Virginia Dental Journal by Virginia Dental Association

Volume 76 â&#x20AC;˘ Number 3 .:. July - August - September, 1999

HIGH

VIRGINIA

QUALITY DENTAL

SERVICES

HEALTH BENEFITS CORPORATION

ARE HARD

FIND ...

A WHOLLY OWNED SUBSIDIARY OF T H E VIRGINIA DENTAL ASSOCIATION

...UNLESS You FIND ACOMBINATION SUCH

AS THE VDSC INSURANCE SERVICE CENTER

AND TRIGON BLUE CROSS BLUE SHIELD.

he Virginia Dental Association (VDA) and the Virginia Dental Services Corporat ion (VDSC) are proud

to announce a new association sponsored healthcare program through Trigon Blue

Cross Blue

Shield , This new program is available for all dentists interested in setting up a benefit program for themselves or their practice,

all our toll-free number between 8:30 am and 5:30 prn. Monday through Friday. Simply dial

1-800-832-7001

for quick

and efficient service. It's that easy, The

VDSC Insurance Service Center also has a toll free fax line,

1-800-886-4913 .

VDA's HEALTH INSURANCE PROGRAM INCLUDES: • Choice of Products - Indemnity, PPO, POS, HMO, and MSAs, • Trigon's extensive networks of participating hospitals and doctors.

• Special Trigon "Value Added" and "Membership" benefits available to you because of your association membership .

association is working to assist members in this important area.

Leslie S. Webb, Jr., D.D.S. Editor 1. Barry I. Einhorn 2. Eric W. Boxx 3. H. Reed Boyd III

Tanya D. Moore Publications ASSOCIATE EDITORS Harry A. "Jack" Dunlevy Barry K. Cutright Robert G. Schuster

Volume

TABLE OF CONTENTS 4

5 6 7 10 15 15 17

19 19

20 21

22 24

25 25 26

28 35

36 38 39 40 43

Editorial Guest Editorial Message From the President Orthodontic and Surgical Management of a Partially Erupted Abstracts The Impact of Student Debt & the Future of Dentistry Legislative Update VDA Names New Executive Director VDSC Virginia Health Care Foundation's Unsung Heroes Award Informed Consent in the Dental Office The Women's Health & Cancer Rights Act of 1998 Direct Reimbursement Ethics Education at VCU School of Dentistry The Golden Rule of Contracting The VDA Outgrows Central Office Continuing Education Executive Council Actions in Brief What Goes Out is Definitely "In" Public Health Dentistry in Virginia: Past, Present, & Future Membership Benefit Highlight Healthy Communities Loan Fund Tops $1 Million Mark 1999 June Committee Meetings VDA News Component News & Specialty News Classified Advertising COVER A Mid-Atlantic Coast sunnse 1999if. Photography by Linda Gilliam. All Rights Reserved. PUBLICATION TEMPLATE C\Change

THE VIRGINIA DENTAL JOURNAL (ISSN 00496472) is published quarterly (January-March April-June. July-Septe by the Virginia Denta! Association 5006 Monument Avenue. PO Box 6906. Richmond. Virginia 23230-0906 Telepho SUBSCRIPTION RATES Annual Members. $600 Others 512.00 In U.S .. 524.00 Outsioe U.S Single copy 56 Second class postage paid at Richmond. Virginia Copyright Virginia Dental Association 1996 POSTMASTER Send address changes to Virginia Dental Journal PO Box 6906. Richmond. VA 23230-0906 MANUSCRIPT AND COMMUNICATION for publications Editor. PO Box 6906. Richmond. VA 23230-0906 ADVERTISING COpy insertion orders contracts and related Information BUSiness Manager. PO Box 6906. Ric

VA 23230-0906.

VIRGINIA JOURNAL EDITORIAL

BOARD

VDA COMMITTEE CHAIRMEN

Ralph L. Anderson James R. Batten Cramer L. Boswell James H. Butler Gilbert L. Button Charles L. Cuttino III Frank H. Farrington Barry I. Griffin Jeffrey L. Hudgins Wallace L. Huff Lindsay M. Hunt, Jr. Thomas E. Koertge James R. Lance Daniel M. Laskin Travis T. Patterson III W. Baxter Perkinson, Jr. Lisa Samaha David Sarrett Harvey A. Schenkein James R. Schroeder Harlan A. Schufe/dt John A. Svirsky Ronald L. Tankersley Douglas C. Wendt Roger E. Wood

Annual Meeting Bruce R. Hutchison

Ethics

Auxiliary Education s: Relations T. Andrew Thompson

Fellows Selection

Donald L. Martin

Budget s: Financial Investments Raymond L. Meade

History s: Necrology

French H. Moore III

Cancer & Hospital Dental Service Michael E. Miller

Infection Control s: Environmental Safety Paul F. Supan

Caring Dentists Harry D. Simpson, Jr.

Institutional Affairs Elizabeth A. Bernhard

Communication s: Information Technology Corydon B. Butler, Jr.

Journal Staff

Leslie S. Webb, Jr.

Constitution s: Bylaws Wallace L. Huff

Legislative

T. Wayne Mostiler

Dental Benefits Programs Fred A. Coots, Jr.

Membership

H. Reed Boyd III

Dental Continuing Education

B. Ellen Bryne

New Dentist

Carolyn C. Herring

Dental Delivery for the Special Needs Patient AI ]. Stenger

Wallace L. Huff

Dental Health s: Public Information AI J. Rizkalla

Peer Review s: Patient Relations Neil J. Small

Dental Practice Regulation Albert L. Payne

Planning

Wallace L. Huff

Dental Trade & Laboratory Relations Jeffrey L. Hudgins

Search Committee for VA Board of Dentistry Wallace L. Huff

Direct Reimbursement David Swett

VADPAC

Rodney J. Klima

Judicial Affairs

M. Joan Gillespie

Nominating

FOUNDATIONS Relief Foundation

VDA Foundation

William H. Allison

Scott H. Francis

1999 ADA DEL

Delegstes:

140!'~DA

William H. Allison (1999) . M. Joan Gillespie (2000) Ronald L. Tankersley (199.9.)

Session, October 9-1 1999, Honolulu, HI David C. Anderson (2001 ) Wallace L. Huff (2001) Leslie 5. Webb, Jr. (2000)

Charles L. Cuttino J11 (2001 ) Emanuel W. Michaels (1999) RichardD. Wilson (1999)

Richard D. Barnes (2000) Lindsay M. Hunt, Jr. ( 1999) EdwardK. Weisberg (2000)

Thomas 5. Cooke 11/ (1999) Bruce R. Hutchison (1999) Andrew J. Zimmer (1999)

Altemste Deiegetes: Anne C. Adams (2000) Bruce R. DeGinder RodneyJ. Klima (2000)

~epresenting and serving member dentists by fostering quality oral health care and education. OFFICERS President: Charles L. Cuttino III, Richmond President Elect: Andrew J. Zimmer, Norfolk Immediate Past President: Wallace L. Huff, Sr. Blacksburg Secretary-Treasurer: Thomas S. Cooke III, Sandston Executive Director: Terry D. Dickinson, DDS P.O. Box 6906, Richmond, 23230-0906 EXECUTIVE COUNCIL Includes officers and councilors listed and: David C. Anderson, Alexandria - Chairman Gus C. Vlahos, Dublin - Vice Chairman Richard H. Wood, Richmond William J. Viglione, Charlottesville

Ex Officio Members: Parliamentarian: Emory R. Thomas, Richmond Editor. Leslie S. Webb, Jr., Richmond Speaker of the House: D. Christopher Hamlin, Norfolk Dean, School of Dentistry: Ronald J. Hunt, Richmond

COUNCILORS I Edward J. Norfolk Williamsburg /I Bruce R. /II Harold J. Neal., Jr, Emporia IV James R. L?nGe, Richmond V Edward M. O'Keefe, Roanoke VI Ronnie L. Brown, Abingdon VII James C. Gordon,Jr., Winchester VI/I Rodney J. Klima, Burke

PRESIDENT

SECRETARY

Tidewater, I

Stanley P. Tompkins 5830 Trucker Street Portsmouth, VA 23708

Harvey H. Shiflet /II 3145 Virginia Beach Blvd., 104 Virginia Beach, VA 23452

W. Walter Cox 5717 Church land Blvd. Portsmouth. VA 23703

Peninsula, /I

Corydon B. Butler. Jr. 1319 Jamestown Rd., #103 Williamsburg, VA 23185

Wayne E. "A.J." Booker 6632 Geo Wa Mem Hwy Grafton, VA 23692

Lawrence A. Warren 106 Yorktown Road Tabb, VA 23693

Southside, /II

Richard F Roadcap 3501 Boulevard Colonial Heights, VA 23834

Richard W Bates 3505 Boulevard Colonial Heights, VA 23834

Richard F. Roadcap 3501 Boulevard Colonial Heights, VA 23834

Richmond, IV

John S Kittrell 2600 Grove Avenue Richmond, VA 23220

HA "Jack" Dunlevy 11601 Robious Rd, Ste 130 Midlothian. VA 23113

William J. Redwine 6808 Stoneman Road Richmond, VA 23236

Piedmont, V

Mark A. Crabtree 407 Starling Avenue Martinsville. VA 24112

Gregory T. Gendron 7 Cleveland Avenue Martinsville, VA 24112

Craig B. Dietrich 604 E. Church Street Martinsville. VA 24112

Southwest, VI

Robert G. Schuster PO Box 68 Laurel Fork. VA 24352

Susan F. O'Connor PO Box 1086 Galax. VA 24333

Paul T. Umstott 300 W Valley Street Abingdon, VA 24210

Shenandoah Valley. VII

Robert B. Hall Jr. 130 W Piccadilly Street Winchester. VA 22601

J Darwin King 1220 N Augusta Street Staunton. VA 244010

Alan Robbins P.O. Box 602 Timberville. VA 22853

Northern Virginia VIII

James L. Gyuricza 5212-B Lyngate Court rke. VA 22015

Neil J Small 9940 Main Street Fairfax VA 22031

Paul N Zimmet 5206 Dawes Avenue Alexandria. VA 22311

EDITORIAL

I~ This issue of the Virginia Dental Journal welcomes Terry Dickinson, DD.S, as our new executive director. Terry brings a wealth of enthusiasm and dental knowledge, both as a practicing dentist and as a volunteer in organized dentistry, to our association, He was selected by the search committee, which reviewed all applications and interviewed several candidates, as the best candidate to replace Bill Zepp, who moved to Portland, Oregon to be the executive director of the Oregon Dental Association. Ironically, my editorial for the January - March 1999 Virginia Dental Jour足 nal was about change. Little did I foresee the personnel change at the helm of the VDA staff, Change offers opportunity, and Terry has expressed a strong desire to make the Virginia Dental Association an even stronger member-responsive organization. Many of you met Terry at our June committee meetings in Virginia Beach. He officially arrived in Richmond from Houston, Texas on July 3 to a full schedule of activities. I hope each of you will get to meet Terry and his wife Cherryl during this year at a component or VDA meeting. Let's give them a warm Virginia welcome. (I guess we have. It's 100 degrees as I write this editorial.) You can learn more about Terry Dickinson on page 17 of this issue,

Leslie S, Webb, Jr., DD.S. Editor

4 Virginia Dental Journal

GUEST EDITORIAL

II And that, of course, raises an ethi cal issue that should cause reflec tion for all of us.

The morning mail has just brought another one. A large-sized, very colorful publication (I refuse to call them journals, full of non-refereed articles advocating a variety of materials, instruments or technologies.) Not surprisingly, the articles are adjacent to large, equally colorful ads that also advocate the same material, instrument or technology. My concern is not so much the pos sible misrepresentation, the appar ent over-treatment, the absence of references or the little sidebars that encourage the reader to attend the clinician's next lecture. My worry is the implication that everything will look as good ten years down the road as it does in the publication pictures. In some visuals, the res torations are so new the cement has not even been totally removed. Have the patients been informed that these restorations and the tis sues that surround them may change with time? Do we have evi dence as to how long these resto rations and their luting agents will last?

In addition to providing competent treatment, one of our most serious responsibilities as a professional is to inform. When we discuss poten tial treatment with a patient, we are obligated not only to present the rationale and benefits of that treat ment. We are also obligated to in form the patient of the potential downside. This includes our opin ion as to longevity and the possi bility of problems (e.g. endodontic treatment, luting agent washout, etc.). As we care for an increasing number of older patients, the need for replacement of even properly done restorations becomes more common. When treating a relatively young patient (as is so often pic tured in these publications), it is our responsibility to let them know that restorations have to be replaced periodically. In a 31 year old patient, with a lifetime expectancy of eighty years or more, this may mean that crowns may have to be remade two or perhaps even three times in their lifetime. Should the patient not know that? When treating a patient for periodontal disease, do we in form the patient of the distinction between "cure" and "managing"? Do we let our orthodontic patients know about data on relapse? When correcting a patient's prob lem, it is both judicious and fair to share with the patient our reserva tions as well as our enthusiasm.

I recently re-made a bridge I had made from dental school some forty years ago. Much to my astonish ment, the patient expressed her dis appointment with my care, stating that I had told her it would last the rest of her life. Because I believed that in those days, I may well have made that foolish promise. Experi ence has led me down a far more prudent path. Live and learn. Those of us who have been in prac tice for some time can testify to the somewhat abbreviated lives of so many "new, cutting-edge" materials and techniques that initially ap peared to be so marvelous. Regret tably, many of these short-term materials and techniques had been marketed to us at seminars and meetings by clinicians who showed dramatically wonderful cases. Time proved otherwise. All of this has made many of us a tad more wary. Today's circumspect and conscientious dentist relies both on experience and evidence based knowledge. We depend on our refereed journals; we request data; we seek counsel from our dental school faculty; we chat with respected mentors in our profes sion; and we consult with col leagues. We do this because we realize that for us to inform the pa tient we also must be informed. I wonder if the patients in those colorful publications with those beautiful smiles were properly in formed. I hope so. Richard D. Wilson, D.D.S.

Virginia Dental Journal 5

MESSAGE FROM THE PRESIDENT

This is the last time I have the op portunity to communicate with you from this column. The year certainly has gone by rapidly. We have seen change and improvement in our as sociation. We now have a new Ex ecutive Director in Dr. Terry Dickinson. Terry and his wife Cherryl have relocated from Hous ton and took over the reigns on July 1, 1999. I am enthusiastic about what the future will hold for the As sociation and you the members. We will maintain the strong connec tion we have with the ADA and con tinue to build on the progress es tablished by Bill Zepp. Volunteerlsrn The Virginia Dental Association is a volunteer organization. That means that for the Association to function efficiently and for the ben efit of all the members, you the members are needed to be the vol unteers. We all have lives that in volve spouses, children, grandchil dren, practices and other organiza tions that vie for our time. Surely each of you can find the time to help this organization and your friends.

6 Virginia Dental Journal

I ]

It has been said that in the nineties there is much more time available to become involved in things that can benefit the whole. In the Vir ginia Dental Association approxi mately 10% of the membership is responsible for the running of the organization. That is not enough. All members have a right and re sponsibility to become involved and a part of the organization that helps control what we are in the practice of, dentistry. Many of you have been asked to serve on committees or in other aspects that make the VDA run smoothly and benefit all the oth ers who call themselves members. To those I say thank you. To those who have not accepted the responsibility of serving the Asso ciation, I say you can still make a difference. You still have a chance to come out of your offices and give something back to the profession, which is your livelihood. That com ing out could be in the form of men tors, committee members, and ad vocates. Dentistry needs your in put. You can only affect dentistry if you are a member and utilize your membership. Change is inevitable; you can be a part of that change and have a voice in how the change is accomplished. View your respon sibility to your association as the right to vote. VDA Central Office We have a great need to expand the Central Office space. This building when the Association bought it in 1991 was what was

needed then. We rapidly paid off the mortgage on the building and saved the Association the interest expense. Now as we have expanded the services of the office to include the DDS and DR programs the 2500 square feet are inadequate. A building committee headed by Dr. David Anderson has been formed and is exploring what the next step will be. The Executive Council has presented a resolution to the VDA House of Delegates asking for an assessment of $50 per member to begin the financing for either purchasing real estate to build an office or an established building which will satisfy the projected needs. These needs include at the present time approximately 5000 square feet of space. The criteria which is guiding this committee is that the Central Office will be located in the Richmond area, and will be near a major highway. I encourage you, the members, to endorse this initiative for the future of the Association. I thank all of you who are a part of the Virginia Dental Association and have helped me this past year. To gether we have made a difference.

Charles L. Cuttino III, D.D.S. VDA President

ORTHODONTIC AND SURGICAL MANAGEIVIENT OF A PARTIALLY ERUPTED MANDIBULAR FIRST MOLAR

Richard H. Lee, D.M.D., Private Practice Orthodontics, Midlothian, VA

Michael E. Miller, D.D.S., Private Practice Oral & Maxillofacial Surgery, Richmond, VA

Most orthodontic patients seek treatment for the correction of crowding, a large overjet, a deep overbite, or a combination of these conditions. Occasionally, in addition to these more routine problems, the orthodontist is confronted with the challenge of bringing an unerupted or partially erupted tooth into its correct position in the dental arch. In such circumstances, the orth odontist must frequently call upon another member of the dental team to aid him/her in successfully ac complishing his treatment objec tives. One of the most common examples of such "dental team work" is the surgical exposure of an impacted maxillary canine that an oral surgeon or periodontist per forms at the request of an orthodon tist. A much less common scenario, and one that will follow in the case study presented in this article, is the treatment of a partially erupted mandibular first molar. An oral surgeon's help was instrumental in the successful results obtained. The patient, a white female, was first examined at the age of 10 years 3 months. She presented with a Class II division 2 malocclusion with a deep overbite and bimaxillary crowding. Although her dental development was in the late mixed dentition, the mandibular right 1sl molar (tooth #30) was only partially erupted, with its occlusal surface about 1 mm. above the surrounding gingiva (Figure 1). Not surprisingly, the maxillary right 1st molar (tooth #3) had super-erupted and was in occlusion with tooth #30. Although the patient's malocclusion would require full orthodontic

treatment at an older age, it was recommended that the situation with tooth #30 be addressed at once. The patient and parents were cautioned that treatment of such problems is difficult and not always successful. Early treatment involved placing orthodontic bands on teeth #3 and #14 and the placement of a transpalatal bar. The goal was to intrude tooth #3 to its correct height, thereby creating adequate interocclusal space for the full erup tion of tooth #30. A removable acrylic bite plate appliance was given to the patient, which also al lowed interocclusal space for tooth #30. The over-riding intent of this phase of treatment was to obtain full eruption of tooth #30 as soon as possible. Since tooth #30 was positioned under the distal height of contour of the mandibular right primary 2 nd molar (tooth #T), an elastic separator was placed be tween these two teeth, moving tooth #30 slightly to the distal to al low clearance of tooth #T. Unfortu nately, further eruption of tooth #30 did not occur.

After several months had passed with no apparent change, the pa tient was referred for evaluation by an oral and maxillofacial surgeon (I\IIEIVI). It was felt that the extrac tion of tooth #T, removal of any ob structing hard and soft tissue over the height of contour of tooth #30, and minor luxation of tooth #30 would hasten its eruption. This was accomplished under local anesthe sia and nitrous oxide conscious sedation and the patient healed uneventfully. However, as the months passed, it was obvious that additional eruption of tooth #30 was not occurring, even though many deciduous teeth were exfoliating. When the patient was 11 years 11 months old, the parents were told that it was appropriate to begin full orthodontic treatment. Having the patient in full appliances would make it possible to treat tooth #30 more aggressively, and it was hoped that success would eventu ally be realized. When diagnostic records were taken, it was noted that the distal root of tooth #30 was developing with a gO-degree dilac eration of the apex, which was likely

Figure 1 - Pre-treatment panoramic radiograph showing partially erupted tooth #30.

Virginia Dental Journal 7

contributing to its eruption problem (Figure 2). Initial treatment emphasis was given to the maxillary arch. Arch expansion in the canine-premolar area was accomplished with a max illary E-arch appliance. Then fixed orthodontic appliances were placed on all maxillary teeth. The patient was asked to wear a cervical pull headgear at least 12 hours every day to address the overjet, and she provided good cooperation. A re movable acrylic bite plate was also worn full time. During this period of developing the maxillary arch, the patient was referred back to the oral surgeon for the extraction of tooth #32 and the exposure of tooth #31.Tooth #31 would have to be sufficiently erupted for the place ment of an orthodontic band before fixed orthodontic appliances could be placed in the mandibular arch. During the extraction of tooth #32 and the exposure of tooth #31, bone distal to tooth #31 was re moved to allow for easier orthodon tic distalization of the tooth. Both teeth #30 and #31 were gently lux ated and found not to be "ankylosed" at this time. When the patient was age 12 years 6 months, tooth #31 was sufficiently erupted to permit placement of a band. All mandibular teeth, with the exception of tooth #30, were placed

in fixed orthodontic appliances. A space was created between teeth #29 and #31, which allowed ad equate clearance for tooth #30 to be moved in an occlusal direction without any interferences. A heavy rectangular wire was placed in the mandibular arch. Due to excellent headgear wear, the distal of the occlusal surface of tooth #3 was in contact with the mesial of the oc clusal surface of tooth #31.This re lationship would serve as a vertical stop for tooth #3, and prevent its extrusion when elastics were placed between tooth #3 and tooth #30. Once this stage in treatment had been reached, it was time for ag gressive surgical intervention by the oral surgeon, who had monitored tooth #30 on a periodic basis, and was convinced that the tooth was not ankylosed. Under local anes thesia, buccal and lingual gingival flaps were developed by the oral surgeon, and a plain orthodontic band was fitted by the orthodontist (RHL). Most of this band went subgingivally, but the orthodontist was able to weld a cleat on the most occlusal areas of both the buccal and lingual surfaces of the band. It would be possible for the patient to attach a vertical elastic from tooth #3 to either of these cleats on the band on tooth #30. Once the orth odontist was satisfied with the fit of the band and the location of the

Figure 2 • Continued lack of adequate eruption of tooth #30 after ex traction of tooth #T and eruption of tooth #29.

8 Virginia Dental Journal

cleats, tooth #30 was gently but sig nificantly luxated with a combina tion of straight and Potts elevators. The band was then cemented on tooth #30 and the gingival flaps were reappoximated with 3-0 chro mic sutures. The patient wa.s then shown how to wear a heavy verti cal elastic between tooth #3 and tooth #30 (Figure 3). After demon strating her ability to correctly place the vertical elastic, the patient was dismissed. Elastic wear was con tinuous. The elastic was changed on a daily basis, and its direction was varied, depending on the posi tion of tooth #30. Sometimes the elastic was attached to the lingual cleat on tooth #30, and sometimes to the buccal cleat. The orthodon tist, who was seeing the patient on a regular basis, provided instruc tions regarding elastic direction. The patient's cooperation was excellent. After a period of five months, tooth #30 had been sufficiently extruded so that an orthodontic band with a normal buccal attachment could be placed. The band with cleats was removed from tooth #30, and the "normal band" was cemented in place. The rest of the orthodontic treatment was unremarkable, and a very satisfactory result was ob tained (Figure 4a & 4b). The final panoramic radiograph shows tooth #30 in satisfactory position and in terestingly, the dilacerated apex of

Figure 3 - Elastic traction applied after exposure. band ing and luxation of #30.

the distal root of tooth #30 has re sorbed (Figure 5). I\lot only was a pleasing smile and a healthy occlu sion obtained, but the necessity for a fixed bridge or implant to replace tooth #30 was avoided. Coopera tion among different dental special ties was instrumental in the success of this case. Figure 4b • After treatment.

Figure 4a - Before treatment. Figure 5 - Final result with #30 in normal vertical position .

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Virginia Dental Journal 9

I ~

yielded a slightly lower % of 68%. Occasionally, the contact of the ~~~~~~~~~~~~~ implant shoulder onto the bony sur The following abstracts were pro face was missing, resulting in a gap vided by the Department of Peri of 0.7 to 1.45 mm. The implants in odontics at VCU/MCV School of the mandible were always in direct Dentistry. We appreciate the con bone contact with the shoulder sideration that these individuals while the mid-palatal location the distance between the implant have made to the Journal. shoulder and the bony surface av eraged 0.94 mm. Wehrbein H, Merz BR, Hammerle CHF, and Lang NP. Bone-to-implant CONCLUSION: The data of the contact of orthodontic implants in present study indicate that orth human subjected to horizontal load odontic implants are well integrated ing. Clin Oral Implants Res 5(9); into the host bone even following 348-353: 1998. long periods of orthodontic loading in humans. AIMS: To evaluate the interface between bony structures and the SUMMARY: To evaluate the inter surface of the implant subjected to face between bony structures and prolonged application of oblique the surface of the implant subjected loading in human. to prolonged application of oblique loading in human, 4 pts were METHODS: 4 pts were treated treated orthodontically for the cor orthodontically for the correction of rection of a Class II malocclusion. a Class II malocclusion. For orth For orthodontic anchorage 4 mid odontic anchorage 4 mid-palatal palatal and 2 retromolar implants and 2 retromolar implants were were placed transmucosally using placed transmucosally using the the Straumann Orthosystem. This Straumann Orthosystem. This one one-part implant has a self-tapping part implant has a self-tapping thread and an outside diameter of thread and an outside diameter of 4 or 6 mm, respectively, depend 4 or 6 mm, respectively, depend ing on the vertical bone volume ing on the vertical bone volume available. The endosseous part of available. The endosseous part of the implant is characterized by a the implant is characterized by a sandblasted and acid-etched sur sandblasted and acid-etched sur face. The % of direct contact bone face. The implants were then sub to-implant contact varied from 34% jected to horizontal loads (2-6 N). to 93% with an average value of The orthodontic implants were used 75.5%. While the mean bone-to during a period of 8-20 months af implant contact was 70.3% in the ter successful incorporation (3 mid-palatal areas, the 2 retromolar months). Histologic analysis of the implants in the mandible yielded a implant-bone interface was per slightly lower % of 68%. Occasion formed. ally, the contact of the implant shoulder onto the bony surface was RESULTS: The % of direct con missing, resulting in a gap of 0.7 to tact bone-to-implant contact varied 1.45 mm. from 34% to 93% with an average value of 75.5%. While the mean BOTTOM LINE: The one-part bone-to-implant contact was 70.3% transmucosal design together with in the mid-palatal areas, the 2 ret a self-tapping thread and a sand romolar implants in the mandible blasted and acid-etched surface

ABSTRACTS

10 Virginia Dental Journal

seems to be adequate for long term orthodontic loading when implanted into the mid-palatal or in the man dibular retromolar area. While the mean bone-to-implant contact was 70.3% in the mid-palatal area, the 2 retromolar implants in the man dible yielded a slightly lower % of 68%.

Dr. John Lee is a 3 rd year gradu ate student in periodontics at VCU. Dr. Lee received his B.S. from Boston College in 1993 and his D.D.S. from Tufts University in 1997. ~

Stoller NH, Johnson LR, Trapnell S, Harrold CO, Garrett S. The phar macokinetic profile of a biodegrad able controlled-release delivery system containing doxycycline compared to systemically delivered doxycycline in gingival crevicular fluid, saliva, and serum. J Periodon tal 1998; 69: 1085-1091.

AIM: To characterize the release profile of doxycycline hyclate from a biodegradable controlled-release delivery system placed in periodon tal pockets. METHODS: This was a one month, single-center study utilizing a single blind, three-cell randomized design. 32 participants with multiple pockets?" 5 mm that bled upon probing were selected. Subjects were randomly divided into 3 groups. Two groups received the local DOXY therapy into all bleeding pockets?" 5 mm on the treatment side of the mouth. Group I had all treated sites covered with a noneugenol periodontal dressing and in Group II treatment sites were covered with a 2-octyl cyanoacrylate dressing. GCF, saliva, and serum samples were obtained just prior to drug delivery and then at hours 2, 4, 6, 8, 18, 24, and days 2,3,5,7, and 8. GCF and

saliva samples were also obtained at days 10, 14,21, and 28. Subjects in Group III took 100 mg of DOXY by mouth at baseline, hour 12, and then 100 mg/day for 6 additional days. GCF, saliva. and serum samples were obtained at baseline, hour 12, and days 1, 2, 3, 5, and 7. DOXY concentrations were analyzed with the aid of reverse phase high performance liquid chromatography. RESULTS: The release of DOXY in the GCF peaked at hour 2 with a peak of 1473 ug/ml for the Group I and 1986 ug/ml for Group II. The mean concentration at day 7 was 309 ug/ml for Group I and 148 ug/ ml for Group II. The highest mean level of DOXY in Group III was 2.53 ug/ml at hour 12. The release of DOXY in the saliva peaked at hour 2 with a peak of 4.05 ug/ml for Group I and 8.78 ug/ml for Group II. The highest oral DOXY level was 0.11 ug/ml. Serum concentrations of DOXY for individuals receiving local drug delivery never exceeded 0.1 ug/ml. For the oral doxycvcline group, serum concentrations ranged from 0.91 to 2.26 ug/ml over the 8 days data were collected. CONCLUSION: The high concen tration of locally delivered DOXY at the treated sites coupled with the low saliva and serum concentra tions indicate that this biodegrad able controlled release delivery sys tem displays an appropriate phar macokinetic profile for delivery into periodontal pockets. SUMMARY: The release profile of controlled-release DOXY delivery system placed in periodontal pock ets was characterized. Two groups received the local DOXY therapy into all bleeding pockets > 5 mm on the treatment side of the mouth. Group I had all treated sites cov ered with a noneugenol periodon tal dressing and in Group" treat

ment sites were covered with a 2 octvl cyanoacrylate dressing. Sub jects in Group III took 100 mg of DOXY by mouth at baseline, hour 12 and then 100 mg/day for 6 addi tional days. The release of DOXY in the GCF peaked at hour 2 with a peak of 1473 ug/ml for the Group I and 1986 ug/ml for Group II. The highest mean level of DOXY in Group III was 2.53 ug/ml at hour 12. The release of DOXY in the saliva peaked at hour 2 with a peak of 4.05 ug/ml for Group I and 8.78 ug/ml for Group II. The highest oral DOXY level was 0.11 ug/ml. Serum concentrations of DOXY for indi viduals receiving local drug deliv ery never exceeded 0.1 ug/ml. For the oral doxycycline group, serum concentrations ranged from 0.91 to 2.26 ug/ml over the 8 days data were collected. BOTTOM LINE: The high concen tration of locally delivered DOXY in GCF at the treated sites (mean con centration at 7 days was 309 ug/ml and 148 ug/ml for Group I and II, respectively) coupled with the low saliva and serum concentrations indicate that this biodegradable controlled release delivery system displays an appropriate pharmaco kinetic profile for delivery into peri odontal pockets. Dr. Patrick Johnson is a 2 n d year graduate student in periodontics atVCU. Dr. Johnson received his B.S. from North Carolina State University and in 1996 his D.D.S. from the University of North Carolina School of Dentistry. He completed a 1 year GPR at Ports mouth Veterans Affairs Medical Center in 1997.

Jensen OT, Shulman LB, Block MS, and Iacono VJ. Report of the sinus consensus conference of 1996. Int J Oral Maxillofac Implants 1998; 13(supplement) 11-32. AIMS: To evaluate the retrospec tive data from sinus floor augmen tation bone grafts which were col lected from 38 surgeons for 1007 sinus grafts that involved the place ment of 2997 implants over a 10 year period. METHODS: Data from a consecu tive series of pts who underwent sinus grafting treatment through Feb. 95, most having at least 3 yrs of follow up after functional resto ration, were requested, along with radiographs, at specific preopera tive, immediate postoperative and longest follow-up times. In this con sensus conference an attempt was made to gather, collate, and verify data from the clinicians experi ences so as to derive a series of consensus statements addressing 6 basic questions. RESULTS: For all implants placed by surgeons, an overall cumulative success rate of 90.0% at the 3-yr time was indicated. Autografts; for the pts grafted with only an au tograft, there was an implant sur vival rate of 88.7% at 5 yrs and 86.1 % at 6 yrs. The addition of an allograft decreased the 5-yr survival rate to 79.5%. There was no stat. sign, difference between the par ticulate and block forms of autog enous bone graft. Allograft: The cumulative success rate after 5-yr was 85.5%. The 5-yr survival rate of simultaneous implant placement with allograft was 93.9%, compared to 84.2% survival for those delayed 4-8 months. and 96.7% for implants placed more than 8 months after grafting. Alloplasts: The cumulative success rate for pure alloplasts was 97.5%. Residual bone; Of the im plants lost. 13 were initially placed Virginia Dental Journal 11

in residual bone of 4 mm or less and 7 were placed in bone of the 4-8 mm. Implant surface; 8.6% of the machined titanium implants and 9.8% of the plasma sprayed im plants were lost. Smoking; 12.7% of implants were lost in the smoker group, whereas 4.8% were lost in the nonsmoker group. Sinus graft height; the least change in graft height was for the combination of an autograft and an alloplast, with a mean of 0.79 mm. The greatest loss in graft height was observed for the freeze dried demineralized bone, with a mean of 2.09 mm of bone loss. CONCLUSION: Sinus lift is an ef ficacious procedure. Sinus lift is ef fective as an adjunctive procedure for implant-supported restorations in the posterior maxilla. SUMMARY: Data from a consecu tive series of pts who underwent sinus grafting treatment through Feb. 95, most having at least 3 yrs of follow up after functional resto ration, were requested, along with radiographs, at specific preopera tive, immediate postoperative and longest follow-up times. For all im plants place by surgeons, an over all cumulative success rate of 90.0% at the 3-yr time was indi cated. Autografts; forthe pts grafted with only an autograft, there was an implant survival rate of 88.7% at 5 yrs and 86.1 % at 6 yrs. The addi tion of an allograft decreased the 5-yr survival rate to 79.5%. There was no stat. sign. difference be tween the particulate and block forms of autogenous bone graft. Al lograft; The cumulative success rate after 5 yr was 85.5%. The 5-yr survival rate of simultaneous im plant placement with allograft was 93.9%, compared to 84.2% survival for those delayed 4-8 months, and 96.7% for implants placed more than 8 months after grafting. Alloplasts; The cumulative success 12 Virginia Dental Journal

rate for pure alloplasts was 97.5%. Residual bone; Of the implants lost, 13 were initially placed in residual bone of 4 mm or less and 7 were placed in bone of the 4-8mm. BOTTOM LINE: 1) Sinus lift is an efficacious procedure, 2) If there is less than 8 mm of vertical bone in the posterior maxilla, the sinus graft should be strongly considered, 3) Autografts and alloplasts performed consistently well either alone or in combination with other materials, 4) Rough surface implants did bet ter than machined-surface im plants. 5) Overall, smoker had a 7% greater failure rate. Dr. Bijan Kooshki is a 3 rd year graduate student in periodontics at VCU. Dr. Kooshki received his D.D.S. from Lunds University, Malmo, Sweden, in 1996 and completed a 1 year AEGD pro gram at Baylor College of Den tistry in 1997. ~

Tangada S, Califano J, Nakashima K, Quinn S, Zhang J, Gunsolley J, Schenkein H, Tew J. The effect of smoking in serum IgG2 reactive with Actinobacillus actinomycet emcomitans in early-onset peri odontitis patients. J Periodontal 1997; 68(9): 842-850.

AIMS: Is smoking associated with a reduction of specific IgG2 reactive with Actinobacillus actinomycete mcomitans(Aa) in black early onset periodontitis (EOP) patients? METHOD: Smoking status was de termined by blood levels of cotinine and classification was as follows: smokers: serum cotinine greater than 75 ng/ml; indeterminate: cotinine 20-75 ng/ml and non smokers: cotinine less than 20 ngl ml. All participants were black and were categorized as having the 10

calized form of EOP (UP) or gen eralized form (G-EOP), depending on the number and type of teeth involved. A standard ELISA method was employed to measure anti-Aa IgG2, anti Haemophilus influenzae (Hib) IgG2 and anti b phosphocholine (PC, the immunodominant antigen strepto coccus pneumoniae) IgG2. These antigens were looked at to investi gate if smoking had similar effects on other IgG2-dominated re sponses. Hypothesis testing be tween groups was determined us ing parametric and non-parametric tests. RESULTS: The concentrations of serum IgG2 reactive with Aa in non smoking G-EOP and UP patients were not statistically different. Se rum anti-Aa IgG2 levels in smok ing UP patients were four times higher than in smoking G-EOP pa tients. It appears that many smok ing G-EOP patients failed to re spond to Aa, whereas smoking UP patients did respond. There was no bet wee n dramatic difference anti-Hib responses in smoking and non-smoking UP and G-EOP pa tients. A differential effect of smok ing on anti-PC IgG2 in G-EOP and UP subjects was not found. CONCLUSIONS: Smoking is as sociated with lower levels of anti Aa IgG2 in black UP patients, with no effect shown in G-EOP patients. The level of anti-Aa in non-smok ing G-EOP and UP patients was the same. Smoking may be asso ciated with reduced levels of anti Aa IgG2, but this is only true in pa tients with the generalized form. IgG2 reactive with Aa may protect against periodontal destruction, and some of the deleterious effects of smoking on periodontal attach ment in G-EOP may be due to the ability of smoking to depress anti Aa IgG2.

BOTTOM LINE: At 9 months sign. reductions from base line favoring the CHX chip compared with both control treatments were observed with respect to PD (CHX chip + Sci RP; 0.95 +/- 0.05mm, Sc/RP alone; 0.65 +/- 0.05mm, chip + SclRP, 0.69 +/- 0.05 mm), and CAL (CHX chip + Sc/RP, 0.75 +/- 0.06mm;Sc/ RP alone, 0.58 +/- 0.06 mm, pla cebo chip + Sc/RP, 0.55 +/- 0.06 mm). Dr. Kevin Quinn is a 2 n d year graduate student in periodontics at VCU. Dr. Quinn received his B.S. from the University of Rhode Island in 1991 and his D.M.D. in 1997 from Boston Uni versity Goldman School of Den tal Medicine.

1999

VIRGINIA BOARD OF

DENTISTRY

The Virginia Board of Dentistry is appointed by the Governor and is composed of seven dentists, two hygienists and one citizen representative. Contact the Board office or a member of the Board on questions on rules and regulations. Nora M. French, D.M.D. Monroe E. Harris, Jr., D.D.S. Michael J. Link, D.D.S. French H. Moore, Jr., D.D.S. Edmund E. Mullins, D.D.S. Gary Taylor, D.D.S. Richard D. Wi/son, D.D.S. Carolyn B. Hawkins, RD.H. Stephanie P. Olenic, RD.H. Pat K. Watkins STAFF Marcia J. Miller, Executive Director Pam Horner, Administrative Assistant Kathy Lackey, Administrative Assistant Lychia Morris, Office Services Specialist 6606 W Broad Street, #401 Richmond, VA 23230-1717 (804 )662-9906 FAX(804)662-9943

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14 Virginia Dental Journal

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"e effect of smoking IgG2 reactive with Acti . .. Jecittus actinomycet emcomitans(Aa) in black EOP pa tients was investigated. Smoking status was determined by blood lev els of cotinine and patients were categorized as having the localized form of EOP (UP) or generalized form (G-EOP), depending on the number and type of teeth involved. A standard ELISA method was employed to measure anti-Aa IgG2. The concentrations of serum IgG2 reactive with Aa in non-smoking G EOP and UP patients were not sta tistically different. Serum anti-Aa IgG2 levels in smoking UP patients were four times higher than in smoking G-EOP patients. It ap pears that many smoking G-EOP patients failed to respond to Aa, whereas smoking UP patients did respond. Smoking is associated with lower levels of anti-Aa IgG2 in black UP patients, with no effect shown in G-EOP patients. The level of anti-Aa in non-smoking G EOP and UP patients was the same. IgG2 reactive with Aa may protect against periodontal destruc tion, and some of the deleterious effects of smoking on periodontal attachment in G-EOP may be due to the ability of smoking to depress anti-Aa IgG2. ~

BOTTOM LINE: Smoking may be associated with reduced levels of anti-Aa actinomycetemcomitans IgG2 in early onset periodontitis patients with the generalized form. Dr. Valerie Smith is a 3 rd year graduate student in periodontics at VCU. Dr. Smith received her B.A. from Temple University in 1992 and her D.M.D. in 1997 from Boston University Goldman School of Dental Medicine.

Jeffcoat MK, Bray KS, Ciancio SG,

Dentino AR, Fine DH, Gordon JM, Gunsolley JC, Killoy WJ, Lowenguth RA, Magnusson N I, Offenbacher S, Palcanis KG, Proskin HM, Finkelman RD, and Flashner M. Adjunctive use of a sub gingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone. J Periodontal 69; 989-997: 1998.

AIMS: To determine the effect of the CHX chip, when used as an adjunct to Sc/RP, on clinical mea sures of periodontitis (PD, AL) when compared with either Sc/RP alone or with the adjunctive use of a placebo chip in patients with AP. METHODS: 2 double blind, ran domized, placebo controlled multicenter clinical trials consisting of 5 centers were conducted. 447 pts with a minimum of 10 natural teeth and periodontal disease (each subject with at least 4 teeth with PD=5-8 mm, and BOP) were recruited. At base line, following one hr. of Sc/RP in pts. free of supragingival calculus, the chip was placed in target sites. Chip placement was repeated at 3 and I or 6 months if PD remained greater than 5 rnm. Study sites in active chip subjects received either CHX chip + Sc/RP or Sc/RP alone. Sites in placebo chip subjects received either placebo chip + Sc/RP or Sci RP alone. Examinations were per formed at base line, 7 days, 6 weeks and 3, 6, and 9 months. RESULTS: At 9 months sign. reductions from base line favoring the CHX chip compared with both control treatments were observed with respect to PD (CHX chip + Sci RP; 0.95 +1- 0.05mm, Sc/RP alone; 0.65 +1- 0.05 mm (P < 0.001; placebo chip + Sc/RP, 0.69 +1- 0.05 mm, P < 0.001) and CAL (CHX chip

+ Sc/RP, 0.75 +1- 0.06 mm; Sc/RP alone, 0.58 +1- 0.06 mm, P < 0.05; placebo chip + Sc/RP, 0.55 +1- 0.06 mm, P < 0.05). The proportion of pts who evidenced a PD reduction from base line of 2 mm or more at 9 months was sign. greater in the CHX group (19%) compared with Sc/RP controls (8%) (P < 0.05). Adverse effects were minor and transient tooth ache, including pain, tenderness, aching, throbbing, soreness, or sensitivity was the only adverse effect that was higher in the CHX group as compared to placebo.

CONCLUSION: This study showed that the adjunctive use of the CHX chip results in a sign. re duction of PD and a sign. improve ment in AL compared with Sc/RP alone. SUMMARY: To determine the ef fect of the CHX chip, when used as an adjunct to Sc/RP, on clinical measures of periodontitis (PD, AL) when compared with either Sc/RP alone or with the adjunctive use of a placebo chip in patients with AP, 2 double blind, randomized, pla cebo controlled-multicenter clinical trials consisting of 5 centers were conducted. 447 pts with a minimum of 10 natural teeth and periodontal disease (each subject with at least 4 teeth with PD=5-8mm, and BOP) were recruited. At base line, follow ing one hr. of Sc/RP in pts. free of supragingival calculus, the chip was placed in target sites. At 9 months sign. reductions from base line favoring the CHX chip com pared with both control treatments were observed with respect to PD (CHX chip + Sc/RP; 0.95 +1 0.05mm, Sc/RP alone; 0.65 +1 0.05mm (P < 0.001; placebo chip + Sc/RP, 0.69 +1- 0.05mm, P < 0.001) and CAL (CHX chip + Sci RP, 0.75 +1- 0.06mm; Sc/RP alone, 0.58 +1- 0.06mm, P < 0.05; placebo chip + Sc/RP, 0.55 +1- 0.06mm. Virginia Dental Journal 13

THE IMPACT OF STUDENT DEBT AND THE FUTURE OF DENTISTRY

II]

Dr. Russell Mosher, 16 t h District Representative of the Committee on the New Dentist

"When I graduated from dental school. .." is a common refrain of dentists of all ages. It is uttered when we reflect on the conditions that existed when we made our practice choices and entered the "real world." Most of us were free to make our own choices. But these days, recent graduates tell us that the staggering level of student debt is affecting their practice choices. The ADA's Committee on the New Dentist, along with the Survey Center and the Council on Dental Practice, conducted a survey to find out how student debt affects new graduates. According to the 1998 Survey of New Dentists on the Impact of Student Debt, 90% of dentists who graduated in 1993 1997 had educational debt upon graduation. Average educational debt for those who had debt was $83,051. Not surprisingly, dentists who graduated from private dental schools had a higher level of debt - an average of $113,566 compared with an average of $66,951 for public school graduates. Levels as high as $300,000 were reported!

tions takes a big bite out of the new dentists' incomes. Overall, dentists who were repaying loans had an average monthly payment of $864. Public school graduates' payments averaged $734; for private school graduates, it was $1,118. Almost two-thirds (63.2%) of re spondents indicated that their edu cational debt affected their practice options when they graduated from dental school. Of those who felt an impact, 94.4% of them said that they "could not afford to start their own practice." Moreover, 91.3% an swered that they "could not afford to purchase a practice." The picture gets even grimmer when you examine the startup costs for financing a practice. Re sponding owner dentists spent $174,192 on average to establish their practice. How many of us could face more than a quarter-mil lion dollars of debt before even one patient comes through the door? It's no wonder that 76.4% of the re spondents indicated that their debt would have a "somewhat" or a "sub stantial" effect on them financially over the next ten years.

I find it very chilling to look at these figures, and I wonder how we are going to attract the best and bright est to the dental profession in the future. Many new graduates are under great financial pressure, even before they buy a house, start a family or even trade in their old car (in my case, a dilapidated 1967 Chevy Bel-Aire that barely made it to graduation.) What can we, as dentists and as ADA members, do to address this issue? When asked in the survey what the ADA should do, the high est response was to "provide re sources to help recent graduates manage their debt." I suggest that the best resource is the member dentist - you and me. We need to provide resources, such as much needed education on financial man agement, as an Association. But even more important, as members, we need to mentor new graduates. Practical information, help and ad vice are what is needed to help our newest colleagues make the best decisions forthem. We need to help them learn how we made dentistry fly - not watch them crash under the heavy load of debt.

Making payments on these obliga

LEGISLATIVE UPDATE Managed Care Ombudsman

A new office of the Managed Care ombudsman is operational at the State Corporation Commision's Bu reau of Insurance. New legislation effective July 1 charges the office with assisting Virginia consumers in un derstanding their rights if they are covered under a managed health care insurance plan. The office has a toll-free number.

1-877-310-6560. In Richmond, call (804) 371-9032 The office Will also take e-mail inquiries at ombudsman@scc.state.va.us. HB 2007 HB 2007 requires health insurers to provide general anesthesia and hos pital charges for dental care to a cov ered person who is under the age of five, severely disabled or has a medi cal condition and requires hospital

II] ization or general anesthesia for den tal care treatment. In Virginia, all mandated health ben efits must go before the Special Ad visory Commission on Mandated Health Benefits. The Commission voted unanimously on June 1, 1999 to recommend that HB 2007 be re ported to the General Assembly for consideration in the 2000 Session. Virginia Dental Journal 15

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16 Virginia Dental Journal

VDA NAMES NEW EXECUTIVE DIRECTOR

I]]

Leslie S. Webb, Jr., D.D.S., Editor

Terry D. Dickinson, D.D.S. has been hired as the new Executive Director of the Virginia Dental Association. He began his duties at the VDA cen tral office on July 1, 1999. Terry, who recently sold his general practice in Houston, Texas, has been active in dentistry and in the Houston, Texas and American Dental Association. He is a Fellow of the Academy of General Den tistry, the American College of Dentists and the International College of Dentists. A graduate of The University of Texas at Austin and The University of Texas Dental School in Houston, he served in the Air Force Dental Corps and then entered private practice. Terry served in many capaci ties in the Greater Houston Dental Society including its President. He has served as the Chairman of The Texas Dental Association, Council on Annual Sessions and as chairman of its 15t Annual Business Con ference. At the ADA, Terry served twice as Chairman of the Council of ADA Sessions and International Programs. He has been an active alumnus of his dental school and served for 6 years on the Texas Board of Dental Examiners. Through working in organized dentistry, especially meeting planning, Terry decided he wanted to be employed in organized dentistry and continue serving his profession. Dr. Dickinson stated, "I believe the Virginia Dental Association must meet or exceed the expectations of our membership. If we don't, someone else will. We cannot take for granted that "business as usual" will retain our membership, as in the past. Competitive forces will continue to take market share of services unless we position ourselves to serve our mem bers of the future, who will look different from what we see today. The expectations of the future member are changing, culturally and socially. We must address that growing generational gap and be prepared to serve and create value based upon that diversity." He also related "Our Association is not just about serving our members and providing leader ship, it's serving our profession by being a haven for help, a guide into the future, and connecting our membership to the bigger health care community. Terry and his wife Cherryl are enthusiastic about their move to Virginia.

Virginia Dental Journal 17

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VIRGINIA DENTAL SERVICES CORPORATION Robert A. Levine, D.D.S., VD5C Board Member

The Virginia Dental Services Cor poration (VDSC), a subsidiary of the VDA, recently endorsed three excellent membership benefit pro grams, Paychex, Mercer Global Advisors, and the MBNA Auto In surance Program. Paychex provides a complete line of payroll services at a cost-effec tive rate in a highly competent man ner. The basic service covers all the facets of payroll administration in cluding electronic submission of tax deposits. And there are many op tions i.e. direct deposit into employ ees bank accounts, section 125 ad ministration, 401 K record keeping, employee management and hand book service, and the Internet re port service. Paychex supports companies of all sizes. Evaluate this program to see if it saves on your accounting fees and/or is a time saving method for you to process your payroll. Paychex offers VDA members a 15% discount. They can be reached at (800) 322-7292, or www.paychex.com .

Mercer Global Advisors (MGA) is a large national fee-only (no commis sions) investment advisor firm. More then 80% of their 4,200+ cli ents are dentists and physicians. They have a broad array of in house specialists, including a num ber of CPAs, MBAs, CFPs and at torneys. MGA offers guidance in such areas as pension and estate planning, portfolio management, retirement planning, budgeting, practice management and profit ability, personal issues, expertise on alternative investments, i.e. real estate transactions, limited partner ships, and more. The MGA program is customized to the individual and can be an ex cellent benefit for dentists at all stages of their career. Learn more about this service by calling MGA at (800) 462-1580, or attend one of their introductory educational courses.

The MBNA Auto Insurance Pro gram has selected the highly rated insurer American International Group, Inc. (AIG) to offer an excel lent policy that will provide consid erable savings for many in the VDA membership. Call (800) 297-4430 with your current policy handy to evaluate your coverage. It is the goal of the VDSC to achieve and maintain excellent endorsed benefits balanced with the most ef ficient use of our VDA members' resources. In today's market, this will be an ongoing process. Your feedback and suggestions regard ing VDSC endorsements will help us serve you better.

For more information, call the VDSC office at (800) 552-3886 (in state) or (804) 358-4927 and speak with Ronya Edwards, Di rector of Operations.

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I r n I N I A HEALTH CARE FOUNDATION'S UNSUNG HEROES AWARD

The Virginia Dental Association would like to congratulate Dr AI J Stenger who was recently se lected for the 1999 Virginia Health Care Foundation's (VHCF) Un sung Heroes Award. Dr. Stenger is an active participant in two VHCF funded projects including Donated Dental Services and Crossover Health Clinic. Through his dedication. Dr. Stenger has made a great Impact on Virginia's underserved. Dr AI J Stenger IS pictured above receiving his award at the reception held May 18.1999.

Virginia Dental Journal 19

INFORMED CONSENT IN THE DENTAL OFFICE

Thomas P. Cox, ARM, General Agent, The Medical Protective Company

The following is offered from a risk management perspective and not as legal advice. The concept of informed consent is at once simple, but not easy; it is old, but constantly changing. Most importantly, dentists and their staff should be ever vigilant about ob taining informed consent before proceeding with treatment. Failure to obtain informed consent can jeopardize quality patient care, in crease the chance of patient dis satisfaction and, subsequently, in crease the chance of a malpractice claim. The first court case related to medical informed consent was the 1905 case M~~---'Y'._Williams {Minnesota}. In this case it was ruled that a health care provider should be held civilly responsible for failure to obtain informed consent, rather than criminally responsible. In the 1914 Schloerldorff _'yI. __Spcle1}LJ2f~e_w YQJkJ:iosJ)itaJ decision {New York}, the basis for the current informed consent concept was formed with the ruling that every human being of adult years and sound mind has a right to determine what shall be done with his or her body; this is known as self-determination. Finally, the 1957 case of Salg~ LelaDdStanfQHL_~_L Unixersitz Boardnt.Irustees {California} is credited with forming the foundation for the informed consent doctrine. In the S.aigQ case it was ruled that a health care provider violates his duty to the patient and subjects himself to liability if he withholds any facts which are necessary to form the basis of an intelligent consent by the patient to the proposed treatment. 20 Virginia Dental Journal

What facts are considered neces sary? This is where the concept of informed consent starts to get com plicated. In the 1972 case of Call: terbury v. Spen.ce {District of Co lumbia} the consumer standard of care was developed. This states that it is the responsibility of the pro vider to try and determine what risks and benefits a reasonable person would want to know in or der to make an informed decision. Virginia allows for a "reasonable and prudent practitioner" to deter mine the standard of disclosure, based on Bl.)' v. Rhoads in 1976; this allows the health care provider to determine what risks and ben efits he feels should be disclosed to each patient. If a provider be lieves a risk is a "material risk," de fined as one which the provider knows would be significant to a rea sonable person in the patient's po sition who is trying to make an in formed decision, the 1977 case of S..aLd__'L._Hatd--JI {Maryland} delin eated that this material risk must be disclosed. What happens if no consent is ob tained? Based on CobbS'i~--.Grant in 1972 {California}, failure to ob tain any consent is grounds for a charge of battery (unwanted touch ing). If the consent is considered incomplete, negligence is the issue. The Cobbs case also determined that consent should include infor mation on the risks and benefits of alternative treatments; however, only feasible and available treat ments must be disclosed {Thornton 'L..P.nne..s1, Washington, 1978} and unethical or improper alternatives need not be disclosed {Archer v. Galbrath, Washington, 1977}. Fi nally, what if the patient refuses treatment? In the 1980 case

Trum_~Thomas {California} it was ruled that the fiduciary nature of the provider-patient relationship requires the provider to disclose the risks involved when a patient re fuses treatment. The reasoning be hind this decision is that patients who refuse treatment are "as un skilled in the medical sciences as those who consent to treatment."

Does that clear everything up? I didn't think so. However, if you keep each of the above decisions in mind it will be helpful in understanding why certain recommendations are made. What is expected of a dentist as it relates to informed consent? In simple terms, think of informed con sent as a process of informed de cision-making; it is expected that the patient will make an informed decision after evaluating the risks and benefits of the proposed treat ment, the risks and benefits of ethi cal and proper alternative treat ments, and the risks and benefits of doing nothing. Who helps the patient gain the knowledge neces sary to make this informed deci sion? The court looks to that per son with the most knowledge of the patient, thecondition, the treatment ontions. and the.risks.and benefits of each option and of doing noth ing; this person is the dentist. Can certain aspects of this process be delegated to staff? Yes, as long as the dentist knows what the staff is doing, because the dentist will ulti mately be held responsible. How does this work in reality? First of all, consideration must be given to the condition, patient and proposed treatment in terms of complexity and severity. A risk

management caveat is that you do not develop a $10,000 solution to a $.10 problem. This means that your consent process must be proportionate to the complexity and severity of the condition and treatment. A semi-annual cleaning should probably not need much more than "I am going to clean your teeth now and there may be some discomfort; tell me if it becomes too uncomfortable." On the other hand, even the most routine root canal carries multiple risks, including the possibility of additional work in the future, and the consent process and documentation should reflect this. If the patient is "high maintenance" this should also be taken into consideration. What about documentation? Appropriate documentation me morializes the process that occurred; it does not replace the process. If staff members are conducting part of the process, using information developed by the

dentist, then this can be documented as "Standard risks and benefits discussed with patient by - - - - - - . I also discussed After this discussion the patient decided to - - - - - - - - In other words, you provide the options, the patient makes the decision! Should you have the patient sign something? Once again, only if it memorializes the process that ac tually occurred and the procedure is significant enough to warrant it. General or generic forms are ac ceptable as long as there is some indication that it was personalized for that specific patient. I also pre fer the last sentence of any consent form to read, "I have been given the opportunity to ask questions and all of my questions have been an swered." Just below this sentence have the patient sign and date the form. This type of document leaves scant wiggle room for a plaintiff's

attorney trying to buud a malprac tice case. Still confused? You're a dentist and you have tremendous vertical knowledge concerning what you do. What do you know about what a colleague does in another spe cialty? There is a good chance you don't know nearly as much as your colleague does. If you are going to be receiving treatment from that colleague, what would you want to know? Better yet, if your mother, father, or spouse was going to be receiving treatment from this col league, what would you want them to know? Sound familiar? It's the Golden Rule: Do unto others as you would have others do unto you, or treat people the way you want to be treated. Keep this in mind and you should be able to do a pretty good job of helping your patients make an informed decision and helping them become a partner in your treatment plan for them.

THE WOMEN'S HEALTH AND CANCER RIGHTS ACT OF 1998

VDSC Insurance Service Center

Late in 1998, Congress passed new legislation affecting health in surance coverage for women. As part of the 1999 Omnibus Consoli dation and Emergency Supplemen tal Appropriation Act, The Women's Health and Cancer Rights Act of 1998 mandates that all group health plans and health insurance compa nies offering medical and surgical benefits for mastectomies must also offer coverage for the follow ing procedures:

other breast to provide a symmetri cal appearance. • Prostheses and the treatment of physical complications during all stages of the mastectomy. A similar Virginia law was enacted on July 1, 1998. The Virginia law required these benefits to be avail able if the mastectomy was per formed after July 1, 1998. How ever, the fed_eLaUaw is.eJfe_ctiveJoJ

newand.renewina gLOJ.tp::LJ2e.gln • Reconstruction of the breast on which the mastectomy was performed. • Surgery and reconstruction of the

Ding Nove.mb~L1~ 19913. In addition, although not originally included in the Virginia law, the federal law re quires employers that fund their own health plan (self-funded

groups) to add this coverage for new and renewing groups effective November 1, 1998. This legislation also requires that all health plan members receive immediate notification of the Women's Health and Cancer Rights Act benefits mandate, re gardless of when these benefits will be added to their health plan. The VDSC Insurance Service Cen ter is staffed with experienced ben efits consultants. Please contact us at (800) 832-7001 for all of your health insurance needs.

Virginia Dental Journal 21

DIRECT REIMBURSEMENT NEWS

Connie L. Jungmann, VDA Assistant Executive Director

Virginia DR Off and Running for 1999

Since my last report, I am pleased to announce that seven new companies have adopted Direct Reimburse ment plans, making a total of eleven plans signed since the first of the year. These seven new plans account for 1048 individuals added to the total number of lives covered by DR plans. Camp_any AtlantiCare Inc. Atlantic Sports & Rehabilitation Family Physicians Ltd. Fas Mart Convenience Stores McKinney and Company Shore Stop Corp. Ltd. Trade Wind Yachts Ltd.

Location Vienna Charlottesville Richmond Mechanicsville Ashland Salisburg, MD Glouchester

Referral Source ADA BAI/Broker BAI BAI/Broker Dr. William Covington BAI/Broker BAI/Broker

As you can see, our joint efforts with the ADA to educate brokers about Direct Reimbursement are beginning to bring significant results. Benefits Administration will continue throughout the year to meet with new brokers and process the referrals submitted by this growing broker network. In spite of our growing success with broker referrals, referrals from dentists continued at a relatively low level during the first quarter of 1999. We continue to hear reports that some dentists' offices still do not understand how DR works, and that the dental office staff does not know how to provide the proper administrative assis tance to those patients on DR plans. As the number of employers utilizing DR continues to grow, it is vitally important that your dental team become educated about Direct Reimbursement. The ADA's brochure, "Direct Reimbursement - a Guide for the Dental Office," was created specifically to answer some of the most com mon questions asked by dentists and their staff about DR. Additionally, the VDA and Benefits Administration have created a "DR Quick Reference Card" offering DR processing tips for the front-desk staff. These and other DR educational materials are included in the VDA's DR Dental Information Packet available upon request by calling the VDA Office at 1-800-552-3886.

DR Statement Stuffers Available A recent mailing was sent to the VDA-member dentists' offices an nouncing the availability of the ADA's Direct Reimbursement state ment stuffer. The mailing was marked "Attention Dental Office Man ager" and included a sample of the brochure. Designed to fit in a standard envelope, the statement stuffer can be used as a tool to educate patients about DR. This colorful brochure presents the con cept of DR in a colorful, easy to understand manner that your pa tients can feel comfortable sharing with their employers or human resource managers.

Drs. Kirk Norbo and AI Rizkalla stop by the DR infor mation booth during the June VDA Committee Meet ings and share comments about the success of DR within their component.

22 Virginia Dental Journal

The first 100 statement stuffers are available at no cost to VDA mem ber dentists upon request. Additional quantities are available through the VDA at a cost of $4.00 per 100 to cover the cost of shipping. To place an order, please contact Ronya Edwards at the VDA Central Office at 1-800-552-3886.

ETHICS EDUCATION AT THE VCU SCHOOL DENTISTRY

David R. Hughes, D.D.S. , VeLl Dentistry '99

Increasingly, the landscape of the dental marketplace has begun to resemble the raucous floor of the British House of Commons. A ca cophony of shouts and Whispers ring in the ears of today's practitio ners from competing interests, which sometimes threaten to drown out the voice of ethical reason. De mands from third party payers, from patients and from within the doors of the private practice regularly test the dentist's leadership and moral reasoning skills, especially in ethi cal gray areas. Luckily, for gradu ating dental students donning their powdered wigs and entering this menagerie of "yays and nays", the road to practice has been paved with similar moral and ethical con flicts in dental school. In the predoctoral dental clinic, stu dents must weigh the treatment needs of their assigned patients with the relentless demands of graduation requirements and self imposed performance expecta tions. In the vernacular of the den tal student, one must ever resist the urge to give in to the "MSB" effect, (Maximum Student Benefit), in fa vor of doing the right thing for the patient. Concurrently, in the class room academic integrity issues arise from students' desire to enter postgraduate programs at all costs,

24 Virginia Dental Journal

or to simply get a difficult course behind them. Ultimately, short-cuts and compromises at any point in dental education can very clearly effect the quality of patient care years to come and will inevitably erode the stature of the profession. Fortunately, just as the school pro vides an armamentarium of special instruments and training to strengthen our technical prepara tion, professional ethics are ad dressed at regular intervals at VCU to fortify our ethical IQ. One impor tant resource specific to our school experience lies in the annual Ceril A. Mirmelstein ethics lectures. This is an alumnus-endowed program providing quality presentations from nationally recognized educators and practitioners who specifically address issues relating to integrity in dental research and practice. Also, the ADA's biannual Sympo sium on Ethics discusses the ADA Principles of Ethics and Code of Professional Conduct in a detailed, scenario-based forum. VCU se niors also devote a session of their Practice Administration course to the subject of professional ethics with an eye to starting off on the right foot. Perhaps with a hint of symbolic irony, the most valuable educational

resources available on ethics at VCU are offered on an optional basis. Albeit classes and clinics are suspended for such programs, the decision to participate rests with the individual. Curriculum initiatives are underway to incorporate elements of active, student-based rather than lecture-based, learning, which would lend themselves well to ethi cal case studies in the mainstream curriculum. Above all, it is clear that professionalism and practice ethics play an essential role in today's academic and "real world" settings. In studies reported in the Journal of Dental Education, scientific in quiry indicates that students not only benefit from ethics instruction, but they value it.' With the support of this body of evidence and with the continued efforts of organized dentistry, ethics education at VCU will undoubtedly take center stage with the other essentials of dental training. Only then will the new den tist be able to hear the voice of truth over the din of his or her handpiece and a thousand clamoring voices. Reference: 1. Bebeau, Muriel J. The Impact of a Dental Ethics Curriculum on Moral Reasoning; Journal of Den tal Education; 1994: 58 (9): 684 692.

THE GOLDEN RULE OF CONTRACTING

Ronald L. Tankersley, D.D.S., Ethics & Judicial Affairs Committee

At the time of consultation, the den Likewise, when treatments are pro tist is obligated to inform the patient vided, the dentist is obligated to of all reasonable treatment options provide the same standard of care for their condition. This obligation to all patients, regardless of exists regardless of whether or not whether or not the patients have the patients have dental benefits dental benefits plans or the type of plans or the type of plan they have. plan they have. The ADA's "Golden Based on the available options, it Rule" of contracting states that is the patient's responsibility to "contract obligations do not alter the make the final decisions about the standard of care that the dentist actual treatment that they receive. owes to all patients".

Our Code of Ethics and Profes sional Conduct requires that the quality of treatment for fee-for-ser vice, managed care, and pro bono patients be the same. We should not agree to treat any of these pa tients unless we can uphold that professional trust.

THE VDA OUTGROWS CENTRAL OFFICE

II]

David C. Anderson, D.D.S., Executive Council Chairman

One of the goals that emerged from the Strategic Planning Workshop held at Wintergreen in November 1998 was an action plan regarding our members' professional resi dence-our Central Office. We have grown in size as an organiza tion, and our staff and equipment needs have grown along with it. Now we are at the point where we have outgrown the office and a new building must be sought.

The cramped office of lisa Finnerty, Public Affairs Coordinator.

Everyone realizes that no one wants or likes a dues increase. Everyone does like to have a grasp on what our expenses will be for years to come. The lesser of two evils is to pursue a new building. I invite you to attend the annual meeting to see the reason why this move is necessary and to see one possible solution. The Budget and Administrative Matters Reference

VDA storage space exceeds full capacity.

Committee will be the place to see the presentation and to ask ques tions and to express concerns on Thursday, September 16, 1999, from 1:30pm- 4:00pm. We want your interest and expertise. Please help us with our solution.

Ronya Edwards, Maketing Coordinator. shares office space with Elizabeth Keith, DDS Project Coordinator. and Barbara Rollins. Assistant DDS Project Coordinator.

Virginia Dental Journal 25

UPCOMING CONTINUING EDUCATION

Component

Meeting

Location

Speaker/TORte

Southwest (6)

CE Program VDA co-sponsored

Higher Educational Center, Abingdon

Dr. Samuel B. Low, Successful Management of the Perio Patient

Sept. 10, 1999

Shenandoah (7)

CE Program VDAco-sponsored

Holiday Inn Emmett St. Charlottesville

Dr. Karen S. McAndrew & Dr. Christopher Richardson, Implants

Sept. 17, 1999'

VDA

CE Program/ Annual Meeting

Hyatt Regency Reston, Reston

Dr. Dan Sullivan, Achieving Esthetic Fixed Imp/ant Restorations

Sept. 18, 1999'

VDA

CE Program/ Annual Meeting

Hyatt Regency Reston, Reston

G.L Johnson, Consults Patients Can't Refuse

Oct. 15, 1999

NVDS (8)

CE Program

Fairview Marriott

Dr. Terry Donovan, Update on Esthetic Dentistry

Nov. 5, 1999

Southside (3)

CE Program VDA co-sponsored

Country Club of Petersburg

Dr. Doug Lambert, Contemporary Concepts in Aesthetic Dentistry

Nov. 12, 1999

Southwest (6)

CE Program

Donaldson Brown Conference Center, Blacksburg

Dr. Michael V. Dishman, B/eaching & Cosmetic Dentistry

Nov. 12, 1999

NVDS (8)

CE Program

Fairview Marriott

Dr. Nader Sharifi, Everybody Wants to go to Heaven, but Nobody Wants to Die: The Rea/it) of Removable Prosthodontics

Jan 21,2000

NVDS (8)

CE Porgram

Fairview Marriott

Ben Bissell, PhD, Managing Change and Transition

Feb. 23, 2000

NVDS (8)

CE Program

Fairview Marriott

Dr. Harold Slavkin, Research Update

March 17, 2000

Southwest (6)

CE Program

Van Dyke Center, Emory

Dr. Adam Kegey, Dental Forensics & Frieda Pickett, RDH, Drugs & Herbal Supplements of the Millenium

March 24, 2000

NVDS (8)

CE Program VDA co-sponsored

Fairview Marriott

Dr. Jeff Morely, Practical Cosmetic Dentistry

April 26, 2000

NVDS (8)

CE Program

Fairview Marriott

Dr. Hugh Doherty, What They Didn't Teach You About Business in Dental School

May 19-21, 2000

Southwest (6)

CE Program/ Annual Meeting

Pipestem State Park, Pipestem, WV

TBA

Aug. 11, 2000

Southwest (6)

CE Program VDA co-sponsored

Higher Educational Center, Abingdon

Dr. Franklin Weine, Avoiding Problems in Clinical Endodontics

Nov. 17, 2000

Southwest (6)

CE Program

Donaldson Brown Conference Center, Blacksburg

Dr. Marvin Ladov, Oral Surgery: Impactions. Extractions & Corrective Actions

Month Aug

13, 1999

*Registration material for the VDA Annual Meeting was mailed in early July. Please do not use the registration form in this issue to register for Achieving Esthetic Fixed Implant Restorations andlor Consults Patients Can't Refuse.

AIDA C路E路R.路P

CONTINUING EDUCATION RECOGNITION PROGRAM The VDA is recognized as a certified sponsor of continuing dental education by both the ADA CERP and the Academy of General Dentistry.

26 Virginia Dental Journal

Are you meeting the mandator, \tequlr nts? 00

odbon

Our trainers are author:" 路 OSHA

The National Sa拢etyCouncil

The American Heart Association

For mor6mformation on training and

703-913-7277 or visit our w

Virginia Dental Journal 27

EXECUTIVE COUNCIL ACTIONS IN BRIEF

JUNE 11 ·13,1999 I. ACTIONS OF THE EXECUITVE COUNCIL

A. THE FOLLOWING CHANGES TO THE BYLAWS WERE APPROVED BY THE EXECUTIVE COUNCIL WITH A RECOMMENDATION FOR ADOP TION BY THE HOUSE OF DELEGATES: The Constitution and Bylaws be amended as follows: 14. Article I, Section 1 F. Student Members shall be those undergraduate dental students either studying or residing in Virginia, who are recommended by their Dean. and ap proved by the Executive Council. 15. Article V, Section 3

A. Elected Delegates shall hold office for three years, not to exceed three consecutive terms, and shall be elected one year in advance. Elected Alternate Delegates shall hold office for two years and shall be elected one year in advance, not to exceed four con secutive terms. limited to eight years, except in the case of the Dean of the Dental School. Their terms of office shall commence so that as nearly as possible one-third of the Delegates and one-half of the Alternate Delegates shall be elected each year ... 16. Article VIII, Section 1

A. Regular Standing Committees Add: 16. Communication and Information Technology Committee

ness of current communication and public awareness; (2) explore areas of non-dues revenue as it relates to the VDA web site; and (3) explore new technologies and advise the Executive Council and membership on these ad vances and issues. 17. Specialized Standing Commit tee and Administrative Standing Committee designations be elimi nated and designate all Standing Committees as "Standing Commit tees"

A. Article VIII, Section 1. Standing Committees: There shall be the following Standing Committees. grouped under three gen eral categories: Regular Standing Committees, Specialized Standing Committees and Administrative Stand ing Committees. They shall be formed and perform duties as set forth in these BYLAWS: and fftey shall be named and numbered as follows: Section 1.A Committees

Regular Standing

B. Committees will be alphabetized and renumbered. C. Article VIII, Section 2 6. Regular Standing Committees shall meet twice a year or at the call of the chairman. Specialized Standing Corn mittees shall meet at least once a year or at the call of the chairman. Admin istrative Standing Committees '\lvill meet at the call of the chairman. D. In Article VIII, Section 4 add for each committee:

Article VIII, Section 4, A. Regular Standing Committees 16. Communication and Information Technology Committee

1. Committee shall meet at least (X) times a year and additional meetings scheduled at the call of the chairman.

a. Membership: This Committee shall consist of eight members includ ing one representative from each com ponent society. b. Duties: (1) enhance the effective

E. Article VIII, Section 2 Add: 12. ADA Councilor Commission mem bers shall be ex-officio members of the appropriate VDA Standing Committee.

28 Virginia Dental Journal

18. Article 1, Section 5.C e. The accused may appeal this de cision, in writing, to the Executive Corn m+ttee Ethics and Judicial Affairs Com mittee of the Executive Council of the Virginia Dental Association. f. The Executive Committee Ethics and Judicial Affairs Committee shall investigate and shall report to the Ex ecutive Council which shall recom mend to the members of the House of Delegates appropriate action to be taken. 19. Article I, Section 6.B a. The component society of which he was a member, by a two-thirds vote, may recommend to the Executive Eth ics and Judicial Affairs Committee. which in turn shall report to the Execu tive Council, which shall recommend such reinstatement to the House of Delegates. B. THE FOLLOWING ITEMS WERE APPROVED BY THE EXECUTIVE COUNCIL WITH RECOMMENDA TION FOR ADOPTION BY THE HOUSE OF DELEGATES: 6. The VDA support the ADA Coun cil on Dental Benefit Programs recom mendation to continue the Direct Re imbursement Program on a National Basis for three additional years to be funded by 2.5 million dollars per year. 7. In the event that Virginia loses a Delegate and Alternate Delegate in its allocation to the ADA House of Del egates, the following policy shall be the be utilized to determine the composi tion of the delegation: the two (2) Alternate Delegates elected at the most recent VDA Annual Meeting will be removed based on shortest length of service on the delegation; if multiple Alternate Delegates have the same length of service, re moval will be done by lottery;

one (1) Delegate elected at the most recent VDA Annual Meeting will move to Alternate Delegate based on shortest length of service on the delegation; If multiple Delegates have the same length of service, removal will be done by lottery. 8. The Direct Reimbursement budget should be combined with the VDA General Fund Budget as of January 1, 2000. Existing excess revenues will be deposited into the VDA Reserve Funds. 9. Whereas the contemporary scope of dental practice continues to evolve; and Whereas legislation may be proposed that would limit the ability of a dentist to practice within the scope of his/her licensure: Therefore be it resolved that the VDA policy is to oppose any legislation that would limit an appropriately trained dentist to practice within the scope of his/her license, education, training and experience. 10. Increase VDA constituent dues by twenty-six dollars ($26.00), bringing the 2000 dues amount to two hundred sixty-one dollars ($261.00). 11. Assess the VDA membership a one-time amount of fifty dollars ($50.00) to be applied to the acquisi tion of a new VDA Central Office build ing. These funds will be sequestered in a separate account. 12. The 2000 Virginia Dental Associa tion Proposed Budget be approved as presented. 13. The VDA needs a new Central Office and this office should remain in the Richmond area adjacent to an in terstate highway. 14. Initial funding of $100,000 for the building should be allocated this year. 15. VDA policy shall be that the Auxil iary Education & Relations Committee shall maintain a directory of all auxil

iary programs in Virginia, including lo cation, program director, number of students in the program, number of graduates, and numbers in the appli cant pool. A written report is to be sub mitted annually to the Executive Coun cil prior to the January Committee Meetings.

31. A letter will be written to VDA mem bers of the Delta Dental Plan of Vir ginia Board of Directors, with copies to the VDA Central Office, requesting that the PAN.DA pamphlet be re printed and that the VDA be allowed to review the revisions before the pam phlet is reprinted.

16. The 2004 VDA Annual Meeting will be held at the Norfolk Marriott & Con vention Center.

32. The VDA President, President Elect, and Chairman of the Auxiliary Education & Relations Committee shall meet on a continuing basis with the community college leadership to con tinue discussions regarding dental hy giene education program expansion.

17. The 2005 VDA Annual Meeting will be held at the Richmond Marriott & Convention Center. 18. VDA policy shall be that the incom ing component presidents shall make recommendations to the chairman of the Search Committee For Board Of Dentistry Candidates (or the Central Office) by November 1.

33. The Executive Committee should explore the possibility of holding the 2006 VDA Annual Meeting at the Homestead.

19. The VDA endorse the candidacy of Greg Chadwick for ADA President Elect in 2000.

34. The VDA should include e-mail and web site addresses of members as part of the format in the next edition of the VDA Membership Directory & Resource Guide.

II. THE FOLLOWING ACTIONS OF THE EXECUTIVE COUNCIL ARE BEING INCLUDED FOR INFORMA TION ONLY.

35. The year 2000 Annual Meeting to be held in Williamsburg, no fee in crease is anticipated, fees will be as follows:

A. The Following Adopted:

VDA member: $90 ADA non-VDA: $190 non-ADA: $290 VDAA: $20 Dental Assistants (non-ADM): $30 Office Staff: $30 Hygienist: $50

Items

Were

27. The VDA Central Office will pub lish a brochure explaining the duties and responsibilities of serving on a VDA Committee. This brochure should be distributed to all current or prospec tive VDA Committee Members. 28. The VDA will donate up to $1000 to the National Dental Museum in Baltimore. 29. Dr. Terry D. Dickinson will be em ployed as the Executive Director of the Virginia Dental Association, with an initial contract period of July 1, 1999 December 31, 2002.

On-Site fees for DDS will increase by $50. On-Site fees for others will increase by $10. 36. An article will be included in the next VDA Journal on the need for a new VDA Central Office with any ap propriate pictures included. B. The Following Item Was Defeated:

30. A request from the New Dentist Committee for an additional $2,000.00 for 1999 to cover the cost of sending two additional Committee members to the National Conference On The New Dentist.

2. The Constitution & Bylaws Com mittee meet in the proper format de termined by the Committee chairman. using a limited agenda, to place in the proper form the amendments to the Virginia Dental Journal 29

VDA Constitution and Bylaws passed at the June Committee Meetings. These changes will be submitted to the Executive Council prior to the House Of Delegates for approval. C. The Following Item Was Referred To Committee: 40. To the Constitution & Bylaws Com mittee to develop proper language in the Bylaws adding the directive to the Auxiliary Education & Relations Com mittee to offer a scholarship program for dental laboratory technician stu dents equivalent to that offered to den tal assisting students. D. The Following Items Were Re ceived As Information Only: 23. The Bylaws of the Fellows Selection Committee will be changed as follows: Article V. Meetings

Section 3. Meetings of Fellows in Com

ponent Societies.

In the last sentence of Section 3, de

lete all words following the word but,

to read as follows:

The Fellows of each component shall

establish a quorum for their meetings.

, but this shall be no loss than one third

of the Fello'v\fs of that component.

24. The following motion for a Fellows Bylaws change was defeated: The Qualifications of a Fellows Candidate Article VI. Qualifications Of Fellows Candidate Section 1. The Qualifications of a Fel lows Candidate shall be: A. A Fellow nominee must be an ac tive, life or retired member of the Vir ginia Dental Association. for at loast ten ye8f3-:

25. VADPAC will sponsor an event at either the April or June 2000 Commit tee Meetings (counts as 1999 Governor's Club benefit), 26, VADPAC will sponsor a Legislative Breakfast with speaker on Friday,

30 Virginia Dental Journal

January 14, 2000, at the Virginia Gen eral Assembly during the VDA Com mittee Meetings

tions Committee approved four dental hygiene loan applications for $1,000 each.

27. Governor's Club membership ben efits will no longer include two tickets to the Annual VADPAC Leadership Dinner, but will receive a ticket to "a" VADPAC event.

33. The Direct Reimbursement Com mittee supports the motion presented by the Dental Benefits Committee re garding the continued support and funding for the ADA Direct Reimburse ment Program.

28. The following slate of names were submitted by the Nominating Commit tee for nomination at the 1999 Annual Session, Sunday, September 19, 1999 in Reston: President-Elect David C. Anderson Secretary-Treasurer Thomas S. Cooke III Councilor-at-Large (2 Positions) D. Christopher Hamlin Rodney J. Klima Gus C. Vlahos ADA Delegate (4 Positions) Bruce R. Hutchison Ronald L. Tankersley Richard D. Wilson Andrew J. Zimmer ADA Alternate Delegate (4 Positions) Thomas S. Cooke III Ronald J. Hunt Kirk Norbo 1. Wayne Mostiler William J. Viglione 29. The name of Dr. AI Rizkalla will be added to the list of prospective Board of Dentistry members. 30. A recommendation that Dr, Gary F. Taylor and Dr. Nora M. French be appointed to serve a second term on the Board of Dentistry will be submitted. 31. The VDA Legislative Committee proposes to evaluate experiences of the other states (including GA, OR, AK) that have updated their statutes to in clude the 1997 definition of dentistry as defined by the American Dental Association. 32. The Auxiliary Education & Rela

34. The Subcommittee on Practice Locator/Trade Names of the Dental Practice Regulations Committee report was accepted for information pur poses. The word "Trade" should be deleted from the report on the advice of the Ethics Committee. The Dental Practice Regulations Committee did not take a position on the report. Report: The Board of Dentistry should consider: (1) Allowing the use of geo graphic locator-trade names which would be registered and approved by the BOD (with a fee to be determined by the BOD). By registering the names with the BOD, the Board has control of the type and appropriateness of the name chosen by the dentist(s). The use of registered locator-trade names would still require the use of the present guidelines on the name(s) of the dentist(s) at the location being dis played on the building. (The use of the term "trade names" mayor may not be used so as not to imply something other than the use of geography for the practice name.) (2) The Board of Den tistry should write the specific rules for this proposed regulation. 35. The Subcommittee on DMSO Issues will become a standing subcommittee of the Dental Practice Regulations Committee. The subcommittee will continue to monitor these issues. The subcommittee will utilize the VDA Journal to inform the VDA membership. 36. The Exhibit Prospectus will be adopted as the prototype for future Annual Meeting Exhibitors. 37. At the 2000 Annual Meeting to be held in Williamsburg, VA. the exhibitor fee will increase $100 per booth, each DDS registered will receive a coupon

good at any exhibitor for $20, the VDA will reimburse the $20 coupons re turned to the VDA from each vendor. 38. All events at the Annual Meeting will be approved by the Annual Meet ing Committee. A form will be sent to each organization to include the follow ing: menu choices, room set-up, AV needs, anticipated attendance. 39. All fees and registrations will be collected through the VDA office. Or ganizations can determine fees for their respective functions. Money will be for warded to the sponsoring organization. The organization will then be billed for the function by the VDA. 40. When a special fundraising event is held at the VDA Annual Meeting, the event will be run by the VDA Annual Meeting Committee. All costs associ ated with the said event will be de ducted and monies from any profit will be donated to the designated benefi ciary. This policy supercedes any other policy with respect to the fund raising events at the Annual Meeting and will be effective for the 2000 Annual Meet ing in Williamsburg. 41. The following editorial changes have been made to the Constitution & Bylaws: A.

Constitution:

1. Article II Purpose The purpose of the Association shall be to promote the art and science of dentistry; to foster professional rela tions among dentists; to represent the interests of the profession and the pub lic which it serves; to elevate the stan dards and improve the methods of den tal education; to promote the continu ing education of the dental practitioner; to encourage the enactment and en forcement of dental laws; 800 to en lighten and direct public education to oral health and advanced scientific dental service; and to foster adherence to ethical principles. 2. Article V Government Section 1. The legislative body of the Association shall be the duly consti tuted House of Delegates, meeting

which convenes at the Annual Meet ing as provided in the BYLAWS. The general membership shall meet con vene following the first meeting of the House of Delegates for the purpose of electing officers. 3. Article VII Principles of Ethics The Principles of Ethics of this Asso ciation shall be the current revised Prin ciples of Ethics and Code of Profes sional Conduct and the Advisory Opin ions of the American Dental Associa tion. Members of the ADA voluntarily agree to abide by the ADA Principles of Ethics and Code of Professional Conduct as a condition of membership in the Association. They recognize that continued public trust in the dental pro fession is based on the commitment of individual dentists to high ethical standards of conduct. B. Bylaws: 1. Article I, Section 1 A. Active Members shall be those who are licensed to practice dentistry in Virginia or engaged in dental teach ing or research in Virginia, or in fed eral or state dental services, or en gaged in formal postgraduate studies, in accordance with the Principles of Ethics and Code of Professional Con duct of this Association, and who are members in good standing of the com ponent societies of this Association. B. Associate Members shall be ethi cal dentists practicing or teaching in any state who are members of the American Dental Association or the National Dental Association in such stffie and/or recent graduates of ac cepted dental schools who are ~ iftte entering the armed forces prior to active civilian practice, All dental mem bers of the armed forces residing in the component area shall be eligible for associate membership providing that they are members of the American Dental Association or the National Dental Association. 2. Article 1, Section 2 E, Students: Undergraduate dental students, either studying or residing in the State of Virginia, may become stu dent members upon recommendation

of the Dean of their school and ap proval of the Executive Council. =fftey Student members shall not be entitled to vote or to hold office; however, the President of the American Student Dental Association of the MCV School of Dentistry shall be a voting member of the VDA House of Delegates. =fftey Student members shall be entitled to participate in the Association's insur ance programs, shall receive the Vir ginia Dental Journal, and shall receive notice of and be entitled to participate in other Association activities. F. Retired Members: To qualify for retired membership, an active member shall submit an affidavit through his component society attesting to his retirement. through his component society. G. Missionary Members: To qualify for missionary membership, an active member shall submit an affidavit through his component society attest ing to his dental missionary status. through his component society. 3. Article 1 Section 3 Members in good standing shall be those who abide by tftese the Bylaws and the Principles of Ethics and Code of Professional Conduct of the Ameri can Dental Association, and the By Iews ef the Virginia Dental Association and of the component society to which they belong, and who have paid their current dues. 4. Article 1, Section 5 j. Alleged violations of the Principles of Ethics and Code of Professional Conduct may be considered by the Ethics and Judicial Affairs Committee without written complaints. In such cases the Committee shall proceed in formally to investigate the allegation and shall, if the allegation has seme ~ substance, attempt to guide counsel the member being investigated in correcting the violation. If the mem ber being investigated is not coopera tive, the committee shall, upon receipt of three written complaints, proceed as previously directed. 5. Article 1, Section 6 Reinstate ment of Members:

Virginia Dental Journal 31

B. Former members who have been dropped because of a violation of the Principles of Ethics and Code of Pro fessional Conduct may, through an appeal, be reinstated in the following manner: a. The component society of which he was a member, bya two-thirds vote, may recommend to the Executive Eth ics and Judicial Affairs Committee, which in turn shall report to the Execu tive Council, which shall recommend such reinstatement to the House of Delegates. b. The motion to reinstate shall also require a two-thirds vote of the mem bers of the House of Delegates. 6.

Article II, Section 1

powered to propose any changes in the Manual or in the BYLAWS. 'which 'will pFOFl9ote betteF functioning of the

I louse. 9. Article IV, Section 4,A g. Be an ex officio director of each of the Virginia Dental Association Educa tieftal Foundation and the Virginia Den tal Association Relief Fund. 10. Article IV, Section 4,B f. Be an ex officio director of each of the Virginia Dental Association Educa tieftaI Foundation and the Virginia Den tal Association Relief Fund. j. Be an ex officio director of each of the Virginia Dental Association Educa tieftaI Foundation and the Virginia Den tal Association Relief Fund.

A. Presentations designed for the

C. The Annual Session of the House of Delegates shall be held, as consti tuted according to these Bylaws, held for the purpose of considering and act ing upon reports and resolutions of of ficers and committees and such other business as may properly come before it.

k. Additional duties to include the following: (1) to stimulate stiFl9ulating interest in outstanding personalities and events in Virginia dentistry of the past; (2) to arrange aFFanging the commemoration of such events or persons through publication of articles or the placing of suitable memorials; (3) to collect-en and preserve pFeseFvation of items of historical interest in Virginia dentistry; (4) to review Fe'viewing questions involving conflict of views or facts in Virginia dental history; and (5) to publishift§-or seekieq publication of various historical accounts of general interest to the public and profession. The Secretary! Treasurer shall report to the Annual Meeting all deaths of members of the Association during the year and handle appropriate correspondence with the families of these members.

7. Article III, Section 5 F. Reference Committees shall consider all resolutions assigned to them and testimony presented during the hearing and shall recommend in writing, actions considered appropriate for the House in respect to each resolution.

F. The Parliamentarian, when re quested, shall assist, in an advisory capacity, the officers, the committees, the Executive Council and the mem bership and shall serve as Parliamen tarian for the House of Delegates. He shall also serve on the Constitution and Bylaws Committee.

8. Article III, Section 6, B e. The Manual may be reviewed by the Executive Committee, the Execu tive Councilor any Component Delega tion and any of the three shall be em

11. Article V, Section 2 A. Election: Delegates and Alter nate Delegates not seFVing ex officio shall be elected by ballot at the Annual Membership Meeting. Nominations

scientific, professional, ethical and per sonal iFl9pFOveFlgent advancement of those attending. B. (Second Paragraph) The privilege of making motions, debating and voting at this meeting shall be limited to those Active, Life, Retired and Missionary Members in good standing who are displaying the official badge. Fifty voting members shall constitute a quorum for a Business Meeting of the Association.

32 Virginia Dental Journal

and elections shall follow the proce dures for nominations and elections of the elected officers of the Association (ARTICLE IV, Section 2. B. and C.). B. Vacancies: a. In cases of emergencies of short duration; when a Delegate or Alternate Delegate cannot fulfill his duties, the Chairman of the Delegation may appoint any member of the Virginia Dental Association temporarily to fill the vacancy. All such appointments must conform to the rules of the House of Delegates of the American Dental Association. b. In cases of reasonable notice: when any Delegate cannot complete his term of office because of resigna tion, death or other reason, the Presi dent of this Association shall appoint his successor from the Alternate Del egates to serve until the next election, subject to the approval of the Execu tive Council. When any Alternate Del egate cannot complete his term of of fice because of resignation, death or other reason, the President of this As sociation shall appoint his successor from the Association membership to serve until the next election, subject to the approval of the Executive Council. 12. Article V, Section 3 B. The Delegation, defined as Delegates and Alternate Delegates, at its first caucus each year, shall elect ffflm its Chairman from its members each year its- ChaiFFl9an. The Chairman's duties shall include a complete report of activities and a detailed block graph report on attendance, such as has been placed in the Journal of the American Dental Association, to be published in the Virginia Dental Journal.

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Virginia Dental Journal 35

[ PUBLIC HEALTH DENTISTRY IN VIRGINIA: PAST, PRESENT, AND FUTURE IJ

James R. Schroeder, D.D.S., State Board of Health Member

With public health dentistry in Vir ginia about to make the leap into the Year 2000, the time is right to reflect on the accomplishments of dental public health in the past century. Before the advent of public health dentistry, overwhelming dental car ies were present in every child. With the help of the Virginia Dental Asso ciation (VDA), Virginia's dental pub lic health program was established in 1921. The Virginia Department of Health (VDH) modestly began pro viding dental services for children who could not afford care. Dentists were employed and assigned to lo cal health departments. In the begin ning, dentists treated children in schoolhouses with portable equip ment transported by horse or Model 1. In later years, portable equipment was replaced with dental trailers and facilities located within the local health departments. Today, some level of dental public health services is available in 29 of Virginia's 35 health districts. Forty eight full-time and 11 part-time pub lic health dentists work with four den tal hygienists and 70 dental assis tants to provide services to more than 37,000 individuals annually. In 1998, nearly 344,000 dental services were provided for these patients at a value exceeding $8 million. Realizing that needs could not be met entirely through the direct pro vision of dental care, VDH provided education and encouraged the prac tice of the latest preventive methods for all Virginia citizens. Restriction of "sweets", brushing and flossing, regular dental checkups and the use of fluorides were public health dentistry's educational messages. Lactobacillus tests, water testing for fluoride content, were preventive measures that were offered free to dentists in Virginia. 36 Virginia Dental Journal

When fluoridation was shown in the late 1940s to be the most effective means of preventing dental caries, VDH (in cooperation with the VDA) became a national leader in encouraging adding fluoride to community water supplies. In 1957, Fries was the first community in Virginia to fluoridate its water supply. Fluoridation remains one of the true successes of public health. Today, more than 5 million people in Virginia, or 81 percent of the state population on public water supplies, receive either adjusted or adequate natural fluoride for the prevention of dental caries. This program continues to be monitored by the health department in conjunction with the State Division of Consolidated Laboratory Services. Virginia Department of Health, through funds received from the Fed eral Preventive Health and Health Services Block Grant, continues to support communities in the initiation and upgrade of obsolete equipment for Fluoridation. The department also implements other preventive programs under this grant such as the school fluoride mouthrinse and dental sealant programs. Currently, 44,000 elementary school children participate in the mouthrinse pro gram statewide. Last year, VDH dental programs provided more than 95,530 sealants for eligible school children. Education continues to be an impor tant component of the dental pro gram. Last year, more than 22,000 children heard lectures or received materials on the importance of oral health. VDH provides consultation and educational services to many of Virginia's Head Start programs, and to school and public health nurses. It participates in community health fairs. VDH's Division of Dental Health

serves as a resource for the dental school and the dental auxiliary edu cational programs in Virginia. Because of these preventive measures, dental caries is declining particularly on the smooth surfaces of teeth, and emphasis is now being placed on sealing the occlusal surfaces of permanent teeth. Not all children, however, are sharing equally in this caries decline as community dental surveys show that children eligible for the school free lunch program have higher rates of decay and receive less care than their counterparts. These children are eligible for treatment in health department dental clinics. In addition, a recent review of dental records of Head Start children by the personnel of the Division of Dental Health found that 13 percent of preschool children in Head Start have Early Childhood Caries. To confirm this data, the Division of Dental Health is currently conducting the first statewide dental needs assessment. More than 7,200 children in first, third and tenth grades have been examined. This valuable baseline information about their dental disease status will help the dental health program plan the future of public health dentistry in Virginia. Since the 1970s, the Virginia Depart ment of Health has administered the Rural Dental Scholarship Program. It was originally initiated by the state legislature in cooperation with the VDA to place graduating dentists in Virginia's rural areas. For each year that a student receives scholarship, he or she serves in a rural area as a means of owning loan forgiveness. As an alternative, the individual can also work for one of the state agen cies that employ dentists. This pro gram has been very successful over

the years in placing dentists in the rural areas of Virginia- In many in stances, a graduating dentist prac tices for the state health department in a rural clinic to satisfy the scholar ship obligation and later decades to establish a private practice in the community. There are currently five scholarships offered per year at $5,000. Recent changes in the scholarship have made it less attrac tive to dental students. VDH is cur rently promulgating regulations relat ing to the scholarship, which will hopefully address these areas. Dental manpower to assure the availability of care to all Virginians continues to be a concern for den tists. In 1996, the health department (at the request of the General As sembly) conducted a manpower study. The Re,oort of Availabili1}L.Qf Dental.Heauh Services was con ducted in conjunction with the VDA and Virginia Commonwealth Univer sity School of Dentistry. This report indicated a strong need to continue the dental scholarship program as 43 out of 136 cities and counties in Vir ginia continue to be underserved based on their low dentist-to-popu lation ratio. In spite of these successes, many challenges remain for dentistry as we strive to continue to assure that the public is property informed through education, and that preventive mea sures and dental care are available and accessible to all Virginians. While the preventive aspects of the dental program remain strong, the care portion has been weakened in some areas by lack of funds and changes in program direction. The dental program has never been man dated, which leaves the program vul nerable to the availability of funds on the local and state level. A number of dental programs have been re duced or eliminated over the past several years. As a result, alternate funding (primarily from the Virginia Health Care Foundation and the De

partment of Education) has been sought in some localities to continue public health dental programs. Some dental programs have been initiated through federal community health centers. Many changes have created the perspective that dental care for the indigent will increasingly be provided by the private sector. These include: a redefinition of the role of state health departments in this country; changes in the state Medicaid program through increased fees; the initiation of the Virginia Children's Medical Security Insur ance Plan, the establishment of com munity health centers (although few offer dental care); and the reduction in dental disease. Historically, care has not been ob tained through alternate means for a number of reasons including a lack of education, a lack of Medicaid pro viders, difficulties in treating very young children and lack of reliable transportation. Some of these barri ers have been overcome in public health clinics. For example, dental trailers VDH operates in many areas make care accessible to children and assure that parents do not need to miss work and income to take a child to the dentist. Dentistry has offered few organized care programs for Virginia's indigent adults in the past, and little is avail able to them today. Medicare and Medicaid programs have few, adult dental care benefits. Some volun teer free clinic programs have been established in communities to pro vide limited care for poor working adults. In addition, a few community health centers provide dental care for adults. Because of cost and difficul ties in obtaining volunteers, most of these programs provide services on a very limited basis. The Virginia Dental Association has started the Donated Dental Services (DDS) pro gram that encourages private den tists to voluntarily treat several adult patients in need each year. This pro gram has great potential with strong

participation from our membership. Communities have the potential to create strong volunteer programs as demonstrated in Richmond, Virginia at the Crossover Health Center, apart from the government. How and what will be the best ve hicle for serving the citizens of our Commonwealth as we approach the new millenium? I believe the most effective and cre ative ways will come out of strong partnerships between the public and private sectors in local communities. These partnerships will address the following: • maintaining a comprehensive edu cation and prevention program to prevent dental disease assurance of strong • an infrastructure of care availability and accessibility by the public and private sectors for people of all ages and abilities • an assurance of an adequate man power base so that care is available for all Virginians The accomplishments over the past century of the dental public health initiatives with strong support from the Virginia Dental Association have been many. We all know there is no guarantee that what was successful in the past will continue to be effec tive in the future. Government alone cannot effectively address dental health care needs without a strong coalition, with the private sector and the Virginia Dental Association. As a new member on the State Board of Health, I welcome suggestions and your experiences with the pub lic health department in your com munity. You may address your com ments to me at: James R. Schroeder, DD.S. 7033 Jahnke Rd. Richmond, VA 23235

Virginia Dental Journal 37

MEMBERSHIP BENEFIT HIGHLIGHT:

LIFE AND DISABILITY INSURANCE PROGRAMS

Kimberly S. Swanson, D.D.S., VDA Membership Task Force

The American Dental Association offers a variety of insurance plans exeJusi'Lely_to members. Surveys of members show that the ADA group insurance plans are among the most valued benefits of member ship. These programs offer cover age designed to meet the special needs of dentists at rates that are among the lowest in the market place. ADA members get high qual ity coverage and guaranteed rights to renewal. The last Virginia Oen tal Journal issue addressed Health and Professional Liability insurance programs. Life and Disability Insur ance plans are briefly described below: TERM LIFE: Offered for member dentists and their families. A Non contributory Life Insurance Plan is also available for dental students. Death benefits range in amount from $25,000 to $1.5 million and can be renewed until age 75. On January 1, 1998, an accelerated death benefit was added. This per mits the payment of death benefits one year before the insured indi vidual dies. This option is offered on proof that the insured person is terminally ill with a life expectancy of less than one year. Also effec tive January 1, 1998, new members of the ADA under age 40 will be able to purchase up to $50,000 of coverage regardless of medical his tory. New members must take ad vantage of the offer within 60 days of notification of eligibility. This is not available to dentists who were previously active members. TERM PLUS: Adds a tax advantaged savings account to the term Life Plan. The maximum amount of coverage available is also $1.5 million, which is fully re 38 Virginia Dental Journal

newable up to age 90. Federal in come taxation is deferred on the interest earned by this account un less it is withdrawn during the dentist's lifetime. However, if this interest is used to pay the life in surance premiums, taxation on the interest can be avoided entirely. In the event of the insured's death, the balance of the savings account is paid in addition to the insurance benefit to the beneficiary-free from Federal Income Tax. Savings can be invested at rates of interest that can be guaranteed for one, three, or five years. Unlike comparable universal life plans, there are no surrender charges and the only additional cost is an annual $50 fee. The Term Plus Feature can be added or eliminated at any time. Under both plans, benefits are doubled if death is a result of an accident prior to age 60, or in creased by 50% if accidental death occurs after age 59. Premiums un der both plans are waived in the event of the insured's permanent total disability. Effective July 1, 1998, participants in both plans will be able to purchase coverage without the accidental death and waiver of premium options in exchange for a lower premium. The ADA Council elected to make these features optional in response to intensifying competition in the life insurance markets. For more information on Life Insurance benefits, call the Great-West Life Insurance Company at 1-800-568-2001. The income protection plan pro vides participating members with a monthly benefit up to $8000 to re place income lost as a result of in

ability to work in their dental prac tice. Payments are made if the den tist elects to cease practicing as the result of an HIV seropositive sta tus-even if there is no physical impairment. There is a long-term coverage option that allows for ben efits to be paid until the age of 65. The short-term plan provides for payment of benefits for two years if the disability is the result of acci dent or sickness. Participants may tailor their coverage meet their in dividual needs. Additionally, there are optional Cost-of-Living Adjust ment Benefits as well as a Future Increase Option that guarantees the right to purchase up to an addi tional $1000 in monthly benefits. The Office Overhead Expense Plan provides participating members with a monthly benefit to reimburse them for the costs of maintaining their dental offices during a period in which they are unable to work in a dental practice. Full benefits are payable even if the dentist is em ployed in a new occupation. Pay ments are also made if the dentist elects to cease practicing as the result of HIV seropositive status even if there is no physical impair ment. The plan provides reimburse ment for all overhead expenses that are tax-deductible. Benefits can be paid for as long as 24 months for disabilities occurring before age 65 and up to 12 months for disabilities cornmencino between ages 65-70. Partial r~lsability benefits can be paid frJr up to three months when the Insured returns to part-time work following at least 60 days of total disability. Premiums paid for the Office Overhead Insurance Plan are tax-deductible as a prac tice expense. During disability, pre mium payments are waived and

any premium previously paid for the disabled period is refunded. For general information and assis tance regarding ADA insurance pro grams, call the ADA Council on In surance, extension 2623. Please take advantage of your membership benefits and call the VDA at (804) 358-4927 or 1-800-552-3886. Call the ADA at (312) 440-2500 or the toll-free number listed on your mem bership card. Membership Matters!

Retraction: In the April-May June issue the Membership Ben efits: Health and Professional Li ability Insurance Programs article stated "Professional Liability In surance is also offered through the ADA. This policy, underwrit ten by the Reliance National In surance Company, offers protec tion against the financial conse quences of professional liability allegations." The ADA no longer offers the Reliance National In surance Company. We apologize for any inconvenience this may have caused.

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[

HEALTHY COMMUNITIES LOAN FUND TOPS $1 MILLION MARK

II]

Lilia W. Mayer, Healthy Communities Loan Fund Coordinator

The Healthy Communities Loan Fund recently topped the $1 million loan mark for medical and dental practitioners seeking loans to work in Virginia's underserved commu nities (Health Professional Short age Areas and Dental Shortage Areas). This benchmark was reached through First Virginia's ongoing partnership with the Vir ginia Health Care Foundation and its Healthy Communities Loan Fund, a program that is striving to bring more primary care providers to these areas. Underserved communities attract a unique kind of individual, one who values a relationship with the com munity, someone who enjoys exert

ing a measure of influence through active participation. Individuals who put these values first are the ones who thrive. Dentist account for 27% of the current HCLF loans.

available by contacting Lilia W. Mayer, Healthy Communities Loan Fund Coordinator at the Virginia Health Care Foundation in Rich mond, Virginia, at (804) 828-7494.

With the Loan Fund's assistance, dentists can obtain individually tai lored loans at low interest rates with no bank fees and no points. The loan funds may be used in a num ber of ways so long as the goal is to attract another dentist. Financ ing can be obtained for building a new facility or expanding an exist ing one; buying equipment; start up costs or operating capital.

The Virginia Health Care Founda tion, in partnership with First Vir ginia Banks, Inc., administers the Healthy Communities Loan Fund as part of the Robert Wood Johnson Foundation and the Vir ginia Practice Sights Initiative - a public-private partnership dedi cated to increasing access to pri mary health care for underserved Virginians.

More detailed information about the Healthy Communities Loan Fund is

Virginia Dental Journal 39

1999 JUNE COMMITTEE MEETINGS

II]

The June Committee Meetings took place June 10-13, 1999, at the Sheraton Oceanfront Hotel in Virginia Beach, VA. All VDA members are encouraged to attend committee meetings!

Drs. Joan Gillespie and McKinley Price take a break between committee meet足 ings to catch up with each other.

Let's make a deal! Drs. Bruce Hutchison and Dan Grabeel enjoy the relaxed atmosphere at the beach.

J The entire group seems to be having a good time, but Dr. Bruce DeGinder appears particularly estatic! (Pictured L to R: Dr. David Swett, Connie Jungmann, Bonnie Ander足 son, Dr. Bruce DeGinder, and Dr. Rebecca Swett)

40 Virginia Dental Journal

Dr. Tom Cooke takes the opportunity to kick back, while Bill Zepp and Dr. Bruce DeGinder talk shop.

Dr. Charlie Cuttino, VDA President and Dr. Anne Adams enjoy their dinner at the Zepp Farewell Dinner.

1999 JUNE COMMITTEE MEETINGS

Pat Zepp with son John Zepp receives roses from the Executive Council as thanks before she leaves for Portland, the "City of Roses" .

Bill Zepp receives the only vest with pins he'll ever show-off.

Welcome! Dr. Terry Dickinson and wife Cherryl attend their first VDA function.

~~ -r*'!..

Dr. Russ Mosher takes care of impor足 tant business, daughter Riley, at the June Committee Meetings.

Dr. Mike Miller stands watch as Dr. Richard Wood's daugh足 ter assists Anne Miller down the steps.

Virginia Dental Journal 41

It takes years to gro

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8:00am 11 :OOpm Executive Committee Meeting 7:00am VSOMS Membership Meeting

8:30am 1:OOpm 5:00pm Golf Tournament - Lansdowne 7:00am ICD Breakfast

8:30am 7:30am 1:OOpm 5:00pm Registration and Ticket Sales 8:15am VDAA Balloting

5:30pm 6:30pm Golf Reception - Lansdowne 8:00am 8:30am 11 :30am Johnson Morning Session VSPD - Dummett Course Thursday, September 16,1999 11 :30am 8:30am 9:00am 4:30pm Alliance Business Meeting 7:30am 9:30am VSOMS Board Meeting 8:00am 5:00pm Registration and Ticket Sales 10:00am 1:30pm Exhibit Hall Opens 10:00am 8:00am 5:00pm Board of Dentistry Meeting Alliance Brunch at Neiman Marcus Pierre Fauchard Luncheon 11 :30am 1:30pm 8:00am 10:30am Executive Council Meeting 11 :30am 12:30pm VSPD Business Meeting 9:30am Alliance Shopping & Lunch 11 :45am 1:30pm VDAA Past Presidents Lunch 10:00am 10:30am Credentials Committee 10:30am 12:00pm VDA House of Delegates 12:00pm 4:30pm CDHS Luncheon/Annual Meeting Johnson Afternoon Session 12:00pm 1:30pm VDA Fellows Luncheon 1:30pm 4:00pm 4:30pm VAE Meeting - Byrne Course & 1:30pm 4:00pm VDA Reference Committees 1:30pm Business Meeting 5:00pm 6:15pm VDA Opening Session 6:15pm 7:15pm Exhibits/Members Reception 1:30pm 2:30pm VDAA Past Pres Council Meeting 7:30pm 9:30pm VDAA Board Meeting 4:30pm 6:00pm Relief Fund Meeting 7:00pm 11 :OOpm ACD Dinner Dance 7:30pm 8:00pm VDAlMCV Reception 6:30pm 10:00pm VDAA President's Banquet 12:00am 8:00pm Friday, September 17, 1999 VDA President's Dinner/Dance 5:00pm Registration and Ticket Sales 7:00am VSOMS Membership Meeting Sunday, September 19, 1999 7:00am 8:30am 7:30am 9:00am DMSO Forum 7:30am 8:30am VAGD Breakfast 8:00am 5:00pm Board of Dentistry Meeting 7:30am 9:00am VDAA Past Presidents Breakfast 9:30am Paychex Seminar 8:00am 8:00am 10:00am Registration 11 :30am Sullivan Morning Session 8:30am 11 :OOam VDA Annual Business Meeting 9:00am 11:15am 9:15am 11 :OOam VDAA General Session 9:00am VDAA Opening Session/ 1st House 9:00am 4:00pm VDHA Board Meeting 1:30pm 10:00am Alliance Board Meeting & 11 :OOam 2:00pm VDA House of Delegates 11 :OOam 12:00pm VDAA Post-Convention Lunch 10:00am 11 :30am Mercer Global Advisors Board Meeting Seminar 2:00pm 4:00pm VDA Executive Council 6:00pm 10:00am Exhibition Hall Opens 11 :15am 11:30am VDAA Balloting 11 :30am 1:30pm ACD Luncheon for Learning 11 :30am 1:OOpm ADA 16th District Delegation 1:30pm 4:30pm Sullivan Afternoon Session

1:30pm 4:30pm VAO Board Meeting

1:30pm 4:30pm VDAA CDPMA Exam

6:30pm 4:30pm Constitution & Bylaws

Committee

4:30pm 6:30pm VAGD Board Meeting

5:00pm 7:00pm Reception with Exhibitors

5:00pm 7:00pm VSOMS Membership

Interviews

6:00pm 7:00pm VDAA President's Social

American Dental Asvociauon 7:00pm 9:00pm VSPD Dinner

140th ADA Annual Session 7:00pm 12:00am Casino Night

Octane! 9 - ] 3,

199~.I

Virginia Dental Journal 43

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DOMPONENT NEWS Component I Tidewater

with that. He is a tough one to keep down. Dr. Russell has long played in a blue grass band of some reputation in our area called "Doc Russell's Blades of Grass". They play at a lot of the picnic type events here and are really very good.

Component II

Peninsula

Dr. Eric Boxx, Editor

Dr. Barry Einhorn, Editor Greetings from the most eastern com ponent in Virginia. Now that summer is truly here you are all cordially invited to come down to Tidewater and take a dip in our ocean. We are winding up another very success ful year, thanks to the outstanding lead ership of our president, Stan Tompkins. We enjoyed several outstanding continu ing education programs. Dr. Joe Camp entertained us with his homespun humor as well as his tremendous expertise in endodontics. Dr. Dean Elledge and Dr. Dick Barnes rounded out our academic year and the attendance at their lectures was overwhelming. Pam Morgan spear headed a very successful Dental Health month program and is already looking forward to the new year. Speaking of the new year, we will start with our annual meeting on August 25 th.We will elect a new slate of officers and directors at that time. Jamie Krochmal will assume the presidency and will be supported by a very capable cadre of officers. We have one continuing ed program already scheduled for Friday, October 29.The speaker will be Dr. Fred Bell, Oral Surgeon and his topic will be "Implants". We are looking forward to the Annual Meeting of the VDA when our own Bud Zimmer will be installed as President. We are proud of Bud and all his accomplish ments. He brings a very strong work ethic along with a sharp mind and a ready wit to the position. Besides, he has more pins on his sash than anyone in the state. We mourn the loss of Erwin Schwartz. Erwin was a fine gentleman and a de voted member of our component. Hope by the time this article is read all of our colleagues have had an opportunity to savor the warmth of summer and had the opportunity to recharge batteries with at least a few days off. See you in Reston'

It has been a fairly quiet summer as far as official dental society activities are concerned. Our one scheduled outing was a night at Harbor Park. The families that came sat through a steady drizzle to see the Tides post a losing effort. So it goes. At our next meeting in September, the following slate of officers will be installed. President President-Elect Secretary Treasurer Councilor

Gary "Sonny Riggs Jim Watkins Eric Boxx Jon Piche Bruce DeGinder

In addition to a new slate of officers, we also have a new Executive Secretary in Kathy Harris. As a new officer myself, I welcome Kathy aboard and look forward to us all learning the ropes together. Component III Southside

Dr. Reed Boyd, Editor The Southside Dental Society has had a full slate of events in the last quarter. We held our semiannual business meeting back in March. In June, we had our an nual CE Course in Emporia with Dr. Joe Tregaskes presenting the program. This meeting is held in conjunction with the Pork Festival. By all accounts, the pro gram was good, the weather was good and the Pork Festival was a lot of fun. There has been a lot of sadness within our component of late. In April, my mother and the wife of Dr. Herbert R. Boyd, died. Shortly thereafter, Dr. Barney Pilcher passed away and just this past week Dr. Tom VanKuren passed away as well. The Component sends its sympathies to the loved ones of these individuals. Dr. Billy Russell is on the mend from by pass surgery. Dr. Russell has recently had one knee replaced and is doing well

The VDA is currently undergoing several changes and more have been suggested. As you probably know by now, Bill Zepp is leaving us to take a similar position in Oregon. The VDA has hired Dr.Terry Dickinson to replace Bill. Dr. Dickinson is a dentist from Texas. He was intro duced at the June Committee Meetings, which were just concluded. Terry seems to be very personable and likable. We will miss Bill and wish him the best in his new job, but I feel like we are in good hands with Terry. You should also know that Ms. Connie Jungmann is leaving as well. She is moving back to Washington state. As Chairman of the Committee on Membership, I had the opportunity to work closely with Connie in her position as Central Office liaison to the Commit tee on Membership and I will miss her as well. Connie was always willing to help out and was very supportive of our Committee's efforts. Good luck Connie! The VDA is investigating the need for new Central Office space. The building we now occupy is quite cramped and parking is even more of a problem. There is a proposal coming before the VDA House of Delegates at the Annual Meet ing this September to assess each mem ber $50 to start a seed fund for the new office. Also of interest is a dues increase that is required to fund the proposed bud get for the next VDA fiscal year. This would be the first dues increase since 1995. These issues are just two of many that YOUR House of Delegates will be deciding when it meets in Reston in Sep tember. I urge you to speak with your delegates about these and any other is sues that will be decided there. As well, make plans to attend the Annual Meet ing of the VDA. It is a great way to pick up those needed CE hours required for license renewal, as well as meet old friends and make new ones. Of particu lar note is an Open Forum on DMSOs that will be held Sunday Morning. Look for more information in the mail and our Journal. The Southside Dental Society is gearing down for the summer but will start back

Virginia Dental Journal 45

up in September with our next business meeting. Our next CE will be held in No vember. Look for details in the mail. We hope to see everyone in September at the Annual Meeting in Reston. Come find out what is going on in YOUR DENTAL ASSOCIATION. Attend the meeting, get informed and involved! See you in Reston!

Component IV Richmond

Dr. Jack Dunlevy, Editor Summer vacations continue. and Com ponent IV's annual Golf Outing and Cook out provided a wonderful end to our regu lar monthly meetings. Dentists, legisla tors, and recent MVC graduates slogged through 18 holes at the Crossings Golf Club. Our component appreciates our corporate sponsors. Special thanks to Drs. Russ Mosher and John Doswell; Tom Burke at MCV; and our Executive Secretary, Linda Simon, for their organi zational efforts.

sity School of Dentistry Alumni Associa tion. Dr. Hartwell, Chairman and Profes sor of Endodontics at VCU School of Dentistry, was recognized for his contri butions at the local, state, and national levels. On June 4, Component dentists partici pated in a campaign dessert at the home of Dr. and Mrs. Fred Carr. The function benefited delegate Panny Rhodes. Ms. Rhodes will be the Republican incumbent nominee for the 68 th District seat in the Fall. New component leaders will be installed at our first monthly membership meeting on September 9 th . Dr. Charles Gaskins III will become President; Russell N. Mosher, Jr. will become President-elect; Dr. AI J. Stenger will become Treasurer; and Dr. Jack A. Dunlevy will continue as Secretary. The meeting will be held at the Capital Club in Richmond. Members are reminded to confirm plans for the VDA Annual Meeting in Reston on September 15-19. We hope to see you there!

Component V Piedmont

Component IV has increased support of the Crossover Dental Health Center re cently. The facility is located at Cowardin Avenue in Richmond. Dental services are provided for those in need. This year, records were set for patient visits and vol unteer hours. Dr. AI Stenger was recently selected as a recipient of the 1999 Vir ginia Health Care Foundation's (VHCF) Unsung Heroes Award. Dr. Stenger is an active volunteer with two VHCF funded projects, the Crossover Clinic and Do nated Dental Services.

Dr. Barry Cutright, Editor

46 Virginia Dental Journal

Dr. C. E. Ayers Dr. Fred Coots Dr. Mark Crabtree Dr. Craig Dietrich Dr. John Fedison Dr. G.T. Gendron Dr. Bill Martin Dr. Elbert Osborne, Jr. Dr. James Shearer Dr. Ed Snyder Dr. C.B. Strange, Jr. Dr. Scott Ward Dr. Doug Price Our October meeting will feature Stephen Sezlner-"101 Technological Pearls". Plan to attend and become Y2K compat ible so you don't have to resort to the Y2K emergency kit, which includes a #2 pencil and yellow notepad. Component VI Southwest

Dr. Robert G. Schuster, Editor

The past year has been successful in many respects. We are grateful for the hard work of our officers, board mem bers, committee chairs, and our Execu tive Secretary.

Two other Component IV members have been recognized. Dr. Christopher Richardson was awarded the Kramer Scholarship for his achievements as a periodontal resident at the University of Texas at San Antonio. Dr. Gary Hartwell received the 1999 Distinguished Alum nus Award by the West Virginia Univer

Our delegates for the Reston meeting include:

Dr. Daniel Becker spoke to the Piedmont Society in April-his topic an "Update in Pharmacology for the Dentist." What a review of pharmacology' He covered a lot of ground and helped simplify an ever expanding field. Likewise, Dr. Becker of fered a "cookbook" approach to handling emergencies in the office. Thanks to Dr. Crabtree for his part in selecting the Homestead as the meeting location. This was a great place to reflect on the past and plan ahead. A reception was held for Dr. Dan Grabeel to show our appreciation for the many contributions that he has made to both our component and the Dental profes sion as a whole. Dr. Grabeel has been the "heart and soul" of our component for many years.

Summer has officially arrived, but the thermometer on my back porch is regis tering lower than normal. I recently re turned from the committee meetings in Virginia Beach, where the cool tempera tures, wind, and rough surf kept most people inside. The ocean always pro vides a certain mystique that allows us to ponder and reflect upon the passage of time. In addition to submitting journal articles, I am serving as president of Component VI. As this year in our component draws to a close, I would like to express my ap preciation to all officers, committee mem bers, and members at-large. Ms. Paulette Beasley, our component Executive Sec retary, has done an excellent job, and I am grateful for her hard work and com mitment. Paulette and I will continue to serve the component through the annual Meeting of the VDA in September. It is the continued support and service of our component membership that fortifies our commitment to the dental profession. Our ninth annual Pipestem weekend meeting on May 14-16, 1999 in Pipestem, West Virginia was very successful. Over

seventy people attended our first annual dessert social. Homemade desserts, gourmet coffee and other refreshments were enjoyed by all. Dr. David Chance provided the educational seminar touch ing on a variety of topics in Crown and Bridge dentistry. Special thanks to Dr. Tom Haller for a fun-filled golf tournament with many prizes and awards. Jerry King of Kreative Kommunications kept every one smiling after the country barbecue with a fun-filled presentation of the "Lighter Side of Dentistry, How to Improve Your Laugh-Life".

Dr. Wallace Huff Immediate VDA Past-President Dr. French Moore, Jr. Virginia Board of Dentistry Dr. Gus Vlahos Vice Chair, VDA Executive Council The final component meeting of this year will be held at the Donaldson-Brown Cen ter in Blacksburg, VA on November 12, 1999. Dr. Michael V. Dishman will be pro viding the seminar entitled "Bleaching and Cosmetic Dentistry".

Dr. Don Martin (left). Dr. George Levick: (center) and Dr. French Moore, Jr. (right) enjoy refresh ments during the dessert social.

Best wishes to our officers elect: Dr. Francis Anne Johnston President Dr. Dana Chamberlain President-Elect Dr. Chris Huff Vice-President Dr. Susan O'Connor Secretary/Treasurer VDA President, Dr. Charles Cuttino will install these individuals, during the Fri day, August 13, 1999, business meeting at the Higher Education Center in Abingdon, VA Dr. Samuel Low will pro vide the educational seminar entitled "The Successful Management of the Pe riodontal Patient". Dr. Low is a national speaker, and his presentation is focused on a dental team approach. The Virginia Highlands Festival will be in full swing durinq the meeting. Activities are also planned at the Martha Washington Inn and the historic Barter Theatre. A per formance of "Guys and Dolls" is sched uled at the Barter.

On March 17, 2000, the component meeting will be held at the Van Dyke Center in Emory, VA Dr. Adam Kegey will provide the morning session on "Den tal Forensics" and Ms. Frieda A. Pickett, RDH will provide the afternoon session on "Drugs and Herbal Supplements of the Millennium". As I close, I am reminded of a section of the Dentist's Pledge taken from the VDA Directory and Resource Guide:

Dr. Wallace Huff (center) commends Ms. Paulette (left), component VI Executive Secretary and Ms. Tami Schuster (right) on a job well-done in coordinating the first annual dessert social.

"I acknowledge my obligation to support and sustain in the honor and integrity of the profession and to conduct myself in all endeavors such that I shall merit the respect of patients, colleagues and my community" Thank you again for allowing this Penn Stater to serve you this year as your Component President, and look out for those Nittany Lions this fall'

Memories From Pipestem,

West Virginia

May 14-16, 1999

Dr. Tom Haller (left), coordinator of the annual golf tournament, gives Dr. Nelson Worrell (cen ter) and Mrs. Anne Worrell tips on how to be on the winning team.

Congratulations to Dr. Gus Vlahos, who has been nominated for a VDA Execu tive Council-at-Large position. Dr. Vlahos currently serves as Vice-Chairman of the VDA Executive Council. Let us show our support by attending the Annual Mem bership meeting during the Annual Meet ing of the VDA in Reston, VA A reception, sponsored by Component VI, will be held during the Annual Meet ing of the VDA The reception will honor our component members who serve at the state level. A special thanks to:

Dr David Chance and sons demonstrate Elec tnc Discharge Machining as It relates to Implant Prosthodontics.

Mr. Jerry King (foreground). of Kreative Kommunications. continues a fun-filled evening after the golf awards ceremony and country barbecue.

Dr. Ronnie Brown VDA Executive Council

Virginia Dental Journal 47

wishing to obtain more information may contact Ms. Betty Ward at Lord Fairfax (540)868-7000 On a sad note, Dr. William Duncan of Staunton Passed away in May 1999.

Dr. Rick Boyle and daughter Catharine accept a prize after a successful round of golf.

Thanks to Dr. Robert Hall for the excel lent leadership he has provided us this past year. It was because of his work that Component VII was well represented at both the winter and summer committee meetings. He also provided us with ex cellent continuing education courses. The final component meeting for the year will be held at the Holiday Inn Emmett Street in Charlottesville on Friday, Sep tember 10, 1999. The guest speaker will be Dr. Karen McAndrew who will speak on Implant Placement We look forward to seeing many of you at the Annual Session in Reston, Sep tember 15-19,1999.

From left to right, Dr. Tom Haller, Dr. Nelson Worrell, Dr. Gus Vlahos, Mrs. Sue Sukle, Dr. Vincent Sukle, Mr. Mark Keuls, Mrs. Jennifer Keuls, RDH, and Dr. John Prince. All were recipients of various awards during the golf tournament awards ceremony.

Component VIII Northern Virginia

Dr. Melanie Love, Editor

Component VII Shenandoah Valley

Dr. Carolyn Herring, Editor It's hard to believe, but summer is practi cally over. Thank you to everyone who attended the June Committee meetings at Virginia Beach. Component VII had an excellent turnout We definitely had bet ter weather for meetings than for beach activities since it turned cloudy and cool for the entire weekend. There is good news on the horizon for the dental hygiene program at Lord Fairfax Community College. The prehygiene curriculum is to begin in Sep tember and it has received applications from 70 interested candidates. The hy giene program will have 20 spots and is set to start in September 2000. The ten tative site is the J. Dowell Howard Vo Tech School. Donations of used equip ment would be appreciated. Anyone

48 Virginia Dental Journal

Greetings from Component 8! We com pleted the Spring of 1999 with an evalu ation of the Northern Virginia Dental So ciety by the ASAE Association Peer Re view Program in order that there was an outside, objective view of the association. The evaluation was performed by a re view team assigned by the American Society of Association Executives (ASAE) at the request of the board of di rectors and the staff of the NVDS. The on-site review was conducted from April 13-15, 1999, during which time volunteer leaders and staff of the association par ticipated in individual discussions with members of the review team either in person or by phone. The review process was accomplished using ten overall criteria: Mission, Goals, and Objectives; Governing Body, Officers, and Directors; Organizational Structure and Documents; Programs, Services and Activities; Association Staff; Financial Planning and Reporting; Membership Development and Retention;Communications; Government Affairs; Office Technology and

Information Management The results of the evaluation will have an impact on the Northern Virginia Dental Society and will allow us to enhance the leadership of our component Component 8's Annual Business Meet ing is scheduled for Wednesday, Septem ber 8, 1999. The 1999-2000 Programs will begin with Dr. Terry Donovan's "Up date on Esthetic Restorative Dentistry" on Friday, October 15 at the Fairview Marriott. We will end the Millennium with "Everybody Wants to Go to Heaven, but Nobody Wants to Die: The Reality of Removable Prosthodontics" presented by Dr. Nader Sharifi, also at the Fairview Marriott, on Friday, November 12, 1999. Enjoy the Sumrnerl

VAO NOTES

Dr. M. Alan Bagden, Immediate Past President The annual meeting of the Virginia Asso ciation of Orthodontists was held at Kingsmill Resort in Williamsburg, VA, during the week of June 26-30, 1999. Record attendance witnessed outstand ing presentations by Dr. Wick Alexander and Mr. Lew Walensky. Festivities in cluded a tavern dinner at Shield's Tav ern, followed by a ghost tour and an un forgettable picnic at the Pettus Site, com plete with a swing dancing lesson! The annual golf tournament challenged nine four-somes and was highlighted by a 35 foot putt by Dr. Bill Wallert resulting in an eagle for his team. Preparations are al ready underway for next year's meeting, which will be held at the Cavalier Resort in Virginia Beach. President Rod Klima has received commitments from Dr. Slick Van Arsdale for the scientific program and from Bill Deal for the entertainment for the final shindig. At this year's business meetings, talk was generated concerning attempts to in crease the number of participating orth odontists in the Medicaid program. Ef forts are now underway to increase the fee allowances for orthodontic care in the hope that it will become more active for more practitioners. The VAO hopes to broaden the network of providers in the state. Increasing fees is the fast step in doing so. Other business concerned the slate of officers for the 1999-2000 term

They are as follows: President- Dr. Rod Klima, President-Elect- Dr.David Jones, Secretary/Treasurer- Dr Steve Hearn, Director- Dr. Bill Dabney, Director- Dr. Penny Lampros, Immediate Past Presi dent- Dr. Alan Bagden, Past President Dr. Bob Miller, SAO Director- Dr John Coker and AAO Delegate- Dr Ed Ross. Future meetings are now being planned for Frenchman's Reef in St. Thomas in the U.S. Virgin Islands for the summer 2001. There is also some discussion cen tering around possible meeting sites be ing Costa Rica and also the Greenbrier, Tides Inn or the Homestead. The offic ers encourage any member to voice opin ions concerning the present and future meetings. Also not to be missed will be the Annual SAO meeting which will be held in Mo bile, Alabama, November 3-7, 1999. A fabulous scientific, entertainment and cultural program is in order featuring mu sician Aaron Neville in the historic Sanger Auditorium and the once in a lifetime opportunity to view the riches of the last czars of Russia, Nicolas and Alexandra. A note of congratulation also goes out to Dr. Mike McCombs concerning his very deserved winning of the VAO Citizenship Award. Those of you that know Mike will all agree that he continually does very positive acts, which always enhance our image among our patient populations. Mike will be receiving this prestigious award at this year's annual meeting. We hope to see a good representation of the VAO to congratulate him. Enjoy the rest of the summer, and have a great autumn. Please Note: The Annual Winter Meeting of the Vir ginia Association of Orthodontists will be held in Snowmass, Colorado, during the week of January 29 - February 4, 2000. The conference will take place at the prestigious Crestwood Condominiums, which are true 'ski in-ski out' units. Snowmass was chosen because of its historically family friendly atmosphere, which combines with its proximity to the adjacent mountains of Buttermilk, Aspen Highands and Aspen Mountain. Some people like to ski the variety of the four mountains, while others like the over 3000 acres, which Snowmass itself af fords. Whatever the ability or desire, this year's meeting should provide it all. (And don't forget this year's gathering will in-

elude the VAO's famous Super Bowl Party on Super Sunday, January 30, 2000!) For those not familiar with the VAO win ter meeting, it should be mentioned that it is open to ALL professionals; not just Virginia orthodontists. Past participants have included general dentists, physi cians, attorneys. financial related profes sionals as well as family, friends and staff. The purpose of this meeting is to pro vide rich continuing education combined with camaraderie of fellow professionals, all who enjoy winter activities. Crestwood has provided deeply dis counted rates for this meeting, which are a fabulous bargain considering that it is a ski in-ski out facility, has daily maid service, pools, sauna, hot tubs, fire places, and all features one would ex pect at a top facility. The discounted rates are guaranteed until OCTOBER, so plans need to be made soon. For any informa tion contact Alan Bagden at (703) 451 3900 or Bob Miller at (804) 971-9601.

VSOMS NOTES

::J

Dr. Michael E. Miller, President As I pen (Microsoft Word) this article, most VSOMS members are hunkering down in preparation for the annual sum mer-long attempt to cull the stampeding overgrowth of a dreaded dental phenom enon that lashes out at teenagers and young adults causing pain, infection, tooth loss, gum disease, orthodontic fail ure, loss of sleep, time out of work, al tered mental status, swelling and facial deformity, just to name a few. I am, of course, referring to the ever present bad actor of the oral cavity-the impacted third molar, euphemistically called the "Wisdom Tooth". Certainly, by the time this is in press this battle will be in full swing and the weariness of the combat ants will soon give way to excitement of the first combined meeting of the VDA and the VSOMS! Without rehashing the educational and social programs of the meeting, which are described elsewhere in this issue of the Journal, suffice it to say that the VSOMS hopes to help make the upcoming event in September the most well-attended and enjoyable VDA Annual Meeting yet. The VSOMS Execu tive Committee encourages all of our members to make it to this year's meet

ing and "invite a friend". With the antici pated success of this endeavor, future collaborative efforts would be welcomed. For the year 2001, plans are being worked on to hold a joint meeting with our orthodontic colleagues of the VAO in St. Thomas, U.S. Virgin Islands, at the Frenchman's Reef Resort. This very spe cial effort will lead to an extraordinary op portunity for fun, friendship, and educa tion. More information to come in the near future. I must take a moment here to reflect on the loss of a friend, colleague and men tor to many of us in the profession of Oral and Maxillofacial Surgery. On June 22, 1999, Dr. George Kaugars passed away after a very courageous fight with can cer. George was foremost a wonderful and loving husband and father of two beautiful children, but he also devoted his expertise to the teaching of OMFS residents at MCV, developing an Oral Pa thology Conference that on a weekly basis instructed and tested many of us in a field of dentistry that he both loved and commanded. The breadth of his knowledge on any aspect of oral pathol ogy was always astounding, and George's wit and humorous presentation made the hour pass almost unknowingly, while at the same time instilling the nec essary information into his receptive stu dents. For all that he has taught so many in our profession, Dr George Kaugars will surely be missed.

[II

PUBLIC HEALTH NOTES

Dr. Karen C. Day, Director Division of Dental Health The Division of Dental Health uses many resources for obtaining dental health educational materials for community pro grams. An excellent resource available to both public health clinics and Private dental offices is the National Institute of Dental Research (NIDR) in Bethesda, Maryland. NIDR offers free pamphlets on tooth care, sealants, fluoride and hazards of smokeless tobacco. Many of their pub lications are available in English and Spanish and in lower literacy levels. Pri vate dental offices are limited to 50 cop ies per order.. To order free copies con tact the mailing/email address below. Allow 3 to 5 weeks for delivery. Another resource for oral health informa tion is the National Oral Health Informa-

Virginia Dental Journal 49

tion Clearinghouse (NOHIC). NOHIC is a service of the National Institute of Den tal and Craniofacial Research and helps meet oral health information needs for special care patients. NOHIC produces and distributes patient and professional education materials including fact sheets, brochures and information packets.

National Institute of Dental Research 31 Center Drive MSC 2190 Building 31/Room 5B-49 Bethesda, Maryland 20892-2190

NidIinJQ@ru:L31"nidLoih..9ID' National Oral Health Information Clearinghouse (301) 402-7364 Fax: (301) 907-8830

Nldr@aeriarom

SCHOOL OF DENllSlRY

Tom Burke, Assistant Dean

Faculty Initiate Critical Thinking into Treatment Planning The School of Dentistry is emphasizing a new educational technique called "case-based" teaching for its senior treat ment-planning course. The major chal lenge to implementing this course with active learning principles is developing course materials that are quite different from the lecture method of slides and overheads. This style of teaching re quires faculty to guide small groups of students through the problem solving process by acting as facilitators. "This is quite different from our usual role as the content expert who imparts knowledge using a lecture format," said Dr. Paul Wiley co-director of the course. Our motto to faculty facilitators is - "act as the guide to the side not the sage on the stage." The ultimate goal of using case-based learning is to actively engage the learner (student) using interactive educational techniques that promote discussion and group decision making. "Case-based" instruction requires an in teractive component to teaching," said Dr. Robert Barnes, co-course director. "It is quite different from the lecture method that all of us on the faculty were exposed to and use frequently. This form of teach ing is dependent on engaging students into discussions and allowing them to

50 Virginia Dental Journal

take an active role in the learning pro cess. By challenging them to participate in the search for information and to come to their own conclusions. Some of the techniques we are using to encourage them include role-playing, patient simu lations, and guided group discussion. This instructional method provides both the instructor and student an enjoyable educational experience," concluded Dr. Barnes. The treatment-planning course was redesigned two years ago and re quires many faculty members to facilitate small groups of students. The course uti lizes simulated cases that contain gen eral information about patient histories, initial oral diagnosis, radiographs, and photos. Students are challenged to treat ment plan these simulated cases as well as present two of their own clinical cases. Faculty facilitators from the Department of General Practice, Periodontics, and Prosthodontic work with the student groups. The primary challenge for faculty facili tating this educational process is simply not giving too much information. In this way students are challenged to interact through discussion as well as structured experiences to treatment plan difficult cases. "We want our students to begin thinking through their treatment options and not simply asking faculty for their opinion. I am pleased with the student re sponse even though some would prefer to be told what to do. In order to graduate a com petent practitioner we need to prepare our students to think through cases and be confident when discussing various treat ment options."

VDA-VCU Freshman Luncheon On May 12, the Virginia Dental Association sponsored the an nual Freshman Luncheon at the Richmond Omni Hotel. The lun cheon is held at the end of their freshmen year to introduce stu dents to organized dentistry. Dr. Charles Cuttino, President of the VDA, hosted the event that featured remarks by Dr. Ronald Tankersley. Dr. Tankersley com mented on the role of the den tal professional and the ethical considerations of self-gover-

nance. "It was a very nice lunch," said freshman class president Kathleen Bryant who was joined at her table by her father Dr. Cary Bryant. "I enjoyed the remarks and we appreciate the opportu nity to meet the VDA leadership and staff. After having completed our first year of dental school we now feel as though we have entered the profession of dentistry." An enjoyable aspect of the luncheon is that students whose parents or relatives are VDA members are invited to join their son, daughter, nephew or niece for lunch. Dr. Tankersley's presentation was inter esting and thought provoking stressing both professional ethics and the impor tance of individual ethics. He commented that dentistry is a profession that is self governing; therefore, we collectively are responsible for its welfare and gover nance. To further his point, Dr. Tankersley commented on various surveys that con sistently rate dentistry as one of the high est rated ethical professions by the gen eral public. "The freshman class never looked so good," said Dr. Marshall Brownstein who is the Assistant Dean for Admissions and Student Affairs. "I haven't seen them dress so nicely since they interviewed,"

Students with Parent, L to R: Dr. Norman Marks and son Aaron. Dr. W. Baxter Perkinson and son Will. Dr. Cary Bryant and daughter Kathleen. Dr. Kelliher and son Sean. and Dr. Edward Ross and daughter Austin

Freshman class at VDA Luncheon

The David A. Whiston Scholarship Established On May 15, the School of Dentistry held its annual convocation at the Ca thedral of the Sacred Heart. The pre sentation of diplomas and the estab lishment of the David A. Whiston Schol arship highlighted the convocation. Dr. Charles Cuttino, President of the VDA, announced to the overflow crowd of families, guests, and friends that the Executive Committee of the VDA had passed a resolution to rename its an nual Virginia Dental Association Schol arship the David A. Whiston Scholar ship. This scholarship honors Dr. Whiston who has served the VDA with distinction for many years and recently completed his service as President of the American Dental Association. Dr. Whiston is the second Virginian to serve in this position. Dr. Harry Lyons was the first Virginian to hold this of fice. Dr. Whiston also serves on the School of Dentistry Advisory Board. Dr. Gerald Brown, President of the Vir ginia Academy of General Dentistry, presented an inspired address chal lenging the graduates to continue their

education and wished them well. Dr. Hunt then presented the graduates with their diplomas. As each returned to their seat, they signed their names in the Schools' Dentists Oath Pledge book which signifies their acceptance and agreement with the ADA's Dentists Pledge, that was established by fac ulty and students of the MCV School of Dentistry at VCU.

RECEPTION AT THE ADA·HAWAII The School of Dentistry

is holding a reception at the

Sheraton Royal Hawaiian Hotel on

October 9 t h from 6 - 7:30pm

in the Regency III Room. Please drop by if you are in the neighborhood. Aloha!

The Class of 1999 statistics: arrived in 1995. 78 selected from 1185 applications. 63 Virginia Residents. major feeder schools VCU & UVA. in 19958 were married. currently 42 are married or engaged, they pro duced 20 children. Their Immediate plans following graduation 36 mem bers are involved in advance training or military programs and the re mainder are going into private practice.

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Virginia Dental Journal 51

classified ads Classified advertising rates are $30 for up to 30 words. Ad ditional words .25 each. All advertisements must be pre paid and cannot be accepted by phone or fax. Checks should be payable to the Virginia Dental Association. The closing dates for all copy will be the 1st of January, April, July, October. Example: October 1, at 5pm is the closing date for the October-November-December Journal issue. After the deadline closes, the Journal can accept no ads nor can it alter or cancel previously ordered ads. This dead line is firm. As a membership service, ads are restricted to VDA and ADA members and are restricted to non-commercial copy. Advertising copy must be typewritten and sent to: Journal Classified Department, Virginia Dental Association, P.O. Box 6906, Richmond, VA 23230-0906. The Virginia Dental Association reserves the right to edit copy and does not assume liability for the contents of classified advertising. LOCUM TENENS Why lose money and increase competition? Closing your office even temporarily is a bad practice. When Doctors per Diem 'covers' your office, hygiene stays active, simple restorative procedures are performed, emergencies seen and patients scheduled for subsequent treatment by you. Service your patients and your overhead while your staff earn their salary. Distinguished dentists in transition or semi retired cover for you during vacation, maternity leave, or disability. Low, flat daily rate, not a percent of produc tion. Limited availability. Call ASAP! Always seeking new 'partners', both GPs and specialists, to work PT at the rate YOU name. No cost, no fees, no obligation, ever. We just want permission to offer you work. We also con fidentially represent a few accomplished professionals seeking partnership opportunities. Visit www.doctorsperdiem.com. or call 800-600-0963. Since 1996. Doctors per Diem, Inc. A very good practice.

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Associate Needed:Weli established dentist in the sce nic Blue Ridge Mountains of Salem, Virginia looking for an associate to join his successful and busy practice. Nine operatories with three hygienists are complemented by a close-knit and jovial staff. If interested and could begin work immediately upon graduation, please contact Dr. G. Sprinkle III, 511 Boulevard, Salem, VA 24153 (540)389-0330 Fax(540)387-0746. Associate Dentist Career Opportunities available in high-end, successful fee-for-service driven practices po tentially leading to partnership/ownership positions. These privately owned practices are looking for ambitious, hard working licensed general and specialty dentists. For a list of current opportunities available in several regions around the country, contact Jeff Nulf at 1-800-889-2893 and/or fax CV to 703-449-9615. Visit www.dentalrecruiting.com for more information.

Associate opportunity in western North Carolina! Practice in the cool green mountains. Established, progressive practice needs associate dentist with buy-in potential. Terrific staff, in-house crown and bridge lab with Empress, no managed care, reputation for high quality and excellent customer service, beautiful freestanding buildinqs, 30 minutes from Asheville. Call 828-627-9005 evenings. Virignia • Radford: Five doctor group seeks associate with partnership potential, in a well established, fee-for service general practice. Call (540)639-1674 or fax re sume to (540)639-9205. Opportunity Wanted - Central Virginia- Personable and motivated young orthodontist with professional experience seeking full or part-time associateship in an orthodontic, multi-specialty, general or pediatric dentistry practice. Flexible with respect to work schedule and contract ar rangements. Send confidential replies to: MAP, 10101 Moorgate Avenue, Apt. 308, Spotsylvania, VA 22553.

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52 Virginia Dental Journal

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