplakia and Kaposi’s sarcoma.7 The prevalence of oral lesions has decreased by more than 30 percent since advancements in ART.8 However, there has been an increase in prevalence of caries and periodontal disease. This increase most likely can be attributed to significant findings of xerostomia in PLWHA. Xerostomia is the subjective complaint of oral dryness. This must be distinguished from salivary gland dysfunction, which is an objective disease characterized by reduced salivary flow. Studies have shown that 40 percent or more of PLWHA experience major xerostomia during their disease. Studies of PLWHA with xerostomia show a frequently negative effect on their quality of life.9 Symptoms of xerostomia include: cracked, peeled, atrophic lips; glossitis (Fig. 1); and, WWW.FLORIDADENTAL.ORG

pale, dry buccal mucosa (Fig. 2). Xerostomia can lead to dysphagia, dysgeusia, oral pain of unknown origin, dental caries, oral infections, periodontal disease, angular cheilitis associated with candidiasis (Fig. 3) and can affect the health-related quality of life. These features of xerostomia can lead to the inability of the patient to take necessary medications, and can influence the intake of proper nutrients, leading to malnutrition and a decline in overall health. There are multiple causes of xerostomia from various mechanisms. For example, anticholinergic effects of many medications, alcohol and drug abuse, and damaging head and neck radiation can cause xerostomia. There are many comorbidities from HIV/AIDS, such as cardiac disease, diabetes and mental health disorders, which occurs in PLWHA. As a result, many of the medications â&#x20AC;&#x201D; especially the antidepressants, anxiolytics, diuretics and antihistamines taken for these comorbidities â&#x20AC;&#x201D; lead to xerostomia.

FIG. 1

There are still differing studies of the xerostomic effects of antiretroviral medications used to treat HIV. Antiretroviral drugs are now recommended for all patients with an HIV diagnosis regardless of their immune system status, as ART enables the immune system and works to decrease the possibility of HIV transmission from one person to another. There are currently six classes of drugs used to treat HIV infection, which include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase inhibitors (INSTIs), fusion inhibitors (FIs) and chemokine receptor antagonists (CCR5 antagonists). In most cases, combination therapy includes three drugs to reduce HIV viremia to below detectable levels. A review of current literature suggests a relationship between orofacial adverse reactions related to these drugs classes. In relation to xerostomia, both the NRTIs and PIs have the most significant oral side effect. Howev-

FIG. 2

SEE PAGE 53

FIG. 3

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FROM PAGE 51

er, recent studies indicate HIV-positive patients who are not on ART are more vulnerable to decreased salivary flow rates.10 In one study, ART did not affect xerostomia or salivary flow rates in the studied population group. While low CD4 counts (<200cells/mm3) have been attributed by many authors to being a significant risk factor for xerostomia and hypo-salivation, others did not find this correlation significant.11, 12 More significant in the era of ART is the increase in prevalence of salivary gland disease. Salivary gland disease can arise in 4 to 8 percent of adults and children with HIV.13 HIV salivary gland disease (HIV-SGD) is a distinct disorder characterized by persistent major salivary gland swelling and xerostomia. Most commonly affected is one or both parotid glands, which sometimes will occur without xerostomia. In some cases, salivary gland enlargement may be the first clinical manifestation of HIV infection, but more often a sign of late HIV infection.13 The exact pathophysiology of HIV-SGD origins includes lymphoepithelial lesions, cysts, intraglandular lymph nodes and an inflammatory infiltration similar to what often is observed in Sjögren’s syndrome; however, with distinct histopathologic and serological differences. In the infiltration, there are persistent circulating CD8+ lymphocytosis and diffuse visceral CD8+ lymphocytic infiltration.14 Inflammatory or infectious diseases are the second most common group of salivary gland disorders in HIV disease, followed by neoplastic lesions. Kaposi’s sarcoma can account for 10 percent of malignant salivary gland neoplasms in HIV disease.15

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Treatment of salivary gland enlargement in HIV remains non-specific, but could include aspiration of cystic lesions, superficial parotidectomy to alleviate swelling and external radiation therapy for benign parotid hypertrophy. Reports of xerostomia in HIV-positive patients must be given careful consideration, as the xerostomia most often reflects the adverse effect of ART and/or HIV-SGD.16 Patients must be advised of the risks of caries and gingival inflammation as well as the physiological effects of xerostomia. The goal for the patient is to alleviate the symptoms by increasing the intake of water, sugar-free gum or candies, salivary substitutes or therapeutic management with cholinergic agents. Overlying these treatments must be a careful monitoring of oral hygiene and the use of prescription topical fluorides. Dr. Schweizer will be speaking at FDC2018 and presenting his course, “HIV, HPV and Hepatitis C in the Era of Antiretroviral Therapy for Oral Health Professionals” on Thursday, June 21, 2018 at 9 a.m.

References: 1. https://www.cdc.gov/hiv/statistics/overview/ ataglance.html. 2. https://www.cdc.gov/nchhstp/stateprofiles/ pdf/florida_profile.pdf. 3. http://www.sun-sentinel.com/local/broward/ fl-hiv-cases-increase-20150724-story.html. 4. http://www.flhealthcharts.com/charts/ OtherIndicators/NonVitalHIVAIDSViewer. aspx?cid=0471. 5. Greenspan D, Komaroff E, Redford M, Phelan JA, Navazesh M, Alves ME, et al. Oral mucosal lesions and HIV viral load in the Women’s Interagency HIV Study (WIHS) J Acquir Immune Defic Syndr. 2000; 25:44–50.

SPEAKER PREVIEW 6. Nokta M. Oral manifestations associated with HIV infection. Curr HIV/AIDS Rep. 2008; 5:5–12. 7. Porter SR, Scully C. HIV topic update: protease inhibitor therapy and oral health care. Oral Dis. 1998; 4:159–63. 8. Ceballos-Salobrena A, Gaitan-Cepada LA, Ceballos-Carcia L, Lezema-Del Valle D. Oral lesions in HIV/AIDS patients undergoing highly active antiretroviral treatment including protease inhibitors: a new face of oral AIDS Patients Care STDS. 2000; 14:627–35. 9. Ivana Maria Saes Busato DDS, PhD, Mariana Thomaz DDS, MSc, Alexandre Assam Toda Disdain Gustavo Polite Alanis DDS, MSc, Beatriz Helena Stile Franke DDS, PhD, Antonio Adison Soares de Lima DDS, PhD, Luciana Reis Azevedo-Alanis DDS, PhD Prevalence and impact of xerostomia on the quality of life of people living with HIV/AIDS from Brazil First published: 5 November 2012. 10. CherianI; A JefthaII Xerostomia and salivary flow rates in HIV patients, S. Afr. dent. j. vol.72 n.2 Johannesburg Mar. 2017. 11. Navazesh M, Mulligan R, Barrón Y, et al. A 4-year longitudinal evaluation of xerostomia and salivary gland hypofunction in the Women’s Interagency HIV Study participants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 June 30; 95(6): 693-8. 12. Nittayananta W, Talungchit S, Jaruratanasirikul S, et al. Effects of long-term use of HAART on oral health status of HIV-infected subjects. J Oral Pathol Med. 2010 May; 39(5): 397-406. 13. http://www.hivdent.org/_oralmanifestations_/PDF/hcdent2005.pdf. 14. Mandel L, Kim D, Buy C. Parotid gland swelling in HIV diffuse infiltrative CD8 lymphocytosis syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85:565–8. 15. Ching DC, Argo Sino R, McKenna BJ, Camarilla JF, Cohen JM. Utility of fineneedle aspiration in the diagnosis of salivary gland lesions in patients infected with human immunodeficiency virus. Dagan Cytopathic. 1999; 21:260–4. 16. Panayiotakopoulos GD, Aaronic K, Kyriakos D, Pianos S, Bourikas N, Vlachos A, et al. Paucity of Sjogren-like syndrome in a cohort of HIV-1-positive patients in the HAART era. Part II. Rheumatology (Oxford) 2003; 42:1164–7.

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Forensic Odontology

BY ANTHONY R. CARDOZA, DDC, D-ABFO

Dr. Anthony R. Cardoza is a general dentist in Santee, Calif. and can be reached at openwide@arcdds.sdcoxmail.com.

The field of forensic odontology is the area of dentistry concerned with the application of law in both criminal and civil proceedings. There are two primary disciplines within forensic odontology: postmortem identification and bite mark (pattern injury) analysis. Forensic odontologists also assist authorities with multiple fatality incidents, age determination based on tooth development and recognition of child abuse/intimate partner violence (IPV). They also participate in civil proceedings as an expert witness.

Dental Identification As forensic dental identification specialists, we typically are the last conventional option for postmortem identification. DNA also is now used, but due to its high cost and the extensive time required for analysis, it is used sparingly or when absolutely no other option exists. Other forms of postmortem identification include visual, personal effects, fingerprints, scars, marks, tattoos and medical radiographs. Forensic dental identification has been successful because of the nature of the human dentition. The enamel is the hardest substance in the body and the only exposed portion of the skeletal system. Teeth are extremely resistant to thermal damage and blunt-force trauma, and the dentition remains stable during tissue decomposition. In addition, the dentition is unique to a specific individual. This includes not only the morphology of the coronal portion of the tooth, but also the morphology of the roots, pulpal chamber and their relationship to their surrounding structures (i.e.,

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sinus proximity, mandibular canal proximity, interproximal bony trabecular patterns, etc.). Following the natural dentition, if you add man-made dental restorations, the unique combination for any given individual can factor into the millions. There are numerous important reasons for identifying the deceased. A legal certification of death is necessary to consummate legal matters such as life insurance, wills, etc. There are family and personal reasons as well (closure). In criminal investigations, it is important to establish the identity of the victim to proceed with the criminal investigation and to identify the suspect. In a fire for instance, the bodies often are burned beyond visual recognition. Personal effects also are destroyed or lost in the fire. Even if the personal effects are recovered, they may not be considered reliable due to the typical calamity that surrounds a fire. A forensic anthropologist will examine the remains of the skeletal system and can then determine age, race and sex of the victim. Positive identification is best performed by examination of the surviving dentition by the forensic odontologist. In a fire where the temperatures may be extremely high (1,000Â° C), even the dental remains may be destroyed. Crowns may fracture or explode, leaving only the roots. The bone also may be completely consumed, leaving only scattered roots with no bony sockets for reference. Forensic dental identification most often is accomplished by the comparison of the radiographs of the teeth of the decedent (postmortem) (Fig. 1) with the dental radiographs WWW.FLORIDADENTAL.ORG

Forensic Odontology: the hours can be long and the monetary return low or even non-existent, but the personal reward and satisfaction can be great.

obtained from the dentist of the suspected victim (antemortem) (Fig. 2). Ideally, the antemortem radiographs furnished should be the original full-mouth series. Often, this is not the case. Children’s radiographs are typically bitewings only unless they have orthodontic records as well. Oftentimes, duplicate radiographs — not the originals — are sent, and have been either poorly duplicated and/or are not labeled right and left for orientation. In addition, the antemortem radiographic image may be of poor quality due to improper operator technique (cone cuts, overlapping interproximals, elongation/foreshortening, etc.) or poor processing (contrast, burned images, etc.). When poor antemortem radiographs are compared to an ideal postmortem radiograph, the two may not appear consistent. This could seriously hamper the identification effort. In forensic dental identification, it’s stressed that good quality, properly mounted and labeled original antemortem radiographs be sent for comparison. In addition, copies of the victim’s dental treatment progress notes should be submitted. This allows the forensic dentist to verify dental treatment that was performed subsequent to the date of the radiographs. It is important as practicing dentists to keep complete patient records on file and continually update them, including the radiographs. One of your records may be needed for a postmortem dental identification.

Bite Mark Analysis The study of bite marks involves the analysis of teeth contacting another object or medium. Thus, bite mark analysis is a type of forensic pattern analysis similar to tool mark analysis. Unlike dental identification, which is a quantitative analysis, bite mark analysis relies on the odontologist’s interpretation of the pattern; therefore, bite mark analysis primarily is subjective in nature. It’s for this reason that bite mark opinions, though based on scientific methods and principles, can be highly variable based on the individual’s interpretation of the pattern injury, resulting in experts often giving different levels of opinion on the same pattern injury. The consequence we see today is that bite mark analysis has become highly controversial. In the United States, there have been 28 exonerations of individuals after they had been previously charged or convicted where the charges/convictions were based partially on faulty bite mark evidence. The study of bite mark analysis involves the comparison of the pattern injury or bite mark to the suspect biter’s dentition. The classic appearance of a bite mark is two semicircular or ovoid arches that oppose each other with a central ecchymosis (Fig. 3). The bite mark pattern is photographed from multiple angles with a scale present for reference. In addition, the bite mark is swabbed for possible suspect DNA. On the biter, it is necessary to take full-arch dental impressions of both the maxillary and mandibular arches. In addition, complete dental

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charting of all the present, missing and restored teeth, including charting anomalies such as fractures, spaces, rotations, etc., wax bites and intraoral photography should be taken. If the accused suspect biter is in jail, then collection of these records will require a court order and the individual has the right to have his attorney present (note: the biter also could be the victim who bit their attacker in selfdefense).

FIG. 1

Once all the records are collected on the bite mark and the suspect biter, then the odontologist can complete the analysis. The analysis consists of a comparison of the bite mark photo, which has been digitally resized to life-size 1:1 proportions to an overlay of the incisal/occlusal edges of the suspect biterâ&#x20AC;&#x2122;s teeth. This is accomplished by creating a digital hollow volume overlay of the dental models by scanning the models using a flatbed scanner into the computer (Fig 4). Then with the use of photographic software, the incisal edge overlay can be inverted and superimposed onto the bite mark pattern photo for comparison and analysis (Fig 5).

FIG. 2

Finally, the odontologist will submit the report to the entity that retained him/her. In this report, the odontologist will list all the steps taken to complete the analysis and formulate an opinion. The range of opinions are: s can include biter in pool of suspect biters

FIG. 3

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SPEAKER PREVIEW s cannot include biter in pool of suspect biters s exclusion (did not make the bite) s inconclusive (not enough data or poor-quality data to formulate an opinion) In summary, forensic odontology is an exciting field where dental health care professionals can use their skill and training in dentistry for a field completely outside of dentistry. Choosing a career path as a forensic odontologist or forensic dental autopsy technician (the auxiliary’s role in forensic dentistry) should not be viewed as a hobby, but in fact, a second career in addition to your primary career in the field of dentistry. The hours can be long and the monetary return low or even non-existent, but the personal reward and satisfaction can be great. Dr. Cardoza will be speaking at FDC2018 and presenting four courses. On Thursday, June 21, 2018, “Dispelling the ‘CSI Effect’ Myth” will be at 9 a.m. and “Dentistry’s Role in the Mass Disaster Scenario: Child Abuse and Intimate Partner Violence Recognition” will be at 2 p.m. On Friday, June 22, “Twenty-first Century Laser-assisted Dentistry” will be at 9 a.m. with a repeat course at 2 p.m.

FIG. 4

FIG. 5

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Get Results with “Magic Communication”

“I’m sorry, we haven’t received your claim.” “Why did I get a statement? I’ve already paid your office my co-payment!” Ah, the wonderful effects of non-communication. Nothing is more frustrating for a dental office than a patient or insurance company who misunderstands what we are trying to communicate to them. BY MS. LOIS BANTA

Lois Banta is CEO, president and founder of Banta Consulting Inc., a company that specializes in all aspects of dental practice management. Ms. Banta has more than 40 years of dental experience, and consults and speaks nationwide. She can be reached at lois@bantaconsulting.com or check out her website at www. bantaconsulting.com.

The most important aspect of dentistry today is not what you say to patients and insurance companies, but how you say it. How many times have you called the insurance company to track a past-due claim, only to be told you have to resubmit it? I can almost hear your silent screams now! There is a definite connection between making the phone call and getting the results from the insurance company the first time. One of the most effective tools in communicating with insurance companies and getting speedy payments isn’t necessarily the content of the claim, but in talking to the insurance customer service representative. You catch so many more flies with honey — make a friend at the insurance company! Yes, that’s right … I said make a friend at the insurance company. You have to be prepared to plead your case, while at the same time get results now.

My suggestion is to call the insurance company with this conversation in mind: “Hello, this is Lois from Dr. Smith’s office. I’m calling to check the status on an outstanding dental claim.” Never say past-due claim; it puts the insurance representative on the defense. Always write down the date, the insurance representative’s full name and any notes pertaining to the conversation. Some insurance companies train their staff to respond to your first phone call by telling you they have not received the claim. What I suggest as a response to that is to ask the representative to put you on hold and check the pending or in-processing claims. This gives the insurance representative the opportunity to put you on hold and now tell you, “Oh, there it is! I don’t know why this wasn’t processed yet!” If they still insist they haven’t received the claim, ask for the fax number and resubmit the claim by fax — not “snail mail” — or resend it by electronic claims if that’s how it was originally sent. Communication with your patients can be equally frustrating if you assume they know the financial policies of your practice. The first thing every dental office needs is to have a financial policy. The second thing is to put it in writing. Always — and with no exceptions —

FLA-MOM — WHAT OUR PROFESSION IS ABOUT! 1. BEST TIME: I look forward to every year is the Mission of Mercy. It is hard to find a better display of what our profession is about: helping people

2. MOST VALUE: I enjoy knowing that the FDA has a team that works hard everyday to protect the patients of our great state and to maintain the high ethical standards of our profession.

3. SAVINGS: I would venture a guess that through FDA Supplies alone I have saved enough to cover the cost of dues. — Dr. Thomas A. Brown Jr • FDA for the Council for Dental Education and Licensure, FDA House of Delegates, Orange Park

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explain all treatment recommendations to your patients before dental treatment is performed. There are many ways of discussing financial arrangements with patients because there are many types of treatment consultations. If the patient is in your office for an emergency and there is time to do the restorative treatment that day, the financial coordinator should come back to the treatment room to answer any questions the patient may have regarding fees and insurance so that the patient can make an informed decision. The doctor and clinical team member must leave the room at this time to allow for privacy. Discussing financial arrangements chairside allows for proper communication to take place regarding the patient’s financial responsibility. If the patient has a continuing care appointment with the hygienist, and dental treatment was recommended that is not too involved, the financial coordinator can make financial arrangements at the front desk if the area is private enough. All financial arrangements should be made before the patient comes in for the next treatment appointment to avoid negative surprises. If there is major treatment to perform, there should be a formal, private consultation for the patient and the financially responsible party (if different from the patient). In all cases, a written plan for treatment and estimate of financial responsibility should be available for every patient. All patients have a right to know

what they are agreeing to — it’s called truth in lending. The importance of communication also comes into play for patients paying their “estimated portion” after insurance payment at the end of their dental appointment. Give patients the potential bad news before they get it on their statement. To avoid any repercussions from receiving a statement after insurance pays and the patient has already paid their “estimated portion,” I tell the patient, “If insurance pays less than we estimate, we will send you a final statement and it will be highlighted in orange at the bottom of your statement with the phrase: ‘We have received final payment from your insurance.’” This absolutely prevents an angry phone call from the patient because they received a statement with a balance due after their previous in-office payment in addition to insurance coverage. Give your patients the potential bad news before they get the “bad news” and you have just diffused a potentially angry situation! It works like a charm. I use another effective communication technique with patients when the payment guidelines in the office have changed. I find this the most difficult transition for patients because they’re used to “making payments.” First of all, you should never have to be the “bank” for your patients. This is where we have become our own worst enemies. In order to effectively change the rules, you need to be excited about the change. The conversation should go like this:

“Mr. Jones, today’s visit was $700. We estimate insurance will pay approximately $350. Therefore, we estimate your portion to be $350. Will you be taking care of that by cash, check or credit card today?” The patient usually responds by saying, “Just send me a statement like you usually do.” This is where the magical conversation must happen. You say, “Actually, our payment guidelines have changed, and we are so excited. We now are prepared to handle your payment in the office today. So, which would you prefer: cash, check or credit card?” If the patient still objects, give him/her a courtesy statement with an envelope and a stamp, and instruct them to send you the estimated amount in the next five days. Let them know that you will follow up with a phone call if for any reason a payment is not received. The important thing to remember in the art of communication is to speak to patients and/or insurance companies the way you would want them to speak to you. Remember the Golden Rule: “Do unto others as you would have them do unto you!” Ms. Banta will be speaking at FDC2018, and is presenting four courses. On Friday, June 22, “Playing the Insurance, Collections and Accounts Receivable Game — Your Way!” will be at 9 a.m. and “High Impact Communication: Words to Use and Words to Lose” will be at 2 p.m. On Saturday, June 23, “Anatomy of a Winning Team: A Recipe for Success” will be at 9 a.m. and “10 Top Management Tools for a Successful Practice” will be at 2 p.m.

SAVED $200 A MONTH! 1. BEST TIME: The West Coast Summer Meeting in Naples is always a highlight of the year for our family. It’s great to have an opportunity to spend time with family and good friends in one of the nicest venues in the state.

2. SAVINGS: When the ADA contracted with the bank holding the note for my student loans, I refinanced the loan and immediately saved money — to the tune of $200/ month. — Dr. Clay McEntire • New Dentist Committee, chair, WCDDA; FDA Council on the New Dentist, St. Petersburg

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EXHIBIT HALL HOURS

FRIDAY • JUNE 22, 2018

9 a.m. – 6 p.m.

SATURDAY • JUNE 23, 2018

9 a.m. – 2 p.m.

Anutra Medical Inc. Aseptico Aspen Dental Atlanta Dental Supply Atlantic Dental Sales Inc.

AA-dec A. Titan Instruments Accutron Inc. ACTEON North America ADS Florida | Henry Schein Professional Practice Transitions ADS Page Brown and Associates Advice Media AFTCO Air Techniques Ansell | Microflex

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9 a.m. – 6 p.m.

IT HIB

THURSDAY • JUNE 21, 2018

3D Diagnostix Inc. 3M Oral Care

S SA

0 1, 2 . V O

Bank of America Practice Solutions Banyan Belmont Equipment Benco Dental Benevis Practice Services Berryhill, Hoffman, Getsee & DeMeola LLC Bien-Air BioHorizons BIOLASE Biotec Inc. Bisco Dental Products BQ Ergonomics LLC Brasseler USA

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CareCredit Careington International Carestream Dental Carl Zeiss Meditec Inc. Carr Healthcare Realty ClearCorrect Clorox Healthcare Colgate COLTENE Cool Jaw by Medico International Inc. Crest + Oral-B Crown Seating CUTCO Cutlery

D Dansereau Health Products Delta Dental Government Programs Demandforce DenMat Dental Equipment Liquidators Inc. Dental Services Group of Clearwater DentalOne Partners Dentsply Sirona Designs for Vision Inc. DEXIS Diatech Inc. DigiDent Labs

Digital Dental Digital Doc LLC Digital Resource Doctor Multimedia Doctor’s Choice Doctors Disability Specialists DoctorsInternet.com Doral Refining Corporation

E-F Eclipse Loupes Envolve Benefit Options | Envolve Dental Inc. Essential Dental Systems FDA Supplies | SourceOne Dental Inc. First Citizens Bank Florida Combined Life Florida Dairy Farmers Florida Dental Association Florida Dental Association Services Florida Medical Advisors Forest Dental Products Inc. Fortress Insurance Company Fotona

G Garfield Refining Company Garrison Dental Solutions GC America Inc. GlaxoSmithKline Glidewell Dental GoldenDent Great Expressions Dental Centers Greenberg Dental & Orthodontics

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These exhibitors have made a commitment to attend the Florida Dental Convention (FDC). Not only do these companies exhibit the latest in technology, materials and equipment, but many sponsor events and continuing education programs at the FDC.

Look to see if your supplier is on the list. Make an effort to stop by their booth in the Exhibit Hall in June for exclusive show specials. Support these companies that support the Florida Dental Convention. H Hager Worldwide Halyard Health Hartzell Instruments Heartland Dental Henry Schein Dental Henry Schein Practice Solutions HIOSSEN Hu-Friedy Hunza Dental

I i-CAT iCoreConnect Inc. ICW International Implant Direct Implant Educators INOVA Federal Insurance Credentialing Specialist integrated dental systems

K Karl Schumacher Dental KaVo Kerr Kettenbach LP Kuraray America

L Lares Research Legally Mine LendingClub Patient Solutions LumaDent Inc.

M MacPractice Medidenta Microcopy Midmark Corporation Modular & Custom Cabinets Ltd.

N-O New Image Dental Laboratory Nobel Biocare NSK America Officite Orascoptic Ortho-Tain | Healthy Start

P Pacific Dental Services Patient News Patterson Dental PDT Inc. | Paradise Dental Technologies Pelton & Crane Perio Protect PerioChip By Dexcel Technologies PeriOptix Philips Sonicare & Zoom Whitening Planmeca USA Inc. Porter Instrument Co. Inc. Power Dental USA Prestige Products Direct Professional Sales Associates Inc. Proma Inc. Prophy Magic Pulpdent Corporation

R-S RF America IDS RGP Dental Rose Micro Solutions Royal Dental Manufacturing Sage Dental SciCan Inc. SDI (North America) Inc. Serve First Solutions Inc. Shamrock Dental Co. Inc. Shofu Dental Corporation Sierra Dental Products Snap On Optics Solmetex LLC Sonendo Inc. Sunset Dental Lab Superior Dental Design Services & Upholstery SurgiTel

Exhibitors in red are FDAS Crown Savings Merchants.

T-U The Doctors Company Thommen Medical U.S. Jaclean Inc. Ultradent Products Inc. Ultralight Optics Inc.

FDA SERVICES INC. IS A MAJOR SPONSOR OF THE FLORIDA DENTAL CONVENTION.

V-W Vatech America VOCO America Inc. Wand Dental Inc. (Milestone Scientific) Water Pik Inc. Wells Fargo Practice Finance

Z Zimmer Biomet Dental

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We’ve designed 14,960 websites. And we only reached that number because dentists like you trust us to help them succeed. Whether this is your first website or your fifth, you’re in capable hands. Be the next dentist to earn new patients with us. Call (866) 756-5042 or visit Officite.com/Consult/TodaysFDA for a free consultation and two months free website hosting.

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(866) 756-5042 • Officite.com/Consult/TodaysFDA Websites and Online Marketing Solutions for Dental Practices

KEYS PRACTICE

TO BUYING YOUR OWN DENTAL

The decision to buy your own dental practice is an exciting one. The benefits are numerous, but so are the potential pitfalls â&#x20AC;&#x201D; the dream of practice ownership can quickly turn into a nightmare if you choose the wrong practice, time the acquisition wrong or fail to make a smooth transition once you take ownership.

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The advice in this article operates on one basic, but important, premise: You are ready (in terms of your clinical experience) to make the move from associate to owner. Of course, no first-time owner can be 100 percent certain she or he is ready, and the only way to know is to take the leap into ownership. So, the next-best thing to absolute certainly is to be certain you are absolutely prepared for the challenges coming your way.

What to Know: Before Buying a Practice Before you set foot in a single potential practice, there are several things to do and consider.

1. Assemble a team of professionals. No matter how good you are, how confident you are and how many majors you had in college, you’re going to need some help. Obtain an attorney to review the intent to purchase agreement, the buy-sell agreement and the lease. Once an offer has been accepted, hire a dental consultant familiar with practice evaluations to assist you with the due diligence and evaluation of the practice on-site. After the on-site evaluation, have an accountant review the profit and loss statements, and the tax returns for the last three years.

2. Arrange for financing ahead of time. It’s good to know what you are willing and able to spend before you begin your search to ensure you look in the right places. You can get a recommendation on lenders from any number of professionals: brokers, consultants, accountants, attorneys, colleagues and former classmates. Compare two to three lenders before making a final decision. Most lenders who specialize in practice acquisition financing will fund up to WWW.FLORIDADENTAL.ORG

100 percent of the practice purchase price depending on the net profit, plus all related working capital and transition cost needs. Be aware that lenders’ policies can vary widely in the length of the approval procedure, interest rate, terms of the loan and whether there are penalties for early prepayment of the loan. So, again, this is something you will want to get started with early.

BUYING A PRACTICE BY KATHLEEN JOHNSON

Kathleen Johnson is a dental practice management and transition consultant with more than 35 years in the dental field. For more information, go to www.kjohnsonconsulting.biz.

3. Obtain insurance. Most practice lenders require disability coverage to collateralize a business loan. The most frequently used disability products for this purpose are income disability, reducing term disability and disability overhead. There are insurance agents experienced in dental practice acquisitions, so it’s in your best interests to seek out such an agent.

Pre-search Considerations Checklist:

4Decide if you want to be totally fee-for-service or will accept PPOs, HMOs and/or Medicaid.

4Prioritize locations based on where you will be comfortable commuting or living. Remember, this isn’t just a job; you are becoming part of the local community. Make sure you aren’t just seeing dollar signs when you search, because dentists who are ONLY invested financially are not as successful.

4Know the kind of office setting you

seek. Does it matter if it’s a suite in a professional building, a free-standing building, or storefront in a shopping center or strip mall? Don’t forget to consider parking and visibility for any practice you visit.

4Know your maximum asking price before you start asking.

4Get in touch with a broker who

a good idea to ask colleagues and former classmates for referrals. You also can shop broker listings online and through local dental association publications.

What to Do: When You’ve Got a Practice in Mind Once you have a practice that looks like it might be a fit, it’s time to get excited, but not too excited. There are still a lot of things to consider before you make an offer. Set a date to visit the practice or attend the broker “open house.” If you’re still excited to move forward, here are some things you’ll want to do.

1. Get a practice evaluation. Contact your consultant or advisor and arrange for an in-depth practice evaluation. Your consultant will review the reports on production, collections, adjustments, new patients and patient visits by month for the current year, each month of the previous year and totals for the previous four years. Evaluating collection versus net production is critical since some practices have regular problems collecting at the time of treatment. You’ll want to know if this is an issue. Adjustments by type also are looked at to determine if the practice is writing off patients’ co-payments or giving regular

is active in the market. It’s always TODAY'S FDA

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BUYING A PRACTICE FROM PAGE 67

discounts and why. Production by category (diagnostic, preventive, restorative, endo, perio, oral surgery, removable and fixed prosthodontics, orthodontics, etc.) also should be evaluated. Are there procedures you don’t do that will reduce your production for which you might consider bringing in an associate? And what procedures might you be introducing to the practice that will increase the production?

2. Get ALL the details of the physical space. A practice that looks good in terms of production and at an open house may not look as good if the terms of the lease are cost-restrictive or the office needs a lot of updates. So, consider all the following: What is the square footage? How many treatment rooms are there and will they need to be updated? What equipment stays with the practice and its condition? And, what are the terms of the current lease? Are they transferrable? Are utilities included? Is there an option to buy the building, and are there zoning restrictions?

3. Get to know the patient population. You’ll want to know the type of practice you’ll be working in and patient demographics — economic status, insurance dependence, residence/ZIP code analysis, proximity to office and patient ages — is a good place to start. In terms of marketing, you’ll also want to know the new patient flow: number per month and referral sources. If these numbers are low, it doesn’t necessarily mean the practice isn’t worth your consideration.

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There may be a missed opportunity here and, of course, this also may justify a lower offer.

4. Get to know the actual patient numbers. What is the number of active patients? Active patients are critical in a practice purchase since goodwill is figured into the purchase price, but determining this number can be tricky. A definition of an active patient is one that has been seen at least one time over an 18-month period, but many dental offices are not consistent with updating patients’ statuses. The number of charts on the shelves or patients listed in a database can include inactive patients who are long overdue to be removed. A good number to go by is the hygiene visits per month, and this is something a consultant can help you determine.

5. Get to the bottom line, then decide. If practice income (overhead plus debt service) is positive and provides a healthy salary, it’s time to decide (with your broker) on how much you will offer and, if this looks to be a significant career opportunity, whether or not you are willing to get into a bidding war. A great practice may be worth it if you know you’ll be here over the long haul. If, however, the practice income does not provide a healthy salary or is, in fact, negative, you may walk away from the potential deal. Before you do, however, consider what may make this practice profitable (or more profitable). Is there untapped potential here? Are you willing to put in the work? And can you get the practice at a bargain so that your risk is lowered? If so, you may be on to an opportunity a lot of other dentists will kick themselves later for missing.

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Pre-offer Considerations Checklist:

4 What are the accounts receivable (AR): amount, aging, collectability, insurance, and is AR for sale?

4 Are insurance payments accepted as payment in full?

4 Be certain that all income is from

dentistry performed in the practice you are purchasing and not from other sources (e.g., a second dental practice, real estate/rent, other outside businesses or even fraudu- lent insurance claims).

4 Do you know why the seller is

leaving, especially if she/he is not of retirement age?

4 If the office is leased, will the land lord assure transfer of the lease?

4 Will the seller sign a restrictive covenant, barring him/her from competing in the same market for a set time?

4 Will the seller carry a note if the bank does not approve the full amount?

4 Can the seller assure you she/he will not talk to current staff prior to closing to assure expected continuity?

How to Do it Right: Making a Smooth Transition Careful transitioning of your new practice is so important to your initial success. This is a big change for the staff and patients, and it’s likely not a change they have been planning — and possibly one they haven’t even been expecting. You’ll want to make sure staff and patients alike are confident that your arrival will mean good things for the practice moving forward.

1. Meet the staff. This is your team, your frontline. They know the patients, and a good way to WWW.FLORIDADENTAL.ORG

make patients comfortable with a new doctor/owner is to quickly gain the confidence of your staff. You should interview each staff member before the close of escrow to discuss their position, hear their thoughts and to give them information on your background. Once a transition is announced, the staff will be able to speak freely with patients, and having this pre-meeting will likely have them reassuring patients that this new chapter for the office will be a good one.

2. Reassure the staff. Since the seller needs to terminate the staff at the close of escrow, it is important that they know you intend to keep them on and that you do not plan to make any drastic changes walking in the door. For instance, some members of the staff may be overpaid in terms of their role, their experience, their abilities or simply the market. The staff may be receiving a benefits package that isn’t sustainable. Your first thought may be to not retain staff members, or to make sweeping changes to the benefits package. This would likely be a mistake. Patients rely on the current staff and would not be familiar with anyone in the practice if you brought in a completely new one. Beyond that, a good staff doesn’t just know how to do their jobs; they know how the office works and the little details that make the day run smoother. The last thing you need on the first day is a mutiny or a staff that is just as inexperienced with the office and the patients as you are. Yes, some changes may be necessary, but drastic changes overnight should be reserved for emergencies. Most changes are best to implemented gradually and not during the transitions in ownership.

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3. Work with the current owner. Decide with the current owner when and how the staff will be informed about the sale. Will he or she introduce you to the staff at that time or a later one? In some sales, the current owner wants to — or is willing to — stay on for a limited time and this can be a great way to transition the practice. Be sure to define how long this will be and what role the (now) previous owner will assume. If he or she wants to stay on as an associate, is there enough work for both of you? And what about compensation? And if the previous owner has no desire to stay on, see if she/he will write a letter of introduction for you to the patients.

and then follow up with the patient. Your clinical skills are crucial, but showing interest in patients touches them while building credibility and likeability — and that’s what counts with patient retention.

Transition Considerations Checklist: 4 What is the previous owner’s philosophy? Randomly select 10-15 percent of the total number of active patient charts. Review the X-rays and diagnoses, type of work, treatment notes and redos. Look at some lab cases. Really get to know your new practice.

4 Does the office have a continued

4. Have a staff meeting. Although you will meet with staff individually before seeing your first patient, you should set a time for a practice transition meeting with all staff present. Your agenda should:

care (recall) system? What type would work best for the patients in this location?

4 What is the current fee structure? If you need to increase fees, can any of them be implemented gradually or at a later date, after patients have gained confidence in you?

4 make sure the staff understands your professional standards and clinical philosophy.

4 allow staff to share their feelings about the practice change.

4 Evaluate staff salaries, hourly rates, hours per week, lengths of employment, benefits and find out if anyone is due for a salary increase.

4 make changes clear, and get feed back and questions from staff regarding the changes.

4 decide how patients should be informed of the change.

5. Use a trick of the trade. For a new owner, reviewing a patient’s chart and finding personal comments about that patient is golden. Personal comments offer a chance to jump-start the relationship and develop it further. If the seller did not make a practice of noting that type of information, start a “personal comments” section on charts or computer notes. Then, you can review personal comments prior to every visit

A Final Note Every purchase and every transition is different. There will be surprises and not everything will go according to plan. Sometimes the surprises will be good ones, and sometimes Plan B will lead to even better things. The important thing to remember is that if you prepare for this big move, and you assemble a good team of professionals to help you along the way, your dream of owning your own practice will become a reality — and it may be even better than you dreamed.

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NEW FDA MEMBER BENEFIT! FDA Career Center

careers.floridadental.org

Job Seekers

 FREE and confidential resumé postings email notifications when new jobs  Automatic match your criteria  Save up to 100 jobs to a folder in your account  Upload up to five career-related documents  Access to our diverse suite of career resources

Employers

 Targeted advertising exposure  Easy online job listing management  Resumé search included with job posting email notifications when job seekers  Automatic match your criteria  Member discounts available

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. WHAT DOES IT INVOLVE? The online mentoring program has been designed with the needs of the student and busy dentist in mind. Connecting will be a simple process: 1. The student will create protégé profile and select a mentor at careers.floridadental.org/ementor. 2. The mentor will receive a mentor request via email to consider. 3. Once you accept a protégé, the two of you will determine how best to communicate. For additional information, or if a change in the mentor/ protégé relationship is needed, please contact Kerry Gómez-Ríos at membership@floridadental.org.

MEDICAL MARIJUANA

TIPS ON HOW TO DEAL WITH MEDICAL MARIJUANA AND YOUR STAFF This article provides some practical tips and a framework to analyze situations when your staff uses medical marijuana. Medical marijuana has been legal in Florida since 2014, but remains illegal under federal law. Recreational marijuana continues to be illegal under both federal and Florida law.

How Did We Get Here? GRAHAM NICOL, ESQ., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

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

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The 2014 Florida legislation, known as “Charlotte’s Web” or the Compassionate Medical Cannabis Act of 2014 authorized a low-THC strain of marijuana to treat chronic seizures or severe muscle spasms and to provide palliative care for the terminally ill. This legislation did not impact dental employers because employees with these conditions are unlikely to be on staff, and the marijuana in question had no intoxicating effect. Next came a failed Constitutional Amendment. Then, on Jan. 3, 2017, Amendment 2, also known as the Florida Medical Marijuana Initiative, became Florida law. It allows medical marijuana to be used by your employees if they have certain health conditions, so long as they have a prescription from a licensed physician who has completed special training. On Sept. 19, 2017, the Florida Department of Health (DOH) released regulations on how to obtain licensure as a Medical Marijuana Treatment Center (MMTC).

NOVEMBER/DECEMBER 2017

Where Are We, Exactly? Pot dispensaries are now coming to your town. TIP: Medical marijuana is not just regulated by conflicting state and federal law. Be aware that counties and municipalities through zoning regulations also have control over whether an MMTC will pop up next to your local hospital or dental office. The Medical Marijuana Initiative authorized in 2017 authorizes higher strength marijuana and makes it available to a far larger number of people than “Charlotte’s Web.” For example, if an employee is diagnosed with post-traumatic stress disorder (PTSD) — an extremely common diagnosis — then they can get a medical marijuana card.

What Does Florida’s Medical Marijuana Initiative Actually Authorize? Persons seeking medical marijuana must be a qualifying patient (or their caregiver), meaning that they have been diagnosed with a debilitating medical condition by a Florida physician. Dentists cannot prescribe, administer or dispense medical marijuana. Only certain medical conditions qualify the person for medical marijuana: cancer, epilepsy, glaucoma, HIV, AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s and similar conditions.

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People who qualify will get a DOH medical marijuana ID card and present it when they fill the prescription at the MMTC. While physicians retain ultimate authority to decide whether the medical use of marijuana outweighs the potential health risks, Florida is sadly well-known for its “pill mills.” Ironically, while Florida cracks down (pardon the pun) on the opioid crisis, it is busy clearing the way for a medical marijuana epidemic. Both drugs are easily susceptible to diversion and improper use, but are not being treated the same.

When Will You Start to See Employees and Patients Who Are Using Marijuana in Your Practice? You already are, of course, but the issue of concern now is that whereas employers used to be on safe legal ground to WWW.FLORIDADENTAL.ORG

fire employees using illicit drugs, Florida’s Medical Marijuana Initiative now creates several new risks for employers. TIP: Check that you have employment practices liability insurance, known as EPL insurance. EPL insurance provides coverage to employers against claims made by employees alleging discrimination (based on sex, race, age, disability, etc.), wrongful termination, harassment and other employment-related issues, such as failure to hire and failure to promote. TIP: You probably have EPL coverage under your business owner’s policy, but the deductible may be $1,000 and the maximum may be $10,000. That effectively leaves you with $9,000 of coverage, which is simply too low in a litigious state like Florida when dealing with highly compensated employees such as those in dental practice. TIP: Contact your insurance agency and, if necessary, purchase a rider for more

coverage. Employment cases have been on the rise for several years and Florida’s Medical Marijuana Initiative will keep employment lawyers busy for many years to come.

Exactly What Kind of Risk Do Dental Employers Face? In addition to creating all kinds of clinical questions for care of patients using medical marijuana, Florida’s Medical Marijuana Initiative creates uncertainty for all Florida employers, including dentists. For example, can you fire an employee who uses medical marijuana after work hours but shows up under the influence during work hours? Can you test for medical marijuana use if you’ve implemented a Florida-compliant Drug Free Workplace Program through your

SEE PAGE 74 TODAY'S FDA

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MEDICAL MARIJUANA FROM PAGE 73

workers’ compensation insurer? If it’s legal under Florida law but illegal under federal law, which law controls? Does the Americans with Disabilities Act (AwDA) mandate employers to make reasonable accommodation of medical marijuana use on, for example, work breaks or at lunch time if the underlying medical condition constitutes a protected disability? What does the Occupational Safety and Health Administration Act say about medical marijuana usage? For further information on these topics, go to http://bit.ly/2zpw86u. TIP: Anticipate that it will take years

for definitive answers to these questions because they are sure to be resolved via case law, not regulation or statute. For example, there are two major lawsuits pending in Florida over the DOH rule determining which entities will get the coveted MMTC licenses. Florida litigation filed so far also includes Attorney General Pam Bondi’s fight to prohibit patients from smoking medical marijuana, which cannot effectively be titrated or dosed. The lawsuit was filed by Orlando attorney John Morgan, who spearheaded Florida’s Medical Marijuana Initiative. It argues that legislators violated the constitutional amendment

by barring smoking of medical marijuana. The law allows medical marijuana to be vaped but is silent regarding whether it can be smoked. Bondi’s office argues that “there was ample opportunity for smoking to be specifically provided for or required in the amendment. But however hard plaintiffs may look for it, a smoking requirement is not in the amendment.” Plaintiff ’s counsel has not responded as of the time of writing this article. But the vaping/smoking litigation promises to be long and expensive. The employment law questions are equally important, and will similarly be heavily litigated. TIP: As case law develops, the FDA will

keep its members informed. Keep reading Today’s FDA! TIP: You do not want to be on the front lines of litigation over dental staff using medical marijuana. Let bigger employers in Florida litigate these matters, and once the dust settles years from now, simply follow that outcome. Don’t make yourself the test case!

Florida Law is Unsettled, But What Are Other States Doing? Cases are starting to trickle out of both state and federal courts. So far, the case law has not been good for employers. Let’s look at two of the most recent examples. In Barbuto v. Advantage Sales and Marketing, a Massachusetts court ruled

that an employee had a valid claim for disability discrimination when the employer terminated her after she failed a routine drug test because she had been prescribed medical marijuana. The claim was based on state law that closely tracks the Americans with Disabilities Act (AwDA). The AwDA says it is unlawful for an employer to terminate an employee’s employment or refuse to hire an individual because of the individual’s disability if the person is qualified to perform the essential functions of the position with reasonable accommodation, unless the employer can demonstrate the accommodation required would impose an undue hardship on the employer’s business. TIP: The AwDA is easy to summarize, but leaves many questions open for litigation. AwDA matters should be handled on a case-by-case basis with competent legal help. This is not a DIY project for a dentist! TIP: The Barbuto case is interesting because the employee was using medical marijuana at home, not in the workplace. This means that employers, who may not even be aware of what their employees do after hours, can still be sued for employment discrimination. TIP: Another interesting lesson to learn

from this case is that the employer faced liability even though it was clear that the employee had never reported to work in an intoxicated state. Maybe the result would have changed if the employee was intoxicated during work hours. But then

MY OUTLOOK MAY BE A LITTLE DIFFERENT. 1. BEST TIME: It is a tie between the Kool and the Gang concert when I had our children, mother in law and staff and last year’s party in the atrium (2017) with my staff.

2. MOST VALUE: My outlook may be a little different. If I could modify the famous quote by President John F. Kennedy. I don’t ask what benefit I can get from the FDA, but rather, what can I do to benefit the FDA and its members. Advocacy is by far the most important benefit the FDA provides. Everything we do in dentistry is decided in Tallahassee by the legislature, the Board of Dentistry or by Congress in Washington DC.

— Dr. Gerald Bird • Chair, FDA Political Action Committee, Cocoa

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again, maybe not: The Medical Marijuana Initiative embedded in the Florida Constitution states that “(n)othing in this section shall permit the operation of any vehicle, aircraft, train or boat while under the influence of marijuana.” Notably absent from this language is any reference to “the practice of a health care profession while under the influence of marijuana.” Section 456.072(1)(z), Fla. Stats., clearly states that “being unable to practice with reasonable skill and safety … by reason of … drugs, narcotics, chemicals or any other type of material ...” is a disciplinary violation for a dentist or dental hygienist. Further, section 456.072(1) (i), Fla. Stats., clearly states that “failing to report to the department any person who the licensee knows is in violation of this chapter” (because, e.g., they are unable to practice safely due to medical marijuana) is a disciplinary violation. A smart plaintiff ’s lawyer could argue that the constitution always trumps a statute and, since the constitution could have easily included the practice of a health care profession alongside the operation of a motor vehicle but chose not to, it is therefore lawful for health care licensees to practice under the influence of medical marijuana. The employer in Barbuto argued, to no avail, that the only accommodation sought by the employee was allowing her to continue using marijuana, which

AS CASE LAW DEVELOPS, THE FDA WILL KEEP ITS MEMBERS INFORMED. KEEP READING TODAY’S FDA!

must be unreasonable per se because it is a federal crime. Next, the employer argued that even if she was a qualified person with a disability, she was terminated for failing a drug test, not due to her disability. TIP: This calls into question drug testing in general and specifically mandatory testing under Florida’s Drugfree Workplace programs. It is unsettling that the court completely ignored an objective drug test administered by an entity other than the employer. If employers cannot rely on scientifically accurate drug tests, how else are they to judge whether an employee is able to perform their essential job functions while using medical marijuana? Bottom line, the court concluded the employee was qualified to perform the essential functions of her job with a reasonable accommodation (i.e., forcing the employer to waive its policy barring employment for people who test

positive for marijuana). TIP: The court did not consider it important to the legal analysis whether medical marijuana was, in fact, even effective (or the most effective) treatment for the employee’s disability or whether there were less risky treatment alternatives. In Noffsinger v. SSC Niantic Operating Co., a United States District Court in Connecticut similarly ruled that an employee may not be discriminated against for using medical marijuana. TIP: The Noffsinger court closely looked at whether federal law (specifically, the Controlled Substances Act, the AwDA, and the Food, Drug and Cosmetic Act) pre-empted the state’s medical marijuana law. Ultimately, it ruled that no conflict between federal and state law existed, and that the federal law — which makes marijuana illegal — does not pre-empt the state law. SEE PAGE 77

PRICELESS! 1. BEST TIME: I truly enjoy all of the Florida Dental Convention every year. From the continuing education to the social events to checking out everything in the Exhibit Hall, it is by far my favorite FDA event of the year! I also am looking forward to my first Florida Mission of Mercy in March. I have participated in Wisconsin, and am excited to do so in Florida!

2. MOST VALUE: My biggest value comes in the political advocacy that is occurring on my behalf as a dentist every day. It’s important for me to know that my best interests as a dentist are being represented without having to lobby myself.

3. SAVINGS: My peace of mind that my profession is being protected is priceless. — Dr. Becky Warnken • FDC Committee on Conventions and Continuing Education, Bradenton

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benefit

NUMBER

YOUR FDA STAFF IS “HELPING MEMBERS SUCCEED” EVERYDAY!

PROFESSIONAL STAFF I help members succeed by making the dues payment process as convenient and painless as possible. I’m always happy to assist with billing, posting of payments, installment setup and much more. My goal is to help members feel the worth of their investment and enjoy being part of the FDA family. – Stephanie A. Taylor, Membership Dues Coordinator

Have a question about your FDA dues? 800.877.7597 • 850.350.7119 • staylor@floridadental.org www.floridadental.org

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FROM PAGE 75

If a Florida court follows the same reasoning, then the fact that marijuana is an illegally obtained controlled substance does not justify disciplining an employee protected under the Medical Marijuana Initiative of the Florida Constitution. In effect, when it comes to employment law, the Florida Constitution effectively trumps federal law. The Barbuto and Noffsinger cases show that courts want to protect employees from being disciplined by their employers for using medical marijuana. Employers can no longer feel comfortable disciplining employees for using medical marijuana because it is illegal to use under federal law.

Help! What Am I to Do? Barbuto stands for the proposition that failing a drug test is insufficient grounds to discipline an employee using medical marijuana. Noffsinger stands for the proposition that even though marijuana use is a crime under federal law, that is insufficient grounds to discipline an employee using medical marijuana. These cases are both very employee-friendly and expose employers to liability for disciplining employees who use medical marijuana. But neither of these cases are Florida law. TIP: Keep current on Florida law and medical marijuana by reading Today’s FDA. TIP: Realize there are no hard and fast answers to disci-

plining staff who use medical marijuana in Florida right now, but recent decisions in other states don’t look promising for employers. TIP: Consult with an attorney who specializes in Florida employment law before you take disciplinary action against an employee for using medical marijuana. TIP: Contact your liability carrier for advice before you discipline medical marijuana users. TIP: Contact the Florida Dental Association if you would like a referral to a Florida lawyer who is certified as an expert in employment law.

 REMINDERS! HERE'S ONE RIGHT NOW! RENEW YOUR LICENSE BY FEB. 28, 2018! Every biennium, we request a list from the Board of Dentistry of dentists who have not yet renewed their license. FDA MEMBERS in this category receive a reminder to renew.

 CE BROKER The FDA automatically posts all your FDA completed CE courses to CE Broker. In addition, FDA MEMBERS receive a discount on CE Broker upgrades.

5 WAYS

WE PROTECT YOUR LICENSE For more information, go to www.floridadental.org, contact us at fda@floridadental.org or call 800.877.9922.

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 FREE CE: ONLINE AND FDC FLORIDA DENTAL CONVENTION: FDA MEMBERS pre-register for FREE and can earn up to 18 FREE CE credits. FDA ONLINE CE: Earn up to 30 FREE CE hours per year. Available 24/7, only to FDA MEMBERS. Take advantage of these courses until Dec. 12, 2017

 LIAISON WITH BOARD OF DENTISTRY The FDA sends staff and an appointed FDA MEMBER to every Board of Dentistry (BOD) meeting. Whenever your license, your ability to practice or your pocket book is affected, the FDA is part of the decision making process at the BOD.  INFORMATION Do you have questions about the biennium, the renewal process, CE Broker or your FDA-earned CE credits? Contact the FDA at fda@floridadental.org, 800.877.9922 or 850.681.3629. Information! It's one of the benefits provided to FDA MEMBERS. TODAY'S FDA

NOVEMBER/DECEMBER 2017

ANNOUNCING NEW CROWN SAVINGS MERCHANT

Member Mortgage Program To learn more, contact Inova Federal at 855.477.3385.

Let new merchant, Inova Federal, make your life easier! As a member of the Florida Dental Association, you will receive specialized services from Inova Federal’s mortgage experts, and they do all the work! Your membership provides these exclusive benefits: • Retirement Ready Mortgage Options • No Closing Cost Home Equity Options • Vacation Home Financing • Premium Pricing on Loans • A Variety of Appraisal Options

ACT OF KINDNESS

HOW A RANDOM ACT OF KINDNESS OPENS DOORS BY VIDEO DENTAL CONCEPTS

We’re sure you’ve had those moments that Hollywood couldn’t even write a screenplay about. We know we did. The power of community in business drives us to work in a more unified manner and achieve goals outside of our individual businesses and practices. We had one of those powerful experiences on June 23, 2017 at the Florida Dental Convention (FDC) in Orlando. And, by the way, we want to thank Elizabeth Bassett and the team at the Florida Dental Association for their outstanding exhibitor relations, coordination and smooth operations at this year’s convention! As Video Dental settled in for the second day of the convention, we wanted to support our CareTeam philosophy with some “random acts of kindness” throughout the show. It’s a part of who we are. The show provides great opportunities for everyone to begin new relationships, support the industry at large and contribute across the entire scope of why the practitioners do what they do — the passion to provide great dental health care. So, being a little on the extroverted side, we wanted to randomly approach people (when the time felt right) and simply give them an iCAM Intraoral Camera as a random act of kindness. No strings attached!

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Down the aisle we observed a group of dental professionals who walked with an obvious sense of great purpose, confidence in care and bright, engaging personas. That’s all we knew about them,

Not only was it beyond a Hollywood story, but it also was our privilege to meet the team from HEP at FDC.

and it would be the firm bedrock of who these professionals would turn out to be. So, we approached them in the aisle as they passed our booth and simply stated, “We would like to extend to you a gift of this iCAM Intraoral Camera.” After a slight pause — and what felt like a moment of our recipient ascertaining what the possible catch might be — they gratefully accepted the camera and begin to talk with us. It’s at that moment that we understood the presence and glow heading down the aisle from moments ago. As we spoke with Patti Hansen, she explained to us that the camera was a

gift that had extra meaning. She and her colleagues are part of the dental services team with the Homeless Emergency Project (HEP) in the Tampa Bay community. HEP has a considerable mission — to eradicate homelessness for veterans, children and all citizens in their area. Their approach is entirely holistic, and their track record of success and fiscal responsibility has made a great impact on Tampa citizens seeking to gain maximum self-sufficiency and stability in a community that genuinely cares. Specific to the dental services provided by HEP, the team works with many veterans through a relationship with the local Veterans Affairs. In addition, they provide dental care for those with health conditions arising out of lack of proper and consistent dental hygiene and health care. So, not only was it beyond a Hollywood story, but it also was our privilege to meet the team from HEP at FDC. That was only the opening of a door. Today, we have gotten closer with HEP and are moving as fast as we can to support their efforts. We challenge the dental industry to always reach beyond the common parameters of practice and business to find your “beyond Hollywood story.” Reprinted with permission. This article originally appeared on Video Dental Concepts’ blog and can be found at https:// www.videodental.com/h-e-p-dental-services-team/.

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NOVEMBER/DECEMBER 2017

MAKE SURE YOUR PRACTICE IS

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Get over $1 million in coverage starting at about $50 per month*. * Rate based on Florida Office of Insurance Regulation filing.

Call us at 800.877.7597 to learn more about Cyberguard Plus coverage.

KEEP IT LOCAL

6 PLACES TO HANG YOUR DENTAL HAT Atlantic Coast District Dental Association

Central Florida District Dental Association

KATHY CORRADO, ACDDA EXECUTIVE DIRECTOR

BY MARLINDA FULTON, CFDDA EXECUTIVE DIRECTOR

Contact the ACDDA at k.corrado@acdda.org or 561.968.7714.

The Atlantic Coast District Dental Association (ACDDA) takes pride in providing you with value for your membership. In addition to joining the state and national associations, you also will be able to join our local societies and network with your colleagues in Broward, Palm Beach, Okeechobee, Martin, Indian River and St. Lucie counties. The ACDDA’s leadership looks out for the best interests of our member dentists. Peer Review is one of your most important member benefits. In the event of a dispute with a patient, the ACDDA can mediate before it escalates to the Florida Board of Dentistry (BOD) or into a legal dispute. Our CE Cruise is a chance for our members to enjoy camaraderie with their spouse, staff and fellow colleagues. Our volunteers and members support the young, brilliant minds of the students at Nova Southeastern University, the Atlantic Coast Research Clinic, Palm Beach State College, Broward College and Indian River State College. Participation at our Annual Winter Meeting has grown exponentially in the last 10 years, and has become the fastest growing meeting in Florida! As a member of the ACDDA, you have the opportunity to join one of our five affiliate organizations. They include: the Treasure Coast Dental Society, North Palm Dental Association, Central Palm Dental Association, South Palm Dental Association and Broward County Dental Association. Each of these affiliates has a monthly/bimonthly meeting that can offer CE opportunities. Our affiliates also offer programs such as Give Kids A Smile and Project Christmas Smile.

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Contact us at centraldistrictdental@yahoo.com or 407.898.3481. Check out our website at www.cfdda.org, and make sure to “like” us on Facebook, too!

The Central Florida District Dental Association (CFDDA) has proudly served dentists throughout the Central Florida region for 95 years! The CFDDA spreads over a large geographic area of Florida and consists of 12 counties: Alachua, Brevard, Flagler, Gilchrist, Lake, Levy, Marion, Orange, Osceola, Seminole, Sumter and Volusia. Our membership is broad and diverse, and includes more than 1,500 dentists. As a CFDDA member, you have the opportunity to join one of the six CFDDA affiliate associations: Alachua, Brevard, Lake, Marion, Greater Orlando and Volusia-Flagler. The CFDDA is committed to cultivating strong relationships with its local affiliates and their members. Leadership and governance is a vital part of our association. The CFDDA is led by an executive council, which meets in person twice a year. The executive council consists of seven officers, four trustees to the Florida Dental Association (FDA), and a representative from each affiliate, for a total of 17 members. Our delegation to the FDA currently consists of 21 delegates and 21 alternate delegates. We encourage any member who is interested to serve in a leadership capacity to contact the CFDDA office. We want to keep our members informed! Communication is vital to a thriving organization and our members receive information via print publications (four newsletters per year), electronic e-news (eight per year), blast faxes and Facebook posts. The CFDDA Newsletter provides a Florida Board of

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Dentistry update, an FDA Board of Trustees report, affiliate updates, featured articles and many other newsworthy updates. In addition, the CFDDA website is an excellent resource for current information. The CFDDA’s Annual Meeting, usually held in the spring, includes scientific lectures, exhibitors and social events. This annual event is a perfect opportunity to interact with your peers and network. Members are encouraged to bring their families, as our meeting venues are selected to provide a family atmosphere with plenty of fun activities for all. The 2018 Annual Meeting will be on May 4-5 at the beautiful Daytona Beach Hilton Resort. We will be offering 12 hours of continuing education at no cost to CFDDA members and their dental teams. In addition, the CFDDA offers required courses online to assist our members with license renewal – again, at no cost. The CFDDA, in conjunction with the FDA, holds two events each year at the University of Florida College of Dentistry (fall/winter). We encourage our members to attend these events. This is a great opportunity to meet dental students, enjoy their fellowship and to discuss the importance of belonging to organized dentistry in a casual and relaxed atmosphere. The CFDDA office and its leadership are happy to provide assistance, answer questions and direct you to the proper resources. Join us today!

Northeast District Dental Association BY DEBBIE DEVILLE, NEDDA EXECUTIVE DIRECTOR

MOM) events that have greatly impacted the underserved in Florida. Thus, we continue to encourage our members to volunteer for the 2018 FLA-MOM that will take place in Fort Meyers. In addition to this event, the NEDDA has many dentists who regularly commit to help those who have minimal access to care through volunteering in health centers, participating in special events benefiting homeless veterans and children, as well as seeing patients pro bono in their offices. The NEDDA enjoys a close relationship with its partner affiliates, the Jacksonville and Clay County Dental Societies, which have dynamic members who participate in regular dinner meetings, full day CE by renowned speakers and many other social/educational events that are designed to encourage communication among the membership. The NEDDA and the leadership of the affiliates work closely to ensure continuity of our mission and provide the best value for the members. These close relationships truly help dentists in the NEDDA succeed! Our executive board is composed of a combination of general dentists and specialists to ensure that the interests of the dentists in the area are well represented. Our board meets regularly to make sure our membership stays informed of events occurring at local, state and national levels. Through a quarterly newsletter and emails, the NEDDA makes it the highest priority to get our members the most up-to-date information available so they are never caught unaware of the challenges facing our profession. Our leadership also encourages active participation with the members. Members are always welcome to contact our executive director for information on issues facing the board or suggestions as to how the board can serve them better.

Contact the NEDDA at 904.737.7545 or ddeville@nedda.org.

The Northeast District Dental Association (NEDDA) is a professional membership organization representing Florida’s licensed dentists in the northeastern counties of Bradford, Baker, Clay, Columbia, Dixie, Duval, Hamilton, Lafayette, Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor and Union. Staying true to the FDA’s mission is our top priority and our vision closely reflects our commitment to helping members succeed. Our component is committed to the improvement of the health of the public, promoting the art and science of dentistry, and representing the concerns of the members of the dental profession. The NEDDA is proud to have worked alongside the FDA Foundation at the previous Florida Mission of Mercy (FLAWWW.FLORIDADENTAL.ORG

Northwest District Dental Association BY ANGEL ESTEP, NWDDA EXECUTIVE DIRECTOR

Contact the NWDDA at nwdda@nwdda.org or 850.391.9310 .

The Northwest District Dental Association (NWDDA) represents and serves Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton and Washington counties. The NWDDA consists of four affiliate associations: Bay, EscambiaSanta Rosa, Leon and Okaloosa-Walton. Each affiliate coordinates local meetings, staff appreciation nights, table clinics for SEE PAGE 84 TODAY'S FDA

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KEEP IT LOCAL FROM PAGE 83

military residents, group mixers and volunteer opportunities to provide oral health education and care. The NWDDA includes Florida’s capital, and the district has a long history of legislative participation and leadership. Member dentists often are called upon to testify at House and Senate meetings, and attend legislative fundraisers and other FDA Political Action Committee activities. ach year, the NWDDA’s meeting offers a perfect balance of E spot-on continuing education (CE) and good old fashioned fun. The 2018 NWDDA Annual Meeting, “Ride the Wave of Dentistry,” will be on Feb. 2-3, 2018 at the Grand Sandestin in Destin. This meeting features Dr. Lee Ann Brady, Dr. Pamela Sims and Ms. Renee Graham; a Lunch and Learn; and, a Beach Party Pub Crawl. As usual, the Annual Meeting will host DeFuniak Springs LECOM D4 students, with business and management strategy guidance offered by Carr, Riggs & Ingram CPAs and Advisors, Harrison Sale McCloy Law Firm and Summit Bank. On March 24-25, 2017, the Northwest District held the Florida Mission of Mercy (FLA-MOM) at Woodham Middle School in Pensacola. Local leaders Drs. Kim Jernigan and Beau Biggs served as co-chairs for this amazing event. Thanks to the outstanding volunteer and sponsor support, the 2017 Pensacola FLA-MOM treated 1,767 patients and provided more than $1.69 million in donated care! Last June, a special welcome party was held for the LECOM D4 students from the DeFuniak Springs campus in Destin. Many of the students have already signed on to become American Dental Association members once they graduate, and the remainder will be encouraged to do so during the 2018 NWDDA Annual Meeting. NWDDA’s affiliates have a full meeting schedule locally – both educational and fun. All meeting schedules are online at nwdda.org, under the leadership of affiliate presidents Drs. Sasha Minor (Bay Dental Association), Brett Laggan (EscambiaSanta Rosa County Dental Association) Erin Shiveler (Leon

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County Dental Association) and Chad Marshall (OkaloosaWalton Dental Association). Holiday parties with affiliates scheduled so far are on Dec. 14 for the Bay Dental Society and Dec. 7 for the Escambia-Santa Rosa County Dental Association. The current NWDDA Executive Council includes: Dr. Jeff Ottley, president and trustee; Dr. Eddie Martin, alternate trustee; Dr. Marla Allen, vice president; Dr. Jodi Prine, treasurer; Dr. Brittney Craig, secretary; and, Dr. Susan Byrne, immediate past president. Dr. Jolene Paramore serves as editor.

South Florida District Dental Association BY YOLANDA MARRERO, SFDDA EXECUTIVE DIRECTOR

Contact the SFDDA at ymarrero.sfdda@gmail.com or 305.667.3647.

The South Florida District Dental Association (SFDDA) was incorporated in October 1922. It serves the counties of Broward, Miami-Dade and Monroe, and is centrally located in the city of Coral Gables. Locally, the SFDDA provides assistance in patient referrals, promotes public dental health through educational materials, and assists members with professional or patient-related issues. As part of our continued effort to promote the best dentistry among our members, we also provide continuing education (CE) through our affiliate societies. The affiliates, Miami Dade, North Dade/Miami Beach and South Broward Dental Societies, are located throughout our district, and each offer monthly CE dinners that feature excellent dental speakers. Members enjoy networking, socializing and receive CE credit — and it’s all included with their American Dental Association membership. When you invest in the tripartite through the SFDDA, you are investing in your profession and counting on us. That is why we deliver by making sure you get the most for your investment.

WWW.FLORIDADENTAL.ORG

We care that you feel valued by providing you with our best products, services and support. We work to build a wealth of resources and professional connections that help you day to day in your practice. We foster strong relationships with the community at large and with governmental agencies by having representatives in more places than any one person could ever be. We are dedicated to providing a voice to the dental profession and preserving its integrity for the well-being of the public and professional community. Together, we are larger than any one individual — and that is the power of numbers.

West Coast District Dental Association BY LISSETTE ZUKNICK, WCDDA EXECUTIVE DIRECTOR

Contact the WCDDA at Kelsey@wcdental.org or 813.654.2500. Please see infographic on page 86 for WCDDA information.

SEE PAGE 86

GET RENEWAL READY @ THE FDA online

FREE

C E C R E D I TS FOR F DA ME MBER S ! Free clinical & legal CE courses

DENTAL LICENSE RENEWAL DEADLINE

New! Mandatory Survey

FLORDA BOD & ADA CERP COMPLIANT

• •

LEGAL CE Patient Abandonment (LC02) What Florida Dentists Need to Know about Prescription, Controlled Substance and Pain Management Laws (LC01)

TODAY’S FDA DIAGNOSTIC DISCUSSION & QUIZ

Go to floridadental.org. Click Convention & CE. Questions 850.800.877.9922 or membership@floridadental.org.

WWW.FLORIDADENTAL.ORG

•

Ace Inhibitor Associated Angioedema of Oral Tissues (DD30)

• •

Proliferativeverrucous Leukoplakia (DD29)

• • •

Pleomorphic Adenoma (DD26)

Lateral Tongue Lesion in HIV Positive Patient: Oral Hairy Leukoplakia (DD28) The Oral Systemic Connection (DD27) Lymphangioma (DD31) * These courses expire on 4/30/2018

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WHICH FDA DISTRICT SHOULD YOU CHOOSE WHEN YOU SETUP YOUR DENTAL PRACTICE? BY DR. HUGH WUNDERLICH, EDITOR WEST COAST DISTRICT DENTAL ASSOCIATION

START HERE

ARE YOU A YES DENTIST? NO

DO YOU HAVE A LICENSE? YES

YES

INVEST IN ALIBABA. RETIRE EARLY.

YES

ARE YOU ALLERGIC TO SUNSCREEN?

GO TO TALLAHASSEE AND JUST ASK FOR A DENTAL LICENSE. HEY, IT WORKED FOR ME. NO OK

YES

NEED TO LIVE IN THE CENTRAL TIME ZONE? YES NO

PASS

YES

YOUNG & HIP? YES

FREQUENT THE “WORLD’S LARGEST COCKTAIL PARTY?” YES NO

NORTHWEST DISTRICT DENTAL ASSOCIATION NORTHEAST DISTRICT DENTAL ASSOCIATION

SOUTH FLORIDA DISTRICT DENTAL ASSOCIATION

LOVE THE MOUSE? NO

WANT TO BE IN THE “BEST COAST?”

TAKE DENTAL BOARDS

PLAY POLO? NO

YES

ATLANTIC COAST DISTRICT DENTAL ASSOCIATION

CENTRAL FLORIDA DISTRICT DENTAL ASSOCIATION

YES

LOVE “MAID-RITE” SANDWICHES, GREEN BEAN CASSEROLE AND THAT JELLO WITH FRUIT COCKTAIL/ MARSHMALLOWS IN IT

YES

NO PASS

WHY NOT? YOU SHOULD.

YES

MAKE A DEAL WITH THE DEVIL

GO TO DENTAL SCHOOL

DO YOU ALIGN POLITICALLY WITH THE I-4 CORRIDOR?

HAVE A RICH BENEVOLENT UNCLE? NO YES

DO YOU WANT TO BE A DENTIST?

AKRON, OHIO

WEST COAST DISTRICT DENTAL ASSOCIATION

YES

THANKS

HAVE A FONDNESS FOR INTERSTATE 10?

DO YOU HAVE $400K

HEY! THEY HAVE SOUTH BEACH ... JUST SAYIN’

2018 Atlantic Coast District Dental Association Winter Conference

Dr. Todd Morgan

Dr. Todd Morgan Will Teach You Easy, Cost- Effective Approach To Implement Sleep Into Your Practice Friday, February 23, 2018

Embassy Suites West Palm Beach, FL

In Addition: Learn How To Maximize Your Billing And Coding With Pristine Medical Billing

The field of dental sleep medicine is rapidly growing. Around 20% of patients in a dental practice have undiagnosed sleep apnea. Dentists are in an excellent position to help treat this epidemic. Many dentists have problems with the obstacles dental sleep medicine entails, sometimes discouraging dentists and their team to hang in there. With the correct protocols in place, dental sleep medicine can be implemented into any dental practice. Dr. Morgan will share his experiences implementing sleep dentistry and how he has achieved success in his practice while making this event a fun experience. Healthy sleep is important to all of us so this day is great for the whole crew! Your team will learn easy medical coding for DSM from a top expert, Randy Curran of Pristine Medical Billing. Ready to start a new start a new profit center in your practice and save lives? See you in February!

For more info contact: 561.968.7714 k.corrado@acdda.org

WELCOMING NEW MEMBERS EVERY DAY! At the South Florida District Dental Association you receive all the benefits of tripartite membership plus ... •

C.E. Dinner Meetings at the local affiliate societies included with your dues

•

Community and camaraderie

•

Opportunities to serve your profession

•

A local voice in advocacy

•

Wonderful mentors ready to help

•

A dedicated staff just a phone-call away

Join Us! Call (305) 667-3647 or visit www.sfdda.org

Update your Find-a-Dentist profile! THREE-YEAR CAMPAIGN: The ADA has launched a threeyear, $18 million program that will focus on directing consumers to make an appointment with an ADA dentist. Through search improvements and digital advertising this campaign will make it easier to find you online. As part of the program, we have enhanced the Find-a-Dentist tool, including more ways to search for you.

WILL PATIENTS FIND YOU? APPEALING! • LAND AT THE TOP of an online search by updating your profile. • Profiles with photos get 11 TIMES MORE CLICKS than those with no photo. • Provide MORE INFORMATION about your practice.

OVERLOOKED? • LAST in a search • FEWER CLICKS • ONLY BASIC information about your practice. • LOSE the advantage of an important, free member benefit. VISIT ADA.ORG/MYADA and log on to highlight your practice by uploading your picture and completing your practice information. If you’re unsure of your user ID or password, call the ADA Member Service Center at 800.621.8099. WWW.FLORIDADENTAL.ORG

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DISTRICT PRESIDENTS Atlantic Coast District Dental Association

DR. CHUCK BRAVERMAN

Dr. Braverman is a general dentist in Jupiter and can be reached at cbraverman252525@gmail.com.

are pressures from many governmental agencies and Congress to implement changes to our profession to adapt with today’s ever-changing society, and this has increased pressure on our legislators to enact laws that may not be best for dentistry as a whole. Economic support and volunteering is needed from the dental profession to help support our lobbyists as they interact and help guide legislators to pass appropriate laws that help both dentistry and our patients. For me, belonging to organized dentistry is just one small way to show there is strength in numbers and to send a unified message to legislators.

What is your favorite member benefit? Being a part of the tripartite is my favorite benefit, especially working with all the volunteer leaders at the CFDDA.

Why did you join the FDA?

What’s the most fun you have ever had at a component meeting?

I joined because it was expected, and the benefits of insurance were terrific.

Going to the great pool at Hammock Resort in Palm Coast after a CFDDA annual meeting!

What is your favorite member benefit?

What seems to be the top/major concern in your component?

My favorite benefit was meeting with my peers.

What’s the most fun you have ever had at a component meeting? Most fun — running into an old friend or classmate.

What seems to be the top/major concern in your component? We have allowed others to dictate our future. In Florida, we have supported candidates based on political affiliation, rather than vetting the candidates‘ support for our profession.* *Please visit http://bit.ly/2zroNqd for the Florida Dental Association Political Action Committee (FDAPAC) policy on providing campaign support.

Central Florida District Dental Association

I see many CFDDA affiliate dental associations struggling to get members to become active at the local and CFDDA level. Many times, just getting members to attend the local dental association (affiliate) meeting is a challenge, much less to recruit a member to volunteer to serve as an officer or in other leadership positions.

Northeast District Dental Association DR. CLAUDIO VARELLA

Dr. Varella is an endodontist in Jacksonville and can be reached at cvarella@me.com.

DR. BRYAN BERGENS

Dr. Bergens is a periodontist in Daytona Beach, and can be reached at bbergens@hotmail.com.

Why did you join the FDA? I believe organized dentistry is our one positive voice, protecting our right to practice dentistry in a manner we choose.

Why did you join the FDA? I joined the ADA, FDA and the CFDDA because dentistry is an honored and respected profession. But as we all know, there

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What is your favorite member benefit? The support my practice has received from all the FDA staff is my favorite benefit. They have helped me anywhere from WWW.FLORIDADENTAL.ORG

finding the best health insurance for me and my family to sending me information about current legislation.

What seems to be the top/major concern in your component? There are many issues concerning dentistry that will most certainly impact our practices. We have many from the government and outside organizations who want to control how we practice, and we should work together to prevent it from happening.

Northwest District Dental Association DR. JEFF OTTLEY

Dr. Ottley is a general dentist in Milton, and can he reached at dmdottley@gmail.com.

fully behind them. Also, playing golf with friends from all over the state is a close second. It’s always fun to catch up away from the meeting’s business.

What seems to be the top/major concern in your component? Well, I will come at this in two ways. First, from the leadership point of view, our concern is reaching newer dentists and getting and keeping them involved in FDA/NWDDA leadership. From a grassroots view, most members in our area are concerned with changes in practice models. Will dentists be able to continue to practice as they choose, not how the government/insurance companies make them? With the threat of new practice models, the constant threat of mid-level providers and possible mandated Medicaid/Medicare coverage, how will things look in five to 10 years?

South Florida District Dental Association

DR. JOSEPH PECHTER

Dr. Pechter is a periodontist in Hollywood, and can be reached at jpechter@gmail.com.

Why did you join the FDA? When I started my practice nearly 20 years ago, membership was seen as a status or recognition of being a good, ethical dentist. As the years passed, I realized how important being a member of the FDA truly is for many reasons — ranging from advocacy to member benefits and discounted services to the invaluable FDA staff working every day to help members succeed. It has become an honor to be a member; it’s like a family.

What is your favorite member benefit? With so many member benefits, it is difficult to pick just one, so I will go with the one that impacts my practice the most — advocacy.

What’s the most fun you have ever had at a component meeting? This is again a hard question to pinpoint one answer, but I must say that hanging out with the senior dental students from LECOM (Defuniak Springs) the last couple of years at our component meetings has been the most fun. This gives us an opportunity to build mentor relationships and friendships, and instill in students the importance of having an organization

Why did you join the FDA? I joined the FDA to be part of the largest organization in Florida that supports dentists and dental specialists. My other reasons are: s continuing education (CE) credits s dental speakers and thought leaders s tradeshows s mentorship s classified ads (jobs, practices, finding staff) s advertising to patients on my website or on the ADA’s Find-a-Dentist tool s savings in dental supplies s savings in dental insurances (FDA Services) s knowing what is “going on“ in the profession

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DISTRICT PRESIDENTS FROM PAGE 95

s meeting with friends s networking s to combat bad dental legislation s to help with board complaints s a chance to be heard s a chance to become a leader There are a lot of reasons! I am very pleased with my decision, and I feel that our organization is strong.

What is your favorite member benefit? My favorite benefit is the CE dinners for our local meetings. We get a chance to catch up with our colleagues, hear about the “dental news” from in-the-know local leaders, such as Drs. Mike Eggnatz and Alan Friedel. We also benefit from high quality CE speakers. My favorite ADA member benefit is access to the ADA e-library. (Did you know that ADA members have access to the ADA e-library, which has more than 500 journals? For example, the International Journal of Periodontal and Restorative Dentistry is included free with your ADA membership!)

What’s the most fun you have ever had at a component meeting? The most fun I’ve had was at the South Broward Dental Society end-of-year meetings with outgoing presidents Drs. Joel Slingbaum, Mark Limosani and Brian Nitzberg. Those meetings topped off great years of hard work, and it was fun for all who attended!

What seems to be the top/major concern in your component? New leadership is my biggest concern. We need more members to actively participate for our organization to survive. Serve, attend, be heard and give back to your profession. It will be mutually beneficial!

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West Coast District Dental Association BY DR. NATALIE CARR-BUSTILLO

Dr. Carr-Bustillo is a pediatric dentist in Riverview and can be reached at ncarrdds@carrdental.com.

Why did you join the FDA? I’ve always been a member of organized dentistry (as far back as the American Student Dental Association). I attended my first Hillsborough County Dental Association meeting within a month of moving to Tampa. There are many people who make decisions regarding our profession (i.e., the Department of Health, Legislature, insurance companies). I think it’s important that we — as dentists and the experts in oral health — come together for the good of our patients to help mold what dentistry is today and will become in the future.

What is your favorite member benefit? I think that one of the most important benefits provided by the FDA is Peer Review. With the entire situation being unbeknownst to me, the patient filed a complaint with Peer Review asking that my license be revoked! I first found out about the issue through Peer Review, and it was handled swiftly and professionally with all parties happy. Having our peers review our patient complaints rather than attorneys and lay people is a great member benefit!

What’s the most fun you have ever had at a component meeting? I always enjoy all our component meetings, but my favorite meeting is the WCDDA meeting at the Ritz Carlton in Naples. It’s a great meeting that allows for continuing education (CE), camaraderie with our fellow dentists and family fun — it’s the perfect balance! Next year due to renovations at the Ritz in Naples, the WCDDA Summer meeting will be at the J.W. Marriott in Marco Island. I’m looking forward to checking out Marco Island (but for those who just love the Ritz, not to worry … we will be back in 2019).

WWW.FLORIDADENTAL.ORG

What seems to be the top/major concern in your component? My main concern for our component is membership! A few years ago, I was appointed to a committee that was created by the governor. The State Oral Health Initiative Plan (SOHIP) was a committee created to advance general health and well-being by increasing critical partnerships, coordination and collaboration in efforts to reduce oral health disparities. The committee was comprised of a “broad-based group of agencies, institutions, organizations, communities, stakeholders, policymakers, leaders and other individuals” to promote optimal oral health. At one large face-to-face meeting in Tampa, I was the only practicing dentist and one of only three dentists at a meeting of about 150 people. As the experts in oral health, we need to be at the table when oral health issues are discussed! This can only happen if we make time to serve our profession. There are so many ways to get involved in organized dentistry. You can:

YOUR FOUNDATION AT WORK RESPONDING TO HURRICANE IRMA The Florida Dental Association (FDA) Foundation’s Disaster Fund exists to support dental professionals in their greatest time of need. Licensed, practicing dentists in Florida impacted by a disaster are eligible for financial assistance in the form of Emergency Disaster Assistance Grants.

s Donate to the political action committees (PAC) to help keep the profession and the legislators in communication with each other.

This year, Hurricane Irma affected many people across the state. Working together with the ADA Foundation, the FDA Foundation has distributed 62 grants totaling $93,000 to assist dentists with emergency personal needs such as food, water, clothing and emergency shelter. FDA leaders and staff made personal calls to members in affected areas.

s Volunteer at the Florida Mission of Mercy (FLA-MOM), a free, two-day dental clinic that provides care for the underserved in Florida. Next year, the event will be at the Lee Civic Center in Fort Myers on March 9-10, 2018.

The FDA Foundation Disaster Fund received $87,000 in donations from these state dental associations: New York, Texas, Oklahoma, Tennessee, New Jersey, Massachusetts, Rhode Island and Louisiana.

s Volunteer to serve on a committee or as leadership in the dental association at the affiliate (county), component (district) or state level. Let your president know you are interested in getting involved!

The FDAF Board also approved a $10,000 donation from the FDAF Disaster Fund to the Colegio de Cirujanos Dentistas de Puerto Rico (Puerto Rico’s dental association) to assist our colleagues affected by Hurricane Maria.

s Donate to the FDA Foundation (the FDA’s charitable organization) to help promote dental health for all Floridians and provide relief to our fellow dentists in time of disaster.

s Attend the CE courses and meetings to ensure their success. s Most importantly: BECOME A MEMBER and ask your fellow dentists to join us in making our profession great!

FDAF RESPONSE AT A GLANCE



Contributions from other states: $87,00

 Number of FDAF Grants to dentists: 62  Total FDAF Grants to dentists: $93,000

WWW.FLORIDADENTAL.ORG

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SEE PAGE 56

THANK YOU, UCF PDSA! Sixty-four members of the Pre-Dental Student Association at University of Central Florida took a bus from Orlando to Penscola to volunteer at the 2017 Florida Mission of Mercy.

FDAS ALERT! Florida Orders Workers’ Comp. Rate Decrease of 9.8 Percent! Florida Insurance Commissioner, David Altmaier ordered a statewide workers’ compensation rate decrease of 9.8 percent in November, a slightly higher decrease than the National Council on Compensation Insurance (NCCI) filed earlier this year.

What you need to know: • •

If the NCCI’s rate request is amended, refiled and approved by Nov. 7, 2017, the rate decrease will become effective on Jan. 1, 2018 for new and renewal business. No action is need by policyholders.

Ask us about the 20% workers’ comp. dividend from the Zenith. Call your insurance experts at 800.877.7597 if you have any questions about how this rate increase may affect your practice’s workers’ comp. policy. WWW.FLORIDADENTAL.ORG

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COMPLEAT DENTISTRY

Can Insurance Companies Make Life Easier? “I know, I know, all you doctors hate insurance companies,” said a patient recently.

DR. EDWARD HOPWOOD

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

Compleat dentistry is a slowerpaced, 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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But this is a big misconception about me and my practice. One of the great benefits of pursuing compleat dentistry is that I no longer hate insurance companies. In fact, I group insurance companies in the same category as I group addition and Phillipshead screwdrivers: They are tools to help make my life easier. I don’t have emotional feelings towards them. In fact, when I find myself getting frustrated with a tool, I step back and realize that my frustration stems from applying the tool to the wrong task — like using a Phillips-head to hammer a nail. In fact, I buy insurance and I am sure you do, too. We buy insurance as a tool to offset risk. When we think about it, much of our success as a society is due to the ability to insure against risk. For example, look at the skyline of any city and recognize that such a skyline would not exist without insurance. No one would build a skyscraper if they couldn’t insure against the risk of a fire that would destroy it. No banks would lend them the money to build a skyscraper and very few people have the money to build a skyscraper. (Go ahead and insert your own joke here about how many skyscrapers are owned by insurance companies.) Further, even the insurance companies buy insurance to cover themselves against the very risk that they have incurred by selling policies. So, if we all buy it, if it has helped

NOVEMBER/DECEMBER 2017

enable great strides in our society and even the companies selling it are willing purchasers of insurance, I think we can all agree that insurance is a useful tool, indeed. If we think about it a little bit further, we can recognize that to be effective, insurance must follow three basic tenets: 1. The risk we are covering must be of sufficient size to be catastrophic. (Try and insure a T-shirt.) 2. The risk must be an uncontrolled risk that both we and the insurance companies hope will never happen. (You can’t insure against tomorrow’s sunrise.) 3. We do all that we can to make sure that it won’t happen or at least we try to protect ourselves from the risk. (They won’t sell fire insurance to an arsonist.) And, if it follows these three tenets, insurance is a tool that works wonderfully. The best example in our state — especially after this past summer — is hurricane insurance. If the storm hits, you could lose your house (Rule 1). We have no control over which way the storm will travel and we hope it doesn’t hit our house (Rule 2). And, we shutter up the windows, trim the trees and throw the patio furniture in the pool when preparing for the storm (Rule 3). Everyone (homeowners and insurance companies) is happy when the storm misses them and those unlucky few who get hit by the storm are upset, but their risk is mitigated.

WWW.FLORIDADENTAL.ORG

So, the insurance companies have actuaries who calculate the odds of the catastrophic event (risk) and then determine how much it would cost to cover that risk. Then they add in a healthy profit for their company (so they can build their own skyscraper) and they charge us a premium that we pay to protect ourselves. Insurance companies are not bad, they are just painfully rational — they wouldn’t sell a policy that doesn’t cover their risk and allow a profit. Like all other tools, insurance works well … until we try to use it for the wrong task. Then it becomes like using a Phillipshead screwdriver as a hammer – sure it may seem to work, but there probably is going to be pain involved and it is not going to be terribly effective. A great example of the insurance tool being misapplied is maternity insurance. Healthy childbirth is not a catastrophic risk, in fact most of us can pay for it easily (Rule 1 violation). Pregnancy is not something we hope will never happen, in fact we control when it happens (Rule 2 violation). Not only do we control when it happens, if you want to get pregnant, you and your spouse often enjoy exerting the effort to make it happen (Rule 3 violation). Because all three rules are being violated, maternity insurance is a tool that is being misapplied. So, the insurance companies have invented something they call “maternity insurance,” but it is nothing of the sort. In fact, the only thing normal about maternity insurance is the profit that the insurance companies make. (Please note here: I am only talking about healthy childbirth, complications of childbirth follow all three rules and are an appropriate thing to insure against.) I found this out when we started planning a family and my wife quit working outside the home. We paid for the doctors who delivered the baby, we paid for the hospital stay and we paid for the anesthesiologist using cash. In fact, the hospital workers were dumbfounded when I went down to pay the bill before leaving – they had never seen that done before, and it took them two hours to get it ready, so we waited. I am telling you this story not to brag about how rich I am — rather, I am emphasizing how cheap I am, because I wasn’t willing to pay the insurance company their profit. I saved our family between $5,000 and $10,000 per child (we have three).

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WHEN WE THINK ABOUT IT, MUCH OF OUR SUCCESS AS A SOCIETY IS DUE TO THE ABILITY TO INSURE AGAINST RISK.

Maybe we should add a fourth tenet of insurance: In order for insurance to work, the company selling it has to make money. Whenever I buy insurance, I want to make sure it follows the three basic tenets and I want to be sure the insurance company makes money. If the company doesn’t make money, then it won’t be in business that long and it is not a company I can count on when a disaster strikes. Further, I would be skeptical about purchasing any insurance where I didn’t see a clear profit for the company selling the policy. If I can’t see the profit, then I am missing something. In the next issue, we’ll talk about how to apply these rules to dental insurance.

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ABSTRACT

ORAL HEALTH DISPARITIES: ALACHUA COUNTY FLUORIDATION BY ERIC DAMIAN PORTALATIN SR., MPH

Methods

Results

Mr. Portalatin is a Community Outreach Assistant at the University of Florida College of Dentistry Department of Community Dentistry and Behavioral Science. He can be reached at EPortalatin@dental. ufl.edu.

If a student lives in area serviced by a fluoridated water system, then they will have better oral health outcomes than a student who lives in an area serviced by an unfluoridated water system. There is a need to assess the oral health of individuals in Alachua County. Not many dentists accept Medicaid in Florida, which has caused an oral health disparity sharply defined by socioeconomic status (SES). CWF is a proven method of preventive health in dentistry. The data allowed for a retrospective cohort study design. Data was collected through a third-grade School-based Dental Sealant (SBDS) Program using oral health screenings. UC and CE are coded as present or absent. TxU is coded on an increasing scale of severity as follows: “no obvious need,” “treatment recommended” and “urgent care needed.” SES was ascertained through the percentage of third-graders who receive free and/or reduced lunch: (0 - 45 percent) – High, (45 - 65 percent) – Medium, (65 - 100 percent) – Low. Fluoridation exposure status was established by cross-referencing fluoridated water treatment plant catchments with elementary school zones.

There were 2,127 students screened in the SBDS program. This accounted for 94 percent of all the third-graders in Alachua County. UC – 38.45 percent (818 participants), CE – 55.71 percent (1,185 participants), “urgent care needed” – 8.09 percent (172 participants). Medium SES: on average the odds of a CE are 42.4 percent higher in areas without CWF. Low SES: on average the odds of “urgent care needed” are 41.9 percent higher in areas without CWF. The odds of a CE are 33.86 percent lower among high SES than low SES in areas with CWF. The odds of “urgent care needed” are 30.46 percent lower among high SES than medium SES in areas with CWF.

Background The anticariogenic effects of fluoride were first documented in the 1930s. In 1945, Grand Rapids, Mich. became the first community to artificially fluoridate their water system. Other communities followed suit with Gainesville, Fla. implementing community water fluoridation (CWF) in 1949. A 10-year follow-up study of the Grand Rapids CWF project showed decreased rates of caries across all ages. Prevalence of fluorosis eventually rose and so did opposition to CWF. Despite the opposition, the Centers for Disease Control and Prevention named CWF one of the Top 10 Public Health Achievements of the 20th Century.

Objectives The main goals of this study are to identify areas of oral health disparities and evaluate the effect to which CWF mitigates untreated caries (UC), caries experience (CE) and treatment urgency (TxU) of “urgent care needed.” Additionally, this study could be used to plan future interventions that accurately meet the needs of Alachua County, Fla. WWW.FLORIDADENTAL.ORG

Conclusions Measure of oral health outcomes varied across SES and CWF status. Overall, third-graders from areas with CWF had a lower percentage of UC, CE and TxU of “urgent care needed.” Absence of CWF does not necessarily mean the presence of poor oral health outcomes. However, frequency and distribution of poor oral health outcomes in Alachua County are more likely in lower SES areas without CWF. Further investigation into the association between CWF and oral health could lead to advances in public health dentistry.

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DRS. LIYA DAVIDOVA*, INDRANEEL BHATTACHARYYA, NADIM M. ISLAM AND DONALD COHEN

A 20-year-old female presented to Dr. Carlo Guevara at the Oral and Maxillofacial Surgery Clinic at the University of Florida College of Dentistry for consultation and treatment regarding a vascular exophytic lesion on the dorsum of tongue. She reported intermittent pain and dysphagia associated with the lesion. This lesion has been present on the tongue for the more than 10 years. Due to similar symptoms in the past (three years ago), the lesion was treated with approximately 20 cycles of intralesional steroid injections, which resulted in some shrinkage but not resolution of the lesion. However, recently the patient reports that two new lesions have developed in the past two to three months. The area is symptomatic, especially to spicy and cold foods, which seem to irritate the lesion. She also reports worsening of the symptoms following an upper respiratory infection. Clinical examination revealed a large exophytic lesion with a pebbly surface, resembling clusters of vesicles on the center of the dorsum of the tongue toward the midline (Figs. 1 and 2). The lesion was at least 3 cm in length and had two smaller satellite lesions on the anterior end. Multiple small punctate ulcerations also were noted on the surface of the lesion, but the patient reported no active bleeding from the lesion. The tongue movement was within normal limits and wasn’t restricted due to the growth. Her medical history was significant for Hashimoto’s thyroiditis, Type 2 diabetes mellitus and hyperlipidemia. She currently is on 500 mg metformin, 2.5 mg lisinopril, oral contraceptive and multivitamins. Her blood sugar levels as well as thyroid hormone levels were well-controlled. A treatment plan similar to that in the past was presented to the patient, and she is scheduled to return to the clinic for intralesional steroid injections and continued follow up. A biopsy was deferred since clinical examination was considered diagnostic.

FIG. 1:

Question: What is the most likely diagnosis? A. Lymphangioma B. Squamous cell carcinoma C. Pyogenic granuloma

FIG 2:

D. Lingual thyroid E. Kaposi’s sarcoma

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translucent vesicles. Such pebbly surface appearance often is referred to as a tapioca pudding- or frog egg-appearance. In some instances, hemorrhage into the lymphatic spaces causes vesicles to acquire a red, blue or purple color (as represented by our case). Deeper lesions manifest as soft, diffuse masses, with insignificant changes in color.

DIAGNOSTICS FROM PAGE 105

Diagnostic Discussion A. Lymphangioma Correct! Lymphangiomas are relatively rare, benign, tumor-like growths of the lymphatic vessels. They represent a developmental anomaly of the lymphatic system and usually are diagnosed at birth (~50 percent) and early childhood (~90 percent by age two). These lymphatic malformations have marked predilection for head and neck (50-75 percent of cases); however, their intraoral occurrence is rare. In the oral cavity, the most common site of occurrence is the anterior two-thirds of the tongue, followed by the palate, buccal mucosa, gingiva and lips. Though this lesion was seen in a slight posterior location, the dorsum of the tongue is a fairly common location. A small percentage (4 percent) of these congenital lymphatic malformations occurs on the alveolar ridge of neonates — especially children of African descent — and exhibits spontaneous resolution. These lesions are seen more commonly in males and involve the mandible bilaterally. They may result in macroglossia leading to airway obstruction, speech disturbances, difficulty in mastication and swallowing, bleeding from trauma, open bite and mandibular prognathism. The clinical presentation of lymphangiomas depends on whether these lesions are superficial or deep-seated. Superficial lesions, such as in this case, demonstrate elevated nodules resembling clusters of clear, yellowish and pink

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The treatment of lymphangioma depends on the type, size, extent of the infiltration into the surrounding tissues and involvement of anatomical structures. Treatment modalities for lymphangiomas include: surgical excision, cryotherapy, electrocautery, laser surgery, sclerotherapy (doxycycline, bleomycin, ethanol, acetic acid, sodium tetradecyl sulfate), administration of steroids, ligation, embolization, radiation therapy and coblation (radiofrequency tissue destruction). Microcystic lesions, such as our example, are difficult to completely remove due to their diffuse and infiltrative nature, while macrocystic lesions are easily excised because they respect surrounding tissues and stay localized. Microcystic lesions show higher recurrence rate, especially if they were surgically removed, while macrocystic lesions recur less due to their well-circumscribed nature. The prognosis is good, except for large lymphangiomas that may cause airway obstruction and lead to death. The clinician should take care to choose the appropriate treatment modality for lingual lymphangiomas due to their microcystic nature, as well as possible functional complications due to potential for blockage of lymphatic drainage, which could seriously compromise movement of the tongue or other involved areas. In addition, due to the potential for hemorrhage, a biopsy should

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be performed with utmost care. B. Squamous Cell Carcinoma Incorrect, but good choice! However, this diagnosis on the dorsum of the tongue would be extremely unlikely and even more so given the patient’s young age. In addition, the lesion has been present for many years, and if this was a carcinoma, significant infiltration and serious consequences such as restriction of tongue movement, pain and ulceration would have occurred. Squamous cell carcinoma (SCCA) of the oral cavity is much more common in older individuals and usually associated with risk factors such as smoking and/or alcohol abuse. Our patient did not have any of the risk factors, including immune suppression. The risk of oral SCCA increases with increasing age, especially in males. In addition, more than 50 percent of the SCCA of the oral cavity arise on the lateral and ventral surfaces of the tongue and only 4 percent or less of SCCA is seen on the dorsum of the tongue. Oral cancer accounts for less than 3 percent of all cancers in the U.S., comprising approximately 22,000 new cases diagnosed annually. Approximately 5,500 people die of this disease each year. The average annual incidence and mortality rates, however, vary considerably. The etiology of oral SCCA is multifactorial and it’s believed that more than a single factor is needed to produce SCCA. Heredity does not appear to play a major causative role in SCCA of the oral cavity. Also, oral SCCA follows an identifiable premalignant lesion — leukoplakia — which was not reported in this patient. The presentation of this lesion also is slightly different from the typical oral SCCA, which usually presents either as an ulceration or as a papillary exophytic growth. The spread of the lesion was, of course, alarming, but WWW.FLORIDADENTAL.ORG

benign lesions such as lymphangioma, pyogenic granuloma, hemangioma, etc. may exhibit rapid increase in size. C. Pyogenic Granuloma Incorrect — excellent choice, though! Based on the patient’s demographics and clinical presentation, this is a possible diagnosis. Pyogenic granuloma is a common tumor-like mass of the oral cavity that represents an exuberant tissue response to local trauma or irritation. The terminology is inaccurate since pyogenic granulomas are neither “pyogenic”— that is, associated with bacteria — nor are they true granulomas. The tongue is not a common location, especially the posterior dorsum of the tongue. In the oral cavity, these lesions most often are located on the gingiva (75-80 percent), caused by gingival irritation and inflammation due to poor oral hygiene. In this case, however, careful evaluation failed to reveal any evidence of trauma. Also in terms of duration, the lesion seen here has been present for many years, which would be unusual for a pyogenic granuloma without progressive fibrosis and collagenization (sclerosed pyogenic granuloma). Older lesions are pinker due to higher collagen content. Pyogenic granulomas have slightly higher predilection for maxillary gingiva and more frequently affect the anterior area than posterior. Also, they more commonly are located on the facial aspect of the gingiva rather than the lingual, although some may involve both facial and lingual gingiva when they extend between the teeth. The other most common lesional sites include lips, tongue and buccal mucosa. Pyogenic granulomas can be smooth or lobulated, pedunculated or even sessile. Their size varies from a few millimeters to several centimeters in diameter. Depending on WWW.FLORIDADENTAL.ORG

the age of the lesion, the color can range from pink to red to purple. Younger lesions are more red or purple due to high vascularity. Pyogenic granulomas usually are painless, even though ulceration and bleeding are common. Rapidly growing lesions may alarm both clinicians and patients, as they may be mistaken for possible malignancy similar to this case. Pyogenic granulomas most commonly occur in children and young adults, although they can develop at any age. Females tend to be more affected, possibly due to hormonal effects, especially during pregnancy. Some of the pyogenic granulomas resolve on their own, some undergo fibrous maturation and assume appearance of fibroma. Conservative surgical excision usually is curative; however, a recurrence rate of 3-15 percent is reported. Rarely, multiple recurrences may occur. To minimize the chance of recurrence, all gingival pyogenic granulomas should be excised down to periosteum and adjacent teeth should be thoroughly scaled to remove any irritants, such as plaque and calculus. Multiple recurrences on nongingival lesions is not unlikely, especially if trauma is a precipitating factor. Treatment for pyogenic granulomas that developed during pregnancy should be deferred, unless the lesion compromises its function and aesthetics. Higher recurrence rate should be expected for the lesions removed during pregnancy. D. Lingual thyroid Incorrect. This is an extremely rare finding on the posterior tongue, which represents ectopic thyroid tissue stemming from failure of the thyroid gland to descend from the foramen cecum to its normal pre-laryngeal site during embryologic development. Usually,

DIAGNOSTICS the lingual thyroid is a single, nodular, vascular, lobulated mass ranging from less than a centimeter to several centimeters, which may block the airway. However, the lesion in this case was much larger and was gradually enlarging in size, which would be extremely unlikely in the case of lingual thyroid. The lingual thyroid generally is found more posteriorly to the foramen cecum, while the lesion in our patient is located more anterior. Also, the lingual thyroid usually presents as a lobulated mass. However, in our case, the lesion appears more pebbled with small ulcerations, erythematous multiple vessel-like blebs. This developmental abnormality is three to seven times more common in females than males, presumably due to hormones. The development of symptoms becomes more evident during puberty, adolescence, pregnancy or even as a late as menopause. Even though lingual thyroid is a developmental anomaly, it may not be noticed until later in life. The mean age of presentation is 40 years, though a wide age range from infancy to 83 years of age has been reported. The lingual thyroid usually is superficial or submucosal, along the midline of the posterior dorsal surface of the tongue between foramen cecum and epiglottis. A rarer sublingual type, arising in the body of the tongue, located in the suprahyoid or infrahyoid region or at the level of the hyoid bone has been reported. Clinical symptoms may mimic our case, including dysphagia (difficulty swallowing), dysphonia (difficulty speaking) and dyspnea (difficulty breathing). Hypo-

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DIAGNOSTICS FROM PAGE 108

thyroidism has been reported in about one-third of patients. In 70 percent of cases, this ectopic gland is the patient’s only thyroid tissue; therefore, biopsy is not advised. Many believe that lingual thyroid enlargement is secondary to compensation for thyroid hypofunction. However, an incisional biopsy might be necessary to rule out malignancy, because in rare instances (1 percent) carcinomas may develop in lingual thyroids. A thyroid scan using iodine isotopes or technetium-99m (99mTc) is recommended to establish the diagnosis. Usually no treatment is advised for asymptomatic lesions; however, periodic follow-up is required. Symptomatic lesions often require suppressive therapy with supplemental thyroid hormone. Surgical removal or ablation with radioactive iodine-131 can be performed if hormone therapy fails to resolve the symptoms. If the mass has to be excised, transplantation of the removed thyroid tissue to another body site may be attempted to prevent hypothyroidism. E. Kaposi’s sarcoma Incorrect — good choice! The clinical appearance makes this choice highly likely and Kaposi’s sarcoma (KS) frequently has been reported on the tongue. In the U.S., these lesions generally are seen in patients with severe or

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significant immune suppression, including patient with AIDS, transplant recipients, or older males of Italian, Jewish or Slavic descent. In our case, the patient is a young Caucasian female (barely out of her teens) who did not give any history of HIV, nor did she present with any other ancillary signs or symptoms associated with HIV infection, such as lymphadenopathy, candidiasis, weight loss or generalized weakness. KS is an unusual vascular malignancy caused by infection with human herpesvirus 8 (HHV-8; KS-associated herpesvirus [KSHV]). HHV-8 shows tropism (specificity) for oral and oropharyngeal epithelial cells. Four clinical presentations are recognized: classic (chronic), endemic (African), iatrogenic (transplant-associated) and epidemic (AIDS-related). KS mainly manifests on the skin or oral mucosa, although lymph nodes and viscera also may be involved. Multiple cutaneous or oral lesions are the usual presentation; however, occasionally a solitary lesion may be identified first. Classic KS mainly is seen in older adults, with the majority of cases occurring in men. Individuals of Italian, Jewish or Slavic ancestry are more commonly afflicted. It presents as multiple blue-purple macules and plaques on the skin of the lower extremities. These painless lesions demonstrate slow growth (years) and develop into nodules. Occurrence in the oral cavity is rare, with the palate representing the most commonly affected site. Endemic KS was a somewhat common neoplasm of children and

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young adults in sub-Saharan Africa even prior to the emergence of HIV/AIDS. The course of the disease in this form varies widely from indolent skin lesions seen in classic KS to more aggressive tumors involving viscera, deeper tissues and bone. Endemic KS used to be the most common form of the disease seen in Africa, while epidemic (AIDSrelated) KS is seen more frequently now. Iatrogenic (transplant-associated) KS occurs in recipients of solid organ transplants (months to few years following a transplant) that are on the immunosuppressive therapy to prevent rejection of the transplant. Epidemic KS currently represents the second most common malignancy among people with AIDS in the U.S. Prior to introduction of antiretroviral therapy, the incidence was substantially higher. In AIDS-related cases of KS, about 70 percent of the patients have oral lesions at some point; in 22 percent of individuals with KS, the oral cavity is an initial site of presentation. Oral sites most frequently affected are the hard palate, gingiva and tongue. The initial presentation of lesions may be of an erythematous blue or brown macules that do not blanch when pressure is applied. As lesions mature, they turn into plaques and nodules. Some may coalesce into an exophytic, diffuse mass. These lesions may be painful, necrotic and may bleed. A biopsy is required to establish a definitive diagnosis. Treatment modalities include: topical therapy with immune modulating medications (e.g., alitretinoin gel or imiquimod cream), intralesional injection of che-

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motherapeutic agents (e.g., vinblastine, vincristine) surgical excision, cryotherapy (for skin lesions), sclerotherapy, laser therapy and radiation (not recommended for oral lesions). KS typically regresses upon return of immunocompetence. Diagnostic Discussion is contributed by UFCD professors, Drs. Indraneel Bhattacharyya, Nadim Islam and Don Cohen, who provide insight and feedback on common, important, new and challenging oral diseases. * Dr. Liya Davidova, Senior Resident in Oral and Maxillofacial Pathology at the University of Florida College of DR. BHATTACHARYYA Dentistry.

DR. ISLAM

The dental professors operate a large, multi-state biopsy service. The column’s case studies originate from the more than 10,000 specimens the service receives every year from all over the United States.

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

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Drs. Bhattacharyya, Islam and Cohen can be reached at oralpath@dental.ufl. edu. Conflict of Interest Disclosure: None reported for Drs. Bhattacharyya, Cohen and Islam. The Florida Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental 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 www.ada. org/goto/cerp.

Useful references: Neville BW, Damm DD, Allen CM, Chi AC. Oral & Maxillofacial Pathology. 4th edition. St. Louis, MI, USA: Elsevier; 2016. Fanburg-Smith JC, Furlong MA, Childers EL. Oral and salivary gland angiosarcoma: a clinicopathlogic study of 29 cases. Mod Pathol. 2003; 16:263–271. doi: 10.1097/01.MP.0000056986.08999. FD. Dilsiz A, Aydin T, Gursan N. Capillary hemangioma as a rare benign tumor of the oral cavity: a case report. Cases Journal. 2009; 2:8622. doi:10.4076/17571626-2-8622.

Toso A, Colombani F, Averono G, Aluffi P, Pia F. Lingual thyroid causing dysphagia and dyspnoea. Case reports and review of the literature. Acta Otorhinolaryngologica Italica. 2009; 29(4):213-217. Kumar LKS, Kurien NM, Jacob MM, Menon PV, Khalam SA. Lingual thyroid. Annals of Maxillofacial Surgery. 2015;5(1):104-107. doi:10.4103/22310746.161103. Mesri EA, Cesarman E, Boshoff C. Kaposi’s sarcoma herpesvirus/ Human herpesvirus-8 (KSHV/HHV8), and the oncogenesis of Kaposi’s sarcoma. Nature reviews Cancer. 2010;10(10):707-719. doi:10.1038/nrc2888. Kamal R, Dahiya P, Puri A. Oral pyogenic granuloma: Various concepts of etiopathogenesis. Journal of Oral and Maxillofacial Pathology: JOMFP. 2012;16(1):79-82. doi:10.4103/0973029X.92978. V U, Sivasankari T, Jeelani S, Asokan GS, Parthiban J. Lymphangioma of the Tongue - A Case Report and Review of Literature. Journal of Clinical and Diagnostic Research: JCDR. 2014;8(9): ZD12-ZD14. doi:10.7860/ JCDR/2014/9890.4792. Sunil S, Gopakumar D, Sreenivasan BS. Oral lymphangioma – Case reports and review of literature. Contemporary Clinical Dentistry. 2012;3(1):116-118. doi:10.4103/0976-237X.94561.

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OPPORTUNITIES Full-time endodontist needed for busy group practice (Tampa area). Guaranteed base of $350,000 plus 40% of collections over 1.1 million. Medical and mal-practice paid for you. 401k match. 3 weeks’ vacation (plus 6 holidays). Excellent opportunity to grow with the practice. Immediate opening. Send resume and questions to: vmonti@happydentistry.com. GENERAL DENTIST - PRACTICE TRANSITION OPPORTUNITY - DILLARD, GA. GREAT OPPORTUNITY FOR A GENERAL DENTIST. Established million-dollar private family practice with great patient flow. Treat our great patients along with an experienced and friendly team. Excellent marketing program in place to continue to build on patient already great patient base. Good % Production based compensation with a base. Your success is in your hands. A stake in ownership is an option and/or near future transition. Doctor owner moved from St. Petersburg years ago and has found great success in this town. Email CV to Colleen@dmacares.com to be considered for this great opportunity. Seeking General Dentist for brand NEW Fully Equipped Stateof-the-Art Dental Facility. Central/Northeast Florida seeking General Dentist for brand NEW Fully Equipped State-of-theArt Dental Facility. Ready for dentist to begin practice NOW. Some experience or general practice residency would be preferred but not necessary. Equity position available from the start. For further details email tlohman@lohmanapartments.com or call 386-235-8045. Lead Dentist (Full-Time)- Bonita Springs. Dr. Wheeley, Clinical Partner, is seeking a full-time Senior Dentist or Associate to lead our practice in Bonita Springs, FL. Enjoy a rewarding career with full office staff, strong schedule and ability to focus on quality patient care. Compensation: Potential Annual Earnings of 200K+. Benefits/Perks: Practice Leadership: Treatment Autonomy; Patient Focus: Established and Growing Patient; Multi-Specialty Office/Digital; Partnership Model – Investment Opportunities/Long Term Doctor Career Path; Full Benefits Offered – Healthcare, 401K, Short/Long Term Disability, Time Off; Malpractice Coverage Assistance; CE Support: Internal/External Advanced Training, Paid ADA & State Dues; Group Practice Camaraderie– Technique Development Assistance, Chairside Mentoring, GEDC Courses. View our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. https://careersclinical-greatexpressions.icims.com/jobs/11714/lead-dentist-%28full-time%29-bonita-springs/job?mode=view General Dentist -- Port Charlotte, FL $7500 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 Port Charlotte, 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 $7500. 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. Prefer 3+ years of experience. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues and have a valid DEA license. Send resume to abrooker@dentalpartners.com or call 321-574-8003 for a confidential review of the opportunity. www.dental-partners.com. General Dentist -- Gainesville, FL Full Time $7500 Sign on Bonus. If you’re looking to make your professional mark on a community, this is your chance. Build valuable relationships

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Percent of Production! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty offices; Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. https:// careersclinical-greatexpressions.icims.com/jobs/11097/ endodontist-%28part-time%29---tampa-bay%2c-fl/ job?mode=view.

established for over 25 years and does not accept any HMO or state funded insurances. We are located in a beautiful spacious state-of-the-art building. Our experienced, team oriented staff is devoted to providing high quality preventive care. We have an onsite pediatric anesthesiologist for I.V. sedations. The compensation package includes; guaranteed base pay of $200,000-$250,000 plus production bonus, paid CE and paid malpractice. Visit our website at www. dentistry-pediatric.com to learn about our practice. Great opportunity for a long, successful and secure future. You may email your resume to dry@dryasrebi.com or call 813600-8032.

RURAL DENTIST WANTED (PEARCE ARIZONA). Part Time with possibility of Full Time. Come to warmer dry weather! Practice located in Pearce, Arizona which is one hour south of Tucson. Open 3 days/week, but able to expand to more days if desired. Looking for someone that is ready to slow down a bit, while possibly supplementing their retirement income. Ranching community if you want that farm you always dreamed of. Associate transition to partner very quick. Opportunities to learn Implants, Orthodontics, and Sleep Apnea Treatment. Wanting outgoing, flexible dentist to lead this team! Could be that semi-retired transition you’ve been wanting! SUBMIT CV TODAY TO milesofsmiles99@ yahoo.com.

Associate. I am seeking a full-time associate for an established, state of the art Prosthodontic Practice in Hallandale Beach. Applicant must have a great attitude and positive personality. Applicant must also be courteous and caring and possess outstanding clinical and patient skills. This is an amazing long-term opportunity for the right person. Please email cover letter and curriculum vitae to gatordmd@yahoo. com.

Endodontist. Experienced board-certified endodontist looking for an endodontic position in South Florida. Please email: advancedrct@gmail.com. GENERAL DENTIST NEEDED. Part-time opportunity for general dentist for a faith based Non-profit clinic in Stuart. Comprehensive dental care provided to low income and Medicaid patients with Clinical freedom and Treatment Autonomy. Compensation is based on hourly rate. Dentist must be or willing to become a Medicaid provider. Please submit resume to Christian Community Care Center at ccccenter@bellsouth.com. ORLANDO - PRIVATE FFS/PPO OFFICE - General Dentist Full Time. An Excellent opportunity to join an Upscale Private Established Dental Office Near Downtown Orlando, providing excellent patient care with the latest State-of-theArt 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% PPO/FFS. (No HMO/No Medicade). 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, 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 Full-Time position, but willing to discuss Part Time if requested. Please Fax Resume to 407-327-1018 or E-mail it to Dr. Marouf at: Doctor@NewSmileDentistry.Net. DDS. General Dentist for Pediatric or General Dentist Limited Orthodontic. With Medicaid Number and Liability Insurance Looking for part time work one or two days a week more than 20 years’ experience with Spanish speaking language and English. ahalvarado@hotmail.com. Pediatric Dentist Lakeland. Excellent opportunity for a passionate, ethical and fun-loving pediatric dentist looking for an associate position leading to partnership. This well respected private Pediatric dental practice has been

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Established group practice seeking General Dentists in Williston & Melbourne! Christie Dental is seeking a General Dentist who shares our values of quality care and service to join our growing team. Community outreach, employee retention, and patient satisfaction are at the core of all that we do. This is a full-time position in Williston, FL with a mix of FFS/PPO/HMO patients. 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. Christie Dental is proud to provide a competitive compensation and benefits package. Please send CV & Cover Letter to kateanderson@amdpi.com. https://www. christiedental.com/. Clinical Assistant/Associate Professor of General Dentistry. The University of Florida College of Dentistry is seeking applications for a full time clinical track faculty position in the Department of Restorative Dental Sciences, Division of General Dentistry at the Assistant/Associate Professor rank. Responsibilities include serving as a student group leader in the DMD Clinical Program, participation in intramural faculty practice, excellence in academic pursuits and service, and some limited participation in the development of research and/or scholarly activities. Minimum requirements: DDS/ DMD, or equivalent dental degree and commitment to working with and building teams. Post-graduate training, DMD teaching experience, scholarly activities, and private practice experience is preferred. To apply, please go to http://jobs.ufl.edu/ and search for job number 503421. http://explore.jobs.ufl.edu/cw/en-us/job/503421/clinicalassistantassociate-professor-of-general-dentistry.

careersclinical-greatexpressions.icims.com/jobs/11427/ dentist-%28%24215k%2b-average-annual-income%29--jacksonville%2c-fl/job?mode=view. Seeking a P/T general dentist in N. Pinellas county, FL. If you are recently retired or an experienced general dentist seeking part time employment, I am looking for 1-2 days a week for a dentist who enjoys some endo, minor oral surgery, implants, as well as general dentistry. I have been a solo practitioner in Oldsmar/Eastlake for 22 years in a fee for service practice, moved to a new office in January, 2017. Please email CV to Janicebranddds@gmail.com

FOR SALE/LEASE INTRAORAL X-RAY SENSOR REPAIR. We specialize in repairing Kodak/Carestream, Dexis Platinum, Gendex GXS 700 & Schick CDR sensors. Repair & save thousands over replacement cost. We also buy & sell dental sensors. www. RepairSensor.com/919-924-8559. Practice in Paradise. Only full time periodontal-implant practice in Key West. 3 operatories with spectacular views of the Gulf of Mexico & equipped with ADEC chairs & delivery systems & digital x-ray. There is a small lab, private office, reception & waiting rooms & sterilization center. Practice is strictly fee for service with highly skilled referral base. This is your opportunity to enjoy working, playing and living in paradise all year round. Practice for sale. 35+years general dental practice for sell in space coast. Owner retiring. Stand-alone building newly remodeled. Digital x-rays and computerized. Six operatories, four equipped. Building is on a very busy road and has a second rentable unit and lots of parking spaces. Practice is still growing W/O marketing. Building is also available for lease or purchase. Contact e-mail: zilla.bsl@gmail.com. General Practice. Destin, FL. Highly profitable, efficient general dental practice for sale in the heart of the Emerald Coast. FFS/PPO. E-mail for particulars. hpk32541@gmail. com. Well-established general practice in Cocoa Beach, Florida with over 40 years in this location. Practice is in a standalone cottage building on A1A with a constant traffic flow. There four fully equipped opera-tories with digital X-rays. I gross over 300 thousand per year on a two day work week for me and four days for hygiene. The entire area is growing rapidly and the building could be purchased too. All forms of specialists are nearby if needed. Please call Dr. William Quinter to discuss this golden oportunity. 321.698.8313.

Dentist ($215K+ Average Annual Income) - Jacksonville, FL. Dr. Rick Woodward has select/upcoming opportunities for Lead Dentists and Associate Dentists to join our growing dental teams in Jacksonville, FL! (Beaches, Southside, Northside, Westside, Baymeadows, St. Johns and St. Augustine.) Compensation: Unlimited Earning Potential: Our Average Florida General Dentist Earns over $215,000 annually! Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Partnership Model – Investment Opportunities/Doctor Career Path; Full Benefits Offered – Healthcare Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; CE Reimbursement, Paid ADA & State Society Dues; Group Practice Camaraderie. Courses: Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Molly McVay | Sr. Clinical Recruiter | phone 248-430-5555. https://

TODAY'S FDA

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OFF THE CUSP

BE THANKFUL Walking through my house this morning, I was greeted by ringing bells. Is it the holiday season already? No one but me was up — it wasn’t the phone; TV was off; Salvation Army doesn’t have a bucket on my street; hasn’t snowed in Imperial Polk County since 1977 (I was here for that, ninth grade) so it wasn’t sleigh bells. No, just my tinnitus, one of the many gifts dentistry has bestowed upon me. JOHN PAUL, DMD DR. PAUL IS THE EDITOR OF TODAY’S FDA. HE CAN BE REACHED AT JPAUL@BOT. FLORIDADENTAL.ORG.

Personal jingling aside, I’m putting away the Halloween decorations, which is a big deal at my house. It’s my wife’s birthday and she is convinced the whole nation throws a costume party in her honor. The city is already putting up Christmas decorations and the Christmas toy catalogs have come in the mail. At least my children are learning their letters by writing their names beside everything they want. They are getting lots of practice and it occurs to me again, that Thanksgiving is getting the short end of the stick. Thanksgiving is becoming just the day before Black Friday — a day to carb up before the shopping marathon. Nobody buys Thanksgiving gifts. You don’t dress up in costumes. Sure, some of you have tall hats and big buckle shoes, but Thanksgiving isn’t necessarily looked forward to with that sense of anticipation. Thanksgiving is a great holiday. Good parades, great food, day off. You can say “Happy Thanksgiving” to just about anyone and expect them to accept it as a convivial greeting. We should be grateful every day, but this is a whole day set aside to ponder our blessings. We are surrounded by blessings — one being a great profession. I don’t have to go to work, I get to go to work. Every day we get a chance to improve someone’s life, calm their fears, relieve their pain, and give them back the outward smile that matches the one that comes from their heart. I’m glad I get to share this profession with all of you — the dentists and our extended dental family. I am thankful for you, each and every one. Now, let’s go eat too much, watch parades, then football and help our kids make those turkeys that start with an outline of their hand.

JOHN PAUL, DMD EDITOR, TODAY'S FDA

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