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HIGH QUALITY HEALTH BENEFITS ARE HARD ... UNLESS
You
To
FIND ...
FIND A COMBINATION SUCH
AS THE VDSC INSURANCE SERVICE CENTER
AND TRIGON BLUE CROSS BLUE SHIELD.
The Virginia Dental Association (VDA) and the Virginia Dental Services Corporation (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.
Call 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.
CALL TODAY for
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 "IVIembership" benefits available to you because of your association membership.
information on the wide variety of exciting health products
our association is offering for the upcoming year. Our service and marketing departments will be delighted to answer your questions. Call the VDSC Insurance Service Center at 1-800-832-7001 to find out how our 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. Michael R. Hanley
Volume 77
Susan P. Lionberger Publications ASSOCIATE EDITORS 4. Harry A. "Jack" Dunlevy 5. Barry K. Cutright 6 Robert G. Schuster
D.D.S.
7. Victor G. 8. Danine F School of Den
January-March 2000
Thomas Burke
Number 1
TABLE OF CONTENTS 4 5 6 6 7 11 17 18 19 25 28 30 32 34 34 35 35 38 40 43 48
Editorial Message From the President Letter To the Editor Candidate Information Lab Communications With Ceramic Veneers Abstracts Overview of Virginia's Sales Tax For Dentists Direct Reimbursement News Report on the 1999 ADA House of Delegates VDA 1999-2000 Committees International College of Dentists VDA News Continuing Education & Meetings Trigon: VDA Sponsored Health Insurance Automated External Defibrillators Virginia Dental Service Corporation Legislative Update Membership Benefit Highlight - Career Alternatives Standard of Care Component News & Specialties News Classified Advertising
COVER: Reflecting Moment at the University of Richmond.
2000\[J Linda Gilliam Photographer. All Rights Reserved.
PUBLICATION TEMPLATE: C:\Change
THE VIRGINIA DENTAL JOURNAL (ISSN 0049 6472) IS published quarterly (January-March April-June. October-December) by the Virginia Dental Association. 5006 Monument Avenue, PO Box 6906, Richmond. Virginia 23230-0906. (804 )358-4927 SUBSCRIPTION RATES: Annual Members, $6.00. Others $12.00 in U.S. $24.00 Outside U.S. Single copy 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. Richmond, 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 B. Ellen Byrne Charles L. Cuttino fII 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 fII W. Baxter Perkinson} Jr. Lisa Samaha David Sarrett Harvey A. Schenkein James R. Schroeder Harlan A. Schufeldt John A. Svirsky Ronald L. Tankersley Douglas C. Wendt Roger E. Wood
Annual Meeting Carole A. Pratt
Ethics & Judicial Affairs
Ronald L. Tankersley
Auxiliary Education & Relations Alan W. Mahanes
Fellows Selection
Donald L. Martin
Budget & Financial Investments James W. Baker
History & Necrology
French H. Moore III
Cancer & Hospital Dental Service Michael E. Miffer
Infection Control & Environmental Safety Paul F. Supan
Caring Dentists
Harry D. Simpson, Jr.
Institutional Affairs
Elizabeth A. Bernhard
Communication & Information Technology Dennis E. Cleckner
Journal Staff
Leslie S. Webb, Jr.
Constitution & Bylaws Charles L. Cuttino III
Legislative
Roger E. Wood
Dental Benefits Programs Richard D. Barnes
Membership
Kimberly S. Swanson
Dental Continuing Education B. Ellen Bryne
New Dentist
Carolyn C. Herring
Dental Delivery for the Special Needs Patient
AI J. Stenger
Nominating
Charles L. Cuttino III
Dental Health & Public Information Samuel W. Galstan
Peer Review & Patient Relations Neil J. Small
Dental Practice Regulation N. Ray Lee
Planning
Wallace L. Huff
Dental Trade & Laboratory Relations Wiffiam M. Midkiff
Search Committee for VA Board of Dentistry Charles L. Cuttino III
Direct Reimbursement David Swett
VADPAC
Rodney J. Klima
FOUNDATIONS Relief Foundation Scott H. Francis
VDA Foundation
Wiffiam H. Allison
1999 ADA DELEGATION Delegates:
14(Jh ADA Session October9-1~
David C. Anderson (2001) Wallace L. Huff (2001) Leslie S.Webb, Jr. (2000)
Alternate Delegates: Anne C. Adams (2000) Bruce R. DeGinder(2000) Kirk Norbo (2001)
199~
Honouu. HI
Charles L. Cuttino flJ (2001) Bruce R. Hutchison (2002) Richard D. Wilson (2002)
Andrew J. Zimmer (2002)
Richard D. Barnes (2000)
Ronald J. Hunt (2001)
William J. Viglione (2001)
Thomas S. Cooke 1/1 (2001) Rodney J. Klima (2000) Edward K. Weisberg (2000)
M. Joan Gillespie (2000) Ronald L. Tankersley (2002)
Representing and serving member dentists by fostering quality oral health care and education.
OFFICERS President: Andrew J. Zimmer, Norfolk President Elect: David C. Anderson, Alexandria Immediate Past President: Charles L. Cuttino III, Richmond Secretary- Treasurer: Thomas S. Cooke III, Sandston Executive Director. Terry Dickinson, D.D.S. P.O. Box 6906, Richmond, 23230-0906 EXECUTIVE COUNCIL Includes officers and councilors listed and: William J. Viglione, Charlottesville - Chairman Bruce R. DeGinder, Williamsburg - Vice Chairman Richard H. Wood, Richmond D. Christopher Hamlin, Norfolk Rodney J. Klima, Burke Ex Officio Members: Parliamentarian: Emory R. Thomas, Richmond Editor: Leslie S. Webb, Jr., Richmond Speaker of the House: Bruce R. Hutchison, Centreville Dean, School of Dentistry: Ronald J. Hunt, Richmond
COUNCILORS I Edward J. Weisberg, Norfolk II Bruce R. DeGinder, Williamsburg III H. Reed Boyd III, Petersburg IV Anne C. Adams, Richmond V Mark A. Crabtree, Martinsville VI Ronnie L. Brown, Abingdon VII James C. Gordon, Jr., Winchester VIII M. Joan Gillespie, Alexandria
VDA STAFF Terry Dickinson, D.D.S. - Executive Director Bonnie Anderson - Administrative Assistant Ronya Edwards - Marketing and Programs Coordinator Linda Gilliam - Director of Finance Julie Heuser - DDS Project Coordinator Susan Lionberger - Events & Publications Coordinator Barbara Rollins - Assistant DDS Project Coordinator
SOCIETY
PRESIDENT
SECRETARY
PATIENT RELATIONS
Tidewater, I
James E. Krochmal 801 W. Little Creek Rd., 107 Norfolk, VA 23505
Harvey H. Shiflet III 3145 Virginia Beach Blvd., 104 Virginia Beach, VA 23452
W. Walter Cox 5717 Churchland Blvd. Portsmouth, VA 23703
Peninsula, II
Gary A. Riggs, Jr. 1610 Aberdeen Rd., Ste. B Hampton, VA 23666
Eric W. Boxx 113 Hampton Highway Yorktown, VA 23693
Kent Herring 122700 McManus Blvd #102B Newport News, VA 23602
Southside, III
Scott E. Gerard 9401 Courthouse Rd., 202 Chesterfield, VA 23832
Ronald L. Wray P. O. Box 150 McKenney, VA 23872
John R. Ragsdale III 9 Hollyhill Drive Petersburg, VA 23805
Richmond, IV
Charles E. Gaskins III 703 N. Courthouse Rd., 201 Richmond, VA 23236
HA "Jack" Dunlevy 11601 Robious Rd, Ste 130 Midlothian, VA 23113
William J. Redwine 6808 Stoneman Road Richmond, VA 23236
Piedmont, V
William W. Martin 4935 Boonsboro Road Lynchburg, VA 24503
Gregory T. Gendron 7 Cleveland Avenue Martinsville, VA 24112
Craig B. Dietrich 604 E. Church Street Martinsville, VA 24112
Southwest, VI
Frances Anne Johnston P.O. Box 2045 Abingdon, VA 24212
Susan F. O'Connor PO Box 1086 Galax, VA 24333
Paul T. Umstott 300 W Valley Street Abingdon, VA 24210
Shenandoah Valley, VII
Carolyn C. Herring P. O. Box 2826 Staunton, VA 24402
Robert B. Hall, Jr. 130 W. Piccadilly Street Winchester, VA 22601
Alan Robbins P.O. Box 602 Timberville, VA 22853
Northern Virginia, VIII
AI Rizkalla 3100 S. Manchester S1. T-4 Falls Church, VA 22044
Melanie R. Love 6711 Whittier Avenue McLean, VA 22101
Neil J. Small 9940 Main Street Fairfax, VA 22031
~I
EDITORIAL
II]
A new millennium begins. A new VDA executive director starts his first full year. Staffing changes occur at the VDA. New VDA officers and committees get their tenures rolling. However, the challenges facing dentistry just don't seem to change. Managed care, medicaid, OSHA, EPA, CDC, legislative issues, dental licensure, continuing education, continuing competency, dental hygiene issues, adequate dental auxiliary manpower pool, patient freedom of choice, access to care, fluoridation, evidenced based care, quality of care, dental education, and our scientific knowledge base all remain on the dental agenda. These issues affect all dentists, whether young or old, teachers, administrators, researches or practitioners. This means they affect you. We must all become knowledgeable about these challenges and we must be willing to get involved in our communities, the legislative pro足 cess, dental education and in organized dentistry if we hope to posi足 tively impact the results. Be involved. Do your part. The profession of dentistry will be stronger due to your efforts.
Leslie S. Webb, D.D.S. Editor
4 Virginia Dental Journal
[II
MESSAGE FROM THE PRESIDENT
I~
provision has been success fully incorporated into the dental practice act in several states to prevent interference from third parties in deliver ing appropriate dental care. 3. Resolution 111 H calls for the Association to "seek or sup port legislation opposing inap propriate third party overpay ment recovery practices." It further encourages state den tal societies to seek or sup port legislation preventing third party payers from with holding benefits due on sub sequent patients to recover previous overpayments. This practice has frequently sug gested errors or wrongdoing on the part of the dentist and tends to have a negative im pact on the traditional dentist patient relationship.
I hope that each of you has had a joyous holiday season and a cheer ful and safe New Year as we begin the new millennium. Last October, the ADA House of Delegates passed several resolu tions which reinforce the Association's commitment to pa tients' and dentists' freedom of choice in the dental care delivery process: 1. The Direct Reimbursement national marketing promotion has been extended for three more years. Although it is un likely that DR would replace traditional dental insurance programs, it continues to give dental insurance benefit pur chasers another choice while maintaining a low administra tive cost and wider treatment choice standards. 2. Resolution 83H "considers any alteration of a dental treatment plan by a third party claims analysis to constitute ... diagnosis" and thereby the practice of den tistry "which can only be per formed by a dentist licensed in the state where the treat ment was rendered." This
The American and Virginia Dental Associations are taking pro-active steps to maintain the freedom of choice for our patients so that our member dentists may continue to deliver necessary, high quality den tal care. Member interest, partici pation and support in these pro grams and policies makes a differ ence. •
Show your interest by commu nicating with your component Councilors, Officers and VDA Committee representatives. Let them know how you feel about these programs and poli cies.
•
Participate by writing a letter, sending a fax or email, or mak ing a phone contact when the
Association needs to make a point with the legislature or other appropriate entity. •
Support the ongoing efforts to maintain freedom of choice for our patients and our practices by giving financial support to ADPAC and VADPAC.
For a more in-depth report on the 1999 ADA House of Delegates please see the article by Dr. Wallace L. Huff on page 19. As the 2000 General Assembly Session continues, we as an As sociation have already reinforced our respected position with the Leg islature through VADPAC's first "Day on the Hill". Members of the VDA Executive Council, VDA Com mittee Chairs, Liaison dentists and interested members participated in numerous visitations with Legisla tors on January 14th . This innova tive activity should be continued and enhanced in future years. As a reminder, mark off April 6-8, 2000 as the dates for the Leader ship Conference to be held at the Omni Hotel in Charlottesville. I am looking forward to seeing you there.
Andrew J. "Bud" Zimmer, VDA President
o.o. S.
Virginia Dental Journal 5
LETTER TO THE EDITOR
I]
To the membership of the Virginia Dental Association: On behalf of everyone associated with Lindl Corporation, I personally would like to thank you for bestow ing on me an honorary membership in the Virginia Dental Association. As I indicated during my comments at the annual meeting, any recog nition of our lobbying activities needs to go to those associated with Lindl Corporation, to the staff of the VDA, and most importantly to the VDA membership. Without their locally elected legislators, very
little would be accomplished in Richmond. I have always been told that you are judged by the company you keep. An honorary membership in the VDA certainly puts me in ex cellent company. A sincere thank you! Sincerely, Lindl Corporation By: Charles R. Duvall
Past VDA President, Charlie Cuttino, pre sents Chuck Duvall with an honorary VDA mem bership at the Annual Meeting in September
1999.
PUBLICATION OF CANDIDATE INFORMATION
IN THE VIRGINIA DENTAL JOURNAL
Nominations for the elective offices of the Virginia Dental Association may be made either by a Compo nent President on behalf of the Component he/she represents, or by obtaining signatures from a mini mum of twenty-five members of the Association. These nominations should be directed to Dr. Thomas S. Cooke, III, VDA Secretary-Trea surer. The following positions are up for election at the 2000 Annual Meeting in Williamsburg: Presi dent-Elect; two ADA Delegate po sitions (3 year term); five ADA Al ternate Delegate positions (2 year term); two executive council (at large) positions (2 year term). All candidates must have submit ted their CVs, picture (black & white head shot preferred), and bio graphical information to the atten tion of Dr. Leslie S. Webb, Jr., Edi tor at the VDA Central Office no
6 Virginia Dental Journal
later than March 15, 2000, for pub lication in the April-May-June issue of the Virginia Dental Journal. Forms of submission of Candidate Information have been mailed to all VDA Component Society Presi dents. Candidates for the office of Presi dent-Elect of the Association will be allowed a maximum of 500 words. Candidates for all other offices will be allowed a maximum of 250 words. Candidates are asked to limit their biographical information to major accomplishments, but to include such pertinent data as edu cation, memberships, honors, po sition of leadership held in the ADA, VDA and Component Society, and community leadership activities. Due to space limitations, the VDA Journal Editor will reserve the right to condense biographical informa tion, if necessary.
Should you have any questions re garding the Virginia Dental Journal criteria, please contact Dr. Les Webb either by phone (804-282 9781) or by fax (804-282-3647). If additional Journal submission forms are needed please contact Susan Lionberger at the VDA Cen tral Office either by phone (800 552-3886) or by fax (804-353 7342).
II
LAB COMMUNICATION WITH CERAMIC VENEERS
II
John C. Cranham, D.D.S.
Christopher A. Hooper, D.D.S
determining factor of crown cal that the embrasure space length after the incisal edge between the two central inci position. The gingival tissues sors is parallel with the long axis should be symmetrical and bal of the face and perpendicular anced as they provide the back to the floor. drop for esthetic resorations. 7. Incisal embrasures move 3. The correct width-to-Iength-ra apically as they move distally tio - The width-to-Iength ratio The contact point between the of the incisors should be 70 central incisors has the most 75%. For example, a 10mm incisal position. The contact long central incisor should be point between the central and 7-7.5mm wide. lateral is positioned more 4. The maxillary incisors are in apically, and the contact point "golden proportion" - The me Provisionals are the key between the lateral and cuspid sial-distal relationship of the has the most apical position of maxillary anterior teeth should Using provisional restorations to all. This provides the anatomy be central incisor, 1.6; lateral work out the esthetics and function that makes each tooth distinct, is the standard for traditional crown incisor, 1; mesial third of the rather than creating a "chiclet" cuspid, 0.6. In other words, if and bridge procedures involving the appearance. maxillary anterior region. 5 When the width of the lateral incisor 8. Posterior teeth become shorter is assigned a value of 1, the doing any maxillary anterior indirect as they move distally - This central incisor should be 1.6 restoration there are four require along with a correctly oriented times the width of the lateral. ments that we must communicate occlusal plane, provides an es The width of the mesial third of to the lab. thetic smile with significant the cuspid should be 0.6 times functional ramifications. the width of the lateral. Hence 9. Posterior teeth fill the buccal 1. The centric stop on the lingual the golden proportion is 1.6 to 2. The correct concave lingual corridor with a full smile - It is 1 to 0.6. contour important to see the buccal sur 5. Maxillary anterior teeth have a 3. The correct incisal edge posi faces of the posterior teeth as tion disto-axial inclination - Maxil they move distally. In large 4. The correct two plane facial lary anterior teeth should have mouths, it is often possible to contour a slight disto-axial cant. This see all the way back to the me should become more exagger sial of the second molars. ated as the teeth move distally. There are nine other factors to be The teeth, therefore, have a The technician can utilize a model considered when optimizing esthet ics. 6 trigonal shape, with the height of our properly contoured of contour of the gingiva slight provisionals to fabricate custom 1. The correct incisal edge posi offset distally from the center of matrices to be sure the restorations the tooth. tion - This determines how esthetically and functionally meet 6. The central incisal edges are the expectations of the patient and much tooth structure is dis parallel to the floor and perpen played in relationship to the the dentists. The same guidelines patient's face. Ideally, there dicular to the center of the also apply to porcelain veneer res should be 1 mm of maxillary patient's face - When looking torations. Without the precise incisors visible at rest, and the at a smile from straight on, the knowledge of the optimum place incisal edges should follow the incisal edge of the central inci ment of the new and improved in smile line. sors should be parallel to the cisal edge position, the laboratory 2. Symmetrical gingival tissues floor and perpendicular to the technician's only option is to guess. nd The gingival tissues are the 2 long axis of the face. It is criti Virginia Dental Journal 7 Numerous articles in the dental lit erature have described the many advantages of the porcelain veneer resortation. 1234 It is exciting to prac tice in a time when we can offer our patients lifelike results combined with functional parameters that will serve them for many years. As the architect of our patient's treatment plan, it is our job to communicate to the ceramist all the necessary in formation for construction.
Case Report Figures 1 and 2 exhibit a healthy 23-year-old female desiring an es thetic change. Upon comprehen sive examination we found her periodontally healthy, with function ally stable temporomandibular joints, and without any clinical or radiographic caries. Occlusal analysis found a cuspid protected occlusion without interferences on her posterior teeth. There was a discrepancy between centric rela tion and centric occlusion without any apparent sign of instability. There were no signs of wear, mo bility, migration, sore muscles, or joint breakdown. Because of the apparent occlusal stability the de cision was made to restore the pa tient in centric occlusion. 7
proportion for 6-11, and an optimum width to length to ratio of 75% in the maxillary centrals. These quali ties became the objective of our patient's treatment plan. This would provide the patient a fuller more balanced smile. The teeth were prepared for 6 em press veneers (fig. 3) following con temporary standards. 9 While the interproximal contacts were not normally broken during veneer preparations, when tooth width is to be changed, it becomes neces sary. It is important to note that these preparations were carried to the linguoproximalline angles. This provides the technician complete freedom to build the optimum inter proximal contour, and build the mesio-distal widths into golden pro portion. A full arch impregum final impression was made, and a facebrow was taken to mount the master cast.
is done two teeth at a time begin ning with the centrals and moving distally (Figure 6 & 7). Following this sequence, the cosmetic objec tives are optimally visualized. It also gave the clinician a chance to evaluate function, phonetics and patient approval.
Figure 4
Figure 5
Figure 1
Figure 3 Figure 6
The Technology Transfer
Figure 2
A Smile analysis was completed using Dickerson's SMILES form. 8 This is a very useful tool to evalu ate many of the nine factors of es thetics previously outlined. From a cosmetic standpoint, the centrals could be lengthened 1.5-2.0mm. The previous composite resin was wider on tooth #9 than it was on tooth #8. The work up included a diagnostic wax up that idealized the new length, achieving the golden 8 Virginia Dental Journal
To communicate correctly with our laboratory, provisional restorations were fabricated that fulfill the four requirements for functionally es thetic restorations, and the nine fac tors for optimum esthetics. By spot etching the center of each prepa ration, the provisionals were con structed using composite resin to the ideal goals described in our plan (Figures 4 & 5). Note how each tooth is constructed to the ideal in cisal edge position, to the ideal width-to-Iength ratio, and the ideal golden proportion. The procedure
Figure 7
Whether doing porcelain fused to metal crowns involving the 6 max illary anterior teeth or porcelain ve neers, it is important to develop a system that will evaluate the above parameters. Curtain tests that are
utilized to find the ideal incisal edge position in removable prosthodon tics also work well in these appli cations. Finding the ideal esthetic position first, and then fine tuning with phonetics is an extremely ef fective technique for finding the ideal incisal edge position. The test begins with the "E" posi tion described by Kois and Spear. 10 The "E" position determines if lengthening the maxillary anterior teeth would cosmetically improve the case. The rule states that if the patient says "EEEEEE" (Figure 8), an imaginary horizontal line is vi sualized on the upper border of the lower lip. A second horizontal line is visualized on the lower border of the upper lip. If the incisal edges of the central incisors are half way between these two lines, this is the 50% position. Maxillary incisors in an older person can be lengthened to 50% and a younger person slightly longer to 70%. Figure 9 shows the patient's "E" position at 70% with the resin in place. This represents an acceptable cosmetic position for a 23-year-old person. We next examine the smile line (Figure 10) in relation to the lip line. Notice how the increased length
Figure 10
uniformly meets the lower lip. The final test is the F and V sounds (Fig ure 11). It should be noted that these sounds only tell you if the res torations are too long, not too short. The dentist can use the E position to determine optimum cosmetic length, and fine tune by shortening as the F and V sounds dictate. This insures the best esthetics and pho netics. Figure 12 represents the gross contouring of the provisional restorations in harmony with the patient's esthetics, phonetics and function.
Figure 13
Figure 14
Figure 12
At the delivery appointment the area is isolated with a split dam technique (Figure 15) and bonded to place using a total etch tech nique. The importance of isolation when dentinal bonding is well docu mented. 11 The veneers are bonded to place two at a time beginning at the midline with the central incisors and moving distally. When proper time is taken in the planning and provisional stages, this appoint ment is one of great joy and con tains few unpleasant surprises (Fig-
The lingual contour and the centric stop will not be changed in this case so there is no need for additional communication. An alginate im pression was made of the provisionals, and then mounted in terchangeably with the die model. The laboratory uses the mounted model of the provisionals to make
Figure 15
Figure 11
Figure 9
a putty index of the exact position (Figure 13). The technician then utilizes the matrix to visualize this exact position while he or she fo cuses on all the artistic nuances communicated in the laboratory prescription. This eliminates any guesswork when it comes to facial contour or length of the final porce lain veneer restorations (Figure 14).
Virginia Dental Journal 9
ure 16, 17). When state of the art adhesive technology is combined, with the tried and true principles of restorative dentistry, we can pro vide our patients with restorations that are not only gorgeous, but will serve them for many years. About the Authors: Dr. John C. Cranham has an esthetic ori ented restorative practice in Chesapeake, where he resides with his wife and three children. He graduated from VCU School of Dentistry Cum Laude in 1988, and teaches a 1/2 day per week in the AEGD program. He lectures extensively on Functional Esthet ics, Posterior Esthetics and Contemporary Occlusal Concepts. Dr. Cranham also teaches at the Esthetic Epitome with Dr. Ross Nash in Charlotte, NC. He is a pub lished author on the above subjects. Dr. Cranham can be reached at 757-465-8900.
Dr. Christopher A. Hooper has an esthetic oriented restorative practice in Virginia Beach, where he also resides with his wife and two children. After graduating from VCU School of Dentistry Magna Cum Laude in 1990, he attended UMKC Advanced Edu cation in General Dentistry program. He lec tures extensively on Functional Esthetics,
"
Figure 16 Implants and Practice Management. Dr. Hooper can be reached at 757-496-7300. References: 1 Christensen GJ, Christensen RP. Clinical ob servations of porcelain veneers: A three year report. J. Esthet Dent 1991: 3: 174-179. 2 Tourati B., Miari B. Light transmission in bonded ceramic restoration. J. Esther Dent 1993; 5 (1): 11-16. 3 Sheets CG, Taniguaehi T.Advantages and limi tations in the use of porcelain veneer restora tions. J. Prosthet Dent 1990;64:406. 4 Stassler HE, Nathanson D. Clinical evaluation of etched porcelain veneers over a period of 18 42 months. J. Esthet Dent 1989: 1:21-28. 5 Dawson PE. Evaluation, diagnosis, and treat ment of occlusal problems, Sl. Louis, MO. CV Mosby Co. 1989, 321-352. 6 Cranham JC, Nash RW. The Functional Es thetic Interface. Compendium June 1999, vol. 20, no. 6, 584-595.
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10 Virginia Dental Journal
Figure 17 7 Cranham JC, Hooper CA. Contemporary es
thetic restorative dentistry, Lecture, VCU School
of Dentistry, October 2,3,4, 1998.
B Dickerson WG. Cooperative treatment plan
ning in creating Empress SMILES. Signature
1996; Summer:2-8.
9 Garber D. Porcelain Laminate Veneers: Ten
years later part I: Tooth Preparation. J. Esthet
Dent 1993; 5(a): 57-62.
10 Spears F. Photography as a laboratory com
munication tool. Dent Economics May 1998; vol,
84, no. 5, 90-91.
11 Hormati A, Fuller J.L. and Denchy G.E. (1980)
Effects on contamination and mechanical dis
turbance on the quality of acid etched enamel.
J Am. Den. Assoc. 100,24.
terations. Consequently, the clini cal radiographic evaluation of teeth submitted to a variable range of pulp treatment can neither predict the biocompatibility of a dental ma terial nor can it indicate the safety of new pulp therapy. Further histo logic studies of pulpal response to new techniques and materials are required to determine biocompatility and pulpal response.
ABSTRACTS
The following abstracts were provided by the Department of Endondontics at VCU/MCV School of Dentistry. We appre ciate the contribution that these individuals have made to the Virginia Dental Journal. Hebling J, Giro EMA, de Souza Costa CA Biocompatibility of an Adhesive System Applied to Exposed Human Dental Pulp. Journal of Endodon tics 1999; 25:676-682. Acidic conditioners and adhesive resin application to the pulp tissue have been suggested as an effec tive and innocuous pulp therapy. However, it has been reported that the components of ad hesive sys tems and composite resins have definite cytotoxicity when in direct contact with fibroblasts. Few stud ies using human teeth have been performed to indicate whether or not dental materials can be used for pulp capping of dental cavities with or without pulp exposure. The objective of this study was to re port the histological features of the pulpodentin complex of human teeth after direct pulp capping with the All Bond 2 adhesive system. Histological observations were compared with the pulp response promoted by calcium hydroxide.
On day 7, group A was associated with abscess formation underlying the adhesive material. These teeth also demonstrated large areas of neutrophilic infiltrate and the death of adjacent odontoblasts. During the 30 and 60 day periods, neutro philic accumulation was replaced by a fibroblastic response. More over, resin fragments dispersed in the pulp tissue were found within the plasma membrane of macroph ages or giant cells. A lack of den tin bridge formation could be shown in all samples in group A. In con trast, group B demonstrated odon toblast-like cells underlying coagu lation necrosis caused by the cal cium hyd roxide. These teeth showed only small infiltrates of in flammatory cells. Pulp repair with dentin bridge formation could be seen starting in 30 days, and it was apparently complete at 60 days. The remaining pulp tissue showed normal histological characteristics. In group C, the pulp tissue exhib ited the normal morphology.
Thirty-two sound human premolar teeth, scheduled to be extracted for orthodontic purposes, were divided into three groups: A, Band C. In group A, dentin and pulp tissue were directly etched for 15 seconds with 10% phosphoric acid followed by application of primer and adhe sive of the All Bond 2 adhesive sys tem. In group B, the axial wall and the pulp tissue were protected with a calcium hydroxide-saline paste
Studies using human teeth, includ ing this study, have indicated that patients submitted to direct pulp capping with dentin adhesives re main asymptomatic for the time periods tested. This clinical find ing confirms the lack of a relation ship between clinical symptoms and histological characteristics of pulp tissue. In addition, this study showed that there was no radio graphic evidence of periapical al
Dr. Linda W. Baughan is a second year post graduate student in endodontics at VCUlMCV School of Dentistry. She received her D.D.S. from VCUlMCV in 1983. She is presently tenured faculty in the Department of Endodon tics, Virginia Commonwealth University.
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Swift, Edward J. and Trope, Martin Treatment Options for the Exposed Vital Pulp Practical Periodontics and Aes thetic Dentistry 1999; 11 (6):735 739. The exposure of dental pulp gen erally occurs by accidental trauma or preparation techniques by the clinician. While frank carious ex posures are optimally treated with pulpectomy and root canal therapy, the proper treatment for mechani cally exposed pulps has been con troversial. The purpose of this ar ticle is to describe the indications, techniques, and prognosis for two types of vital pulp therapy: direct pulp capping and partial pulpotomy. Vital pulp therapy has a high rate of success if the pulp is not in flamed, the coronal restoration seals out bacteria, and a nontoxic pulp dressing is used. While the capping of an inflamed pulp can be successful, the use of a partial Virginia Dental Journal 11
pulpotomy technique should be considered instead. It is essential that bacteria be eliminated during the healing phase, or failure is likely to occur. Calcium hydroxide is the most common pulp dressing used today. Its high pH is antibacterial and causes liquefaction necrosis of exposed pulp which will in turn stimulate secondary dentin forma tion. Calcium hydroxide powder and paste preparations such as Dycal? and Life® are all acceptable as pulp capping agents but require a proper coronal restoration to pre vent microleakage.
DIRECT PULP CAPPING. Indica tions: recent «24 h) or mechanical exposures on immature teeth or teeth with simple restorative needs. Technique: Anesthetize, rubber dam, disinfect tooth with chlorhexidine, gently rinse pulp with sterile saline or anesthetic. Blot gently with sterile cotton pellet if hemorrhage occurs. Place calcium hydroxide then a resin-modified glass ionomer base/liner (e.g. Vitrebond"). Finally, place a den tin/enamel bonding system to seal the cavity and then restore with an appropriate restoration. Recall: at 1, 3, 6, and 12 months, then yearly and use electrical pulp testing, ther mal testing, palpation and percus sion to evaluate pulpal health with periodic radiographs to detect the development of any apical pathol ogy. Prognosis: 80% successful when performed under ideal con ditions. PARTIAL PULPOTOMY. Indica tions: also called "Cvek pulpotomy," recent (but >24 h) or mechanical exposures on immature teeth or teeth with simple restorative needs where more extensive pulpal in flammation is expected than with a direct pulp cap. Technique: Anes thesia, isolation and disinfection as described above. At the exposure site, 1 to 2 mm of the superficial 12 Virginia Dental Journal
pulp tissue should be removed with a high-speed diamond bur under copious water irrigation. Extend preparation apically if excessive bleeding continues. Rinse with sterile saline or anesthetic. Dry with sterile cotton pellet. Place a cal cium hydroxide paste. Place liner, bonding system and restoration as described above. Recall: as above. Prognosis: 95% for traumatized teeth where pulpal inflammation is limited predictable. The success rate for carious exposures is under investigation.
Dr. Nicole M. Yingling is a first year postgraduate student in en dodontics at VCU School of Den tistry. She received her D.M.D. from the University of Connecti cut School of Dental Medicine in 1992. She is currently on active duty with the United States Air Force. ~
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Doroschak AM, Bowles WR, Hargreaves KM. Evaluation of the Combination of Flurbiprofen and Tramadol for Management of En dodontic Pain. J. Endodon 1999; 25:660-3. Odontalgia has been reported as the most common type of orofacial pain. The hyperalgesia associated with odontalgia may be difficult to manage and can present a chal lenge for the practitioner. This study evaluated the hypoth esis that a combination of an NSAID (flurbiprofen) and an opioid (tramadol) provide greater pain re lief than either drug alone. Flurbiprofen was selected because it is a potent anti-inflammatory an algesic effective for endodontic pain and tramadol was selected be cause it is a centrally acting anal gesic.
Forty-nine patients reporting spon taneous pain originating from a vi tal/nonvital tooth underwent pulpec tomy under local anesthesia. The patients were then administered, on a double-blind basis, either: (I) pla cebo (one capsule to start and then every six hours); (II) flurbiprofen (100mg loading dose and then 50mg every six hours); (III) tramadol (1 OOmg loading dose and then 1OOmg every six hours); or (IV) a combination of flurbiprofen and tramadol (II & III). A pain evalua tion form was then filled out by the patient six hours after treatment and then for the two days following treatment, twice in the A.M. and twice in the P.M. Results from the present study demonstrated that definitive dental treatment, com bined with placebo medication, re duced pain by >50% by the first day after the emergency appointment and 90% by the second day. The combination of the two drugs pro vided significantly better analgesia in the first 24 hours than that pro duced by either drug alone. After the first 24 hours, their effective ness was equivalent to that seen in the placebo group. Since NSAIDS have a ceiling in their analgesic dose-response curve, certain patients may require additional pain management therapy with an opioid analgesic and together with endodontic therapy can provide significant short-term (24-hour) pain relief.
Dr. Harold J. Martinez is a sec ond year postgraduate resident in Endodontics at the VCU School of Dentistry. He received his D.D.S. degree from the Balti more College of Dental Surgery University of Maryland in 1995. Dr. Martinez completed a one year AEGD while on active duty with the U.S. Air Force from 1995 to 1998. ~
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Jones DM. Effect of the Type of Carrier Used on the Results of Dichlorodifluoromethane Applica tion to Teeth. Journal of Endodon tics 1999; 10:692-694. A valid diagnosis is fundamental in providing proper dental treatment. The diagnosis of pulpal disease is most often based on the correla tion of clinical symptoms, and the results of diagnostic tests such as the electric pulp test, cold test, and heat test. Thermal tests have been proven to be one of the most pre dictable tests in endodontics, and the cold test has perhaps been the most widely used in pulpal diagno sis. Agents such as ethyl chloride, ice, CO 2 snow (dry ice), and dichlo rodifluoromethane (DDM) have been reported for use as a source for cold. DDM is sold commercially as Endo Ice. This study deter mined the temperature changes produced within the pulp chamber after applying DDM in a spray or liquid form to the surface of a tooth using four different applicators. The apical 2.0 to 3.0 mm of an ex tracted mandibular incisor was sec tioned and a thermocouple wire placed into the apical foramen un til the tip of the wire reached the pulp chamber. A radiograph was exposed to ensure proper place ment of the wire. The root of the tooth was securely held in position by a wooden pin positioned on a table. Four different applicators were used to test temperature changes: (i) #2 cotton pellets (large), (ii) #4 cotton pellets (small), (iii) wood handle cotton-tip applica tors, and (iv) cotton rolls. Each of the applicators was tested 10 times. The DDM was sprayed di rectly onto the cotton pellets from a distance of 5.0 mm for 3 seconds. This allowed the applicator to be come saturated to the point of hav ing DDM dripping from the appli cator. The intrapulpal temperature
was recorded prior to placement of the dripping applicator onto the midfacial surface of the crown for 10 seconds. A second temperature was recorded after placement of the applicator, and the difference be tween the two readings was calcu lated to determine the change in pulp chamber temperature. The 10 cotton-tip applicators and cotton rolls were tested in the same manner as the cotton pellets except that they were held directly on the tooth instead of with cotton pliers. The entire procedure was then re peated, except the four applicators were saturated with DDM in the fol lowing manner. DDM was sprayed into a paper cup until a liquid had formed in the bottom of the con tainer. Each applicator was then dipped into the liquid until satu rated. The applicators were applied to the teeth as stated above, and temperatures were recorded. The mean temperature change in °C after direct spray ranged from .5 °C with the cotton tip applicator to 47.1 °C with the large cotton pel let. The small cotton pellet and the cotton roll changes were 2.8 °C and 5.8 °C respectively. The results after submergence in DDM were similar with the mean change of the large cotton pellet being 39.1 ° and the cotton-tip applicator being .9 °C. The large cotton pellet, when sprayed or dipped, was found to be significantly different from all other groups. All other groups were not significantly different from each other. The larger cotton pellet (#2) held by stainless steel forceps, was found to be significantly better than the other carriers in obtaining and holding reduced temperatures. The volume of DDM each applica tor could hold seemed to be the determining factor in mean tem perature change. The small cotton pellet did not offer enough material
to hold sufficient amounts of DDM to significantly reduce the tempera ture. The cotton-tip applicator also held less volume of DDM, and the tightly wound cotton fibers may not have allowed complete penetration of the DDM. Additionally, the wooden stick may have acted as an insulator. The cotton roll allowed for more volume of DDM, but could have allowed wicking of the DDM into the unsprayed end thereby re ducing its effect. In conclusion, a sprayed large cot ton pellet produced the coldest tem peratures within the pulp chamber when compared with the other ap plicators. The mean temperature change of 35°C to 45 °C as seen with the large cotton pellet should allow for truly diagnostic pulp tests.
Dr. David B. Ferguson is a first year postgraduate student in en dodontics at MCVNCU School of Dentistry. He is a graduate of Kansas State University, and re ceived his D.D.S. degree from the University of Missouri-Kansas City School of Dentisty 1990. Dr. Ferguson completed an AEGD with the U.S. Army Dental Corps in 1991. He is currently a Major, and will return to active duty af ter completion of the endodon tic residency.
Tamse A, Fuss Z, Lustig J, Kaplavi J An Evaluation of Endodontically Treated Vertically Fractured Teeth Journal of Endodontics 1999, July: 506-508 A vertical root fracture (VRF) in an endodontically treated tooth is a postendodontic treatment compli cation that leads to extraction of either tooth or root. The VRF may be a longitudinally or diagonally ori ented root fracture, either originat ing in the crown or limited to the root Virginia Dental Journal 13
only. The signs, symptoms, and radiographic features may imitate periodontal disease or root canal treatment failure, thus making di agnosis difficult. The purpose of this survey was to evaluate the clinical manifestations and radiographic features of 92 endodontically treated teeth re ferred for extraction after a clinical diagnosis of VRF or endodontic fail ures and that proved to indeed have a VRF following the extraction. Patients from five public clinics were referred from July 1995 to January 1997, to one oral surgeon for extraction, accompanied with the initial diagnosis of VRF or en dodontic failure and a recent radio graph. Patients were examined by the oral surgeon for chief com plaints and for sig ns and symp toms: (a) sensitivity to palpation and percussion; (b) presence and loca tion of a fistula; (c) presence, loca tion, and depth of a periodontal pocket, and (d) swelling. The di agnostic periapical radiographs and clinical findings were later evalu ated by the authors. The results revealed that premolars were the predominant group to have VRFs (52%). Of that, the maxillary second premolars ac counted for 27.2% of the fractures. In the mandible, the fracture was found in the mesial root of molars 24% of the time. Pain (51%) or abcess (31%) was the major com plaint. The most predominant clini cal sign was deep pockets in 62 cases (67%). Usually these pock ets were located on the buccal. Other signs and symptoms were sensitivity to percussion, mobility, and a fistula. The most significant finding was that a combination of periapical and lateral radiolucency (often described as "halo" or "J shape") was present in 58 cases (63%). 14 Virginia Dental Journal
Diagnosis of VRF in an endodonti cally treated tooth is a complicated problem for the clinician. This is evident from this study in which the diagnosis of "root canal failure" by the referring dentist was made in 53% of the cases. In only 33% of the cases was the correct diagno sis of VRF made. This study identi fied some of the prominent clinical findings and radiographic features for VRFs in endodontically treated teeth that can help the practitioner make a correct diagnosis of VRF. Dr. Mark A. Kerr is a first-year postgraduate student in Endo dontics at the VCU School of Dentistry. He received his D.D.S. from VCU School of Dentistry in 1996. After graduation, Dr. Kerr completed an AEGD program at VCU and then practiced general dentistry in the Richmond area.
Nielson CJ
Periapical Repair after Conserva
tive Treatment of a Cariously In
volved First Molar
Journal of Endodontics 1999:
Jan:60-62
The purpose of the article was to
present a case report wherein ex
isting pathology, including both
bone and root resorption was suc
cessfully treated and pulp vitality
maintained by restoration of a deep
carious lesion in a mandibular first
molar.
Moore in 1967 was the first to re
port successful restitution of peri
apical health by the use of both in
direct and direct pulp-capping pro
cedures. His protocol included
treating deep caries with calcium
hydroxide, then at a subsequent ap
pointment, removing all the remain
ing carious dentin and restoring.
Sapone in 1976 reported two cases
of cariously involved teeth with pe
riapical lesions that were success fully treated with direct pulp cap ping. Jordan et al in 1976 used a protocol in which subsequent re moval of the remaining caries was not done after initial indirect pulp capping and was able to show reso lution of periapical pathosis with preservation of pulp vitality in 11 cases. The author presented a case involv ing a 23 year old male with a deep carious lesion in the mandibular right first molar. The patient was asymptomatic and was currently demonstrating normal responses to thermal and electric vitality testing and percussion. Distinct apical ra diolucencies were noted on the blunted distal and mesial roots along with condensing osteitis. With the absence of clinical symptoms, the decision was made to tempo rarily restore the tooth then evalu ate and permanently restore at a future date if symptoms did not arise. Complete caries removal, without a carious or mechanical exposure, and placement of an IRM restoration was indicated at this time. 7 weeks later, the IRM was left in the deepest portion of the preparation and an amalgam res toration was placed over the IRM base. The patient was reevaluated at 8 weeks post-amalgam place ment, 8 months and 11 months with updated radiographs. At all time intervals, the bone revealed os seous healing with diminishing os teitis. The tooth remained asymp tomatic throughout the reevaluation period and tested normal to percus sion, thermal test and the EPT at the final appointment. Bottom Line: No report has ever shown success in patients over the age of 24 years old. The author suggested that patients under the age of 24 years old would have younger pulps, which could with stand the onslaught of carious in
the modified fluid transport device. An aseptic technique should be Eighty human mandibular maintained especially during de premolars each with a single canal layed post space preparation and were obturated with laterally con subsequent post cementation. The densed gutta-percha cones and a post space should be well irrigated sealer. Immediate post space before cementation and the post preparation was carried out on half should preferably be cemented with the number of teeth and delayed the tooth under rubber dam. If an post space preparation performed aseptic technique is not used, con 1 week after canal filling on the re tamination during these procedures maining 40 teeth. Leakage along may jeopardize apical healing. Dr. John T. Marley is a second the apical root fillings was deter year-postgraduate student in en mined using a fluid transport device Dr. Peter Mayer is a second year dodontics at MCVNCU School of under a head space pressure of 30 postgraduate student in Endo Dentistry. He received his D.D.S. kPa (0.3 atm). dontics at the VCU School of Dentistry. He received his D.D.S. degree from the State University of New York at Buffalo School of The results revealed that after im degree from Case Western Re Dental Medicine in 1994. He is mediate post space preparation, no serve University School of Den tistry in 1988. Upon graduation presently on active duty with the filled root showed leakage regard US Army and will continue to less of the type of sealer used. he completed a GPR at serve on active duty upon When delayed post space prepa Southside Hospital in Young ration was performed, five apical stown, Ohio. Dr. Mayer served completion of the program. root fillings using AH26 and two api in the U.S. Navy Dental Corps ---~---cal root fillings using Pulp Canal from 1989 to 1998. Sealer showed leakage of less than or equal to 20 microliters per day. Fan S, Wu M-K, Wesselink PR Coronal leakage along apical root The difference in fillings after immediate and delayed leakage between the post space preparation. fillings using different sealers was not sig Endodontics & Dental Traumatol nificant and the data ogy 1999; 15:124-126 of using different In some cases an endodontically sealers were pooled The Virginia Board of Dentistry is appointed by the treated tooth whose treatment af to form two groups Governor and is composed of seven dentists, two ter an evaluation period is clinically each of 40 teeth: im hygienists and one citizen representative. Contact the and radiographically successful mediate and delayed Board office or a member of the Board on questions needs to be restored with a post post space prepara on rules and requlations. and core and artificial crown. In this tion. The apical root Nora M. French, D.M.D.
fillings after delayed case delayed post space prepara Monroe E. Harris, Jr., D.D.S.
tion is required. This preparation post space prepara Michael J. Link, D.D.S.
procedure may damage the sealer tion leaked signifi French H. Moore, Jr., D.D.S.
which has set in the apical root ca cantly more than Gopal S. Pal, D.D.S.
Gary Taylor, DD.S.
nal, thus compromising the apical those after immedi Richard D. Wilson, D.D.S.
seal. Performing post space prepa ate post space Carolyn B. Hawkins, R.D.H.
ration immediately after root canal preparation. Stephanie P. Olenic, R.D.H.
obturation but before the sealer Susan A. Underwood, Citizen Member
cement sets may, however, mean In this study delayed STAFF
that the apical seal remains intact. post space prepara Marcia J. Miller, Executive Director
tion resulted in more Pam Horner, Administrative Assistant
The purpose of this study was to leakage than imme Kathy Lackey, Administrative Assistant
measure microleakage along the diate preparation, Ida Hill, Office Services Specialist
6606 W. Broad Street, #401
apical root fillings in a crown-apex which was in agree Richmond, VA 23230-1717
direction after immediate and de ment with the results (804 )662-9906 FAX(804 )662-9943
layed post space preparation using in previous studies. suits due to the richer blood supply and natural defenses. Case selec tion and diagnosis are considered critical to the success of these cases. Clinical success depends on a tooth demonstrating vitality to thermal and electrical stimulation, an absence of spontaneous pain and an absence of rarefactions on the radiographs.
1999
VIRGINIA BOARD OF
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Virginia Dental Journal 15
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16 Virginia Dental Journal
II
OVERVIEW OF VIRGINIA'S SALES TAX FOR DENTISTS
II
David S. Lionberger, Esquire - Christian & Barton, L.L.P.
Virginia imposes a sales tax upon purchases of tangible items (other than real property) in Vir ginia. A complementary tax, the use tax, is imposed upon tangible items which are acquired outside of Virginia (i.e., not subject to Vir ginia sales tax) but are used in Virginia. Localities also impose sales and use taxes, and the combined state and local sales tax rate and use tax rate is 4.5% of the sale or cost price of an item. Code of Virginia §§ 58.1-603 to 58.1-605. Medicines and drugs dispensed by or sold on prescriptions or work orders of licensed dentists are related to the provision of pro fessional medical services and may be sold to patients free from the state and local sales and use tax. Code of Virginia § 58.1 609.7; 23 Va. Admin. Code 10 210-940. However, except for controlled drugs purchased by li censed physicians, dentists are generally deemed to be the con sumers of all tangible items pur chased for use in their practice. Therefore, dentists pay the sales tax on any purchases of supplies used in providing dental or orth odontic services (including bulk orders) (e.g., administrative sup plies, medical supplies and mis cellaneous items used in prac tice). 23 Va. Admin. Code 10 210-2060; Ruling of Commis sioner, P.O. 98-103, May 26, 1998; Ruling of Commissioner, May 30, 1984. If the supplier falls to collect the sales tax at the time of purchase, the dentist should report the tax by filing a consumer use tax return, Form ST-7.
Pursuant to an exception effec tive in 1998, non-prescription drugs and proprietary medicines acquired for the cure, treatment or prevention of disease are free from sales tax, regardless of the status of the purchaser. Thus, dentists may acquire these items for use in their practice free from sales tax, and may sell these items to patients free from sales tax. The Department of Taxation has issued some guidance on this test, for instance ruling that tooth paste and cod liver oil do not qualify for the exemption since they are not primarily medicines. Ruling of Commissioner, P.O. 99 32, Mar. 18, 1999. Essentially, the Department considers three factors to determine whether a particular item constitutes a non prescription drug andlor propri etary medicine: 1)
2) 3)
Is the item a non-prescrip tion drug (i.e., a substance or mixture of substances containing medicines or drugs for which no prescrip tion is required)? Is the product for topical or internal use? and Is the product for the cure, mitigation, treatment or pre vention of a disease in hu man beings?
The Department consults the Federal Food and Drug Administration's guidelines in the classification of products for pur poses of the non-prescription drugs and proprietary medicines exemption. Further, the sales tax does not ap ply to durable medical equipment
purchased by or on behalf of an individual patient. Durable medi cal equipment is that which: (1) can withstand repeated use; (2) is primarily and customarily used to serve a medical purpose; (3) generally is not useful to a per son in the absence of illness or injury; and (4) is appropriate for use in the home. 23 Va. Admin. Code 10-210-940. The fact that an item is purchased from a medi cal equipment supplier is not dis positive of its exempt status. In order for an item to be exempt from the tax, it must meet all of the above criteria. For example, the sales tax applies to sales to a dentist by a dental laboratory or supplier of dentures, plates, braces and similar pros thetic devices, or the component parts thereof, unless such den tures, braces, etc. are purchased on behalf of a specific patient. If such items are purchased in bulk by a dentist and then dispensed to a particular patient, the origi nal purchase by the dentist will be subject to the tax even if the items withdrawn from the bulk inventory are modified for a specific patient. However, the tax does not apply to charges by the dentist to the patient for such dentures, plates, braces, etc. 23 Va. Admin. Code 10-210-500. Sales tax applies to purchases by a dentist of furnishings, equip ment, tools and all other dental supplies of any type. By contrast, the sale of a service, other than services to fabricate an item for a customer or services which are provided in connection Virginia Dental Journal 17
with or as part of the sale of tan gible items, is not subject to sales tax or use tax. Dentists are deemed to be providing profes sional services, thus the sale of such services to a patient is not subject to sales tax. The charge for any dental services provided should be clearly separated from any charge for tangible items pro vided to a patient. Code of Vir ginia § 58.1-609.5(1); 23 Va. Admin. Code 10-210-2060. Dental laboratories engaged in
~I
the production of dentures and prosthetic items are generally deemed to be industrial manufac turers who can qualify to buy ma terials used directly in manufac turing such items exempt from sales tax. When dental laborato ries make sales of such items to dentists, they must collect and pay the tax on all charges for such property, including any charges for labor or other expenses, since the labor is considered to be pro vided in connection with the sale of the tangible item.
David S. Lionberger is an associate with the Richmond, Virginia law firm of Christian & Barton, L. LP He practices in the tax, corporate and busi ness law departments.
DIRECT REIMBURSEMENT NEWS Ronya Edwards, Marketing and Programs Coordinator
A Look Back at 1999
A Look Into 2000
1999 was a good year! Benefits Administration, Inc. (BAI) signed on 11 new firms in 1999. As of December 31, 1999 BAI admin isters DR plans for a total of 32 companies in Virginia, bringing the total number of lives covered under a DR plan to approximately 5,300. Two new firms are sched uled to sign on to a DR plan on January 1, 2000-Chesapeake Hardware Products, Inc. in New port News and NCS Technolo gies, Inc. in Sterling.
The ADA House of Delegates voted to continue the DR market ing campaign for another three years. So now the ADA is plan ning to modify their marketing strategy to include two new print advertisements with more con cise messages and strong calls to action and an expansion of the target audience to include com panies of between 25 and 2,999 employees.
As of December 1, 1999 the ADA has reported 312 DR implemen tations have taken place nation ally, as reported by those states participating in the DR campaign. Also, there have been 3,587 in quiries and requests for more in formation on DR received by the ADA. The word is spreading and more and more CEOs, CFOs, HR Managers, and brokers are be coming more aware of Direct Re imbursement. 18 Virginia Dental Journal
The VDA will continue to support the ADA's campaign with our own marketing efforts on the state level. The VDA promotes DR through trade shows, magazine advertisements, targeted mailings to CEOs, CFOs, and HR manag ers of Virginia businesses, DR information packets for employ ers, broker training, and through the VDA web site. The VDA not only tries to educate employers about DR but also VDA member dentists and dental office staff through DR dental information
packets, mailings, free brochures and educational materials for dental professionals and patients, and speaking about DR at com ponent and study club meetings. The VDA Direct Reimbursement Committee, with the help of Jon Swan and Cork Coyner of Ben efits Administration, Inc., is hard at work trying to promote DR throughout Virginia and to come up with innovative and effective ways of educating more people about DR. If you have any feed back or would like to learn more about Direct Reimbursement or maybe even have a possible DR lead, please contact Ronya Edwards at the VDA office.
REPORT ON THE 1999 ADA HOUSE OF DELEGATES
Wallace L. Huff, D.D.S., Chairman, VA Delegation
Approximately 32,000 attendees consisting of dentists, team mem bers, exhibitors and guests were present at the 140th annual session of the American Dental Association held in Honolulu, Hawaii October 9-13,1999. This was the first time that the ADA annual session had been held at the I\lew Hawaii convention center and was also the largest, but as Dr. Kathryn Kell, chair on ADA Ses sions and International Programs stated, "The people of Hawaii and the convention center representa tives went all out to accommodate each attendee. Everyone really had the Aloha Spirit. Everyone seemed excited to be there and were having a great time." Dr. Richard F. Mascola, a Prosth odontist from Jericho, NY was in stalled and the 136th President of the association. Dr. Robert M. Anderton, a general dentist and lawyer from Argyle, Texas who served as 15th district trustee on the ADA board of trustees, was elected by the house as President-Elect of the ADA in a two way race. Candidates for the offices of the First Vice President, Second Vice President and speaker of the house of delegates ran uncontested as did trustee candidates for four districts. Elected unanimously were Dr. J. Kendall Dilletray Wichita, Kansas as first Vice President and Dr. Ronald B. Gross Dottstown, PA as Second Vice-President. Both Dr. Dillehay and Dr Grose are orth odontists. Dr. James T. Fanno (also an orthodontist) from Canton Ohio was elected for a fifth term as speaker of the house.
The four new trustees are Dr. Edwins S. Mehlman, an endodon tist from Providence, RI, 1st district; Dr. Richard Haught, a general den tist from Tulsa, OK, 12th district; Dr. Edward Leone, Jr., a general den tist in Denver, CO, 14th district and Dr. Frank K. Eggleston, a general dentist in Houston, TX 15th district.
that would combine grassroots training and in depth education on issues of importance to dentistry. The House further voted to ensure that all action team leaders be given the opportunity to attend this con ference. As in the past, the ADA will pay airfare for action team lead ers or their designated alternate.
Dr. Rene M. Rosas is beginning his fourth year as treasurer and Dr. John S Zapp continues to serve as the ADA Executive Director.
The American Dental Political Ac tion Committee (ADPAC), received $75,325 in capital club contributions at the national meeting in Honolulu. A one year membership in the capi tal club requires a minimum $100 contribution and is separate from the contributor's state dental PAC contributions. ADPAC provides po litical education and contributes to selected candidates for congres sional office and supports the as sociation network of grassroots dentists who work with members of congress to advance the profes sions legislative agenda. I would like to inform the dentists of VA that all delegations of the 16th district (VA, SC, and NC) had 100% par ticipation in this endeavor and that also included the executive direc tors. I want to personally thank the Virginia delegation for demonstrat ing their leadership and commit ment to our profession by partici pating in ADPAC's major donor program to ensure that dentistry has a role in electing the people who will write the laws that affect the delivery of dental care.
Congressman Charlie Norwood (R GA and a dentist) made an unex pected visit to the first meeting of the HOD on October 9 and was greeted by an standing ovation. The applause was for the work Congressman Norwood had done in getting the U.S. House of Rep resentatives to pass the ADA sup ported patients bill of rights 275-151 on October 7. Congressmen Norwood and John Dingell (D-NY) cosponsored this patient protection legislation. Rep. Norwood gave much of the credit for this legisla tive victory to the delegates, the as sociations non-stop lobbying for ef fective patient rights legislation, and to the ADA grassroots action teams. The ADA has already achieved nu merous legislative victories through the grassroots efforts, but to ensure that our profession is not only be ing protected from issues that af fect our profession now, we must continuously prepare for issues in the future. With these thoughts in mind the HOD ratified the recom mendation from ADPAC and the council on government affairs that the association develop a new spring conference in Washington
The house considered more than 133 resolutions and as anticipated the resolutions dealing with new specialties in the dental profession received the most activity. The three (3) applicants seeking spe cialty status in this years house were oral and maxillofacial radiolVirginia Dental Journal 19
ogy, dental anesthesiology and oral medicine. Of the three, only oral and maxillofacial radiology received the HOD's approval on all six of the requirements for specialty recogni tion and become the first new spe cialty in dentistry in the last 36 years. Endodontics was the last specialty before this. Dental anes thesiology and oral medicine failed to get the needed votes on all the requirements set by the national certifying boards for dental special ists. The majority of testimony for both of these specialities focused on compliance with requirement #4 which stated that in order to be rec ognized as a specialty, substantial public need and demand for ser vices, which are not adequately met by general practitioners or dental specialists, must be documented. Both of these applicants failed to meet that requirement. Dr. Mascola, the ADA's new president complemented the house vote on OMR by stating that the advancing new technology and complex oral health procedures in our profession indicated the need for a new speci ality. Rest assured, you will be hearing more from the other spe cialty applicants at future HOD's meetings. As always, the 2000 budqet was a featured agenda of the 1999 House (Resolution 38). As you may re call, the 1998 HOD directed that $343 ($382 less $25 for DR (direct Rebursement)and $14 for one-time programs be used as the "baseline" membership dues "figure for the 2000 budget. Keeping this fact in mind, the full dues payment for ADA members will be $395 for the year 2000. The increase is $52 against the base figure but only $13 more than full dues paying members paid last year. The increase in dues will help cover a $6.4 million deficit in next year's $70,718,490 budget. The task of deciding which pro grams are essential and which 20 Virginia Dental Journal
ones can be eliminated based on revenue seems to get more difficult each year. One of the resolutions adopted by the HOD with a high budgetary im pact was Res.35 - Direct Reim bursement. This resolution directs the ADA to conduct a second three year national marketing campaign to promote DR for another three years. The resolution also calls for the ADA to provide support for con stituent dental societies that are in terested in doing their own promo tional campaigns - and that progress reports on the campaign be presented to the House each year. The $2.5 million funding is subject to yearly approval by the HOD. The DR Campaign now in volves 42 Constituent dental soci eties. Overall awareness of DR has gone from 0 in 1996 to 80% today. The resolution dealing with dental indicators received almost as much activity as the specialities. The committee report that came from a 1996 House resolution defined den tal indicators as "assessment in struments". The Reference Com mittee heard many speakers voice concerns that the indicators could be used against dentists in their dealings with third parties or in law suits. The Board of Trustees sup ported Res. 87 from the 5th District which called for the Dental Indica tors Committee and program to be disbanded. Res. 87 was adopted by the House and all the resolutions that were related to dental indica tors (13 resolutions) were declared moot. Chuck Norman (NC), Chair man of the Council on Dental Prac tice is to be commended on the hard work he and his committee put forth on this issue. Resolution 114 approves up to $400,000 be appropriated from the ADA Capital Improvement Program account to prepare appropriate ar
chitectural interior design plans and to solicit bids for the completion of the renovation of the Chicago Headquarters Building. The Board of Trustees are to report the pro jected costs and proposed funding to the 2000 HOD. Other significant resolutions that were passed by the House: Res. 112H - Urges that the ADA Board of Trustees investigate and report by next April the financial, po litical and administrative conse quences of HR 1304 and similar legislation to the Association, its constituents and components. HR 1304 would allow physicians, den tists and other health professional to negotiate contracts collectively with Health Plans, and the House is asking the Board to look care fully at the ramifications of such leg islation at the local, state and na tional levels. Res. 50H - Encourages dental schools and ADA component and constituent societies to enhance communication and work together to address issues of mutual impor tance, including access to care and development of satellite dental clin ics. Res. 68H - Calls for ongoing sup port to implement and maintain an ADA allied dental personnel recruit ment and retention program to be funded in 2000 for $72,150. Ap propriate ADA agencies will estab lish an oversight recruitment and re tention committee for immediate implementation of proposed pro grams. Res. 71H - Directs the ADA to sup port lifelong continuing education of its members and encourages vari ous methods of demonstrating con tinued competency through over sight of practitioners by state
boards of dentistry and peer review. The ADA discourages mandated, periodic in-office audits or compre hensive written examinations to as sess continued competency or as a requirement of license renewal. The ADA encourages new methods of supporting continuing compe tency and will promote this policy in all discussion of competency is sues. Res. 78H - Calls for a recruitment campaign to attract qualified stu dents including qualified underrepresented minorities - into dentistry. The proposed program and its finances should be submit ted to the 2000 House of Delegates for consideration. Res. 89 - Calls for the ADA to closely monitor all activities in the area of continuing competency. The resolution was referred to a Board-appointed task force which has been charged with developing "Dentistry-The Model Profession," a position paper on issues of regu latory boards, government struc ture, profession authority and con tinuing competency. The paper will be presented to the Board of Trust ees at its April 2000 meeting. The 1999 House of Delegates' adoption of Res. 11 H amends the Association's Guidelines of licen sure policy as it relates to licensure by credentials. Res. 3H - Directs the Association to encourage state dental societies to educate professionals and con sumers about fluoride, to urge state and local dental public health and drinking water authorities to iden tify the state's groundwater sectors with natural fluoride levels above 2.0 parts per million, and to com municate with local health and drinking water authorities about standards for fluoride levels. Di rects the Association to urge den
tists to become familiar with fluo ride concentrations that exceed 2.0 parts per million in their local water supplies and to provide appropri ate counseling to patients in an ef fort to reduce the risk of dental fluo rosis in permanent teeth. Res. 4H - Accepts provisional or in terim restorations and prostheses as valid treatment modalities that should be reimbursed. Directs As sociation to urge third-party payers to accept this policy. Res. 24H - Urges that state tobacco settlement funds be targeted to ward improving health and reduc ing the morbidity and mortality of tobacco-related diseases. Further urges that state tobacco settlement funds be used to increase funding to dental programs in order to im prove access to care for underserved populations. Also urges that a portion of state tobacco settlement funds be targeted to ward tobacco control programs. Urges the Association to continue to assist constituent dental societ ies in forming strategies that pro mote the use of state tobacco settlement funds accordant with Association policy. Res. 83H - Declares that a third party challenge of a dental treat ment plan be considered diagno sis, and thereby constitutes the practice of dentistry which can only be performed by a dentist licensed in the state where the treatment was rendered. Encourages the American Association of Dental examiners, state dental associa tions and states' board of dentistry to adopt this position and pursue legislation and/or regulations to meet this end. Res. 111 H - Calls for the Associa tion to seek or support legislation opposing inappropriate third-party payer overpayment recovery prac
tices. Encourages state dental so cieties to seek or support legisla tion to prevent third-party payers from withholding fully assigned benefits to a dentist when an incor rect payment has been made to the dentist on behalf of a previous pa tient with the same third-party payer. Res. 15H - Adopts new policy on health information confidentiality and privacy that: •
supports legislation to protect patient health information;
•
limits third-party use of patient identifiable information to that necessary for proper patient care except for specified re search purposes;
•
establishes patient protections and rights with regard to per sonally identifiable health infor mation and how that informa tion is used;
•
declares immunity from liability for health care providers who unintentionally release confi dential information or who prop erly disclose information subse quently disclosed or misused by a third party; and
•
requires that law enforcement officials obtain proper authori zation to examine patient records.
Res. 47H - Amends the ADA Prin ciples of Ethics and Code of Pro fessional Conduct by adding a new POSTEXPOSURE,BLOODBORNE PATHOGENS section: "All dentists, regardless of their blood borne pathogen status, have an ethical obligation to immediately inform any patient who may have been exposed to blood or other poVirginia Dental Journal 21
tentially infectious material in the dental office of the need for postexposure evaluation and fol low-up and to immediately refer the patient to a qualified health care practitioner who can provide postexposure services. The dentist's ethical obligation in the event of an exposure incident ex tends to providing information con cerning the dentist's own bloodborne pathogen status to the evaluating health care practitioner, if the dentist is the source individual, and to submitting to testing that will assist in the evaluation of the pa tient. If a staff member or other third person is the source individual, the dentist should encourage that per son to cooperate as needed for the patient's evaluation." Also directs the Council on Scientific Affairs to develop and publish a report on postexposure protocols and re sources for further information. Res. 74H - Urges constituents so cieties to support enactment of leg islation giving each Board of Den tal Examiners the means to stop un licensed dental or dental hygiene practice. Res. 92H - Directs the Association to support and encourage states to adopt adequately funded fee-for service models for Medicaid pro grams to increase dentist participa tion and increase access to care for Medicaid participants. Res. 21H - Changes the office of ADA treasurer to make it an elec tive one; establishes rules for the election of treasurer; and specifies that the treasurer may serve a maximum of two consecutive three year terms of office. The resolu tion also urges the Board to amend its rules to designate the treasurer as chairman of the Administrative Review Committee, and to amend its rules to correspond with the amendments to the Constitution 22 Virginia Dental Journal
and Bylaws made in this resolution. Res. 29H - Directs the ADA presi dent to appoint a task force to study the allocation of delegates and the composition of the ADA House of Delegates. The task force shall consist of one member from each of the 16 trustee districts, and find ings and recommendations are to be reported to the 2000 House of Delegates.
throughout the annual session in Honolulu, Hawaii. And last, but not least - for his selection of attire that made the Va. Delegation the bright est and sharpest looking group there! Well - at least we were able to find a fellow delegate without much effort.
Res. 46H - Authorizes the Future of Dentistry Project, directing that a report be made to the 2000 House of Delegates.
The members of the VA Delegation - Drs. Weisberg, Deginder, Klima, Cooke, Barnes and Cuttino, who were the reporting caucus chairper sons of the Reference Committee that they served on... Thanks for a job well done.
Res. 1H - Amends the ADA Bylaws, Chapter XVII Finances, by the ad dition of new Section 50. Special Assessments to allow the House of Delegates the option of approving special assessments to fund spe cific projects that are of limited du ration.
Rod Klima (Chairman of VADPAC and the 16th District representative to ADPAC 2000) for his efforts in helping the 16th District achieve 100% participation in ADPAC's capital club. Thank you Rod and congratulations on your appoint ment to ADPAC 2000.
Res. 85H - Calls for a study of the Active Life member category to consider an allowable income level or hours worked that would permit Active Life members to pay no dues and maintain membership for report to the 2000 House of Delegates.
The outgoing VDA delegation members, Will Allison and Manny Michaels. Both Will and Manny have played key roles in the suc cess of the VDA Delegation. Both have been an asset to our profes sion, the VDA and the ADA. Both of them will be sorely missed, not only by the members of the VA del egation but by all who have been fortunate enough to have served with them. Thanks for your tireless efforts and ajob well done. I would also like to recognize Ken Morgan (NC) who is also retiring as a del egate. Thank you Ken, for the many contributions you have made to our profession.
A special thank you goes to: Ron Tankersley, who served as chairman of the 16th District Cau cus and did an outstanding job. Will Allison, who served as parlia mentarian for the 16th District Cau cus. Dr. Terry Dickinson, our new VDA Executive Director and Staff (espe cially Bonnie Anderson) for the ar rangements in Charlottesville, VA. Everyone was most appreciative of the effort put forth to ensure that the 16th District had an enjoyable meet ing in a great location in prepara tion for the 1999 ADA HOD. Thanks also for the support
I want to thank all the members of the Virginia Delegation for their con scientious and tireless efforts put forth from the pre-convention cau cus at the Boar's Head Inn, Charlottesville, VA, to the Conven tion Caucus, Reference Committee hearings and House of Delegate Sessions in Honolulu, Hawaii. Ev
eryone did a superb job and they are to be commended for their great effort.
cian Competition. You make all of us in the dental profession proud. Thank you.
Bettie McKaig (NC), who served as 1st VP of the ADA this past year. Thanks Bettie, for a job well done.
Our Trustee, Dr. Greg Chadwick who has announced his candidacy for President of the ADA. Greg has been an involved and effective leader as the 16th District Trustee Congratulations to:
Charlie Cuttino, who was elected and has represented us with dis Secretary-Treasurer of the 16 th tinction at the ADA in Chicago. He is committed to our profession and Trustee District (Year 2000).
has the knowledge and the experi Dave Anderson, who served as 16th ence to lead the American Dental Association. It would be an honor District Teller to the HOD in Hono for the 16th district to have this lead lulu. ership bestowed upon another one Mannie Michaels (one of my men of our own. (Dr. Jim Gaines (SC) tors), who was installed as Presi and our own favorite son, Dave dent of the International College of Whiston, have both served as Dentists in Honolulu (U.S. Section). President of the ADA.) The cam paign has started and more infor Hang M. Dang, a dental student mation will follow. from Virginia Commonwealth Uni versity, who was a winner of the Dr. Carroll Player, (SC), who was 1999 ADA/Dentsply Student Clini elected to replace Dr. Chadwick as
our trustee when he finishes his term in 2000. I feel confident that we will receive the same high cali ber of leadership from Dr. Player that we have come to expect from our past trustee, Dr. Chadwick. Members of the VA delegation who serve on ADA Councils and Com mittees are: Charlie Cuttino - Council on Dental Benefits Pro grams Rod Klima - ADPAC (2000) Chris Hamlin - Council on Ethics, By-laws, and Ju dicial Affairs. The 2000 16 th District Caucus will be September 22-24 at the Em bassy Suite, Greensboro, South Carolina. Hal Zorn, the Executive Director of SCDA, will be in charge of the arrangements.
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[II
VDA 1999-2000 COMMITTEES
The 2000-2001 VDA Membership Directory & Resourse Guide has not been produced yet. Below is an updated list of the VDA 1999-2000 Committees for your convenience. ANNUAL MEETING Dr. A. Carole Pratt, Chairman Dr. Ralph L. Howell, Jr Dr. Corydon B. Butler, Jr. Dr. John M. Bass Dr. Frank D. Straus Dr. Edward M. O'Keere Dr. Patrick J. Woznak Dr. Kirk Norbo Ex Officio: Dr. Andrew J. Zimmer, President Dr. David C. Anderson, President-Elect Dr. Thomas S. Cooke III, Secretary Treasurer Dr. Michael E. Miller, VSOMS AUXILIARY EDUCATION & RELA TIONS COMMITTEE Dr. Alan W. Mahanes, Chairman Dr. Theodore A. Blaney Dr. Michael R. Hanley Dr. Elizabeth C. Reynolds Dr. Jeffrey A. Clifton Dr. Dana H. Chamberlain Dr. John E. Boyles Dr. Sudha P. Patil At-Large: Dr. Ronald G. Downey Dr. Charles R. French II
Dr. Patrick D. King
Dr. Albert L. Payne
Dr. J. Roger Kiser, Sr.(VDAA Liaison)
BUDGET & FINANCIAL INVEST MENTs COMMITTEE Dr. James W. Baker, Chairman Dr. Wayne E. (A.J.) Dr. David R. Ferry Dr. Charles E. Gaskins III Dr. William W. Martin Dr. David L. Stepp Dr. Gerald J. Brown Dr. Charles R. French II Ex Officio: Dr. Thomas S. Cooke III, Secretary Treasurer
CANCER AND HOSPITAL DENTAL SERVICE COMMITTEE Dr. Michael E. Miller, Chairman Dr. James E. Krochmal Dr. L. Warren West Dr. Jonathan E. Carlton Dr. James P. Julian Dr. Michael A. Abbott Dr. R. Jonas Collins Dr. Patrick J. Dolan At-Large: Dr. Karen C. Day, Div. Dental Health, State Health Dpt. Dr. William S. Deeley, Va. Society of Pediatric Dentistry Dr. Jeffrey 1\1. Kenney, VSOMS COMMITTEE ON THE NEW DENTIST Dr. Carolyn C. Herring, Chairman Dr. Todd Bivins Dr. Matthew D. Dollar Dr. Dr. Marc A. Beltrami Dr. Karen McAndrew Dr. Garland G. Gentry Dr. Timothy E. Collins Dr. Peter K. Cocolis, Jr. EX-OFFICIO: Dr. Russell N. Mosher MCV Student Liaison: Darcy Amacher CARING DENTISTS COMMITTEE Dr. Harry D. Simpson, Jr., Chairman Dr. Allen S. Zeno Dr. Carl D. Hellberg Dr. Gordon Prior Dr. Victor S. Skaff, Jr. Dr. George D. Gilliam Dr. Thomas M. Starkey Dr. Michael S. McCann At-Large: Dr. Walter H. Dickey Virginia Board of Dentistry Liaison Rep resentative: COMMITTEE FOR DIRECT REIM BURSEMENT Dr. David Swett ,Chairman Dr. C. Mac Mahanes Dr. Mitchell A. Avent Dr. C. Sharone Ward Dr. Marcel G. Lambrechts. Jr. Dr. James K. Muehleck Dr. Susan F. O'Connor
II
Dr. Theodore P. Corcoran
At-Large:
Dr. Steven J. Barbieri (Endodontics)
Dr. John A. Svirsky (Oral Pathology)
Dr. Ronald L. Tankersley (Oral Sur
gery)
Dr. Robert A. Miller (Orthodontics)
Dr. Kathryn A. Cook (Pediatrics)
Dr. Benita A. Miller (Periodontics)
Dr. Douglas D. Wendt (Prosthodontics)
Ex Officio:
Dr. Leslie S. Webb, Jr.
COMMUNICATION & INFORMATION TECHNOLOGY COMMITTEE Dr. Dennis E. Cleckner, Chairman
Dr. Corydon B. Butler, Jr.
Dr. Brian Dixon
Dr. CarlO. Atkins, Jr.
Dr. James W. Shearer
Dr. Claude V. Camden, Jr.
Dr. Robert B. Hall, Jr.
Dr. Joseph Cusumano
CONSTITUTION & BYLAWS COM· MITTEE Dr. Charles L. Cuttino III (Immediate Past President), Chairman Dr. Bruce R. Hutchison, Speaker of the House Dr. Emory R. Thomas, Parliamentar ian Dr. Gary R. Arbuckle, Past Parliamen tarian At-Large: Dr. Emanuel W. Michaels Dr. Guy G. Levy Ex Officio: Dr. M. Joan Gillespie DENTAL BENEFITS PROGRAMS COMMITTEE Dr. Richard D. Barnes, Chairman Dr. Dennis E. Cleckner Dr. Richard W. Bates Dr. Benita A. Miller Dr. B. Scott Ward Dr. Susan F. O'Connor Dr. Robert E. Grover Dr. Kirk M. Norbo At-Large: Dr. John R. Ragsdale III (Periodontist) Dr. Cramer L. Bosewell (Orthodontist) Dr. 1. Wayne Mostiler (Oral Surgeon) Virginia Dental Journal 25
Dr. Mitchell A. Avent (Pedodontist) Ex Officio: Dr. Leslie S. Webb, Jr. (ADA Council) Dr. John W. Willhide (ADRP) MCV Student Liaison: Guy Hughes
DENTAL CONTINUING EDUCATION COMMITTEE Dr. B. Ellen Byrne, Chairman Dr. Ralph L. Howell, Jr Dr. Robert W. George Dr. James L. Slaqle, Jr Dr. James R. Evans Dr. French H. Moore III Dr. Rebecca S. Swett Dr. AI Rizkalla Dr. Gilbert L. Button (MCV) Dr. Gary R. Hartwell (MCV) Ex Officio: Tom Burke, MCV CE DENTAL DELIVERY FOR THE SPE CIAL NEEDS PATIENT COMMITTEE Dr. AI J. Stenger, Chairman Dr. Stanley P. Tompkins Dr. James D. Watkins Dr. Kevin S. Swenson Dr. John M. Fedison Dr. Glenn A. Young Dr. David Swett Dr. Patrick J. Dolan Dr. Richard D. Barnes, Dental Ben efits Programs Chairman Dr. William M. Midkiff, Dental Trade & Lab. Relations Chm. Dr. Samuel W. Galstan, Dental Health & Public Information Chm Dr. Karen C. Day, Div. Dental Health, State Health Opt. Dr. James H. Revere, Jr., MCV School of Dentistry
DENTAL HEALTH AND PUBLIC IN FORMATION COMMITTEE Dr. Samuel W. Galstan, Chairman Dr. Pamela Ann Morgan Dr. Sharon C. Covaney Dr. Shari L. Ball Dr. Robert Carlish Dr. Thomas W. Littrell Dr. Ellen R. Kelly Dr. Brenda J. Young At-Large: Dr. Gisela K. Fashing Dr. Roger H. Flagg Dr. Dan Kelly Ex Officio: Dr. Karen C. Day, Div. Dental Health, 26 Virginia Dental Journal
State Health Opt.
Dr. Leslie S. Webb, Jr., Journal Editor
DENTAL PRACTICE REGULATIONS COMMITTEE Dr. N. Ray Lee
(Oral Surgery),Chairman
Dr. Sanford L. Lefcoe, Jr.
Dr. James D. Watkins
Dr. Earl L. Shufford
Dr. Norman J. Marks
Dr. Albert L. Payne
Dr. Frances Anne Johnston
Dr. Robert B. Hall, Jr.
Dr. James L. Gyuricza
Dr. William E. Bernier (Endodontics)
Dr. Dennis G. Page (Oral Pathology)
Dr. John F. Monacell (Orthodontics)
Dr. Roger E. Wood (Pedodontics)
Dr. Steven L. Saunders (Periodontics)
Dr. Dewey H. Bell, Jr. (Prosthodontics)
Dr. Joseph M. Doherty (Public Health)
DENTAL TRADE AND LABORA TORY RELATIONS COMMITTEE Dr. William M. Midkiff (At-Large), Chair man Dr. John C. Cranham Dr. George L. Nance, Jr. Dr. Howard Baranker Dr. Daniel F. Savage III Dr. David L. Stepp Dr. Harry M. Sartelle III Dr. Joseph Cusumano At-Large: Dr. Karen McAndrew Dr. Raymond L. Meade ETHICS AND JUDICIAL AFFAIRS COMMITTEE Dr. Ronald L. Tankersley, Chairman Dr. Emanuel W. Michaels Dr. Daniel E. Grabeel Dr. Lawrence J. Kyle Dr. Raleigh H. Watson, Jr. Dr. Harold J. Barrett, Jr. Ex Officio: Dr. Andrew J. Zimmer, VDA President MCV Student Liaison: Todd Pillion INFECTION CONTROL AND ENVI RONMENTAL SAFETY COMMITTEE Dr. Paul F. Supan, Chairman Dr. Roger H. Flagg Dr. Michael E. Sagman Dr. Richard F. Roadcap Dr. William D. Covington Dr. Charles E. Harris Dr. Andrew B. Martof
At-Large:
Dr. Julie G. Sharp
Dr. Robert M. Block
INSTITUTIONAL AFFAIRS COMMIT TEE Dr. Elizabeth A. Bernhard, Chairman Isle of Wight Health Dept.) Dr. Charles Wesley Dr. Frank B. Sherman Dr. Frank H. Farrington Dr. C. James Harland, Jr. Dr. Karen Day Dr. W. R. Armentrout At-Large: Dr. Francis F. Carr. Jr. Dr. James I. Bernhardt Ex Officio: Dr. Raymond Smith. Dr. W. C. Fleenor Dr. E. L. Overman JOURNAL STAFF COMMITTEE Dr. Leslie S. Webb, Jr., Editor & Chair man Dr. Bernard I. Einhorn Dr. Eric W. Boxx Dr. Michel R. Hanley Dr. H.A. "Jack" Dunlevy Dr. Barry K. Cutright Dr.Robert G. Schuster Dr. Victor G. Saunders Dr. Danine Fresch Thomas C. Burke, MCV School of Den tistry Dr. Karen C. Day, Div. Dental Health, State Health Dpt.( Dr. Terry D. Dickinson, Business Man ager LEGISLATIVE COMMITTEE Dr. Roger E. Wood, Chairman
Dr. William H. Higinbotham, Jr.
Dr. Jeffrey N. Kenney
Dr. Bonnie Pearson
Dr. Dana H. Chamberlain
Dr. J. Ted Sherwin
Dr. William H. Allison
At-Large:
Dr. Francis F. Carr, Jr.
Dr. Wallace L. Huff
Dr. Melanie R. Love
Dr. Michael S. Morgan
Ex Officio:
Dr. Ronald J. Hunt, Dean, MCV School
of Dentistry
Jocelyn Lance, Alliance Representa
tive
MCV Student Liaison:
Madeline Hahn
MEMBERSHIP COMMITTEE Dr. Kimberly S. Swanson, Chairman Dr. Richard K. Quigg Dr. Jon E. Piche Dr. Kevin Swenson Dr. James W. Shearer Dr. Timothy E. Collins Dr. Rebecca S. Swett Dr. Gary J. Johnson Ex Officio: Dr. Anne C. Adams MCV Student Liaison: Ashley C. Epperly
Dr. Stanley P. Tompkins Dr. Corydon B. Butler, Jr. Dr. Richard F. Roadcap Dr. John S. Kittrell Dr. Mark A. Crabtree Dr. Robert G. Schuster Dr. Robert B. Hall, Jr. Dr. James L. Gyuricza AD HOC COMMITTEES 1999·2000 AD HOC SUBCOMMITTEE ON MI NORITY/DIVERSITY MEMBERSHIP RECRUITMENT
PEER REVIEW AND PATIENT RELA TIONS COMMITTEE Dr. Neil J. Small, Chairman Dr. W. Walter Cox Dr. Kent Herring Dr. John R. Ragsdale III Dr. William J. Redwine Dr. Craig B. Dietrich Dr. Paul 1. Umstott Dr. Alan Robbins
A. MINORITY/DIVERSITY MEMBER
PLANNING COMMITTEE Dr. David Anderson, President-Elect Dr. Charles Cuttino, Immediate Past President Dr. Wallace Huff, Past President Dr. A. Carole Pratt, Chairman, Annual Meeting Committee Dr: Alan W. Mahanes, Chairman, Aux iliary Ed. & Relations Committee Dr. James W. Baker, Chairman, Bud get & Financial Affairs Committee Dr. David Swett, Chairman, Commit tee For Direct Reimbiursement Dr. Carolyn C. Herring, Chairman, Committee On The New Dentist Dr. Richard D. Barnes, Chairman, Dental Benefits Programs Committee Dr. AI J. Stenger, Chairman, Dental Del./Special Needs Patient Comm. Dr. N. Ray Lee, Chairman, Dental Practiace Regulations Committee Dr. Ronald L. Tankersley,Chairman, Ethics & Judicial Affairs Committee Dr. Roger E. Wood, Chairman, Legis lative Committee Dr. Kimberly S. Swanson, Chairman, Membership Committee
Dr. Emanuel W. Michaels Dr. Charles F. Fletcher Dr. Leslie S. Webb, Jr.
SEARCH COMMITTEE FOR VIR GINIA BOARD OF DENTISTRY CAN DIDATES Dr.Charles L. Cuttino III (Immediate Past President), Chairman
SHIP RECRUITMENT Dr. Dr. Dr. Dr.
James D. Watkins Carole A. Pratt Barry I. Griffin Sudah P Patil
B. LIFE AND RETIRED MEMBER SHIP RETENTION
EXECUTIVE COUNCIL Dr.Wiliiam J. Viglione, (At-Large) Chair man Dr. Andrew J. Zimmer, President Dr. David C. Anderson, President Elect Dr. Thomas S. Cooke III, Secretary Treasurer Dr. Charles L. Cuttino III, Immediate Past President Dr. Rodney J. Klima (At-Large) Dr. D. Christopher Hamlin (At-Large) Dr. Richard H. Wood (At-Large) Dr. Edward J. Weisberg (1) Dr. Bruce R. DeGinder Vice Chairman Dr. H. Reed Boyd III Dr. Anne C. Adams Dr. Mark A. Crabtree Dr. Ronnie L. Brown Dr. J. Darwin King, Sr. Dr. M. Joan Gillespie Ex Officio: Dr. Bruce R. Hutchison, Speaker of the House Dr. Ronald J. Hunt, Dean, MCV School of Dentistry Dr. Emory R. Thomas, Parliamentar ian Dr. Leslie S. Webb, Jr., Journal Editor OTHER COMMITTEES 1999-2000
AD HOC COMMITTEE ON RECOG NITION AWARDS FOR VDA MEM BERS Dr. Charles L. Cuttino III (4) Chairman Dr. Emanuel W. Michaels Dr. Anne C. Adams Dr. Russell N. Mosher SALES/USE TAX STRIKE FORCE (Seeking clarification of the taxable sta tus of dental materials and supplies used in Virginia.) Dr. James W. Baker Dr. Robert A. Levine Chuck Duvall (Lobbyist) EXECUTIVE COMMITTEE Dr. Andrew J. Zimmer, President Dr. David C. Anderson. President Elect Dr. Thomas S. Cooke III, Secretary Treasurer Dr.Charles L. Cuttino III, Immediate Past President Dr. William J. Viglione, Council Chair man Dr. Bruce R. DeGinder, Council Vice Chairman
FELLOWS SELECTION COMMIT TEE Dr. Donald L. Martin, Chairman Dr.Harry E. Ramsey, Jr. Dr. Richard D. Barnes Dr. James K. Johnson Dr. Donald G. Levitin Dr Frank C. Crist, Jr. Dr. William J. Viglione Dr. Henry M. Botuck NOMINATING COMMITTEE Dr Charles L. Cuttino III (Immediate Past President), Chairman Dr. 1. Wayne Mostiler Dr. Thomas J. Morris Dr.Richard F. Roadcap Dr. Gary R. Hartwell Dr. Gregory 1. Gendron Dr.Frances Anne Johnston Dr. Robert G. Hall Dr. Kirk Norbo VIRGINIA DENTAL POLITICAL AC TION COMMITTEE Dr. Rodney J. Klima, Chairman Dr. Tracy S. Oliver
Virginia Dental Journal 27
Dr. David P. Mueller Dr. William R. Parks Dr. Bruce R. DeGinder Dr. Ronald L. Wray Dr. Scott E. Gerard Dr. Edward F. Ross, Jr. Dr. Roger E. Wood Dr. Frank C. Crist, Jr. Dr. Edward P. Snyder Dr. Gus C. Vlahos Dr. Ronald D. Jessup Dr. Victor G. Saunders Dr. Gerald J. Brown Dr. Bruce R. Hutchison
II
INTERNATIONAL COLLEGE OF DENTISTS
FOUNDATIONS AND SERVICE CORPORATION - 1999-2000 VIRGINIA DENTAL ASSOCIATION FOUNDATION Dr. William H. Allison, President Dr. Ralph L. Howell, Jr. Dr. James K. Johnson Dr. Anne C. Adams Dr. Daniel E. Grabeel Dr. Peter J. McDonald Dr. C. Mac Garrison, III Dr. Charles French, II Dr. Andrew J. Zimmer, VDA President Dr. David C. Anderson, VDA President Elect Dr. Thomas S. Cooke III, VDA Secre tary/Treasurer VIRGINIA DENTAL ASSOCIATION RELIEF FUND FOUNDATION Dr. Scott H. Francis, President Dr. Harold P. Hearner, Jr. Dr. Scott E. Gerard Dr. Edward F. Ross, Jr. Dr. Gregory T. Gendron Dr. Cramer L. Boswell Dr. William A. Grupp II Dr. Susan W. Connolly Dr. Andrew J. Zimmer, VDA President Dr. David C. Anderson, VDA President Elect Dr. Thomas S. Cooke III, VDA Secre tarylTreasurer VIRGINIA DENTAL SERVICES COR· PORATION Dr. Jeffrey Levin, President Dr. Frank C. Crist, Jr. Dr. Fred A. Coots, Jr. Dr. James E. Hardigan Dr. Robert A. Levine Dr. Harvey H. Shiflet III Beach Dr. Thomas S. Cooke III - Ex Officio
28 Virginia Dental Journal
New Fellows from the Virginia Class of 1999 of the International
College of Dentists inducted into the college at the annual con
vocation ceremony on October 8, 1999 in Hawaii.
Front Row (Left to Right): Dr. Thomas W. Littrell (Galax), Dr.
Wallace L. Huff( Blacksburg), Dr. Daura Christopher Hamlin (Nor
folk), Dr. James W. Baker (Chesapeake), and Dr. Emanuel W.
Michaels (President of the USA section of the ICD).
Back Row (Left to Right): Dr. Albert L. Payne (Danville), Dr.
Peter J. McDonald (Christiansburg), Dr. Richard D. Huffman, Jr.
(Roanoke), Dr. C. Daniel Dent (Richmond), and Dr. Richard O.K.
Wilson (Richmond).
New Fellows from the Virginia Class of 1999 inducted into the American College of Dentists on October 8, 1999 at the annual convocation ceremony. Left to Right: Dr. Ronald J. Hunt (Rich mond), Dr. Herbert Reed Boyd, III (Petersburg), Dr. Edward J. Weisberg (Norfolk), Dr. Jay S. Lipman (Hampton) and Dr. Kevin M. Laing (Van Wert, Ohio).
Dr. Emanuel W. Michaels, President, USA Section of the International College of Dentists.
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I~
VDA NEWS
[I In recent months there has been quite a change in the staff at the VDA. As we said "good-bye and good luck" to Mr. Bill Zepp, Connie Jungmann, Tanya Moore, Lisa Finnerty and Liz Keith, we also said "hello and welcome aboard" to Dr. Terry Dickinson, Julie Heuser and Susan Lionberger. Under the di rection of Dr. Terry Dickinson (VDA Executive Director), these are the faces of the staff of the VDA.
in accounting and real estate sales and management. Her hobbies include gardening and photography. Three of her photographs were used for Virginia Dental Journal covers in 1999. Her work is also displayed on this issue's cover. She also has some photo graphs exhibited in a local art gallery.
Ronya Edwards
Marketing & Programs
Coordinator
Ronya is the Marketing & Programs Coordinator for the VDA and the Di rector of Operations for the Virginia Dental Services Corp. (VDSC). She works closely with the VDSC, the VDA Foundation, the Relief Fund, and Di rect Reimbursement. She also main tains the VDA website (www.vadental.org).
Bonita L. (Bonnie) Anderson
Administrative Assistant
Bonnie was born and raised in Minne sota where she attended Bethel Col lege in S1. Paul. Before moving to Vir ginia in 1982 she lived in Lincoln, Ne braska for 15 years. Bonnie joined the VDA staff in January 1996, leaving her position with a law firm in Chesterfield County where she had worked as of fice manager and paralegal for 11 years. Bonnie and her husband Doug live in Midlothian and have two adult children and five grandchildren. As Administrative Assistant Bonnie works with the Executive Director, has internal oversight responsibility for all VDA committees and committee meet ings, has direct responsibility for cer tain specific committees, as well as the Executive Council, the House of Del egates and the VDA Fellows. In addi tion to her other duties, she greets VDA visitors and directs incoming calls to the appropriate staff member.
30 Virginia Dental Journal
Ronya graduated from the University of Richmond in December 1997 with a BS in Business Administration with concentrations in Marketing and Eco nomics. She began working at the VDA in January 1998. Ronya believes that she has gained valuable experience while working at the VDA and has met and had a chance to work with a lot of nice people. She is thankful for such a won derful opportunity.
Julie Heuser
Donated Dental Services
Project Coordinator
Julie has served as the Donated Den tal Services Project Coordinator since July of 1999. Her responsibilities in clude the case management of DDS patients and mangement of volunteer dentists and labs, as well as fundraising, public relations and volun teer recruitment associated with the Project. Julie is a May 1999 graduate of the University of Virginia and is glad to be "back home" in Richmond.
Linda Gilliam
Director of Finance
Susan P. Lionberger
Events & Publications
Coordinator
Linda has been with the VDA for 9 years this March. Her background is
Susan's responsibilities include plan ning the VDA Annual Meeting, the
ogy from Mary Washington College and Medical Technology Certification from the University of Virginia. Bar bara lives in Chester with her husband, two terrific children and three cats.
January & June Committee Meetings, and the April Leadership Meeting. She also is responsible for all printed ma terials pertaining to the meetings as well as laying out the Virginia Dental Journal. She recently started working on the events and publications needs for the VSOMS and VAO. Susan is a 1992 graduate of the Uni versity of Tennessee in Knoxville and a 1993 graduate of the Southeastern Paralegal Institute in Atlanta. Before joining the VDA in August 1999, Su san was the events planner for the law firm of McGuire, Woods, Battle & Boothe LLP in their Richmond office. Susan enjoys traveling, cross stitch, and University of Tennessee football. She and her husband of 9 months live in Richmond with their cat, Ziggy.
r-----------.,
Barbara Rollins
Assistant DDS Project
Coordinator
Barbara Rollins came to the VDA as Assistant Donated Dental Services Project Coordinator in October 1998. Her primary responsibility is to assist in coordinating DDS, which involves screening and matching qualified ap plicants needing dental services with volunteer dentists in the program. She enjoys being part of this valuable project. Barbara received a Bachelor of Science degree in Medical Technol
The Virginia Dental Association's attorney, Mark Rubin, has completed a written review of the Trigon contract analysis that the American Den tal Association recently provided to the association. Because of the number of issues addressed and the length of the analysis, it was felt that further clarification of the most important points should be addressed by our at torney. This analysis is currently available at the Association's of fice. If a member would like a copy, please call (804) 358-4927 or fax your request to (804) 353 L 7342. .I
"Hello... I'm a 77 year-old widow I live off $500 every month My teeth are rotting out of my mouth Please help me
I have nowhere else to turn .. ." Hear the cry for help. There are elderly, disabled, and chronically ill people in your community who need dental care and cannot afford it. These people have comprehensive dental needs, and they have nowhere else to turn. You can make a difference in these people's lives. Help give someone a reason to smile. Donated Dental Services provides free comprehensive dental care to elderly, disabled, and chronically ill individuals through a network of caring volunteer dentists, specialists, and laboratories. People like you. Join the DDS volunteer team and give a DDS patient a reason to smile-s-straight from your heart, right in your own office.
Donated Dental Services The inherent dignity of every individual is reflected through a healthy smile.
Call (804) 257-98]0 for information on how you can volunteer.
Virginia Dental Journal 31
~I
UPCOMING CONTINUING EDUCATION
I!
Component
Location
Speaker/Topic
Feb. 23, 2000
NVDS (8)
Fairview Marriott
Dr. Harold Slavkin, Research Update
Feb. 23, 2000
VAGD
Charlottesville
Dr. Glenn Menzie, Precision Attachments
March 6-10, 2000
MCV-Anatomy
MCV
Dr. Hugo Seibel & Dr. Milton Sholley, Head and Neck Anatomy
March 10,2000
Peninsula (2)
Newport News Omni
Dr. Robert Strauss, Medical Emergencies in the Dental Office
March 17,2000
Southwest (6)
Van Dyke Center, Emory
Dr. Adam Kegey, Dental Forensics and Frieda Pickett, RDH, Drugs & Herbal Supplements of the Mi/lenium
NVDS (8)
Fairview Marriott
Dr. Jeff Morely, Practical Cosmetic Dentistry
March 24, 2000
VDA co-sponsored
April 14, 2000
Tidewater (1)
Holiday Inn Chesapeake
Dr. Tom Orent, 1000 Gems
April 26, 2000
NVDS (8)
Fairview Marriott
Dr. Hugh Doherty, What They Didn't Teach You About Business
in Dental School
May 19, 2000
Shenandoah (7)
Sheraton - Harrisonburg
Steve M. Seltzer, MBA, 101 Technology Pearls for Dentistry
May 19, 2000
VAGD
Richmond
Dr. Dan Becker, Pain & Anxiety Control; Medical Urgencies &
Emergencies in Dental Practice
May 19-21, 2000
Southwest (6)
Pipestem WV State Park
June 22-25, 2000
VSOMS
Sheraton - VA Beach
Dr. Peter Waite, Snoring and Sleep Apnea
Southwest (6)
Higher Educational Center -- Abingdon
Dr. Franklin Weine, Avoiding Problems in Clinical Endodontics
VDA co-sponsored
Sept. 1-2, 2000
VAGD
Virginia Beach
Dr. Henry Gremillion, Facial Plans
Sept. 15, 2000
VDA Annual Meeting
Williamsburg Lodge
Dr. Gerard J. Chiche, Recipe for Successful Anterior Esthetics
Sept. 15, 2000
VDA Annual Meeting
Williamsburg Lodge
Dr. John A. Svirsky, AIDS/OSHA/Infection Control for the 21st
Century
Sept. 16, 2000
VDA Annual Meeting
Williamsburg Lodge
Dr. John A. Svirsky, Name That Disease and Other Oral Pathology Party Games
Sept. 16,2000
VDA Annual Meeting
Williamsburg Lodge
Dr. Roger L. Kiesling, Clinical Decisions in Practice Survival
Oct. 29, 2000
Tidewater (1)
TBA
Dr. Fred Bell, Implants
Nov. 4-5, 2000
VAG 0
Richmond
Dr. Ed McGlumply & Dr. Larry Peterson, Implant Dentistry
Dr. John Kois, Periodontics & Restorative Dentistry
Nov. 17, 2000
Southwest (6)
Donaldson Brown Conference Center, Blacksburg
Dr. Marvin Ladov, Oral Surgery: Impactions, Extractions Corrective Actions
Aug. 11, 2000
32 Virginia Dental Journal
TBA
Component CE Programs --For registration information, please contact the appropriate person below: ($40 - Members of VDA & Auxiliaries --$75 - Persons other than VDA members. Fee includes lunch and coffee break.) Component Component Component Component Component Component Component Component
I (Tidewater) II (Peninsula) III (Southside) IV (Richmond) V (Piedmont) VI (Southwest) VII (Shenandoah) VIII (Northern VA)
Virginia Donne (Executive Secretary) Kathy Harris (Executive Secretary) Dr. James L. Slagle (CE Coordinator) Linda Simon (Executive Secretary) Dr. William W. Martin (CE Coordinator) Dr. Francis Anne Johnston (CE Coordinator) Patricia Fuller (Executive Secretary) Susann W. Hamilton (Executive Director)
(757) (757) (804) (804) (540) (540) (804) (703)
491-4626 565-6564 733-9490 379-2534 344-4112 628-9507 985-1939 642-5297
MCV Program - For registration information for the Alton D. Brasher Postgraduate Course in Head & Neck Anatomy, please call Dr. Hugo Seibel at 804-828-9623 VAGD Programs - For registration information, please call the VAGD Office at 804-320-8803 VDA Programs - Registration information will be mailed in June/July for the 2000 Annual Meeting in Williamsburg.
AIDA C·E.R..P
CONTINUING EDUCATION RECOGNITION PROGRAM The VDA is recognized as a certified sponsor of continuing dental edu cation by both the ADA CERP and the Academy of General Dentistry.
MEETINGS
[I
II]
Month
Organization
Meeting
Location
April 5-9, 2000
VDA
Leadership Meeting
Omni Hotel - Charlottesville, VA
June 8-11, 2000
VDA
Committee Meeting
Sheraton Oceanfront Hotel - Virginia Beach, VA
June 22-25, 2000
VSOMS
Annual Meeting
Sheraton Oceanfront Hotel - Virginia Beach, VA
June 23-27, 2000
VAO
Annual Meeting
Cavalier Hotel - Virginia Beach
Sept. 13-17, 2000
VDA
Annual Meeting
Williamsburg Lodge - Williamsburg, VA
Sept. 22-24, 2000
16th District
16th District Caucus
Embassy Suite - Greensboro, SC
Oct. 28-Nov. 1, 2000
ADA
Annual Session
Chicago, Illinois
Jan. 2001 (dates TBA)
VDA
Committee Meeting
TBA
April 2001 (dates TBA)
VDA
Leadership Meeting
TBA
June 7-10, 2001
VDA
Committee Meeting
Sheraton Oceanfront Hotel - Virginia Beach, VA
June 23-28, 2001
VAOIVSOMS
Annual Meeting
Frenchman's Reef Marriott - St. Thomas VI
Sept. 12-16, 2001
VDA
Annual Meeting
Hyatt Hotel - Crystal City, VA
Sept. 18-22, 2002
VDA
Annual Meeting
Waterside Marriott -- Norfolk, VA
Sept. 10-14, 2003
VDA
Annual Meeting
Marriott - Richmond, VA
Sept. 8-12,2004
VDA
Annual Meeting
Waterside Marriott - Norfolk, VA
Sept. 14-18,2005
VDA
Annual Meeting
Marriott - Richmond, VA
Virginia Dental Journal 33
II
TRIGON: VDA SPONSORED HEALTH INSURANCE
II
VDSC Insurance Service Center In the results of a physician sur vey released last fall, Trigon Blue Cross Blue Shield and its affili ated HMO, HealthKeepers, Inc., emerged as front-runners among eight other managed care orga nizations. The survey was con ducted by Virginia's largest local medical organization, the Rich mond Academy of Medicine. The survey collected opinions about managed care organizations from 465 physicians and office manag ers. In total scoring of their re sponses, Trigon tied in the num ber-one spot. Physicians gave Trigon the top "better than average" rating in
II
several areas, including: Conducts easy and appropriate special referrals Has precertification/referral pro cess that is reasonable to fol low Helps patients understand precertification/referral process Has reasonable fee-for-service payments In a category to rate overall per formance, physicians were asked if they would recommend a spe cific insurance plan to a family member or friend. The survey's summary of the answers speaks for itself: "The responses were wide ranging, with Trigon's HMO
and non-HMO product as the most favored."
Trigon Blue Cross Blue Shield
has the largest PPO network in Virginia, with more than 14,000 participating physicians and hos pitals. The Virginia Dental Ser vices Corporation and the Virginia Dental Association is proud to sponsor the Trigon health insur ance plans. For information on starting a plan for yourself or your practice, contact the VDSC Insur ance Service Center at (800) 832 7001 Monday through Friday from 8:30 a.m. to 5:30 p.m. Our expe rienced staff will assist you with all your health insurance needs.
AUTOMATED EXTERNAL DEFIBRILLATORS
II
Jeffrey Levin, D.D.S., VDSC President The Automated External Defibril lator (AED) Protocol Committee, an ad hoc committee of the Vir ginia Dental Services Corpora tion, met on November 30, 1999 to establish guidelines and make a recommendation to dentists concerning the use of the AED during emergency situations aris ing in the dental office and else where for the purpose of saving lives. The Protocol Committee consists of the following: Drs. Jeffrey Levin, Richard Wilson, Charles Cuttino, Michael Miller, Ronald Tankersley, and Robert Strauss. The committee is staffed by Ronya Edwards of the VDA. The AED Protocol Committee rec ommended to the Executive Council of the VDA to strongly en 34 Virginia Dental Journal
courage members of the dental profession to become certified in CPR as well as trained in the proper use of AED equipment when available. The American Red Cross as well as the American Heart Associa tion are now training people in the use of the AED during CPR courses. The Virginia General Assembly passed an Amended Good Sa maritan Law in April 1999 protect ing health care professionals in the use of AEDs for the purpose of saving lives during an emer gency situation. Courses are being given through out the year at the MCV/VCU
School of Dentistry, the American Heart Association, and the Ameri can Red Cross. The VDSC plans to introduce an AED purchasing and training pro gram to the VDA membership in the near future. As a VDA mem bership benefit, members will re ceive a rebate with the purchase of an AED unit as well as a cer tificate for free training through either the American Red Cross or the American Heart Association. More information on this benefi cial program is forthcoming.
IL
VIRGINIA DENTAL SERVICES CORPORATION
II
Dr. Thomas Cooke III, VDA Secretary-Treasurer Over the past year, the VDSC has grown in both services offered to our members and non-dues rev enue to the VDA. This year that contribution amounts to about $25.00 per dues paying member. Over the past three years, that amount approaches $40.00. As the VDSC continues to grow and ex pand its programs and as more VDA members utilize these ser vices and participate in the VDSC endorsed programs, the more money that can be given back to the VDA to help support and fund VDA functions and to help maintain dues levels.
The VDSC has added numerous VDA member programs since its incorporation in 1995 that can en hance your practice and maybe even save you a couple of dollars in the process. The following are just to mention a few: For electronic claims processing, call ENVOY at 888-545-6127 For payroll services, call PAYCHEX at 800-729-2439 For office supplies, call Association Members Only at 800-420-6421
VDA LEGISLATIVE UPDATE
For dental supplies and equipment,
call Profit Finder at 800-443-5095
For financial services, call Mercer
Global Advisors at 800-462-1580
For more information on all of the VDSC and VDA endorsed pro grams please call Ronya Edwards at the VDA office at 800-552-3886 and ask for a brochure. You can also visit the VDA web site at www.vadental.org and check out the Endorsed Programs web page. Help support your association-we all benefit!
II]
Chuck Duvall, VDA Lobbyist It is difficult to try to look into the crystal ball in late December and give you news that will be current when you receive this in February. With that as a caveat, we will at tempt to try to highlight briefly some of the legislative matters we have touched upon previously and oth ers that have arisen since you re ceived your last publication of the Virginia Dental Journal.
The bill has been introduced by Delegate Jim Shuler (D Blacksburg) who introduced it pre viously.
Special Needs Dental Care:
Governor Gilmore, when he re leased his 2000-2002 biennial bud get on December 17, 1999, incor porated no new funds to increase the Medicaid dental service reim bursement rates.
As we previously reported, the Mandates Commission of the Bu reau of Insurance has reviewed this legislation which mandates general anesthesia for special needs den tal care. The Mandates Commis sion unanimously reported that the legislation should be considered fa vorably by the General Assembly.
Medicaid Dental Service Reim bursement Rates: As we last reported, the ongoing saga of Medicaid dental service re imbursement rates continues.
A report prepared as a result of budget language VDA secured in the 1999 Session indicated that an additional $10 million would be needed to bring the dental reim
bursement rates up to the 85th per centile. VDA has requested additional fund ing through a budget amendment. Many of you, by the time you read this report, will have been contacted and asked to advise your legislator(s) to assist in trying to secure additional Medicaid dental service reimbursements. Licensure of Health Care Facilities: Legislation is being reviewed by the General Assembly that would re quire the licensing of health care provider offices. Obviously, this in cludes dental offices. One of the criteria for licensure being dis cussed is the use of anesthesia. Dr. Ron Tankersley and Dr. Roger Wood, representing VDA, made Virginia Dental Journal 35
excellent presentations before a legislative subcommittee looking at this issue. They noted that at present the Board of Dentistry re quires a dentist licensed in the Commonwealth to demonstrate competency in the administration of various levels of anesthesia before they are allowed to administer an esthesia. In fact, the dental model described to the Legislature by Doctors Tankersley and Wood was held out as a model that other health care providers should emulate. With all of that said, however, there is still legislation being reviewed that may require the licensure of dental offices. VDA is in opposi tion to such legislation since all practitioners are licensed and vari ous state and federal entities have regulatory authority over dental of fices. Dental Study: The Joint Health Care Commission completed a very extensive review of dental services in underserved areas during 1999. As a result of that study, various pieces of legislation have been in troduced including:
•
A bill to create a dentist's loan repayment program.
•
A resolution to examine the fea sibility of establishing a public dental health program in those communities which do not have access to public dental health services.
•
A request that the VCU/MCV School of Dentistry develop a plan for establishing a precep tor externship program for den tal students.
36 Virginia Dental Journal
The Joint Commission has also in troduced a resolution to continue their study for another year. As part of the continuation of the study, they plan to review: •
Various ways to increase the number of persons with dental insurance.
•
Review methods to increase the number of dentists partici pating in the Medicaid program.
•
Potential safety concerns re garding the use of dental amal gam.
We indicated at the outset that it is difficult in December to crystal ball all of the various issues that will be introduced in the 2000 Session of the Virginia General Assembly. Obviously, we have touched upon only a few. By the time you receive this, hopefully you will receive ad ditional information from VDA that outlines the full complement of leg islation. VADPAC Participation is Essential: Most of you have paid your VDA dues and hopefully have partici pated in VADPAC for this year. If you have not done so, we encour age you to become a part of VADPAC. It is vital that VDA play an active role in campaigns across Virginia. Just to give you some indication of what is spent in campaigns, I thought we might share with you information presented by the Vir ginia Public Access Project (VPAP), which is a non-partisan group that collects information regarding cam paign financing. According to the V PAP, the top fif teen donors by occupation are as follows:
1. 2. 3.
4. 5. 6. 7. 8.
9. 10. 11. 12. 13. 14. 15.
$2,417,498 -- Attorneys/
Law Firms
$1,223,921 -- Real Estate Developers $ 850,161 -- Electric Utilities $ 746,357 -- Tobacco $ 729,770 -- Auto Dealers $ 711,453 -- Physicians $ 680,946 -- General Contractors $ 638,796 -- Realtors $ 601,728 -- Technology Firms $ 597,276 Coal Mining/Processing $533,161 Beer & Wine Distributors $ 527,156 -- Banks $ 503,284 -- Telecom Long Distance $ 489,034 Insurance Companies $ 457,468 -- Trial Lawyers
(Totals include donations to Senate candidates between 1/1/96 and 11/ 25/99 and to House of Delegate candidates and party/leadership committees between 1/1/98 and 11/ 25/99.) The General Assembly Session is scheduled to adjourn on March 11, 2000, with the Veto Session sched uled for April 19, 2000. If you have any questions at all dur ing the session, please feel free to contact the VDA directly or call my office at 804/644-7884 or bye-mail at Lindlcoro@aol.com. As always, thank you for your assistance in helping us advocate for your pa tients.
MERCY MEDICAL CENTER DIVISION OF DENTISTRY
AND THE MARYLAND ACADEMY OF GENERAL DENTISTRY
CONTINUING EDUCATION PROGRAM PRESENT
DRUGS IN DENTISTRy-UPDATE 2000路:路 FRIDAY, FEBRUARY II, 2000 -
8AM-12:30PM .:. Richard f1jnn, Ph.D
Dr. Wynn is professor and Director of Pharmacology, University of Maryland Dental School. He has extensive experience in research, teaching and pharmacologic considerations in the practice of dentistry. The all new "nuts and bolts" course will bring you up to date with newly approved drugs and considerations for the compromised dental patient. This information will change the way you practice dentistry MEDICAL EMERGENCIES IN THE DENTAL OFFICE - AN OvERVIEW FRIDAY, MARCH 3, 2000 - 8AM-12:30PM .:. Mark Eisen, DDS, MS
Dr. Eisen is a former Assistant Professor of Oral and Maxillofacial Surgery at the University of Maryland Dental School. He is currently in an Oral and Maxillofacial Surgery group practice in the Baltimore area. The course will review office preparation, prevention and recognition of medical emergencies. The discussion will include the basics of the emergency medication box, and the treatment of the most common emergencies.
CONSERVATIVE ANTERIOR ESTHETIC RESTORATIVE DENTISTRY: THE ART OF MAKING SMILES SATURDAY, MARCH 25, 2000 - 8AM-12:30PM .:. Howard Strasslet; DMD, FADM Dr. Strassler is a professor and Director of Operative Dentistry at the University of Maryland Dental School. He is a consultant for numerous dental manufacturers ad journals as well as having published over 350 papers. Selection of the proper dental material from the plethora of choices is critical for patient health and satisfaction. Maintaining color stability of natural teeth and restorations is also important. This course is an in-depth study of these primary restorative problems.
ANTI-INFECTIVE PERIODONTAL THERAPY SATURDAY, MAy 13, 2000 - 9AM - 12:30PM .:.Thomas Rams, DMD, MSD and Lawrence Page, DDS, Ph.D Dr. Rams is Professor and Chairman, Department of Periodontology, Temple University School of Dentistry, and Director of Oral Microbiology Testing Service.
Dr. Page is a full-time periodontist in Ellicott City, Maryland and a Clinical Professor of Periodontology at Temple University
Dental School. He has numerous publications and practices anti-infective therapy.
Effective methods for the diagnosis and control of subgingival infections and resulting periodontal diseases will be presented. Both patient subgingival control training and routine office subgingival control techniques are able to control periodontitis. Data showing long-term control of periodontitis with pockets initially as deep as 8-12 mm will be presented.
REGISTRATION Name (s)
_
Address,
_
Phone and Fax
_
Pay $85 registration per course by check,
VISA, MASTERCARD, D1SCo\'ER:
Card #
_ _ _ _ _ _ Exp. Date:_
Register by phone: 410-332-9262 or by Fax: 410-545-4253
Note: Courses will be hosted by Mercy Medical Center, 301 St. Paul Place, BaltiInore, MD 21202 Continental Breakfast and cornpliInentary parking are included in registration fee. These courses each qualify for.fow (4) hours of CDE credit toward the Academy of General Dentistry Fellowship & Membership. .vlorviandAcademv
q/ C7enem! Den/lit?)
11 an
A(ad(7J~)
oj Genera! DenlHl~l aptJTOced .vationol Sponsor for F-IC71J/.\LtGD credn 12/1/89-12 /.'1/ 198
r;
Mere}' MEDICAL
CENTER
paid advertisement Virginia Dental Journal 37
II
MEMBERSHIP BENEFIT HIGHLIGHT- CAREER ALTERNATIVES Kimberly S. Swanson, D.D.S., VDA Membership Task Force
Each year the American Dental Association Council on Access, Prevention, and Interprofessional Relations receives over 500 re quests for information on alterna tive dental careers from members considering leaving traditional practice. Non-clinical career alter natives include academia, public health, the dental product indus try, the insurance industry, and in stitutional accreditation services. In 1995, the Council developed an "Alternative Dental Careers Packet" in response to members needs. This packet discusses is sues and factors that dentists need to take into consideration when thinking about career alter natives. The material included is purposefully general in order to address a wide range of situa tions and needs. It will serve as a starting point for dentists to ex plore options and allow them to pursue further focused research on the alternative career of their choice. The packet underwent a complete revision in 1998 and now includes information on ap plicable web sites. The packet is available to members only through the ADA Manager of Interprofessional Relations at ex tension 2861. The ADA also addresses nontra ditional practice settings. "Devel oping New Ways to Practice Den tistry" is a new publication avail able through the ADA Catalog. In formation on options such as por table dentistry, on-site dental clin ics, and dentistry in private homes are available. Also avail able is "Providing Dental Care in Long-Term Care Facilities: A Re 38 Virginia Dental Journal
source Manual". Call the ADA Catalog at 1-800-947-4746 for additional information. Approximately 2,750 dentists serve in the Armed Forces and United States Public Health Ser vice. In 1997, the Department of Defense Authorization Bill gave dentists more incentive to enlist by providing an automatic $30,000 signing bonus. Attractive loan repayment programs are also available. Participating den tists are eligible for ADA tripartite membership or direct member ship in the ADA. Direct member ship means that the dentist is an ADA member but not a member of the state or local society. This would be appropriate for dentists who have frequent geographical transfers. For information, call ADA extension 2607 or e-mail the ADA at membership @ ada.org. For information on the U.S. Pub lic Health Service, call the Pub lic Health Dental Staffing Officer at 1-800-279-1605. Dentists and Dental Students interested in careers in dental re search should contact the Na tiona I Institute of Dental Research at www.nidr.nih.gov.This web site lists employment, training, and career development opportuni ties. Students may also make ini tial inquiries with the Associate Dean For Dental Research at their school. Also, the University of North Carolina-Chapel Hill has a web site, Careers in Dentistry, that highlights the many different careers that dentistry offers. Con tact the ADA Office of Student Affairs at extension 2386 for more information.
For dentists in traditional and non traditional careers who want to add something to their personal and professional life, there is al ways the option to spend time doing volunteer work overseas. Interested member dentists may request a free copy of "Interna tional Dental Volunteer Organi zations: A Guide to Services and Directory of Programs." Call the ADA Department of International Dental Health at extension 2726. There is also information on the ADA web site www.ada.org under the Dental Practice section. For more information on the many benefits of membershlp in orga nized dentistry, call the ADA at (312) 440-2500 or use the mem bers-only 800 number listed on the back of your membership card. You may also call the Vir ginia Dental Association at (804) 354-4927 or 1-800-552-3886. Membership matters!
Looking for info on upcoming
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Virginia Dental Journal 39
~I
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STANDARD OF CARE 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 term "stan dard of care" has clinical and legal implications
The standard of care ("standard") is often an issue in medical mal practice cases. The plaintiff will at tempt to prove that the care pro vided by a doctor was below the ac cepted standard; the defense will attempt to prove that the doctor met the standard. But, what is a "stan dard of care?" How is it deter mined? Is it an absolute standard? What factors may determine the standard in a given situation? These are some of the questions this article will attempt to answer by reviewing the facts of a dental mal practice case. The patient was a 53 year-old fe male who presented, on an emer gency basis, complaining of intrac table pain in #19. Her past medi cal history was significant for de pression, hypertension, diverticuli tis and hypercholesterolemia. As the doctor, a general dentist in pri vate practice, attempted local an esthesia in preparation for a root canal, the hypodermic needle broke at the hub and became lodged in the patient's jaw. The procedure was immediately discontinued, the patient was referred to a surgeon, and the needle was removed the next day without complication. Postoperatively the patient claimed to have developed TMJ dysfunc tion, as well as trigeminal neural gia related to extensive scar tissue in the area of the incision. She also claimed intractable facial pain, which forced her to quit employ 40 Virginia Dental Journal
ment and take disability retirement, as well as forcing her to limit her daily activities. When the patient filed a proper and legal claim for damages, she became a "plaintiff' and the doctor became a "defen dant." The plaintiff alleged that the stan dard was breached because a 30 guage short needle was used in the administration of the anesthetic; it was argued that a 27-guage long needle should have been used. The plaintiff identified dentists in general practice willing to testify, based on information in dental jour nals and textbooks, that the needle broke, upon contacting bone, be cause it was the wrong needle. Note that the plaintiff's experts were from a different part of the state than the defendant dentist. The defense identified as experts den tists from the defendant's geo graphic area, willing to testify that using a 30-guage short needle was appropriate in this case and is, in fact, the standard in the geographic area in which the defendant prac tices. Questions concerning the defendant's clinical competence were not raised.
Further complicating this case was the issue of whether it was a medi cal malpractice case or a product liability case. The plaintiff retained an expert with a PhD. in electrical engineering willing to testify that the needle was structurally sound, breaking upon contact with bone only because it was the inappropri ate needle. The defense countered with a Ph.D. in mechanical engi neering willing to testify that the needle failed because of a struc tural weakness.
Another peripheral risk manage ment item that must be mentioned is informed consent. Proper in formed consent is more accurately described as informed decision making; the dentist assists the pa tient in making an informed deci sion about what treatment option to pursue. Is so doing the dentist also gets the patient's expectations in line, as well as ensuring that the patient understands the risks, then allows the patient to make the de cision on how to proceed. The standard of care is often de termined by a reactive rather than proactive analysis
In a perfect world the standard of care would be determined by a group of dentists, in practices simi lar to the defendant's practice, who would argue, in a very scientific and factual way, which needle should have been used in this specific case. This group would rely on the facts of the case, current literature, research, expert evidence, and per sonal experience. The goal would be consensus. But a malpractice case is not a sci entific inquiry. The only consensus that matters is whether a jury be lieves, based on a preponderance of the evidence, that a dentist made a mistake that a reasonable and prudent dentist would not make, and that the error harmed the pa tient. Perhaps this sounds more like a professional difference of opinion? It may well be, and a professional difference of opinion alone does not mean that one position is correct and the other is incorrect. However,
when a claim of malpractice is al leged in Virginia, the plaintiff must have an expert willing to assert that the standard of care was breached; when this happens, professional differences become opposing ex pert arguments in an attempt to convince a jury that one side or the other is wrong. During the discov ery period after a suit has been filed, depositions of the experts will occur. Each attorney will attempt to isolate strengths and weak nesses in the position of the ex perts, with an eye on discrediting the opposition's experts in front of the jury. Prior to trial the plaintiff's attorney will attempt to convince the defense that it should settle; the defense attorney will attempt to convince the plaintiff that there is no case and going forward will be futile. At trial each side will attempt to present its experts in a manner that does the best job of educating the jury. The doctor will attempt to explain how he or she tried to do the best job possible; the plaintiff will talk about how much he or she has been harmed. This is quite re moved from a scientific inquiry. Many doctors compare it more to theater, often a theater of the ab surd. So, what is the standard of care? Black's law dictionary says that the standard of care is "... that degree of care which a reasonably prudent person should exercise in same or similar circumstances." The flex ibility built into this definition frees dentists from the responsibility to be perfect in practicing their profes sion. Rather than being perfect or heroic, they must simply be reason able and prudent. Be cautioned, however, that general dentists pro viding care that might arguably fall within the purview of specialists could be held to the standard of the special ist.
Since it is not carved in stone, the current standard will be influenced by multiple factors: 1) currently ac cepted methods of performing a specific procedure; 2) the location and services generally provided by the practice; 3) the state of current research and technology related to the procedure. These factors are combined with the doctor's assess ment of the patient, including the patient's condition and history, lead ing to a clinical decision as to what the best treatment should be. The patient should then be given the recommended treatment plan, along with other viable options, and the patient then makes the decision as to what will be done. This is personalized care that in creases the probability that the pa tient will receive quality care. When this approach is taken, and well documented, a vigorous defense can be mounted against any alle gation of malpractice. Why? Be cause it can be demonstrated that the dentist genuinely tried to do what was in the best interest of the patient.
influence members of a jury be cause this is the kind of commit ment that each jury member ex pects from his/her own doctor. Is the standard of care an abso lute standard? Any standard must be based on a uniform foundation. However, the treatment should not be "assembly line" care but, instead, personalized for each patient. By staying cur rent in your field, trying to do what is best for the patient, working to develop positive communication with patients and staff, and by docu menting your care and your patient advocacy, you will increase the probability of quality patient care and patient satisfaction. This, in turn, will decrease the risk of litiga tion.
How is a standard of care deter mined? As you can see, the answer de pends on whether the question is being asked about a specific pro cedure in your office or in a court of law. In your practice the standard of care is determined by you. It should be based on the usual risk management recommendations: stay current with your continuing education; attend meetings of and contribute to your specialty society and study club; and, keep up with journals specific to your practice. These activities are obvious com ponents of excellence in practice; they also speak volumes on behalf of any doctor forced to defend alle gations of malpractice. They in turn Virginia Dental Journal 41
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~I
A thought for the new millennium. Will dental decay be around for the next hun dred years? I think not! But there will always need for dentists, so don't look for a new profession any time soon.
COMPONENT NEWS
Component I Tidewater
f'
Dr. Barry Einhorn, Editor
•
By the time this column is read Y2K will have come and gone and the billions of dollars spent to avoid problems all but forgotten. I find it interesting that big busi ness had no qualms in spending enor mous sums of money on a suspicion of trouble and when it comes to providing health care and dental care for our citi zens there is a reluctance to spend the dollars. Speaking of providing dental care for indigents, we are proud to be partners with the American Red Cross in the es tablishment of a Dental Clinic at the Park Place Multi-Service Center in downtown Norfolk. This clinic is a first nationally for the Red Cross and hopefully will serve as a model for similar clinics throughout the country. The clinic will provide emer gency care as well as preventative ser vices. The clinic will be manned by vol unteers from Component #1 and stu dents from the School of Dental Hygiene of Old Dominion University. Special rec ognition was given to the efforts of Drs. Ed Weisberg, Ed O'Keefe, Jamie Krochmal, Charles Wesley and Robert Howell in the establishment of the clinic. On Friday April 14, we will hold a con tinuing ed course featuring Dr. Tom Orent. It is entitled the 1000 Gems Semi nar. The program will be held at the Holi day Inn Chesapeake. Please call Ginnie Donne at 757-491-4626 for information. We are gearing up for National Children's Dental Health Month. Dr. Anthony Peluso is serving as chairman and is co ordinating with Dr. Alex Kordis of the U.S. Navy. The Navy has been a willing and effective partner for years in our cam paign to bring the message of preven tion to the school children of Tidewater. We all mourn the loss of our friend and colleague Dr. Herbert Bonnie. Herb was one of the giants of organized Dentistry in our state and remained actively in volved in our profession until his death. We will miss his sage advice and keen sense of fairness.
Component II Peninsula
I treated a Donated Dental Services pa tient this week. He was a mildly retarded man who didn't really appreciate what was happening. But his elderly aunt who cares for him and his Alzheimer afflicted mother was so thrilled that I am still feel ing good about it three days later. Call Julie Heuser at DDS (804) 257-9810 and sign up to help someone in your area.
Dr. Eric Boxx, Editor
If you are in Southpark Mall on Saturday February 26 th don't be alarmed to see a large number of dentists present. It's our annual Dental Health Fair, headed up by Dr. Sam Galston.
No news to report.
That is all the news from the Southside. Talk to you in May!
Component III Southside
Component IV Richmond
Dr. Mike Hanley, Editor
..
WOW ... This column actually made it to print! Not that I was really worried about Y2K. I was pretty sure that when I woke up on January 15t there would be a mes sage about teeth on the recorder and a lab bill in the mailbox. I am, however, running a special on I.R.M., Carbocaine 3% and Bumble Bee tuna (in water). The Southside is planning a number of events in 2000. We've already had a very interesting presentation from Dr. Paul Ferrara, the director of Virginia's Foren sic Science Department. Tell you what, at your next crime scene, don't leave any DNA ... they will find you! It was our annual Spouses' Night. Some wives were overheard to say "even in winter all they talk about is golf." If you or your staff need an OSHA & Oral Pathology update, please join us on Feb ruary 25 with the nonpareil Dr. John Svirsky presiding. Following that will be a CPR recertifica tion course with Vivian Biggers, RN. Over the holidays, no fewer than four friends and acquaintances had heart or choking problems. Two of them died. My wife will be joining me in the class. Bring your spouse ... you may need their help sometime.
Dr. Jack Dunlevy, Editor New Year's greeting from your col leagues in Central Virginia. Component IV has begun the New Year with a full slate of activities. Our January monthly membership meet ing featured A.Wiliiam Feria, M.D., speaking on "Sedation of Patients in the Dental Office." Our February monthly meeting featured Joseph Callahan, .1.0., who discussed "Medical Dental Ethics as it applies to Medical Malpractice." Com ponent IV also sponsored an all day pro gram on February 11. William C. Strupp, Jr., D.D.S. gave a "Crown and Bridge Update." February is Children's Dental Health Month and the Dental Alliance of the RDS is again assisting the Dental Health, Pub lic Information and Community Involve ment Committee in several programs. The Committee sponsored a Poster Con test for fifth graders at the Richmond Public Schools. with winners selected at the Dental Health Fair. The Fair takes place at the Science Museum on Febru ary 19. Special thanks to the RDS Alli ance for their work with the puppet show. MCV dental students again lend a hand at this annual event. The March monthly meeting will feature four periodontists from our component. Dr. Charles E. Gaskins, III, Component
Virginia Dental Journal 43
IV President, will moderate a panel dis cussion. Panelists will include Dr. John C. Doswell, II; Dr. Barry I. Griffin; and Dr. Chris R. Richardson. The topic will be "Adjunctive Periodontal Pocket Manage ment Strategies." We also anticipate another all day course. On March 24, Dr. Gordon Christensen speaks on "What's New, What's Hot, What's Not." Our April monthly meeting will feature Dr. Anchew Martof. He is set to discuss "Dental Management of the Head and Neck Cancer Patient." The Component expresses appreciation to the Alliance of the RDS, as well as to Dr. and Mrs. John Kittrell. The Alliance sponsored a dessert for Senator John Watkins at Kathy and John Kittrell's home. Senator Watkins was re-elected this year, and his jurisdiction includes parts of Component IV. Also, Dr. Charlie Clough has retired from his oral surgical practice after many years of service in Richmond. Enjoy your re tirement, Charlie. We're sure you'll stay busy! Component V Piedmont
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Dr. Barry Cutright, Editor The Piedmont Component met in Roanoke in October. Dr. Steven Seltzer presented the lecture entitled "101 Tech nology Pearls for Dentistry." It was simi lar to watching market wrap up after a heavy day of trading. Dr. Seltzer left no stone unturned. Summarizing what's up, what's down, and what's history. Fortu nately, for those of us who tend to be at tention deficit, he also left a great hand out which included special requirements, tips and where to buy. If you are antici pating changes in your game plan, you should make a point to tap into his plethora of research. Back to the future. A note about our spring meeting. Dr. Hugh Doherty, DDS and CFP will present two half-day pro grams. Day One -- "How to Play the Great Game of Business and Win." 44 Virginia Dental Journal
Day Two - "It's Your Money - Use It or Lose It." Dr. Doherty has authored over 200 manu scripts on management and finance and currently is author of a monthly column "Money Smart" for the dental publication Dental Economics. This meeting is scheduled for Friday and Saturday, April 28 and 29, 2000 at the Homestead. The Homestead meeting was over booked last year, so I would encourage you to plan now to "spend and attend" this meet ing. Don't worry, you'll make it back with one good idea. In fact, you may make such a good decision that you don't care what the ADA or VDA dues are ... imag ine that.
A component meeting is also scheduled for August· 11, 2000 at the Higher Edu cation Center in Abingdon, VA. Dr. Franklin Weine will present "Avoiding Problems in Clinical Endodontics". The Virginia Highlands Festival in Abingdon is also scheduled at this time. The festi val features arts, crafts, antiques and entertainment. Best wishes to all for a Happy New Year that will hopefully bring new challenges and aspirations. Component VII
Shenandoah Valley
4:;
Component VI Southwest Dr. Victor G. Saunders, Editor
Dr. Robert G. Schuster, Editor The word "sweet" often causes one to ponder desserts, chocolates, or other caries contributing agents. But in South west Virginia "sweet" translates to the Sugar bowl bound VA Tech Hokies. Yes, on January 4, 2000 the Hokies will play the Florida State Seminoles for the col lege football national championship. Many of our component members are Hokie fans and congratulations are in order. The approaching New Year causes us to reflect on history, but also stimulates thoughts of future plans and goals. Our component is currently preparing for the winter committee meetings in Richmond, VA, on January 14-16, 2000. The first component meeting of 2000 will be held at the Van Dyke Center, in Emory, VA on March 17. Dr. Adam Kegey will begin the day with a presentation on Fo rensics, and Ms. Frieda Pickett, RDH will follow with a presentation entitled "Drugs & Herbal Supplements of the Millen nium". Our Spring meeting will be held at Pipestem State Park and Resort in West Virginia on May 19-21, 2000. This is a family weekend event which features a golftournament, old-fashioned barbecue, and the many amenities offered by Pipestem Resort State Park.
Happy New Year and welcome to the new millennium from Component 7! We hope everyone had a happy and healthy holi day season! The Shenandoah Valley Dental Associa tion Officers fro the year 2000 are Dr. Carolyn Herring, President; Dr. Vic Saunders, President-Elect; Dr. Robert Hall, Secretary-Treasurer; Dr. Darwin King & Dr. Bill Viglione, Executive Coun cil. We would like to welcome the following new members into Component 7: Prac ticing in Charlottesville -- Dr. Ed Akeel, Dr. George Choby, Dr. Suzanne Dennis and Dr. Paul Byers transferring from Camp Lejeune, NC. The Component is eagerly preparing for the Spring Meeting to be held March 17, 2000 in Charlottesville at the Omni Ho tel. The speakers will be Dr. Asgeir Sigurdsson, Dr. William Vann, Jr., and Dr. Martin Trope, all of whom are from the University of North Carolina School of Dentistry. The topic will be "Primary and Permanent Tooth Trauma: Current Therapies and Future Directions." Dr. Sigurdsson is the graduate program di rector in endodontics, Dr. Trope is the chairman of the endodontic department and Dr. Vann is the chairman of the pedi atric dentistry department. The SVDA Summer Meeting will be held May 19,2000 in Harrisonburg at the Four Points Sheraton. The title of the CE pro
gram will be "101 Technology Pearls for
Dentistry" by ADA Speaker, Steve M.
Seltzer, MBA.
Best Wishes for a successful and pros
perous Y2K'
Component VIII
Northern Virginia
Dr. Danine Fresch, Editor No news to report.
[II
VAE NOTES
II]
Dr. Steven Barbieri, President Since you are reading this, I assume we all survived Y2K and are now looking forward to the new millennium. Before discussing the future, however, a brief look back is in order. The last Virginia Academy of Endodontists meeting of the 20 th century was exciting and informative. Dr. Ellen Byrne presented a wonderful discussion on antibiotic usage and the problems associ ated with the development of resistant bac terial organisms. Congratulations to two of our members, Dr. Bruce Overton and Dr. David Wozniak upon achieving Diplomate of the Board status in 1999. Dr. James Lance, one of the founders of the VAE, retired after 27 years in private practice. We wish him well. As for the future, the first year of the 215t century should prove to be eventful. Plans for a spring meeting to be held in conjunc tion with MCV are under way. In addition, our annual meeting will be held in conjunc tion with the VDA annual meeting in the fall. Details will be forthcoming in future issues of the Virginia Dental Journal. We welcome all members to participate in these programs.
VAO NOTES
I~
Dr. M. Alan Bagden, Immediate Past President As winter continues, it's more than appro priate to ponder warm summer breezes and THE BEACH ...Virginia Beach, that is This year's annual meeting will be hosted by President Rod Klima at the "old favorite" ... Virginia Beach. This year's
meeting will be held at the Cavalier Con ference Center on the beach during the end of June. The exact dates are June 24-27, 2000. The featured speaker will be Dr. "Slick" VanArsdale who will certainly present a world class perio-ortho lecture for all in attendance. To make this meeting even greater, we will be fortunate to have the all-time favorite beach band ... BILL DEAL. ..performing for the annual beach party. If you have never seen them, or have seen them countless times, you're sure to remember this as the ultimate in sand-in-your-toes rock and roll. Mark it now on your calender and plan on attending! Also worth noting is the formation of the College of Diplomates of the American Board of Orthodontics Foundation (CDABOF). This very worthwhile endeavor will serve to support the ideals of the CDABO while at the same time supporting the advancement of superior research and continuing education as well as providing financial support to residents and recent graduates to assist them in attaining their board certification. Contributions can be sent to Dr. Alan Bagden to support this group. Make any donations payable to the CDABOF. A cumulative list of contributors will be maintained in the VAO newsletter. Additional mailings and pledge information will be forthcoming as the year progresses. Enjoy the rest of the winter. Plan on at tending the AAO and VAO meetings. They're both great opportunities to get to gether with peers and learn what's new in our wonderful profession.
~L VSOMS NOTES
II]
Dr. Paul K. Hartmann, President The Virginia Society of Oral and Maxillofa cial Surgeons is busy preparing for our Feb ruary ACLS Recertification Course at St. Mary's Hospital in Richmond. This will be offered on Saturday, February 19th followed by a Risk Management Course on Sunday, The Risk Management February zoCourse will have a class for staff as well as a class for VSOMS members and nonmem ber OMS's. We are all sorry about the departure of Lisa Finnerty at the VDA Central Office. Lisa has been so supportive and helpful to all the OMS's across the Commonwealth over the last few years in both legislative and administrative affairs. She has moved to Roanoke to start a new career in the phar maceutical industry. and we wish her the best of luck.
A reminder to set aside the time for Dr. Peter Waite at our 2000 Annual Meeting in Virginia Beach, June 22-25. Dr. Waite is the Chairman the Department of Oral and Maxillofacial Surgery at the University of Alabama and will lecture on "Snoring and Sleep Apnea". This is one you shouldn't miss.
~I
ALLIANCE NEWS
II]
Carol Rasmussen, President
The Alliance once again joined the Virginia Dental Association at the Omni Hotel in Richmond on January 14 and 15, 2000 for our Winter Board of Directors Meeting and Luncheon and at the state capital in Rich mond for Legislative Day. The Board discussed where the Virginia Alliance has been and where the members see us going. New topics of focus for Den tal Health Education were entertained and we renewed our commitment to our legis lative grass roots efforts. Information and invitations went out to all members to attend Leadership Conference, which will be held in Indianapolis in April 2000. Through a special funding grant from the American Dental Association, several scholarships will be awarded to those mem bers wishing to help with expenses. Appli cations are available through Board Mem bers and Component Presidents. Every Conference has been a fun and rewarding learning experience and this year Indy is revving their engines and tweaking their performance for a memorable time. Please get your applications in early and be an in tegral part of our "pit crew." Williamsburg in September is not really that far away. Plan now to attend. The dates are September 14-16,2000. Co-Chairs for this event are still needed. If you or some one you know can help us "strut our stuff," please speak with your Component Presi dent or any Board Member. Chicago in October follows the above date quickly and the "Windy City" is promising "the time of your life with priceless sensory experiences." Sounds good to me. Dare to be there!
"Say, What?" Say, what if there were an organization comprised exclusively of spouses of den tists? What if these spouses provided ser vices and dental health education to their local and state communities? What if mem bers' involvement provided an outlet for creativity, personal growth, improved selfVirginia Dental Journal
45
esteem and social enrichment? What if it didn't take a lot of time or money but any and all efforts were welcomed and appre ciated? Say, what if YOU were a member of such an exciting organization? You could expe rience warm camaraderie and lasting friendships with wonderful and caring people who understand and support the dental profession and the dental family. The profession you dental spouse chose to pledge allegiance to and to which we all embrace? You could share your thoughts and talents and choose to make a difference. We need you. Don't say, "What?" Say "Yes." Send your name, spouse's name and VDA number, home address and telephone number to Ms. Barbara Yandle, Member ship Chair, 5900 Turkey Oak Road, Rich mond, Virginia 23237. Include a check in the amount of $35 (State and National Dues for 1 year).
[II
PUBLIC HEALTH NOTES
~
Dr. Karen C. Day, Director Division of Dental Health The Division of Dental Health was recently awarded $107,147 for two categorical fluo ridation grants from the Centers for Disease Control and Prevention (CDC). The grants were written in cooperation with the Office of Water Programs in the Virginia Depart ment of Health. These grants will fund im provements in monitoring and reporting water system compliance to CDC, initiat ing and upgrading fluoridation of several water systems and establishing a fluoride training center for engineers and water works operators. Fluoridation of public wa ter systems began in Virginia in the Town of Fries in 1952. Today 162 water systems provide optimally fluoridated water to Virginia's citizens. Out of 5.9 million Virgin ians who are served by community water systems approximately 4.8 million people receive fluoridated water. With 81% of com munity water system customers drinking fluoridated water, Virginia has met the Healthy People Year 2000 Objective. CDC also recently cited fluoridation as one ofthe top ten public health measures of the twen tieth century. Extensive research has shown repeatedly that fluoridation of pub lic water supplies is a safe and effective way to reduce tooth decay. However, in spite of all the improvements in oral health, many due to fluorides, tooth decay is still a serious problem affecting an average of 45 percent of children in Virginia.
46 Virginia Dental Journal
~I
SCHOOL OF DENTlSlRY
Tom Burke, Assistant Dean Oral Pathology - .com or bust We've all have heard and read that the Internet (the Web) is where it is "happenin" these days, and for the Department of Oral and Maxillofacial Pathology this is also the case. We have been on the web for a couple of years at www.vcu.edu/dentistrv/ opath. The purpose of our web site is to serve you. As of this moment there are a number of things you can do with our web site: 1. Order "biopsy kits" and "cytology kits" - A biopsy kit includes a plastic bottle filled with 10% formalin, a "Tissue Ex amination Request Form," and a post age-paid mailer. These have unlim ited shelf-life, so it is best to have them on hand prior to actually needing them. When the time arrives, simply biopsy the patient, drop the specimen in the bottle, then into the mailer, and then into the mailbox. We'll send you a di agnosis (fax and mail) and replace ment kits. Cytology kits work much the same way. The service is billed to the patient's medical insurance, not to your office. This year we've diagnosed about 7,300 cases and it's growing. 2.
newsletters to our tissue contributors on a periodic basis. Now you can go back and refer to those previous is sues. 6. You can e-mail us with any ideas. How we can better serve you and your of fice? We already provide an autoclave spore testing service that many prac titioners use, but you may have other ideas. We're thinking about a "case of the month" and expanding our CE offerings on the site. If you have any suggestions, just send us an e-mail or call us at 1-800-677-7841. As the future unfolds, the Department of Oral Pathology will be utilizing the web even more for undergraduate and postgraduate dental education within the School of Den tistry and through distance learning outside of the School of Dentistry. As an example, with Dr. Lou Abbey's leadership, we have submitted a grant to do distance education in General & Oral Pathology for a number of outlining Dental Hygiene programs. Who knows, down the road we may be doing real time intraoral consults of you and your patients, in your office, from our offices in Richmond. Teleradiology and telehistology are also on the horizon So stay tuned for future improvements and as always send us your ideas or come by and visit when you are in Richmond. Remember- our web site is www.vcu.edu/ dentistrv/opath
Refresh or expand your knowledge base - you can take a Continuing Edu cation course on Oral Cytology and actually receive CE credit from the VCU School of Dentistry. Maybe you'd like to take a stroll down memory lane and peer in on our Sophomore Dental Oral Pathology Course. For the futur ists, there is a web-based case simu lation software called IMPACT (Inter active Multimedia Patient Case Tutor) which will give you the chance to "play doctor" with an interesting case.
3. Check out some really cool hyperlinks to other Oral Pathology Sites on the Internet - Via our web site you can access a lot of knowledge stored at other schools and agencies. 4.
E-mail us your clinical or radiographic consults. E-mail them to us using .jpg files. You can then call us with your questions or concerns.
5.
Read past issues of our department newsletter. We normally mail out
Dr. Lou Abbey and Dr. John Svirsky con sult on one of the 7,300 biopsies reviewed in 1999.
VCU School of Dentistry Student Wins Fifty-three students from dental schools throughout the United States and Puerto Rico participated in the 1999 ADA/ DENTSPLY Student Clinician Program held in conjunction with the 140th Annual Session of the ADA in Honolulu, Hawaii in October 1999. Only six students were se lected as winners. Ms. Cindy Dang, Medi cal College of Virginia, won second place in the Clinical Application and Techniques Category. Her winning clinic title was "Wear behavior of flowable and condensable com posite resins."
scope of pre-doctoral education, and the incorporation of new prosthodontic materi als into the curriculum. Dr. Donald Crabtree, Assistant Professor of Prosthodontics organized and planned the meeting. "This was the largest group ever to attend the annual meeting. The exceptional attendance enhanced discus sion and provided attendees with the op portunity to share educational concerns," concluded Dr. Crabtree. Ms. Hang "Cindy" Dang of the Medical College of Virginia was awarded second place at the 1999 ADAfDENTSPLY Student Clinician Pro gram
VCU School of Dentistry Hosts 1999 An nual Meeting for Prosthodontics VCU School of Dentistry's Department of Prosthodontics planned and implemented a regional workshop attended by one-third of the nations dental schools. The meet ing was held in conjunction with the Ameri can Association of Dental Schools and fo cused on the important issues facing prosthodontic education. Thirty-five faculty members representing fifteen dental schools from the southeast and mid-atlantic states traveled to Richmond to discuss is sues of competency and evaluation, the
Prosthodontic educators pose during a break in the meeting activities.
INTRODUCING DENTAL DUES GOLDOPTIONSM FINANCING. IT JUST GOT EASIER! Need to Pay your Dental Dues?
Need New Office Equipment?
Need to Consolidate Your Bills?
The Virginia Dental Association is pleased to present the Virginia Dental Association GoldOption SM Loan with no annual fee, no prepayment penalty and no collateral. In as little as 15 minutes you can have up to $50,000* at your disposal, to use for virtually any purpose you can imagine - even paying your dental dues! The Virginia Dental Association GoldOption Loan offers you the cash you want at the rate you deserve. Your preferred status makes you eligible for this fixed-payment loan at the low variable rate of Prime+2%. ** You select your payment amount based on your term and the amount you borrow. GoldOption allows you to request additional funds to use over and over again. Access your funds by direct deposit into your personal checking account, direct payment to creditors or by check. Apply by phone and receive a decision in as little as 15 minutes!
Call toll free 1-800-527-3621
When calling please mention Priority Code: JPX9-DZ-873-WN
• Receipt of maximum credit line is subject to income and creditworthiness standards.
** The Annual Percentage Rate(APR) is a variable APR of prime plus 2%, currently 10.5%. There is a check transaction fee equal to 2% of the
U.S. Dollar amount of each check you use to obtain an advance (fee: minimum $2; maximum $15). To avoid check transaction fees, have your funds deposited directly into your checking account or sent directly to your creditors. 'lJ'Upon approval, MBNA will send funds as requested. The total amount requested cannot exceed your credit line. If it does, and MBNA cannot contact you, all approved amounts may be sent to you in check form for your endorsement. Allow two weeks processing time from account opening. Please continue to make payments to your creditors until you receive MBNA payment confirmation from those creditors. GoldOption. MBNA. MBNA America. MBNA Consumer Finance are service marks of MBNA America Bank. N.A. (0 1998 MBNA America Bank, N.A.
Virginia Dental Journal 47
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: April 1, at 5pm is the closing date for the April-May-June Journal issue. After the deadline closes, the Journal can accept no ads nor can it alter or cancel previously ordered ads. This deadline is firm. As a membership service, ads are restricted to VDA and ADA members unless employment or continuing educa tion related. 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 or reject any ad
and does not assume liability for the
contents of classified advertising.
Opportunity Wanted - Central Virginia - Personable and mo tivated young orthodontist with professional experience seek ing full-time or part-time associateship in an orthodontic, multi speciality, general or pediatric dentistry practice. Flexible with respect to work schedule and contract arrangements. Send confidential replies to : Dr. MAP, 9425 Charter Creek Drive, Apt. 2-E, Ashland, Virginia 23005. Ergonomic Equipment For Sale: Eliminate aching backs, wrists and necks. Patented technology to help your practice in comfort and prevent job related staff and hygienist ailments. Call Dr. Joe Chicurel (540) 943-5389. CONTINUING EDUCATION: 16 CREDITS/$100.00 (8 CEU'S/ $50). FOR STATE LICENSURE. OTC and Rx Oral Medicine Self-Study Exams. Send $100 to American Academy of Oral Pharmacology, 860 E. Broad St., ATTN: Dental CE Dept., Elyria, OH 44035. (877) 877-SMILE (7645).
Dentist Career Associateship Opportunities available in high-end, successful, fee-for-service driven practices poten tially leading to partnership/ownership positions. These pri vately owned and operated practices are looking for ambitious, hard-working licensed general and speciality dentists. To learn about the tremendous opportunities available in MD and VA, contact Jeff Nulf at 1-800-889-2893 and visit our website at www.dentalrecruiting.com.
OPPORTUNITY FOR GENERAL DENTISTS: Nation's larg
est most experienced Interim Professional Service (Locum
Tenens) for dentists. Competitive pay, travel opportunities and
flexible schedules.
Forest Irons & Associates, Inc. 888-433-2603.
Partnership available with a large, well-established, 20-year practice on the Hampton/Newport News peninsula. This prac tice enjoys many new fee-for-service patients monthly. This is an opportunity for a general dentist who is interested in prac ticing comprehensive dentistry while learning the business skills of managing a practice. In addition, techniques on how to earn millions and invest these assets will be shared if the part nership is consummated. Experience preferred, but will con sider efficient, talented dentist who practices all phases of gen eral practice and can communicate well with patients. Fax resume to 757-827-7772
Dentist Coordinator Position Available -- provide 20 hours per week of dental care to homeless patients and supervise dental students. Days are negotiable but prefer Monday, Wednesday, and Friday. $35 per hour. Newly renovated facil ity and all new state-of-the-art equipment. Send resumes to J. Price, 517 West Grace Street, Richmond, VA 23220
Dental Practice For Sale By Owner: Well-established Gen eral Dental Practice and attractive office for sale in Smithfield, Virginia. Three operatories furnished with three-year-old equip ment. All operatories, business office and laboratory comput erized and networked with digital x-ray, intraoral cameras (3) and Florida Probe. Call (757) 357-4121 for more information and/or viewing appointment.
ANew Narne ... ANew VDA Annual Meeting
QirHEi~ia
MEETING
September 13-17, 2000 Williamsburg Lodge - Williamsburg, VA 48 Virginia Dental Journal
What's So Special About Partials FroDl Virginia Dental Laboratories?
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Integrity. Virginia Dental Laboratory uses
• Vitallium® Alloy-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.
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 (757) 622-4614 (800) 870-46 14 © 1992 Austenal. Inc. All Rights Reserved. Vitallium" trademark licensed to Austenal. Inc. by Pfizer Inc.