• • Dental journal VOLUME 72
•
NUMBER 1
•
APRIL/JUNE 1995
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LABORATORV, INC.
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L
FOA
THE
PAOFESSIONAL
VIRGINIA DENTAL ASSOCIATION OFFICERS Councilors President: Leslie S. Webb, Jr. 1) Edward J. Weisberg, Norfolk 6800 Patterson Ave., Richmond, VA 23226 2) Richard D. Barnes, Hampton President Elect: Ronald L. Tankersley 3) Harold J. Neal, Jr., Emporia 716 Denbigh Ave., Suite C-l, Newport News 236024) James R. Lance, Richmond Immediate Past President: Raleigh H. Watson, Jr. 5) Daniel E. Grabeel, Lynchburg, Chairman P.O. Box 191, Berryville, VA 22611 6) Gus C. Vlahos, Dublin Secretary-Treasurer: Charles L. Cuttino, III 7) William J. Viglione, Charlottesville 3217 Grove Avenue, Richmond, VA 23221 8) David C. Anderson, Alexandria, Vice Chairman Executive Director: Mr. William E. Zepp, CAE P.O. Box 6906, Richmond, VA 23230
Ex Officio Members: Parliamentarian: Emory R. Thomas, Richmond Editor: Francis F. Carr, Jr., Richmond Speaker of the House: Bernard I. Einhorn, Norfolk Dean, MCV School ofDentistry: Lindsay M. Hunt, Jr., Richmond
EXECUTIVE COUNCIL Officers Listed Above and Councilors: Councilors at Large Thomas S. Cooke, II, Sandston (1996) Wallace L. Huff, Blacksburg (1996) Stanley M. Stoller, Springfield (1995) Andrew J. Zimmer, Norfolk (1995)
ADA DELEGATION to the 136th Annual ADA Session, Oct. 7-11, 1995, Las Vegas David A. Whiston, Trustee Delegates: 16th District William H. Allison (1996) Daniel E. Grabeel (1995) Emanuel W. Michaels (1996) Ronald L. Tankersley (1995) Stephen L. Bissell (1996) Wallace L. Huff (1995) Richard D. Wilson (1996) M. Joan Gillespie (1997)
•
Alternate Delegates: Gary R. Arbuckle (1996) Richard D. Barnes (1995) Charles L. Cuttino, III (1995)
Bruce R. DeGinder (1995) Bernard I. Einhorn (1995) Andrew J. Zimmer (1995)
Dr. Lindsay M. Hunt, Jr. (1995) Raleigh H. Watson, Jr. (1995) Leslie S. Webb, Jr. (1996)
COMPONENT SOCIETY DIRECTORY SOCIETY
PRESIDENT
SECRETARY -lREASURER OR SECRETARY
PATIENt RELAnONS COMMITTEE
Tidewater
C. Marshall Mahanes 7913 Azalea Garden Road Norfolk, VA 23518
David P. Paul, ill 4616 Thoroughgood Drive Virginia Beach, VA 23455
W. Walter Cox 5717 Churchland Blvd. Portsmouth, VA 23703
Peninsula
Bruce R. DeGinder 240 McLaws Circle, SU 153 Williamsburg, VA 23185
Jeffrey N. Kenney 12420 Warwiclc. Blvd. Newport News, VA 23606
Lawrence A. Warren 106 Yorktown Road Tabb, VA 23602
Southside
H. Reed Boyd, ill P.O. Box 1369 Petersburg, VA 23805
Roger A. Palmer 307 Dogwood Lane Emporia, VA 23860
John R. Ragsdale, ill 9 Holly Hill Drive Petersburg, VA 238847
Richmond
Jeffrey Levin 501 Libbie Avenue Richmond, VA 23226
Benita A. Miller 5700 Old Richmond Ave., SU C-14 Richmond, VA 23226
Thomas S. Cooke, ill 39 West Williamsburg Road Sandston VA 23150
Piedmont
James W. Shearer 25 Cleveland Avenue, SU 8 Martrinsville, VA 24112
Gregory T. Gendron 7 Cleveland Avenue Maninsville, VA 24112
Edward M. O'Keefe 4102 Electric Road Roanoke, VA 24014
Soumwest
Paul T. Umstott 300 West Valley Street Abingdon, VA 24210
Dana Chamberlain 645 Pane. Blvd., SU 225 Abingdon, VA 24354
Jack D. Cole 303 Coun Street Abingdon, VA 24210
Shenandoah Valley
Wayne D. Remington P.O. Box 145 Earlysville, VA 22936
Alan J. White 40 Lambert Street, SU 221 Staunton, VA 24401
William J. Viglione 3025 Berkmar Drive Charlottesville, VA 22901
Northern Virginia
Rodney J. Klima Burke Professional Center 4205-B Lyngate Court Burke, VA 22015
James A. Pell 7 Comers Prof. Bldg. 6319 Castle Place, SU I-E Falls Church, VA 22044
Neil J. SmaIl 9940 Main Street Fairfax, VA 22031
MEMBER PUBLICATION, AMERICAN ASSOCIATION OF DENTAL EDITORS
Mr. William E. Zepp, CAE, Business Manager
Francis F. Carr, Jr., Editor
ASSOCIATE EDITORS 1) Bernard I. Einhorn 5) Edward P. Snyder 2) Jeffrey N. Kenney 6) R. Graham Hoskins 3) H. Reed Boyd, III 7) William C. Bigelow 8) Bruce W. Jay 4) Benita A. Miller MCV - Michael V. Dishman April-June 1995
Volume 72
Number 2
TABLE OF CONTENTS
5
Editorial, Letter to the Editor
6
Guest Editorial
8
President's Message
10
VDA Welcomes New Executive Director An Alternative Approach to the Treatment of Oral Leukoplakia
12
Class II Posterior Composites--Ways to Reduce Bond Stress and Microleakage by Using Low Modulus Materials
15
Northern Virginia Sponsors the Future
16
Legislative Update
17
VADPAC
19
Component News
COVER: View at Montpelier. Orange County. home of James Madison. fourth president of the United States. Photographed by Dr. Ted W. Sherwin. Orange. TIIE VIRGINIA DENTAL JOURNAL (lSSN 0049 6472) is published quan.cr1y (Jan.-March, April-June, July-Sept., Oct.-Dec) by the Virginia Dental
Association at the Corporate Centre, 5006 Monument Avenue, P.O. Box 6906, Richmmd Virginia 2323(}'0906, Telephone 804/358-4927.
SUBSCRIPTION RATES: Annusl: Members, $6.00. OthC115 $12.00 in U.S., $24.00 in other countries. Single copy $6.00. Second cia .. postage paid at
Richmond, Virginia. Copyright Virginia Dental Associatim 1995.
POSTMASTER: Send address changes to: Virginia Dental Joumsl, P.O. Box 6906, Richmond, VA 23230-0906.
MANUSCRIPT AND COMMUNICATION for publicatims should be addressed to the Editor, Francia F. Carr, Jr., P.O. Box 6906, Richmond,
Virginia 23230.
ADVERTISING COPY, insertim orders, contracts and requests for infonnation relating to advertising should be addressed to the Business Manager,
Mr. William E. Zepp, CAE, P.O. Box 6906, Richmond, Virginia 2323(}'0906.
VIRGINIA DENTAL JOURNAL
EDITORIAL BOARD Dr. Louis M. Abbey Dr. Ralph L. Anderson Dr. James R. Batten Dr. Cramer L. Boswell Dr. James H. Butler Dr. Gilbert L. Button Dr. Frank H. Farrington Dr. Barry 1. Griffin Dr. Jeffrey L. Hudgins Dr. Wallace L. Huff Dr. Lindsay M. Hunt, Jr. Dr. Lisa Samaha Hunter Dr. Ford T. Johnson Dr. Thomas E. Koertge Dr. James R. Lance Dr. Daniel M. Laskin Dr. Travis T. Patterson, III Dr. W. Baxter Perkinson, Jr. Dr. David Sarrett Dr. Harvey A. Schenkein Dr. James R. Schroeder Dr. Harlan A. Schufeldt Dr. Kenneth J. Stavisky Dr. John A. Svirsky Dr. Ronald L. Tankersley Dr. Douglas C. Wendt Dr. RogerE. Wood
COMMITTEES 1995 Annual Meeting Dr. Bruce R. Hutchison, Chairman Budget and Financial Investments Dr. Jeffrey Levin, Chairman Cancer and Hospital Dental Service Dr. Robert L. O'Neill, Chairman Caring Dentists Dr. Harry D. Simpson, Jr., Chairman Constitution and Bylaws Dr. Raleigh H. Watson, Jr., Chairman
4
Dental Care Programs Dr. Kirk M. Norbo, Chairman
Planning Dr. Raleigh H. Watson, Jr., Chairman
Dental Delivery for the Special Needs Patient Dr. Gregory T. Gendron, Chairman
Relief Dr. E.Y. Lovelace, Jr., Chairman
Dental Education and Continuing Education Dr. James K. Johnson, Chairman Dental Health and Public Information Dr. Gisela K. Fashing, Chairman
Search Committee for VA Board of Dentistry Candidates Dr. Raleigh H. Watson, Jr., Chairman Virginia Dental Political Action Dr. John C. Doswell, II, Chairman
Dental Practice Regulations Dr. Douglas C. Wendt, Chairman Dental Trade and Laboratory Relations Dr. Harlan A. Schufeldt, Chairman Environmental Health and Safety Dr. Dennis E. Cleckner, Chairman Executive Dr. Leslie S. Webb, Jr., Chairman Financial Aid and Auxiliary Educa足 tion Dr. Anthony W. Savage, Chairman History and Necrology Dr. Edmund E. Mullins, Jr., Chairman Institutional Affairs Dr. C. James Harland, Jr., Chairman Insurance Dr. J. Darrell Rice, Chairman Journal Staff Dr. Francis F. Carr, Jr., Chairman Legislative Dr. Harold J. Barrett, Jr., Chairman New Dentist Dr. Benita A. Miller, Chairman
NOTE THESE DATES: (Mark your calendarnowfor these future meetings) VDA Committee Meetings June 9-11,1995 Cavalier Hotel, Virginia Beach VSOMS Annual Meeting June 29-July 2, 1995 Kingsmill Resort, Williamsburg VAO Annual Meeting June 23-27, 1995 Kiawah Island, South Carolina VDA 126th Annual Meeting September 13-17, 1995 Hyatt Regency Reston
Nominating Dr. Raleigh H. Watson, Jr., Chairman
16th Trustee District Caucus September 22-24, 1995, Charleston, SC
Peer Review and Patient Relations Dr. Edward M. O'Keefe, Chairman
ADA 136th Annual Meeting October 7-11, 1995, Las Vegas
Editorial
~)
L e VDA Annual Meeting is just around the comer. Reston and the membership to a fine session; scientific, educational and social.
washi~kon
the
We must remember how important the House of Delegates is to our Annual Meeting. As the "supreme authoritative body of the Association," each of its sessions are conducted crisply and authoritatively by the Speaker. In its actions, the House can set policies and can approve the budget. These powerful duties require responsible actions. Too often there are extremely short House sessions with little debate of the serious issues involved. The House has the power to debate and decide policy for the Associa tion; it should do more of it. Remember: • The longer health care stays under the present intense public scrutiny, the more planning and action are necessary from the House. • The more the Delegates take part in the VDA process, the broader the base of the Association response and the greater its credibility. This is our twenty-fourth House of Delegates session; it needs to be our best. Do your part.
'Frands :F. CaTT, Jr., 'Eaitor
Letter to the Editor Dear Dr. Carr: Thank you for permitting me to use the Journal to convey my appreciation to all members of the Virginia Dental Association for the privilege and pleasure of serving as your executive director from May 1, 1970 until January 1, 1995. As I became a part of your profession, I realized that dentistry in Virginia is highly respected because of dedicated practitioners. When I became involved with changes in the education and regulation of health professions, I was so proud that Virginia dentists always considered the welfare of their patients as a requisite for change. To Dr. Raleigh Watson and all of you who shared in the Presidential Banquet in Williamsburg, your tributes and gifts will be a constant reminder of how fortunate I am to have been a part of your caring Association. To Dr. Fred Carr and all who contributed letters and articles in the Virginia Dental Journal, you have my humble and everlasting appreciation. To all of the people I worked for and with--dentists, your families, your staffs and many others from related organizations, especially our MCV School of Den tistry, you enriched an important part of my life. My love and friendship will be with you always.
Mrs. Pat K. Watkins 5
Guest Editorial
Recently I reread an essay that Dr. Harry Lyons wrote in 1962, in which he described the implicit contract that exists between the dental profession and the public. Dr. Lyons wrote: "The professional person is educated beyond the general level of his community and has special knowl edge and skills. He professes his dedication to the public's welfare over his own. He professes that he gives more than he receives, willingly and by design. He professes his indebtedness to his predecessors from whom he inherited the knowledge, the skills and the tradition of his profession. He professes that he, in turn, will enrich and further endow the profession in which he enjoys membership. "No one has privileges greater than members of the health service professions-privileges granted by society, both by custom and by legislative enactment. The healing arts professions, early in our country's history, were given privileges that may be described as monopolistic in that no one but a physician may practice medicine, only a dentist may practice dentistry. "It is axiomatic that for every privilege granted by society it exacts a concurrent responsibility. This is the privilege-responsibility complex of a profession. "Dentistry's monopolistic privileges carry the implied obligation of providing dental health care ulti mately for the entirepopulation of our country, rich and poor alike, This is a responsibility that the profession may ignore only at the peril of losing its privileges and its status. In the past this responsibil ity has not always been met fully. As a consequence, the profession has suffered modifications in some state laws governing the practice of dentistry." Essentially our agreement is that as professionals we are granted a monopoly in providing dental care, autonomy in regulating our practitioners, and are relatively free from excessive governmental regula tion. In exchange we agree to fulfill the dental health needs of the public, including those with limited ability to pay our fees. Certainly our autonomy has been abridged somewhat by the FTC, OSHA, Medicaid and third party agencies. Nevertheless we still retain a remarkable amount of independence. Only we can perform dentistry, limiting our competition. We set our own fee schedule and decide where and how we practice. Few fields are as autonomous as ours. Recently a letter in a local newspaper described the difficulty in identifying dentists who accept Medicaid patients. The letter raises the question whether we are keeping our pan of the contract. The dentists responding to the complaint pointed out that Medicaid payments have been frozen for ten years and are woefully inadequate. But if we view dentistry as a vital health service, as I am certain we do, refusing to see at least some Medicaid patients may be indefensible. If a dentist refuses to treat indigent patients, he or she must ask, "What will be the outcome if every dentist's response is the same as mine?" We will have abrogated our contract and will deserve to come under more governmental con trol. The best remedy is for all offices to agree to accept some Medicaid patients. In that way no single office will be unduly burdened, and more importantly, we would be fulfilling our responsibility to the public.
6
I believe there was a time when the dental profession would have accepted this responsibility. Some one would have called a special meeting, everyone would have shown up, and after an animated discus sion there would be an agreement that would involve everyone's participating in the solution. Not now. Today we have consultants who recommend niche marketing. (I've never heard of one recommending targeting poor people.) Convert MOD amalgams to full crowns. Market dentistry as a purely cosmetic service. Set your fees higher than your colleagues to establish your superiority. Have we gone too far down the road, away from the implicit contract we had with the public? Has governmental intervention altered the relationship irreversibly? Perhaps the pressures on both parties in these complex times have led to the abrogation of the tacit agreement that once existed. Mavbe so. But there is still a need for the professional person to empathize with those unable to
ur services. We cannot go who, like Dr. Harry Lyons,
STATEWIDE CONTINUING EDUCATION REGISTRATION FORM Mail to: Virginia Dental Association P.O. Box 6906 Richmond. VA 23230-0906
Program Name: Name:
Component #------,-_~~Make separate check payable to: Virginia Dental Association
Date
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'ecognize that what society _ _
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Street Address: ity, State, Zip: Office telephone number: Other personnel attending:
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ontributor to the Journal.
~
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(Please use full names)
$20-Members ofVDA & auxiliaries; $75-Persons other than VDA members. Fee includes lunch and coffee break. For additional information, call VDA at 11800/552-3886.
Please copy form if you are registering for more than one Component Meeting.
See page 9 of this Journalfor listing of Continuing Education programs.
rgoing a complete transfor /alue to the membership, the rmation and materials. In ished on an annual basis. and activities of the Asso )ctober, following the VDA
Annual Meeting. As we work on this project over the next few months, we would be more than happy to consider materials for inclusion or make corrections from the previous edition. If you have any contributions for the Directory, please contact Lisa Finnerty at the VDA central office at 1/800/552-3886 or FAX the material to 1/804/353-7342. We sincerely hope that this departure from the usual release date will not inconvenience you in any way. We can assure you that the finished product will be well worth the wait! .1.
7
I believe there was a time when the dental profession would have accepted this responsibility. Some足 one would have called a special meeting, everyone would have shown up, and after an animated discus足 sion there would be an agreement that would involve everyone's participating in the solution. Not now. Today we have consultants who recommend niche marketing. (I've never heard of one recommending targeting poor people.) Convert MOD amalgams to full crowns. Market dentistry as a purely cosmetic service. Set your fees higher than your colleagues to establish your superiority. Have we gone too far down the road, away from the implicit contract we had with the public? Has governmental intervention altered the relationship irreversibly? Perhaps the pressures on both parties in these complex times have led to the abrogation of the tacit agreement that once existed. Maybe so. But there is still a need for the professional person to empathize with those unable to provide for dental care for their families. Each one of us can do more than we do to help those who are in need of our services. We cannot go back to a simpler time, but we can return to the virtues of our predecessors who, like Dr. Harry Lyons, exuded professionalism, integrity and compassion. If not, Dr. Lyon's observation will surely come true, " ...it is important to recognize that what society gives it may also-take away..."
Robert M. Rubin, DMD.
Dr. Rubin is an orthodontist in Norfolk, and a long-time contributor to the Journal. t::..
Membership Directory Receives Facelift The Virginia Dental Association Membership Directory is currently undergoing a complete transfor足 mation. In an effort to increase utilization of the Directory and increase its value to the membership, the Directory will be greatly expanded and will feature extensive resource information and materials. In addition, the VDA Membership Directory and Resource Guide will be published on an annual basis.
In order to provide the most current information regarding the leadership and activities of the Asso足 ciation, the publication date for the Directory is being scheduled for early October, following the VDA Annual Meeting. As we work on this project over the next few months, we would be more than happy to consider materials for inclusion or make corrections from the previous edition. If you have any contributions for the Directory, please contact Lisa Finnerty at the VDA central office at 1/800/552-3886 or FAX the material to 1/804/353-7342. We sincerely hope that this departure from the usual release date will not inconvenience you in any way. We can assure you that the finished product will be well worth the wait! t:.
7
President's Message Much activity has occurred in the Virginia Dental Association since my last report. Chuck Duvall, our lobbyist, has done a great job in guiding our legisla tive package through the Gen eral Assembly. We achieved all of our legislative goals for this session. A listing of our legisla tive achievements is found elsewhere in this issue of the Journal. In my visits to the General Assembly, I found strong support for dentistry among our legislators. I attribute this to a strong liaison system and the efforts of our members who serve as liaisons. If you are not currently serving as a liaison to your legislator and would like to become involved, let your component president or the VDAknow.
I would like to thank Drs. Rod Klima, David Anderson, Tom Cooke, Ron Tankersley, Phil Peters and Charlie Cuttino for taking time to speak to our legislative issues at the General Assembly. Personal involve ment of members at committee hearings is a must for success. A special thank you also goes to the Legislative Committee and Dr. H.J. Barrett, Jr., its chairman, This is an election year in Virginia. Get involved with the candidates in your district.
Work in the campaign; throw a party for a candidate and contribute to their campaign. Make them aware of dentistry. Join VADPAC and ADPAC so that dentistry's message is heard in the Virginia legislature and in Congress. I would like to recognize those VDA members serving on ADA councils and commit tees: Dr. Richard Wilson, Chairman,
Council on Dental Education
Dr. James D. Watkins, Council
on Dental Education Dr. Ellen Byrne, Council on Scientific Affairs Dr. M. Joan Gillespie, Council on Ethics, Bylaws and Judicial Affairs Dr. Leslie S. Webb, Jr., Council on Dental Benefit Programs Dr. Anne C. Adams, ADA Committee on the Future of Auxiliaries Dr. Ronald L. Tankersley, Parameters Committee Dr. David A. Whiston, ADA Trustee These VDA dentists devote significant time to their duties and should be applauded for their service. They are a valu able resource for our Associa tion. Dr. Bennett A. Malbon served as vice chairman of the Council of Governmental Affairs and Federal Dental Service. His recent death has saddened us all. His contribu tions to this Council, the VDA
and dentistry will be missed. Our sympathies and support go to his family. At our central office, the phone system has been up graded and activity is in full swing for upcoming meetings. The VDA committee meetings will be held June 9-11 at the Cavalier Oceanfront Hotel in Virginia Beach. Our annual . meeting at the Hyatt Regency Hotel in Reston on September 13-17 will feature two full days of continuing education. Dr. Gerald Chiche, Dr. Howard Skurow and Mr. Don Martin are our speakers. I look forward to seeing you at these events. Dr. Leslie S. Webb, Jr. VDA President
Bennett A. Malbon, D.D.s. Bennett Malbon, oral sur geon, leader in organized dentistry, education and philan thropy, died on Sunday, April 23, 1995. Our profession mourns the loss of this dedi cated, positive and talented dentist. Dr. Malbon was in Washington, D.C., attending a meeting of the Regents of the American College of Dentists at the time of his death. Born in Currituck County, N.C., October 27,1931, Dr. Malbon graduated from Randolph-Macon College in 1954 and the Medical College
8
-
of Virginia in 1958. He com pleted the Oral Surgery resi dency at MCV in 1961 and he began practice in Richmond "with Dr. Philip Peters in 1961, . a relationship that lasted for 34 ·years. He became Board certi '3fied in 1963.
In dentistry, his prominent ervice included terms as president of the Virginia Dental Association, the Virginia Society of Oral and Maxi11ofa ial Surgeons, the Richmond .ental Society and the Rich 'ond Dental Study Club. He ad been an ADA delegate ce 1980, chairman of the A 16th District Caucus, and currently chairman of the frginia Delegation. He was a mber of the ADA Council overnmental Affairs and a stee of the American Dental sociation Political Action ittee, He was Regent of ency 3 of the American lege of Dentists and had ved as president of the lnia Section of the Ameri ollege. He was active at vels of his Oral and Maxil ial Surgery organizations, elude service on the Pro ional Conduct Commission
,e American Association of
. and Maxillofacial Surgery.
ad been a consultant to the
uire VA Hospital and had
Chief of Dental Services
th Chippenham and Rich
d Memorial Hospitals. Dr. n's confident presence in ,-u............ dentistry and his counsel will be missed.
as
Dr. Malbon was a lifelong supporter of higher education. He served on the Board of Trustees of Randolph-Macon College and the MCV-VCU Alumni Association Board. He participated in search commit tees for the current president of Randolph-Macon College and for two deans of the School of Dentistry at MCV. His persis tence and vision while VDA president led to the Endowment Fund for the School of Den tistry. Dr. Malbon believed that our lives are made better by sharing with others. In long service as a trustee of the MCV Foundation, he constantly impressed the need for giving to advance the educational goals of the profes sion. He was on the Board of the Maymont Foundation, working to improve that Rich mond institution and to con tinue his love of gardening. His patients and his fellow practi tioners in their lives are richer for his presence. He was a member of Omicron Kappa Upsilon and Delta Sigma Delta, a fellow of the Virginia Dental Association, the American College of Den tists and the recipient of the Harry Lyons Award from the Richmond Dental Society. Dr. Malbon is survived by his wife Susan Gladding Malbon; one daughter, Jane Bell Dunlap; a son, Bennett A. Malbon, Jr.; a
grandson, Ryan Dunlap; and a brother, Alton Malbon of Wake Forest, N.C. Services were held at Grace and Holy Trinity Episcopal Church on Thursday, April 27, with burial in Holly wood Cemetery. .1
Bennett A. Malbon 1931-1995
Bennett Malbon was an indi vidual with many talents. A compassionate oral surgeon, he was eulogized in a Richmond newspaper which said, "Pulling teeth does not usually engender great affection, but the news of Dr. Malbon's passing brings sadness to many, not only his family and close friends." A talent which brought him great pleasure was his lovely back yard garden which he created. To honor him, his friends and family would like to transform an area outside the student dining room, between two buildings at the MCV School of Dentistry, into the Bennett A. Malbon Memorial Garden. You may send contributions to the Dean's Office, MCV School of Dentistry, P.O. Box 980566, Richmond, VA 23298-0566. .1 9
Welcome to the New Executive Director
He is a Montana native and holds a B.A. from the Univer sity of Portland (Oregon) and an M.A. from the University of Hawaii. He has taught in both high school and college and served as an elementary and secondary school principal in Montana and Washington. Bill and his wife Patricia have two children, Amy Zepp Still and Jon Zepp. William E. Zepp The Virginia Dental Associa tion extends a warm welcome to Mr. William E. Zepp, CAE, who became the new executive director of the VDA on January 1, 1995. Bill Zepp joins us after a successful eight-year term as executive director of the Mon tana Dental Association.
Bill was the first full-time executive director of the Mon tana Dental Association. He set up their office, organized meetings, programs and proce dures, and worked with the 11th ADA Trustee District. Montana law allows for den turists and for general supervi sion of hygienists; so he knows how to work in difficult legisla
tive circumstances. While in Montana, Bill became a Certi fied Association Executive and is active in their Association. Since his arrival, he has been busy organizing the office, hiring and training new staff, manning our meetings and working through his first General Assembly session with our new lobbyist. He has become involved in 16th ADA District activities and has already visited several compo nents. We are glad to have him in our Association and look forward to a long and pleasant relationship. ~
An Alternative Approach to the Treatment of Oral Leukoplakia
by Dennis G. Page. D.D.S., M.S., Associate Professor, Department of Oral Pathology, Medical College of Virginia School of Dentistry and Thomas M. Grisius, B.S. and Marianna Clougherty, B.S., dental students, MCV School ofDentistry. Corresponding author: Dr. Dennis Page, Depart ment of Oral Pathology, MCV.
Oral leukoplakia is a white lesion of the oral cavity that is defined by two clinical charac teristics. It cannot be rubbed off and a definitive diagnosis cannot be rendered solely from its clinical appearance.' Leukoplakia can be caused by numerous factors, including but not limited to chronic irritation, tobacco and alcohol use, vi ruses and neoplasia. Large 10
studies have revealed that approximately 20% of all leukoplakias are either epithe lial dysplasia or squamous cell carcinoma at the time of initial recognition.' However, the percentage of premalignant or malignant lesions is as high as 45% in high-risk sites such as the floor or mouth or ventral surface of the tongue. One study showed that 17.5% of leukoplakias evolved into squamous cell carcinoma over a mean follow-up time of eight years.? Leukoplakias have a surprisingly high recurrence rate of 34.4%, even after com plete excision.I It is obvious that leukoplakic lesions, espe cially in high-risk sites, need to be excised but is also apparent that surgery may be somewhat limited in its ability to success
fully eradicate the problem. These findings have led to an intense search for alternative approaches in treating leukoplakia. One of the most promising agents for treating leukoplakia is 13-cis-retinoic acid (Accutane®), which is a retinoid. RETINOL AND RETINOIDS
Vitamin A (retinol) is found in dairy products, eggs and meat.I Hypervitaminosis A can occur because the percentage of retinol absorption remains constant even as the intake increases." The excess retinol is stored in the liver and abnormal liver function tests have been reported in patients who con sume as little as 50,000 ill/day, but liver damage can occur at
lower doses if the patient drinks alcohol. 5 Retinoids are compounds that are either natural or synthetic analogues of vitamin A. Of the more than 1,500 synthetic analogues, 13-cis-retinoic acid (13-cRA) has generated the most clinical interest. Unfortu nately, side effects such as cheilitis, dry skin, hypertri glyceridemia, xerostomia, and teratogenic effects have been reported.> These side effects are dose-dependent, with the incidence and severity being high at the 2 rug/kg/day level. However, the side effects diminish considerably at the 0.5-1.0 mg/kg/day level, which appears to be tolerable for most patients. RELATIONSHIP TO CANCER ~
The first study that showed an association between vitamin A deficiency and cancer appeared in 1941. 5 Subsequently, a low intake of vitamin A has been linked with an increased risk for cancer of the lung, colon, breast, pharynx, larynx, esopha gus and bladder." THERAPEUTIC USE IN ORAL LEUKOPLAKIA The use of vitamin A supple ments in the treatment of leukoplakia began in the early 1960s but was not widely accepted because of the side effects." Silverman and his colleagues7 showed clinical success in 7 of 16 patients (43.8%) with the administration of 300,000 to 900,000 ill/day delivered as troches. However, three of the four patients with complete resolution had recur rences within two weeks of discontinuing the vitamin A troches. In addition, half of the patients in the study developed noticeable side effects.
The development of 13-cRA in the 1970s made possible the systemic administration of retinol for therapeutic purposes. A group from M.D. Anderson Cancer Center found a greater than 50% reduction in lesion size in 27 of 44 (67%) oral leukoplakias treated with 1/2 mg/kg/day 13-cRA.8 However, 79% of the patients developed side effects. Hays and his colleagues? used 1.5 mg/kg/day of 13-cRA for three months to obtain clinical improvement in 62% of their patients with oral leukoplakia. By continuing the responding patients on a main tenance dose of 0.5 rug/kg/day, they achieved a relapse rate of only 10%. Lippman and his co workers!" treated patients with a three month induction of 13 cRA at 1.5 rug/kg/day, which was then reduced to a mainte nance dose of 0.5 rug/kg/day for nine months. Of the patients who completed the mainte nance phase, there were no relapses. This study demon strated the value of using a higher initial dose but then reducing to a lower dose to maintain a disease-free status. Based upon these studies, it appears that 13-cRA can re verse abnormal epithelial. proliferation within the oral cavity. Although there has been considerable speculation, the specific biochemical mecha nism for this action is un known. One popular theory is that 13-cRA suppresses epider mal growth factor and in that fashion alters epithelial prolif eration.
Roche, Inc., to begin a clinical trial in the use of 13-cRA for the treatment of oral leukoplakia. In order to be eligible for the study, the leukoplakia must be at least two centimeters in diameter and have been present for at least one year. Females who are capable of having children and patients with active liver dis ease are excluded form partici pation. Each eligible patient is given 50 mg of 13-cRA per day, but not to exceed 1 mg/kg/ of body weight. Given an average body weight of 150 pounds, most patients will be slightly under the 1 mg/kg limit. As a comparison, 13-cRA (Accutane) is prescribed at levels of 0.5-2.0 mg/kg/day for adolescents with severe acne. Patients will be clinically examined, biopsied if neces sary, and serum profiles ob tained prior to taking the medication. Thereafter, they will be seen at monthly inter vals and the dosage adjusted as appropriate based upon side effects and lesion improvement. There is no cost to the patient for his or her participation in the study. For further informa tion contact Dr. George Kaugars at 800/677-7841. REFERENCES
1. Waldron CA, Shafer WG. Leukoplakia revisited. A clinicopathologic study of 3256 oral leukoplaIdas. Cancer 1975; 36:1386 1392.
RESEARCH AT THE MEDI CAL COLLEGE OF VIRGINIA
2. Silverman S, Jr., Gorsky M, Lozada F. Oral leukoplakia and malignant transformation; a follow-up study of 257 patietss. Cancer 1984; 53:563 568.
After obtaining permission from the Committee for the Conduct of Human Research, we received funding from
3. Willis ED. Biochemical Basis of Medicine. Bristol, England: John Wright & Sons Limited, 1985:159 165.
11
4. Havel RJ, Calloway DH, Gussow JD, Mertz W, Nesheim MC. Fat soluble vitamins in recommended dietary allowances. 10th ed. Washing ton, D.C.: National Academy Press, 1989:78-93. 5. Lippman SM, Kessler JF. Meyskens FL. Retinoids as preventive and therapeutic anticancer agents (Part II). Cancer Treat Rep 1987; 71:493-515. 6. DeVita VT, Jr., Hallman S, Rosenberg SA. Cancer: Principles and Practice of Oncology. 3rd ed. Phila delphia: J.B. Lippincott Company, 1989:167-180. 7. Silverman S, Jr., Renstrup G, Pindborg H. Studies in oral leukoplakias: ill. Effects of vitamin A comparing clinical, histopathologic, cytologic, and hematologic responses. Acta Odont Scand 1963; 41:271-292. 8. Hong WK, Endicott J, Itri LM. 13 cis-retinoic acid in the treatment of oral leukoplakia. New Engl J Med 1986; 315:1501-1505. 9. Hays G, Lippman S, Weber R, Batsakis J, Wargovich M, Hong W. Evaluation of a synthetic analog of vitamin A and beta carotene on the clinical and histologic appearance and biologic markers in human, premalignant oral lesions. Oral Surg Oral Med Oral Pathol 1991; 72:311. (abstract) 10. Lippman SM, Toth BB, Batsakis JG, et al. Low-dose 13-cis-retinoic acid (13cRA) maintains remission in oral premalignancy: more effective than beta-carotene in randomized trial. Proc Am Soc Din OncoI1990; 9:59 (abstract)
11. Lippman SM, Garewal HS, Meyskens FL. Retinoids as potential chemopreventive agents in squamous cell carcinoma of the head and neck. Prev Med 1989; 18:740-748. ~
12
Class II Posterior Composites-Ways to Reduce Bond Stress and Microleakage by Using Low Modulus Materials by Peter C. Moon, Ph.D. Associate Professor, Department ofRestorative Dentistry. MeV School ofDentistry
With the increased patient interest in alternatives to amalgam restorations, there have been several reviews of clinical problems of posterior composftes.t-s-' The reviews emphasize how the problems can be minimized. The prob lems are related either to wear or microleakage. Recent clini cal research reports suggest that wear can be greatly reduced by proper selection of materials and avoidance of extremely large restorations and careful evaluation of bruxing pa tients. 4 ,5 Microleakage, the topic of this paper, is a source of stained margins, pulpal sens itivity and secondary decay. These clinical "problems" are most evident on dentin margins where the bond is not as strong as it is to enamel. These dentin margins occur in deep proximal Class II restorations and root caries. The ways to reduce microleakage described in the reviews will be summarized. Next, a new way to reduce bond stress and failure which causes microleakage will be introduced that depends on using low elastic modulus materials. Microleakage is the result of polymerization shrinkage as the composite cures. Marginal gaps are formed as the shrinkage stress developed during curing exceeds the bond strength. To insure the dentin bond provided by a dentin bonding agent is fully developed before the composite resin starts to shrink, the dentin bonding adhesive should be precured before the
composite resin. is light cured. The reviews pomt out several ways to r~uce the shrinkag~ . stress acting on t~e bond so. It IS not over stressed into breaking and gap formation. The first procedure controls the direction of the shrinkage to reduce stress. Shrinkage is greater toward the light for light cured composites by a factor or two as measured by strain gauges used in the MCV dental materi als laboratory. This shrinkage has been observed in our laboratory as a concave depres sion formed on the bottom of an open-ended cylinder filled with composite w hen cured from the top down. Thus, curing from the occlusal causes the composite to pull away from the gingival margin and form a gap at the dentin margin in deep class two restorations (i.e, where the stress is the highest and the bond is the weakest due to distance from the light source). Horizontal incremental layering and curing has not been shown to reduce the shrinkage gaps or bond stresses significantly when curing from the occlusal sur face only. It does produce a more complete cure for the bottom layers than bulk cur ing. 8 However, curing vertical increments through the buccal and lingual tooth surface using a clear matrix and wedges is more effective because the shrinkage is toward the cervical floor and proximal walls. 6 ,7 The final increments should be cured again occlusally after finishing for a final cure of 60 seconds to reduce wear.? Also, to seal occlusal gaps, heal finishing cracks, or voids, a low viscosity resin like Fortify (Bisco Dental Co.) may be used during the final curing step after finishing.l
Another method of reducing shrinkage that has been sug gested is to reduce the volume of composite polymerizing. This can be accomplished by inserting a precured composite ball into the interproximal area of restoration after it is filled with composite.l" The excess composite that is pushed out is removed and the restoration cured from buccal, lingual, and finally from the occlusal as previously described. Also a study showed that curing a composite resin veneer that covers cervical dentin has a much lower leakage if cured from the lingual through the tooth initially than if cured only from the facial. 11 Sized stan dard preformed silanated porcelain proximal inserts are commercially available to replace the precured composite ball fabricated bythe dentist.' There is a third way to reduce polymerization bond stress that was not included in the re views. This new way we have developed at MCV is to use low elastic modulus materials in the interproximal area and dentin interface that can stretch to allow stress relaxation. 12 There are three materials that can be used to accomplish this objective. The first is the low modulus light cured glass ionomer liner, Vitrabond (3M CO.)14 The self-curing glass ionomers like Ketac- Bond (Espe Co.) have a much higher modulus and are not as effec tive. Vitrabond has an elastic modulus that is only about one fifth of Ketac-bond and 1/50th of a highly filled composite like P-50 (3M Co.).14.16 The Vitrabond can stretch 50 times farther to relax the stress. A cured Vitrabond liner of several hundred microns (.3mm) should coat the pulp wall and preparation floor, but not
extend out on gingival floor as it can dissolve out if extended to the margins. 1 To further reduce the stress, a thicker low modulus dentin bonding agent layer should coat the preparation walls. 23,24 Two coats of Scotchbond Multipur pose or Prime and Bond are about 26 microns which would reduce the bond stress. The coats need to be cured sepa rately. The low modulus of unfilled dentin bonding agents are usually less than Vitrabond. Air thinning should not be used as a thicker layer of this low modulus resin enhances stress relaxation at the dentin inter face. Also, air thinning inhibits curing and may weaken the bond~9
The last lower modulus material to use is a microfilled resin like Silux or Silar for the interproximal portion of the Class II in increments up to the height of contact and on the prep floor. The modulus of these microfills is less than half that of P-50 and can stretch twice as much as P-50 to relax the shrinkage stress.l" The self-cure Silar has an advantage in lowering the stress because it cures more slowly. It can creep as it cures to reduce the effec tive shrinkage.P" Also, it does not required the clear matrix band and wedges to allow buccal and lingual light curing. Clinical studies have shown that interproximal wear is not higher for microfills.U How ever, the final occlusal incre ment placed should be a wear resistant hybrid composite like TPH.l It is recommended that some combination of these stress reducing procedures be used for large deep Class II restoration to mininuze microleakage.
These methods benefitdeep Class I restorations also. The use of one procedure alone may not prevent microleakage. 13.22 Posterior proximal composites should not be placed especially on dentin unless precautions to limit interproximal gap forma tion from developing are followed.
REFERENCES 1. Leinfelder, KF. UsingComposite Resin as a PosteriorRestorative material, JADA. V122.pp6S-70 (April 1991).
2. Cheung GSP.Reducing Marginal Leakage of PosteriorComposite Resin Restorations: A review of clinical techniques. J. Prosthet. Dent., V63. pp286-288 (March 1990). 3. Bowen RL, EichmillerFC, MarjenhoffWA. Glass-Ceramic Inserts Anticipated for "Megaftlled" CompositeRestorations, JADA, V122, pp71-75 (March 1991).
4. Wilson EG, Mandradjieff M, BrindockT: Controversies in Poste rior CompositeResin Restorations. Dent. Clin. Non Am. V34, (1) pp27 44 (Jan 1990). 5. Mazer RB. Leinfelder KF, MicrofillPosterior Composite Resin. JADA, V123 pp33-38 (April 1992). 6. Lutz F, Krejei I, LuescherB, Oldenburg TR, ImprovedProximal Margins Adaptationof ClassII Composite Resin Restorations by Use of Light-ReflectingWedges, Quintes sence Int, V17, pp659-664 (1986). 7. Lembrechts p. Braem M, Vanherle G, Evaluation of Clinicalperformance for Posterior CompositeResins and Dentine Adhesives. Opec. Dent. V12. pp53-78 (1987). (Continued on next page)
13
8. Moon PC, Covey DA, Mechanical Properties of Microfill and Hybrid Composite Resin Restorative Materi als, J. Dent Res., AADR Abstract #1284, V68, p341 (1989). 9. Glasspoole EA, Erickson RL, Effect of Finishing and Degree of Cure on Composite Wear, J. Dent. Res., Abstract #145, V68, p127 (1990).
of Vitrabond/P-50 Class II Restora tions. J. Dent. Res., IADR Abstract #2393, V70, p565 (April 1991).
/
18. Moon PC, Moxley JE, Haas TW, Measurement of the Mechanical Properties of Dentin Bonding Adhe sives, J. Dent Res., IADR Abstract #1020, V70, p393 (April 1991).
\.
10. Bowen, RL, direct communica tion.
19. Rueggeberg FA, Margeson DH, The Effect of Oxygen Inhibition on an Unfllied/Filled Composite System, J. Dent. Res., V69, pp1652-1658 (1990).
11. Segura KJ, Donly KJ, Croll T, The Effect of Polymerization Shrink age During Veneer Placement, J. Dent. Res., lADR abstract #240, V70, p295 (April 1991).
20. Feilzer AJ, De Gee AJ, Davidson CL, Different Setting Stresses in Composites for the Two Curing Modes. J. Dent Res., IADR Abstract #2084, V70, p527 (1991).
12. Davidson c.L., Kemp-Scholte CM, Complete Marginal Sealing by Improved Strain Capacity, J. Dent Res., IADR Abstract #736, V68, p959 (1989).
21. Ziemieki TL, Wendt JR, Leinfelder KF, Wear of Composite Resin in Proximal Contact, J. Dent. Res., IADR Abstract #260, V70, p298 (April 1991).
13. Kamp-Scholte CM, Davidson CL, Marginal Integrity Related to Bond Strength and Strain Capacity of Composite Resin Restoration Sys tems, J. Prosth. Dent., V64, pp658 664 (1990).
22. Poschke A., Bergmann P., Woack, MJ, Roulet JF, Margin Quality of Posterior Hybrid Composite Restora tions in Vitro. J. Dent Res., IADR Abstract #1014, V70,p392 (April 1991).
14. Lewis BA, Burgess JD, Gray SE, Mechanical Properties of Five Dental Base Materials, J. Dent. Res., IADR Abstract #2408, V70, p567 (1991).
23. Moon PC, Moxley JE, Haas TW, Mechanical Properties of Polymer Filled Dentin Bonding Adhesives, J. Dent. Res. AADR Abstract #1368, V71, p. 277 "(March 1992).
15. Barkmeier WW, Huang CT, Bond Strength and Microleakage of a New Dentin Adhesive System, J. Dent Res., IADR Abstract #159, V69, pl28, (Mar. 1990). 16. Jones CW, Hall GC, Johnson C, Rizkalla AS, Suton EJ, Mechanical Properties of Three Commercial Composites, J. Dent. Res., IADR Abstract #1720, V70, p481 (1991). 17. McCaghren RA, RetiefDH, Sussell CM, Microleakage Evaluation
14
24. Moon PC, Chang YH, Effect of Dentin Bonding Adhesive Layer Thickness on Composite Resin Shrinkage Stress, J. Dent. Res. AADR Abstract #1351, V71, p275, (March 1992). ~
Pearlofthe Month
'"
by Francis J. Filipowicz, D.D.S., M.S. ~
"Hot Compress" A hot, moist compress is one of the most effective ways to soothe muscle spasms or focalize an area of infection.. Patient compliance is not always great since the proce dure is inconvenient and a bit messy. Placing a wet towel or wash cloth in the microwave for a minute more or less will make the procedure much more effective and convenient. Since the center of the towel will be hotter, it will maintain the heat for a much longer period. One could do the same thing with a small, moist poultice held over a periodontal abcess. Some of the principles for cold and hot compresses: 1) Cold will minimize circu lation, reduce swelling and works best with trauma. 2) Heat will increase circula tion, repair and draw or focalize an area of infection. ~
DENTISTRY:
HEALTH CARE
THAT WORKS
Northern Virginia Sponsors the Future by Timothy E. Russell, DD.S.
The Northern Virginia Dental Society launched its Science Talent Awards Program in March. This is its initial effort to recognize the research accomplishments of area high school students. Competitions were held at five regional science and engineering fairs involving seven county public high school systems. NVDS judges evaluated 1,395 projects. each project had won at the student's respective high school. Winners at the regional level were chosen for their exceptional science talent as evidenced by their project presentations and interviews. Fifty-eight awards were presented to the winners. Awards consisted of certifi cates, ADA Select literature and the National Institute for Dental Research's Broadening
parents, counselors and teach ers of talented science students (3) promote dentistry to the viewing public at local and regional levels (4) gain valu able media exposure and (5) provide another way for den tists to contribute to their community. Costs are minimal and the benefits are substantial.
If you would like information about the Component VIn Awards Program, please call Dr. Tim Russell at 703/360 1776. .1 Dr. Russell is a 1964 graduate ofMCV and practices in Alexan dria. He has served as student mentor, Scientific Review Commit tee member and as judge and chairman ofcategory judges at local and regional levels ofother science fair competitions.:
Dr. Shalba Ranjbar (r.) interviews one ofNVDS' s 58 award winners.
the Scope: a Long Range Research Planfor the Nineties.
Participation in regional science and engineering fairs provides our profession with a fresh and exciting means to compete for highly qualified students on a "level playing field." Components are able to (1) promote dentistry within the scientific community (2) pro mote dentistry as a career to
NVDS joined more than 70 scientific and engineering organizations in judging projects at the Fairfax competition.
15
Legislative
UPDATE
The following is a review of legislation of interest to the Virginia Dental Association and the status of those issues upon adjournment of the General Assembly. Licensure by Endorsement: Senate Bill 767, patroned by Senator Jane Woods, and House Bill 2002, patroned by Delegate Dave Brickley, were introduced at the request of the Virginia Dental Association. These bills prohibit licensure by endorsement and retain the current requirement of testing for all dentists seeking a license to practice in the Common wealth of Virginia. Governor Allen signed the licensure by endorsement legislation, which will become law effective July 1, 1995.
Confidentiality of Records: This measure parallels exist ing § 54.1-2910 dealing with confidentiality of investigative information for those individu als licensed by the Board of Medicine. The Virginia Dental Associa tion called for the introduction of this measure because it believed that the confidentiality of all investigative materials, unresolved complaints and unsubstantiated complaints should be maintained by the Board of Dentistry. At the present time, the Board may disclose any and all material maintained on individual dental practitioners to any requesting individual or organization under the Freedom of Infonna tion act. This provides an intrusion into the privacy of the dentist and may lead to the dissemination of unfounded facts to the general public.
HB 1913 maintains the confidentiality of these files and thus precludes the kind of actions described above. This bill has been signed by Gover nor Allen. Pans Le~islation: SB 553 requires insurers, health service plans and health maintenance organizations to . provided coverage for diagnos tic and surgical procedures involving any bone or joint of the skeletal structure including any bone or joint of the head and neck, face or jaw. Lan guage in SB 553 was the product of compromise be tween the insurance industry and the Virginia Dental Asso ciation during deliberations before the Special Advisory Commission on Mandated Health Insurance Benefits. The measure, which becomes law on July 1, is needed be cause some insurers exclude coverage for the treatment of diseases of the facial bones and
(L. to r.): Gov. Mills E. Godwin, Jr. and VDA President Elect and Mrs. Ron Tankersley discuss Virginia issues at the VADPAC dinner. 16
joints while providing coverage for identical or similar treat ment of those diseases affecting bones and joints elsewhere in the body. Any Willin ~ Provider: Delegate Jay DeBoer (Demo crat, Petersburg) patroned House Bill 1869, which was initially designed to clarify Virginia's Any Willing Pro vider Statute. During the course of consid eration of this measure in the Health, Welfare and Education Committee of the House of Delegates, an amendment was added which would basically have stripped outthe existing Any Willing Provider language. VDA was part of a group of health care providers that spoke adamantly in opposition to the amendment. This amendment was subsequently defeated in the committee, and Virginia's Any Willing Provider Statute remains intact. The Virginia Chamber of Commerce listed the repeal of the Any Willing Provider Statute as one of its major initiatives for the 1995 session of the General Assembly. The Chamber, joining forces with the insurance industry and other business entities, will undoubt edly try a repeal of this statute in future General Assembly sessions.
Utilization Review: The Virginia Dental Associa tion joined with numerous health care providers in advo cating the introduction of HB 1973. This measure, patroned by Delegate John Watkins (Republican, Chesterfield County), puts into place an effective utilization review criteria for the patients and health care providers of the Commonwealth. The VDA feels that the measure is bal anced in terms of trying to consider the requirement of insurers, HMOs, health care providers and patients. As passed, the measure accomplishes the following: • Places requirements on insurers, HMOs and others that perform utilization review to determine if treatment or testing is medically necessary. • Includes an involved set of internal appeals and reviews. • Puts into law the standards generally set out by the Utiliza tion Review and Accreditation Committee ( a national group of insurers, HMOs and others that perform utilization review). • Requires an independent final appeal that is to be conducted by a peer of the treating health care provider licensed in Vir ginia or another state with comparable licensing laws.
• Prohibits the utilization review agent from retaliating against a provider for advocat ing the needs of his/her patient. Assi&nment of tax credits: Senate Bill 1106 allows clinics that provide health care services without charge to assign a portion of their tax credits to physicians and den tills. who provide health care services, again, without charge at the clinic. All of the items listed above, with the exception of the Any Willing Provider bill (HB 1869) have been signed by the Governor and will become law on July 1, 1995. The VDA was also involved in measures which provide for immunity from civil liability for acts or omissions committed by dentists while providing their services without charge at a "free" clinic in the absence of gross negligence or willful misconduct. Jim Scott (Demo crat, Fairfax County) was the patron of this bill. /).
DENTISTRY:
HEALTH CARE
THAT WORKS
17
Virginia Dental Political Action Committee VADPAC sponsored two programs in connection with the VDA Winter Committee meetings. On Friday, January 27, Dr. Charles Blair of Blair McGill Associates of Charlotte spoke on Overhead Control That Makes Cents to 78 Vir ginia dentists, spouses and staff. Dr. Blair graciously donated his services to ADPAC and VADPAC for this seminar to assist dentistry's legislative efforts.
for our visit to the Dental Association meeting in Rich mond recently. It was a most interesting evening and I was pleased to have a chance to meet a number of the dentists who were attending. There was a good spirit prevailing and it was a wonderful evening for us to be with such a fine group of Virginians.
Over the years we have been to many meetings of various kinds, but there was a special warm feeling with your group. With all good wishes and appreciation, I am Most sincerely,
Mills E. Godwin, Jr
Friday evening, Governor Mills E. Godwin, Jr., addressed an enthusiastic group of Vir ginia dentists and guests at the VADPAC annual dinner. Twice governor of the Common wealth, Mr. Godwin offered thoughtful advice and warm encouragement to us from his years of public service. Dr. John C. Doswell u,
VADPAC chairman, urges all
Virginia dentists to join
VADPAC in order to get out
the message that "Dentistry is
Health Care That Works." li.
Dr. Charles Blair (c.) answers questions during a break at his VADPAC seminar, "Overhead Control That Makes Cents."
A Gracious "Thank You" Dr. John C. Doswell, n Richmond, Virginia Dear John: Thank you so much for your nice note to Katherine and me expressing your appreciation 18
Dr. John C;. Doswell II (1.) presents Governor Godwin with a framed print of tlu: State Capitol in appreciation for his address at the VADPAC dinner.
Component News COMPONENT I
COMPONENT 1/
Tidewater Dental Association
Peninsula Dental Society
Barry Einhorn Associate Editor
Dr. Jeffrey N. Kenney Associate Editor
A number of our members have retired in recent months. We wish them luck in their "new" lives and hope that they will enjoy long life and good health. The lucky guys are: Roger Visser, Barry Einhorn, Irwin Hurwitz and Brodie Williams, Jr. Dr. Williams practiced dentistry for 52 years; 47 of those years as an active and contributing member of our component.
As summer approaches, the Peninsula Dental Society continues to be busy. At our March membership meeting, officers elected for 1995-96 were as follow: President Gisela Fashing; President Elect Jeffrey Kenney; Secretary-Cory Butler; Treasurer-Guy Levy; Councilor-Richard Barnes.
We are proud of Dr. Jack Cherin who was appointed chairman of the Ethics Com mittee of the American Acad emy of Head and Neck Pain and TMJ Orthopedics by its board of directors. Jack was also elected associate editor of the Journal of the American Academy ofHead and Neck Pain. We are also proud of Dr. Ed Weisberg, who was elected president of the Optimist Club of Ward's Comer, Norfolk. Ed has a distinguished career of working with youth in our community, which is the primary focus of Optimists.
Direct reimbursement (DR) has become a major goal for our component. Ron Tankers ley gave an informative over view at our March membership meeting. An effort was made to organize our membership to recruit potential companies via personal contacts with CEOs and other important company employees. Our DR Committee met several times, including March 27, to discuss strategies for contacting businesses (especially those with over 100 employees). Basically, the dentist is not trying to sell the concept, rather to make the initial contact, and to get the company interested in a money saving, win-win situation. The CEO or company representative was encouraged to attend a
meeting hosted by our compo nent, with DR expert Roger Schultz presenting the pertinent important information and data regarding DR programs. This meeting was held on May 23; since this was after Journal deadline, details will appear in upcoming Component News. Our joint CE meeting with the Tidewater Dental A'ssocia tion was held April 28 and 29. We look forward to more joint CE courses in the future. Important upcoming VDA dates include the June 9-11 VDA committee meetings in Williamsburg and the VDA Annual Meeting in Reston, September 13-18. From the General Assembly, the existing any willing pro vider legislation was preserved in spite of efforts by multiple opposing groups. In theory, this prevents closed-panel insurance plans. This does, however, fall short of the VDA goal to prohibit economic discrimina tion against non-participants of an insurance plan. Also, a bill passed which provides recourse for practitioners who feel patients have been unfairly treated by insurance utilization review procedures. In addition, the VDA' s legislative initiative against licensure by endorse ment passed. (Continued on next page)
19
COMPONENT III
Southside Dental Society
Dr. H. Reed Boyd, III Associate Editor Much has been going on in our Component here in South side Virginia. On April 1, a Health Fair was held in South Hill, a small community at the junction of 1-85 and U.S. 58, about 80 miles south of Rich mond. Dr. John Bass and his wife Faye were instrumental in organizing the fair, getting the Southside Dental Society and the MCV School of Dentisrry together to provide more than 300 oral health and cancer screenings in the new Mobile Dental Van. I had seen the van in photos and had even seen its exterior. Now that I have been inside and actually been a part of its mission, let me tell you what an impressive facility this van is. It is a fully self-con tained dental office any of us would be proud to work in. Keith Williams, its custodian, is very capable and knowledge able in its workings. Gone are the days of straight-back chairs, flashlights and tongue depres sors for examination. With the van, which is attractive both inside and out, we can now serve the public in a profes sional and comfortable setting for both patient and dentist without sacrificing the quality of the service we provide. I 20
would encourage each compo nent to get in touch with Dr. Frank Farrington, Chairman of Pediatric Dentistry at MCV and schedule a van visit in your component. The January 9, 1995 issue of ADA News reported that Mary Logan, Director of the Division of Legal Affairs of the ADA, was leaving. In the "My View" column she wrote, "If I were a dentist..." In this article she mentioned many of the benefits of membership in organized dentistry. She closed her article with this statement: "I'm not a dentist. I'm just a lawyer. But, I'm still proud. This is a terrific organization, and that's the real scoop." That to me is high praise coming from anyone. I would encourage each of you to go back and read this article. It will make you proud and very glad you are a part of organized dentistry, especially if the dues seem high. I was in St. Petersburg, Florida for a course (all of which I would highly recom mend) with Dr. Pete Dawson. Reading USA Today, I ran across an article about a former major league baseball player and chewing tobacco. Bill Tuttle played center field for several major league teams from 1952-63. Today, he is dying from oral cancer which doctors relate directly to his chewing tobacco. The Ameri can Fund for Dental Health has
recruited Joe Garagiola to be national spokesperson for its National Spit Tobacco Educa tion program. Gloria Tuttle, Bill's wife, wrote a very touch ing letter outlining the ordeal she and her husband are now going through due to chewing tobacco. In the letter she details how Bill Ieamed everything from the other big leaguers about the game, including 'how to chew tobacco. Now, she says, he can't even open a bottle of ketchup due to the ravages of the cancer. She opened her letter, "I am watch ing the man I love die. It is the most difficult thing I have ever had to do in my entire life." This is an important message that needs to be brought in to our high schools and colleges in an effort to prevent more cases such as Bill's. I have copies available of the article and letter if anyone would care for them. Our component notes with sadness the passing of Dr. Joseph H. Turner on April 17, 1995. He had been practicing dentistry for 63 years. Dr. Turner attended VPI in 1927-28 and graduated from MCV's School of Dentistry in 1932. Back then, the dental program was only five years long; one year of undergraduate college and four years in dental school. He began practicing in Front Royal in 1932 and moved to Fayetteville, NC, in 1934, where he practiced for one
year. He returned to South Hill in 1935 and practiced there permanently. Dr. Larry Hens ley, a dentist, married his daughter and practiced with Dr. Turner for two years. In 1972 Dr. Turner planned to retire and built a retirement home in Palmer Springs on Kerr Lake. However, he quickly found out that he missed dentistry and added a two-chair office onto his new retirement home and continued to practice dentistry until he formally retired again in early 1995,63 years after beginning his first practice and just before his untimely death. Dr. Turner had iJ long and great career in dentistry. He was a past president of the Southside Dental Society and was active outside of dentistry. When he returned to South Hill in 1935 he organized the Union Gospel Chapel. Dr. Turner would have been 88 in July of this year. We gratefully remem ber his long and successful career. Component III and the VDA extend our sympathy to his family. I would encourage each of you to keep abreast of the VDA and ADA calendars of events and make plans to attend those meetings as well as those of your own component. Hope to see you at the VDA Annual meeting in Reston, September 13-18. Mark your calendar now!
Dr. Benita A. Miller Associate Editor Our members have been busy this winter and spring. In February Dr. Willie Crockett was presented with our Society's highest honor, the Harry Lyons Award for out standing leadership, scholarship and service to the dental profes sion. A long-time professor at MCV, Dr. Crockett has re ceived many other honors including Fellow of the VDA, Fellow of the American Col lege of Dentists, president of OKU, and the O.W. Clough Teaching Award for his dedica tion to teaching and to den tistry. Always active in his community, Dr. Crockett also established a dental clinic for the Crump Nursing Home in Henrico County. He has always had our highest respect as the utmost professional and gentle man, and his open mind and forward thinking made him a consummate teacher. He is greatly admired by all and brings distinction to the Harry Lyons Award. Another newsworthy mem ber, Dr. Bob Eshelman, re ceived attention from the Richmond Times Dispatch for his non-dental pursuits. An amateur radio operator since
age 14, Dr. Eshelman recently was named World's Greatest DXer by QST Magazine, a leading amateur radio magazine published by the American Radio Relay League. The title refers to his ability to establish long distance, or DX, contacts in other countries, and Dr. Eshelman has made these contacts with amateur radio operators in all of the 326 countries where it is possible to do so. Through its president, Mrs. Jennifer Hudgins, the members of the Alliance to the RDS have ccordinated a number of activi ties to benefit dentistry and the public's awareness of oral health. Gift bags and baskets of apples were presented to all state legislators during National Dental Health Month. For its major philanthropic project for March, the Alliance sponsored a "Table Topper" party and brunch at the home of Mrs. Caroline Sweeney. A great success, this festive event raised funds for the MCV Mobile Oral Health Clinic, a staffed and equipped dental vehicle providing primary oral health care and education to rural and urban underserved communities throughout the state. MCV provides faculty, staff and students to deliver care, but other costs such as dental supplies, maintenance and travel expenses come from a variety of sources. If you (Continued on next page) 21
would like to make a tax deductible contribution to the MCV Mobile Oral Health Clinic, please contact Mrs. Pat Hunt at 804/323-1686. We have a hiatus from con tinuing education through the summer until September 19, when we will sponsor our VDA statewide program: Dr. Leonard Horowitz on Dentistry in the Age of AIDS. He is the author of Deadly Innocence, the controversial accounting of the events surrounding the deaths of Dr. David Acer and Kim berly Bergalis. More details in this summer's Journal. Weare saddened by the loss of five of our members: Drs. Bennett Malbon, Ralph Hodges, C. Rodes Boyd, William Overcash, Jr., and Aubrey Harlow. On a happier note, we wel come our newest arrivals: Bayley Locker Wood, born to Letty and Richard Wood; Anne Temple Londrey, born to Susan and Jeff Londrey; Kathryn Margaret Finley-Parker, born to Kitt and Tom Finley-Parker; and Jacob Scott Gore, born to Michelle and Scott Gore. COMPONENT vu Shenandoah Valley Dental Society
William C. Bigelow Associate Editor
22
As spring begins in this area we enjoy the gorgeous trees and flowers that decorate our beau tiful part of the State. As the second quarter begins we look forward to interesting and enlightening continuing educa tion courses. The spring meet ing of Component VII was held on May 19, 1995 at the Omni Hotel, Charlottesville. Drs. J. Gary Maynard, Jr., and Richard D. Wilson presented a program on Practice Building with Periodontics and Restorative Dentistry. Plans are being made for the fall meeting in October 1995 at the Wintergreen resort. A program on Porcelain Veneers and Aesthetic Dentistry will be presented by Dr. Cherlyn Steets from Newport Beach, Califor nia. As information on that meeting is formalized, registra tion forms will be sent to the members. Any member of the VDA outside the Component interested in attending this meeting should contact the Component President Dr. Wayne Remington at 804/973 7744. The Component would also like to take this opportu nity to welcome new members into the Component: Dr. Anna Maria Boggs is practicing ped odontics in Harrisonburg. Dr. John Boyles has joined the practice of Dr. Bob Markley in Staunton. Dr. Jack T. Kay ton III has joined the practice of Dr. Wayne Remington in Charlot
tesville. We welcome all of these new dentists to the area and are excited about their membership in the Component. We are looking forward to an exciting year and invite any of the other components to our area to visit. COMPONENT VIII Northern Virginia Dental Society
Dr. Bruce W. Jay Associate Editor Greetings from Northern Virginia, host of the 1995 Virginia Dental Association meeting in September 13-17, 1995, at the Hyatt Regency Reston. If you haven't marked your calendar, do so now, as this meeting promises to be one of the most exciting yet. The Nonhern Virginia Dental Clinic (Component VIII's volunteer clinic for the indi gent) recently received a grant in the amount of $20,000 from the Eugene and Agnes Meyer Foundation. Our clinic is being overwhelmed by the number of needy patients and any help that you may be able to give would be cheerfully accepted. Please call 703/820-7170 to offer any donations or support. Our component mourns the passing of Dr. Joe W. Guest on March 9, 1995. A graduate of
the University of Tennessee, he received his dental degree from the University of Kentucky. He served in the Navy Dental Corps before settling in Arling ton in 1982. Joe was a fellow of the Academy of General Den tistry and active in Rainbow Christian Services and the Kiwanis Club of Arlington. The Northern Virginia Dental Society welcomes its newest member, Dr. Ea-Lim Bophary.
MCVNews by Michael Dishman, MeV Editor The School of Dentistry is happy to announce that the renovation of the Dental Hy giene Clinic is finished. The completion of this state-of-the art facility, along with the new Graduate Prosthodontic Clinic and the renovated Wood Clinic, mark the culmination of this clinic renovation at the School of Dentistry. In this issue we feature the Department of Oral and Maxil lofacial Surgery. Dr. Dan Laskin serves as chairman of a this active department. Pres ently there are over 25 research projects underway. Members of the department have published 11 articles, 11 abstracts, 8 book chapters and 3 books and presented 38 lectures at various professional meetings and courses during the last year
alone. Two dental students and one resident participated with members of the faculty who co authored five presentations at the recent meeting of the Amer ican Association of Dental Research in San Antonio. Also, the department recently re ceived $12,500 from the American Association of Oral and Maxillofacial Surgeons for a research training grant for dental students interested in oral and maxillofacial surgery. Several of the articles, chap ters and books mentioned above are noteworthy. The book chapter and articles are: • Abubaker, AD: Differential diagnosis of arthritis of the temporomandibular joint. Oral and Maxillofacial Clinics of North America, 1995. • Campbell, RL: Monitoring during outpatient general anesthesia: What should be done and need not be done. Chapter in "Controversies in Oral and Maxillofacial Sur gery," P. Worthington and W.D. Evans (eds.) W.B. Saunders, 1994. • Worley, CM, Strauss, RA: Augmentation of the anterior temporalis fossa after temporal is muscle transfer. Oral Surg, Oral Med, Oral Path. 78:146-150, 1994. • Giglio, JA, Gunsolley, JC, Laskin, DM, Short, K: Effect of removing third molars on plaque and gingival indices. J. Oral Maxillofac Surg. 52:584 587, 1994.
• Bluhm, AE, Laskin, DM: The effC?ct of polyetra-fluorethylene cyhnders on osteogenesis in rat fibrelar defects. J Oral Maxillofac Surg. 53:163-166 1995. ' The books are: • Medical Management of Temporomandibular Disor ders." Laskin, CM (ed.). Oral and Maxillofacial Clinics of North America, W.B. Saunders 1995. ' • Progress Notes: The Changing Face of Oral and Maxillofacial Surgery." Laskin, DM, W.B. Sanders, 1995. The last work represents 20 years of editorials written by Dr. Laskin as editor in-chief of the Journal of Oral and Maxillofacial Surgery. The faculty of the department maintain busy didactic and clinical teaching schedules in addition to their considerable scholarly contributions. The department has expanded the training of residents in oral implantology, especially in the management of patients with complex problems requiring sinus lifts, bone grafts and nerve transposition. The department is actively pursuing contributions for the S. Elmer Bear Professorship Fund. This named professor ship will honor the past chair man of the department. Contri butions are welcome. Under the direction of Dr. Dan Laskin the Department of Oral and Maxillofacial Surgery (Continued on next page) 23
is prominent at the local, regional and national levels. The faculty of the department maintain a high level of teach ing, service and scholarly activities. L\
News from the Division of Dental Health The Dental Disease Preven tion Grant, which is part of the Preventive Health and Health Services Block Grant, has been available to the Division of Dental Health since 1981. This funding, which comes to the state from the federal govern ment, has been used for preven tion activities such as commu nity water fluoridation, school based fluoride mouthrinse programs, care programs in areas where no dental public health program existed and for the education of Virginia's youth regarding the hazards associated with tobacco prod ucts. Some of the successes of this program are having 90% of the population on public water supplies feasible to fluoridate consuming optimally fluori dated water, caries prevention programs in three dental short age areas in the state, 31,000 children not on fluoridated water supplies participating in a school based fluoride mouthrinse program, and placing 55,000 dental sealants in dental public health pro grams in 1994. 24
Despite the activities and allocations of this grant, (about $200,000 per year) there are still areas in the Common wealth where populations are underserved. For example, no community water fluoridation, no school based prevention projects regarding the benefits of regular dental care, no access to routine dental care for dental specialists. When asked why this situation exists, decision makers have stated that there is no demand. In an effort to alleviate this problem, part of the Dental Disease Prevention funding this year supported a dental educa tion project in the counties south of Richmond to promote oral health. A dental hygienist was hired to plan and imple ment this project. She came to the Division of Dental Health with a wealth of experience from the North Carolina Public Health Program and the Uni versity of Virginia Hospital dental program. Ms. JoAnn Wells, RDH, travels daily to Halifax, Mecklenburg and Dinwiddie Counties to provide education to school children regarding proper prevention techniques, nutrition and the benefits of regular dental care. Her educational information extends to teachers and school administration also. She is responsible for creating an interest in having the water fluoridated in Halifax County,
introducing school based fluoride mouthrinse there, reviving the mouthrinse pro gram in Brunswick County and developing an interest in all three counties for a dental prevention project. With the cooperation of the Halifax School District, an oral health survey is planned for May in Halifax County. Although a cursory survey of the children's oral health reveals a high caries rate, according to Ms. Wells, people accept this as the norm. No public health dental programs exist in these areas to treat the indigent and because of the small number of practitioners in the area, few are available for referrals of this magnitude. Ms. Wells has done an outstanding job of creating the awareness of the need for dental care. Next year, preventive grant money will again support this project and plans are to begin projects such as this in Appo mattox, Campbell and Bedford Counties in the Southside and King and Queen, King William and other counties of the Middle Peninsula. The need for dental care is there. Through good dental education programs we can create the awareness in the public that the need exists and we hope this awareness will lead to a demand for optimal oral health. Public health
working cooperatively with the private practice of dentistry is a great partnership in fulfilling the demand for optimal oral health for all Virginians. For further information about this preventive program or dental public health programs, please call Dr. Elizabeth Bernhard at 804n86-3556.
VDA Counsel Honored John P. Ackerly, III, VDA counsel since 1968, was named to the Board of Visitors of the University of Virginia on March 1, 1995 by Governor George Allen. A graduate of the University and its law school and a partner in Mays & Valentine in Richmond, Mr. Ackerly will serve for a four足 year term. He is widely known in dentistry for his extensive knowledge of issues in our profession. The VDA congratulates our able attorney on his appointment and wish him well as he serves his alma mater. ,1
Contract Analysis is available through the VDA Central Office 1/800/552-3886 or 804/358-4927.
Virginia Board of Dentistry The Virginia Board of Den足 tistry 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. President Patricia Lee Speer, DDS 1st term ends 6/30/96 6606 W. Broad St. Richmond, VA 22314 804/662-9906 Vice President Alonzo M. Bell, DDS 1st term ends 6/30/96 1755-B Duke Street Alexandria, VA 703/836-3384 Secretary-Treasurer Catherine Cotter Haywood, RDH,MEd 1st term ends 6/30/96 Spotsylvania Voc. Ctr. 6703 Smith Station Road Spotsylvania, VA 22553 703/898-2655, FAX 891-1784 Mark A. Crabtree, DDS 1st term ends 6/30/98 407 Starling Avenue Martinsville, VA 24112 703/632-7392, FAX 632-2341
Erma Freeman, DDS 1st term ends 6/30/97 21207 Chesterfield Ave. Ettrick, VA 23803 804/526-2424, FAX 526-4660 John L. Harris, III, MS, DDS 1st term ends 6/30/95 1930 Braebum Drive Salem, VA 24153 703/989-5098 Robert 1. Isaacson, DDS, MS, PhD 1st term ends 6/30/97 MCV School of Dentistry DepanttnentofChthodontics Richmond, VA 23298-0566 804/828-9326, FAX 828-5789 French H. Moore, Jr., DDS 1st term ends 6/30/96 303 Court Street Abingdon, VA 24210 703/628-7862, FAX 676-5537 Saundra D. Nelson, RDH, MS 1st term ends 6/30/96 2000 27th Street Newport News, VA 23607 804/244-1010, FAX 929-0589 Marcia J. Miller, Executive Director 6606 W. Broad Street, #401 Richmond, VA 23230-1717 804/662-9906, FAX 662-9943 ,1
Paul F. Ferguson, Esq. 1st term ends 6/30/97 2030 Clarendon Blvd., #300 Arlington, VA 22201 703/527-0764 25
r
Mrs. Jocelyn Lance ofRichmond addressed the ADA Grassroots Confer足 ence in Washington, D.C., in March. She is National Legislative Chairman ofthe Alliance to the American Dental Association.
The Alliance to the Virginia Dental Association visited the Virginia General Assembly on February 14,1995. Bearers of the Valentine's Day gifts were (1. to r.): Mesdames Brenda Gordon, Allene Rice and Melanie Kerneklian. 26
1995 VDASTATEWIPE CONTINUINGEPUCATION pROGRAM
Component 2 Kim Blore
October 27
Newport News
Component 3
October 20
Country Club
Dr. Harold Crossley .
A Reviewof Drugs of Abuse and Their Impact on Dental Practice Drs. John Moriarty & David Simpson
Periodontics: Current Therapy for the General Practitioner • Component 4 Linda Simon '.
September 29
Richmond
Component 6
August 11
Abingdon
Dr. Leonard Horowitz
AIDS-Politics, policies & DentalPractice Management Dr. Jerry Bouquot
Pathology
* To register for this course, contact the Richmond DentalSociety. Ca/lMrs. Linda Simon, executive secretary, at 804/379-2534 or write to: Richmond Dental Society P,O. Box 13066 Richmond, VA 23225 Additional Component Continuing Education Friday, November 3, 1995, 8:30 a.m.-4:30 p.m. Component 5 will host a seminar on Problem Solving in Prosthodontics. Speaker: Dr. James P. Coffey, Dept. of Prosthodontics, VCU/MCV School of Dentistry Location: Roanoke Airport Marriott 2801 Hershberger Road Roanoke, VA 24017 Contact: Dr. Richard Huffman, 703/989-3321
4
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C'NA The ProfessionDl ProtedorP1atl is Q~tdid~ ofPoe 6' Broum,Inl., tmd is underwritten byContinental Casualty Company and . Ntilional Fire Insurance Company of Hmtford, two of the CNAInsllrance Companies.
Virginia State Dental LaboratoriesAssociation
Office: 1009 Borden Road > Richmond, Virginia 23229 804/282-7334
Please support our member labs: CENTRAL ViRGINIA Capitol-Great Impressions 2103 Lake Ave. Richmond, VA 23230 804/282-6200
Pontiques Ltd. 401 Oyster Point Rd. #6 Newport News, VA 23602 804/882-8730
Saunders Dental Lab, Inc. P.O. Box 13866 Roanoke, VA 24034 703/345-7319
Goodwin Dental Lab 2110 Maywill St. Richmond, VA 23230 804/358-2113
Poplar Hill Ortho Lab 4012 Raintree Rd. #120B Chesapeake, VA 23321 804/484-1919
Top Shelf Dental Ceramics, Inc. 403 Boulevard Salem, VA 24153 703/389-9006
TIDEWATER ViRGINIA
Professional Dental Lab, Inc. 603 J. Clyde Morris Blvd., #7 Newport News, VA 23601 804/599-6705
Zuber Dental Arts Lee-Hi Shopping Center Salem, VA 24153
Quality Dental Lab, Inc. 5265 Challendon Dr. Virginia Beach, VA 32462 804/497-8211
NORTHERN ViRGINIA
Bay View Dental Lab, Inc. 7829 Caribou Ave. Norfolk, VA 23518 804/588-5544 Churchland CR & BR Lab 3802 Poplar Hill Rd., #F Chesapeake, VA 23321 804/484-4106 Crown & Bridge Lab, Inc. 7511 Avenue J Norfolk, VA 23513 804/588-1591
Virginia Dental Labs, Inc. 130 W. York St., P.O. Box 807 Norfolk, VA 23510 804/622-4614
703m2-0548
Aloha Dental Studio
7200 R Telegraph Square Dr.
Lorton, VA 22079
703/339- 7754
SOUTHWEST ViRGINIA
Johnson-Miller Dental Lab
915 N. Stafford Street (1st Fir.)
Arlington, VA 22203
703/525-3771
Ernst Dental Lab 454-0 Wythe Creek Rd. Poquoson, VA 23662 804/868-8978
Dental Prosthetics, Inc. 1736 Memorial Ave., SW. Roanoke, VA 24015 703/345-5388
Northern Virginia Dental Lab, Inc.
4126 Village Ct.
Annandale, VA 22003
703/941-2214
Ferguson CR & BR Dental Lab 102 American Legion Rd. Chesapeake, VA 23321 804/483-0100
First Impressions Dental Lab 221-A Pollard St. Vinton, VA 24179 703/345-5388
Pedemonte Dental Ceramics, Inc.
5101 Backlick Rd., #A
Annandale, VA 22003
703/354-6220
James River Dental Lab 95 29th Street Newport News, VA 23607 804/244-7198
Haislip Dental Lab Drawer 427 South Boston, VA 24592 804/575-7947
Saylors Dental Lab, Inc.
8669 Phoenix Drive
Manassas, VA 22110
703/361-4176
Lab One 1003 Norfolk Square Norfolk, VA 23502 804/455-8686
J&M Crown & Bridge Lab 4326 Brambleton Ave., SW. Roanoke, VA 24018 7031989-3277
Triangle Dental Lab
P.O. Box 145 Triangle, VA 22172 703/221-1555
Old Dominion Orthodontic 500 Rodman Ave., #3 Portsmouth, VA 23707 804/399-1229
Pennington Crown & Bridge Lab 128 N. Pollard St. Vinton, VA 24179 703/343-0434
Make a risk-free, tax_deductible, investment of $60 and realistically saveseveral hundred dollarson dental supplies. Guaranteed. Ordera DentaCheque couponbook and evaluate the 103 offers from 57 companies. If you can't benefit, return the bookfor a fun refund. Offers indude 5% invoice discountshonored by 17 dental supply companies, freeprodUCts, and rebateson popularanesthetics, needles, diamonds, restorativeand impressionmaterials, infection control and cotton products,prophyand endosupplies, and more. Coupons are validthroughout '95.
There isan important humanitarian reason to order a book and evaluate how much you can save. The NationalFoundation of Dentistryfor the Handicapped, a charitable affiliate of the ADA, uses revenue from DentaCheque salesto expandits programs. This year, the projects will provide more than $3.2 millionin dental services for 35,000 mentally, physically, and medically disabled individuals. Many very deserving andvulnerable people need help. I urge yOU to placean order bycallingthe Foundation at 1_800-366-3331. Thanksvery much.
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Cordon l. Christensen,D.D.S., M.S.D., Ph.D.
Member, Boardof Directors
National Foundation of Dentistry for the Handicapped
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Medical Protective Policyowners
NEVER get letters like this!
Any allegation of malpractice against a doctor is serious business. If you are insured by The Medical Protective Company, be confident that in any malpractice claim you are an active partner in analyzing and preparing your case. We seek your advice and counsel in the beginning, in the middle, and at the end of your case. In fact, unless restricted by state law, every individual Medical Protective professional liability policy guarantees the doctor's right to consent to any settlement-颅 no strings attached! In an era of frivolous suits, changing government attitudes about the confidentiality of the National Practitioner's Data Bank and increased scrutiny by credentialing committees, shouldn't you have The Medical Protective Company as your professional liability insurer? Call your local General Agent for more information about how you can have more control in defense of your professional reputation.
A+ (Superior) A. M. Best
800/344-1899路
AA (Excellent) Standard & poor's
What's So Special About Partials From Virginia Dental Laboratories?
Integrity. Virginia Dental Laboratory uses • Vitallium® Ailoy-s-the only partial denture alloy that is processed under the same quality control conditions as orthopedic implant alloy-with over 50 years of patient success.
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Experience. The exceptional skills, quality • craftsmanship, and proven techniques of Virginia Dental Laboratories come only as the result of years of experience, painstaking effort and a deep commitment to integrity.
Accuracy. Our entire procedure for construct • ing Vitallium Partial Dentures is quality-con trolled to achieve the utmost accuracy. This accuracy means faster delivery of the restoration; reduced chairtime and greater patient satisfaction.
Commitment. Virginia Dental Laboratories is • dedicated to providing you and your patients with the highest quality partial dentures available. We believe that the combination of our quality raw mate rials, such as Vitallium Alloy; our skilled technicians; our unequaled experience and our steadfast dedication specially qualify us to satisfy the needs of you and your patients.
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Quality. Our partial denture restorations begin • with quality raw materials such as Vitallium® Alloy. Vitallium Alloy® is totally biocompatible. It is nickel- and beryllium-free. Its surface won't tarnish, dull or corrode in the oral cavity or in the body.
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For special treatment on your next partial denture case, please contact Virginia Dental Laboratories!
We are happy to survey, design and estimate from your diagnostic casts at no obligation to you! Contact us today!
Since
1932
irginia Dental Laboratories, Inc. 130 W. York Street Norfolk, Virginia 23510 (804) 622-4614
]l)Y::! Austcnal. Inc. All Rights Reserved. Vitallium ' trademark licenser!
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AustenaJ. Inc. hy Pnzer Inc.