June 2016
June June2016 2016
TEXAS TEXASDENTAL DENTAL
Rita RitaM.M.Cammarata, Cammarata,DDS DDS President President Texas TexasDental DentalAssociation Association
The Texas Dental Journal
INSIDE: INSIDE:
ADDRESSES ADDRESSESTOTOTHE THETEXAS TEXASDENTAL DENTAL ASSOCIATION ASSOCIATIONHOUSE HOUSEOFOFDELEGATES: DELEGATES:
OUTGOING OUTGOING PRESIDENT, PRESIDENT, 15TH 15TH DISTRICT DISTRICT TRUSTEE TRUSTEE AND AND INCOMING INCOMING PRESIDENT’S PRESIDENT’S ADDRESS ADDRESS
Vol. 133, Issue 6
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Contents Established February 1883
n
June 2016
Vol 133, No. 6
FEATURES 344 | Address to the Texas Dental Association House of Delegates Craig S. Armstrong, DDS, President
352 | American Dental Association 15th District Trustee’s Address Richard C. Black, DDS, ADA 15th District Trustee
344 | Incoming President’s Address
About the Cover: TDA President Rita M. Cammarata, DDS
Rita M. Cammarata, DDS, President
DEPARTMENTS
364 | Dental care in Texas: An
338 | Oral and Maxillofacial Pathology Case
opportunity for implementing a
of the Month
comprehensive and patient-
341 | Critically Appraised Topic of the Month:
centric approach with special
The Incidence of Root Fracture is Similar
emphasis on cancer patients
Restorations
and survivors Irene Tamí-Maury, DMD, MSc, DrPH Aditya J. Wagh, BDS Nathalie E. Abou Khalil Ellen R. Gritz, PhD Mark S. Chambers, DMD, MS The authors analyze survey data on Texas dentists providing care to cancer patients.
Between Metal Post and Fiber Post Retained
363 | In Memoriam | Memorial and Honorarium Donors 374 | Value for Your Profession: Sterilizer Monitoring: How it should be done, and what to do if you get a positive test result 375 | Calendar of Events 378 | Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management
TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.
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381 | Advertising Briefs 394 | Index to Advertisers
Editorial Staff
Board of Directors
Daniel L. Jones, DDS, PhD, Editor Harvey P. Kessler, DDS, MS, Associate Editor K. Vendrell Rankin, DDS, Associate Editor Billy Callis, Managing Editor Hannah Atteberry, Publications Coordinator Barbara Donovan, Art Director Paul H. Schlesinger, Consultant
Editorial Advisory Board Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD William C. Bone, DDS Phillip M. Campbell, DDS, MSD Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Scott R. Makins, DDS, MS Daniel Perez, DDS William F. Wathen, DMD Robert C. White, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS The Texas Dental Journal is a peer-reviewed publication. Texas Dental Association 1946 S IH-35 Ste 400, Austin, TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 Email: tda@tda.org • Website: www.tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly (one issue will be a directory issue), by the Texas Dental Association, 1946 S IH-35, Austin, TX, 78704-3698, 512-443-3675. Periodicals Postage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35, Austin, TX 78704. Copyright 2015 Texas Dental Asociation. All rights reserved. Annual subscriptions: Texas Dental Association members $17. In-state ADA Affiliated $49.50 + tax, Out-of-state ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affiliated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 NonADA Affiliated. For in-state orders, add 8.25% sales tax. Contributions: Manuscripts and news items of interest to the membership of the society are solicited. Electronic submissions are required. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. For more information, please refer to the Instructions for Contributors statement on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles. Advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of the quality of value of such product or of the claims made of it by its manufacturer.
Association of Dental Editors and Journalists.
PRESIDENT Rita M. Cammarata, DDS 713-666-7884, rmcdds@sbcglobal.net PRESIDENT-ELECT Jose “Joey” L. Cazares, DDS 956-686-5000, cazaresdds@sbcglobal.net IMMEDIATE PAST PRESIDENT Craig S. Armstrong, DDS 832-251-1234, drarmstrong01@gmail.com VICE PRESIDENT, NORTHEAST Dennis E. Stansbury, DDS 903-561-1122, drstansbury@gmail.com VICE PRESIDENT, SOUTHEAST Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net VICE PRESIDENT, SOUTHWEST Vivian A. Teegardin, DDS 956-428-8884, vteegardin@yahoo.com VICE PRESIDENT, NORTHWEST W. Kurt Loveless, DDS 806-797-0341, wklovedds@gmail.com SENIOR DIRECTOR, NORTHEAST Jacqueline M. Plemons, DDS 214-369-8585, drplemons@yahoo.com SENIOR DIRECTOR, SOUTHEAST Lance V. Sanders, DDS 512-345-4334, lvzplace@sbcglobal.net SENIOR DIRECTOR, SOUTHWEST Victoria A. Vickers, DDS 210-349-4424, vickersdds@mastersdentalgroup.com SENIOR DIRECTOR, NORTHWEST Scott A. Morse, DDS 817-277-5341, drmorse@sbcglobal.net DIRECTOR, NORTHEAST Debrah J. Worsham, DDS 936-598-2626, worshamdds@sbcglobal.net DIRECTOR, SOUTHEAST Victor Rodriguez, DDS 281-280-0380, vicrod@yahoo.com DIRECTOR, SOUTHWEST Delton D. Yarbrough II, DDS 432-336-8574, delton.yarbrough@gmail.com DIRECTOR, NORTHWEST Ron Lee, DDS 817-545-2144, drr.lee@sbcglobal.net SECRETARY-TREASURER* Cody W. Graves, DDS 325-648-2251, drc@centex.net SPEAKER OF THE HOUSE* John W. Baucum III, DDS 361-855-3900, jbaucum3@gmail.com PARLIAMENTARIAN** Gregory W. Rashall, DDS 936-336-5171, rashdent@sbcglobal.net EDITOR** Daniel L. Jones, DDS, PhD 214-828-8350, djones@bcd.tamhsc.edu *Non-voting member **Non-member attendee
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ORAL
and maxillofacial pathology
Clinical History A 24-year-old African American male presented to an oral and maxillofacial surgeon with a complaint of a recurrent swelling of the left maxilla. He
case of the month
Ashley N. Clark, DDS, FAAOMP, DABOMP, Department of
had a similar mass in the area surgically removed approximately 3 years
Diagnostic and
ago; he was told at that time the lesion was not cancer. The patient stated
Biomedical Sciences, University
that he did not know the exact diagnosis and was not warned of possible
of Texas School of Dentistry at
recurrence. He reported noticing the recurrent swelling in the same area two years ago but did not seek treatment because he was asymptomatic and was attending school. The patient decided to seek treatment when he began feeling pain associated with the lesion, which occurred approximately
Houston. Laith Mahmood, DDS, MD,
2 months prior to the appointment. The patient complained tooth number
Parkway Oral
14 was mobile and he noticed bleeding while brushing the area. Intraoral
Surgery and
examination showed a 4x2 cm mucosal-colored, ulcerated mass of the
Implant Center,
left posterior maxilla (Figures 1,2). Cone beam CT scanning revealed a multilocular radiolucent lesion causing significant buccal expansion with perforation, as illustrated in Figures 3-6.
Houston, Texas Afshan Kaviani, DDS, Kaviani
Surgical exploration revealed a white, gelatinous mass with a tenacious
Family Dental,
texture. An incisional biopsy was performed. Histopathologic examination
Houston, Texas
of the specimen revealed the expansile mass was comprised almost exclusively of a loose myxoid stroma with few collagen fibrils and haphazardly scattered spindle-shaped and round cells in moderate numbers, as noted in Figures 7 and 8. Epithelium was not found. Additionally, portions of the neoplasm were heavily infiltrated by
Jerry E. Bouquot, DDS, MSD, FAAOMP, DABOMP,
lymphocytes, plasma cells, and neutrophils (Figure 9). By far, the most
FICD, FACD,
conspicuous aspect of the submitted specimen was the loose myxoid stroma
Department
without the presence of epithelium.
of Diagnostic and Biomedical
What is the final diagnosis? See page 378 for the diagnosis and discussion.
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TDA Journal | Vol 133 | No. 6
Sciences, University of Texas School of Dentistry at Houston.
Figure 1. A large, erythematous and ulcerated mass occupying the maxillary buccal vestibule.
Figure 2. Occlusal view of the lesion, which is approximately 3 centimeters in greatest diameter.
L
Figure 3. Radiographic image showing a large, expansile intraosseous mass which has bulged into the sinus and appears to have several areas of perforation in the thinned cortex.
Figure 4. Radiographic image showing a multilocular radiolucency with facial and palatal expansion and cortical thinning, possible perforation. An incidental finding of torus palatinus is also visible.
Figure 6. 3-Dimensional reconstruction of the lesional bone destruction shows no resorption of the molar roots. Figure 5. Cone beam computed tomography taken of the area showing a large mass of the left maxilla.
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Figure 7. Low-power view showing a loose, slightly myxoid stroma with moderate cellularity.
Figure 8. High-power view showing spindle-shaped and round cells within the stroma in a haphazard arrangement.
Figure 9. Medium-power view showing the dense inflammatory cell infiltrate composed primarily of lymphocytes and neutrophils. Plasma cells and scattered eosinophils were noted elsewhere within the lesion.
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Photo by Goen South Events
146th Annual Session of the Texas Dental Association
Address to the Texas Dental Association House of Delegates—May 6, 2016 Craig S. Armstrong, DDS Texas Dental Association President
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Mr Speaker, Members of the House of Delegates, Officers, Past President and Guests: Good Morning! Five flat tires, 2 bent rims, countless thunderstorms, multiple delayed flights, over 35,000 traveled miles and 1 wedding later, here we are together once again. It’s been an extremely busy year! It seems hard to believe that it has been a year ago that I stood before you here in San Antonio and presented my vision for our beloved TDA. In my speech I issued a challenge to all of us‌to not let adversity define us but instead to let adversity be the impetus for change. I challenged us to renew our focus on membership, the very lifeblood of our organization. To focus on membership, specifically on marketing, diversity and retention. To stop talking about what we needed to do and simply get it done.
By all accounts, the 84th was one of the Texas Dental Associations finest moments. Because of the efforts of CLRA, our lobby team and you, our grassroots membership, we were able to pass legislation favorable to dentistry and defeat that legislation that
Photo by Goen South Events
sought to harm our profession.
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This time last year we were anxiously awaiting the end of the 84th legislative session. A session that had been painted by our lobby team as one that could be a “tipping point” for the Texas Dental Association. A session dealing with topics that included the unwarranted expansion of the scope of practice, coordination of insurance benefits and tax relief for dentists just to name a few. By all accounts, the 84th was one of the Texas Dental Association’s finest moments. Because of the efforts of CLRA, our lobby team and you, our grassroots membership, we were able to pass legislation favorable to dentistry and defeat that legislation that sought to harm our profession. Soon after the end of the legislative session your TDA Board rolled up its sleeves and got to work.
For the teambuilding event, the Board was divided into 3 teams with the goal of working as a team to complete the task of assembling 3 bicycles that eventually would be given to the Boys and Girls Club of Austin. Each group was given various tasks to be completed, and as they were completed, the group was awarded a bicycle part. The group that completed the task in the least amount of time was given extra accessories or “bling” that would enhance the look of their bicycle once assembled. Once all the bicycle parts were obtained, the group had to then direct a blindfolded team member to assemble the bicycle. The group had to come up with a marketing plan and present their finished product
to a Shark Tank panel consisting of some pretty intimidating sharks, which included some of very own TDA employees and our executive directors’ daughter Ellie, who served as a surprise panelist. It was a whole lot of fun. I know you will find this hard to believe but dentists are a very competitive group, and that became abundantly clear from this event. Competition aside, the most important result of this exercise was that the board left as a cohesive group ready to get down to the business of the TDA. Following the Board meeting, we held our leadership conference, “LeadTDA: Focus on the Next Generation.” Leaders from across the state were invited to attend and for the first time, the TDA sponsored several new dentists from across the state in order get their input and engage them in organized dentistry.
Photo by Goen South Events
Knowing that this year was going to be a challenging year for the Board, one in which we all needed
to be rowing together to get our ship headed in the right direction, I felt that a team building event was in order and was the appropriate way to kick off our year together.
ADA President Dr Carol Summerhays presents Dr Armstrong with an award for his year of service.
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Photo by Goen South Events
Our featured speaker was Dr Russell Walker, an exciting speaker who serves as the academic director of the ADA’s Kellogg Executive Management Program. He highlighted some of the attributes and challenges of one of the fasting growing segments of our population, the Millennial. This is an important group, a group that we must embrace going forward in order to be successful. Dr Walker shared with us the types of things associations must do to attract and retain members of this group. This is something the TDA has committed an enormous amount of time, energy and resources to; something which, we are hopeful, will pay huge dividends in the future. While we have embarked upon this journey to engage the Millennial, this cannot happen without making some bold and perhaps uncomfortable changes. To that end, I would like to thank the members of the Task Force on Governance for their report and the recommendations that they brought forth, which are in your House book for consideration during the reference committees. I issued a challenge to the chair of this task force, Dr Rashall, to bring us something that would make us feel a little uncomfortable.
Last year I challenged us to be bold in our vision and stop just talking about making change and actually do something about it. I hope this House will look at the recommendations that this hard working group of young leaders has brought forth and make the right decisions.
Well, when you read the recommendations that they brought forward I think you will agree that they accomplished their goal. Last year I challenged us to be bold in our vision and stop just talking about making change and actually do something about it. I hope this House will look at the recommendations that this hard working group of young leaders has brought forth and make the right decisions. This year saw an increase in the anti-fluoridation movement not only nationally but here in the state of Texas. As a result the Board felt it was time for the TDA to have a standing committee of the Board whose sole function was to monitor
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and to respond to the increase in the anti-fluoridation movement here in Texas, hence, the Community Fluoride Committee was established. In past years, the Council on Dental Economics shouldered the responsibility of handling fluoride issues as they arose, leaving little time to focus on its other duties. Dr Delton Yarbrough chairs this new Committee. To let you know, as a former chair of the Council on Dental Economics and longtime consultant to CODE, Dr Yarbrough has been a one-man show in dealing with fluoride issues in Texas. So thank you Dr Yarbrough for your years of service on CODE and now as chair of this new committee. This year presented many difficult financial decisions for consideration by your TDA Board. While there was lively discussion at times, this Board came together and showed that it was willing to do what was needed to take the TDA to that place that we all knew it could go. Sound decisions were made, not on the basis of what had been done in the past or with regard to divisional representation on the Board, but what was best for TDA. I applaud their efforts. The way meetings were conducted changed; many of our councils and committees conducted their business via electronic means instead of face to face in Austin. Other previously held meetings were eliminated, and as you can imagine these were difficult decisions but decisions that were made by this Board, serving as good financial stewards of the finances of the TDA. Whenever the Board made a decision, the financial implications were analyzed and if we could not afford it, the Board reconsidered it.
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There was an ownership by this Board that I had not witnessed previously. This year, while revenues came in a little under our projections, your Board of Directors, making tough financial decisions, was able to end the year with revenue over expenses of approximately $139,000. This did not happen without great consternation and planning. I would like to take this opportunity to thank our new Secretary Treasurer, Dr Cody Graves, for stepping up and getting the job done. The knowledge he brings to TDA has proven to be a tremendous asset for us. Thank you, Dr Graves. His knowledge, combined with the ability to work closely and efficiently with Ms Dee Dee Delagarza and our Executive Director is one of the reasons we ended our fiscal year in the black. This year I am happy to report that we were able to launch 2 important strategic initiatives, addressing 2 important challenges facing the TDA. Membership and Communications. Let’s talk about membership first. Your Council on Membership has been hard at work this year under the steady leadership of Dr Jodi Danna. Dr Danna and her council prepared a Members Dues Survey. The Council prepared questions designed to solicit member input on dues amounts, structure, and payment methods. The purpose of this survey was to collect information that will aid the Council on Membership in its study on the different dues categories and their effect on membership.
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In addition to everything else that is going on, there are 31 state agencies up for Sunset Review. One of those, as you all know, is the Texas State Board of Dental Examiners. While we navigate through the choppy waters of this process, our outside lobby team, along with help from Mr Jess Calvert and Ms Diane Rhodes, work tirelessly to ensure that TDA is well represented.
Another task this Council accomplished was the formulation and completion of a member value survey. The TDA in the past often assumed it knew what the rank and file member wanted and what they placed value on. Instead of assumptions we now have tangible data, data which will enable us to move forward with plans to provide and perhaps improve those benefits that our members place high importance on and change or eliminate those that have shown to be of low value. Last year I mentioned that for the first time ever, the TDA has set aside funds for a membership initiative. Funding for this initiative was designed to help component societies boost membership growth and retention, something we have been struggling with for years. The funds allocated were based on an application each component society submitted along with stated objectives and criteria and the ability to obtain the desired outcomes. These societies are expected to provide periodic progress reports along with a final report that details the execution of the program in order that other TDA component societies may benefit from the knowledge obtained. To date $28,000 has been distributed to 8 component societies for their local initiatives, with others still in the application process. This is an extremely exciting time for the TDA and the information that we will obtain will be invaluable in the acquisition and retention of new members. Will all of these initiatives be successful? No, but we need to be bold in our attempts to keep the TDA headed in the right direction and while there may be setbacks, we will
Dr Craig S. Armstrong (left) of Houston receives the official Past President’s Pin from past president Dr David A. Duncan at the Saturday morning past president’s breakfast.
learn from the knowledge gained. That being said I truly feel that we are properly aligned for success. Another initiative that was approved and launched this year was a Strategic Communications Initiative. Dr Jennifer Bone, Chair of the Committee on Communications, spearheaded this effort. For the first time ever the TDA has developed a Comprehensive Communications Plan. The central objective of the plan being that all TDA Communications will point to either 1. The value of TDA membership or 2. The importance of having dental care provided by a TDA member. Folks, this is huge! Never before have we had something of this nature that dovetails perfectly into the work
that Dr Danna and her Council on Membership are doing. In launching this outward facing brand awareness campaign, the Communications committee has already identified a small market in which to test its strategies. Tyler, Texas has been selected and will be the target market in which many different advertising methods will be employed. Methods that will be used include: conventional print advertising, the wrapping of busses, ads on bus stop benches and both streaming and conventional radio messages. With this outward brand awareness campaign, we hope to reach non-members and encourage them to become be a part of the TDA family. Again, I am so excited about the work that this committee is doing and the dividends that we will reap from its success. www.tda.org | June 2016
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“
Towards the end of my presidential year we saw a flurry of activity surrounding the State Board of Dental Examiners develop. We had Governor Abbott appointing 3 TDA members to the Board—Dr David Tillman from Fort Worth, Dr Jorge Quirch from Houston and Dr Bryan Henderson from Dallas. All great additions to the State Board. We also had a ruling from a federal judge in Austin, that dentists not practicing in one of the 9 ADA recognized specialties may advertise as “specialists” if certain conditions are met. In addition to everything else that is going on, there are 31 state agencies up for Sunset Review. One of those, as you all know, is the Texas State Board of Dental Examiners. While we navigate through the choppy waters of this process, our outside lobby team, along with help from Mr Jess Calvert and Ms Diane Rhodes, work tirelessly to ensure that TDA is well represented. We recognize that there will be challenges from the insurance industry and other outside forces that want to change the way you practice dentistry, but rest assured, the TDA will be there providing one of its most valuable member benefits, advocating for you the member. As I alluded to last year, a vision with as broad a scope as mine, cannot and will not, be completed in any one presidential year. That is certainly the case this year and that’s OK, for we have such a capable leader in our president elect, Dr Rita Cammarata. Dr Cammarata has a vision; she will take ownership and continue what we have started. In my heart I know the best days of the TDA are still ahead of us and Dr Cammarata is the right person to take us there.
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Last year I left you with a departing thought from the renowned American author and poet Maya Angelou. It was certainly fitting last year but it
means so much more to me today, and I would like to share it with you again. ‘Life is not measured by the number of breaths we take but by the moments that take our breath away.’ Serving as your president has been one of those moments.
A successful leader can only be successful by surrounding him or her self with the right people. I have been unbelievably fortunate this year to have the privilege of working with some amazing volunteer leaders, without you all, this year would have been impossible. I would like to thank all those that have volunteered and served on TDA committees and councils; you have truly made a difference and have been a big part of the success of the TDA this year. I would also like to personally thank the TDA Board, your professionalism, attention to detail and the friendships that we forged will never be forgotten. Thank you; it has been an honor to serve with you this year. In our dental offices our jobs would be impossible if not for the efforts of our outstanding dental team members. The same can be said of my time as president. It would have
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been impossible without the help from an amazing team. I would like to personally thank the exceptional TDA team for your support during my extended term as president. You all have been amazing and have made a job that sometimes felt overwhelming, doable, and made me look good in the process. I will be forever grateful. Last year I left you with a departing thought from the renowned American author and poet Maya Angelou. It was certainly fitting last year but it means so much more to me today, and I would like to share it with you again. “Life is not measured by the number of breaths we take but by the moments that take our breath away.” Serving as your president has been one of those moments. Thank you.
YOUR PATIENTS TRUST YOU. WHO CAN YOU TRUST? If you or a dental colleague are experiencing impairment due to substance use or mental illness, The Professional Recovery Network is here to provide support and an opportunity for confidential recovery.
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Visit us online www.txprn.com www.tda.org | June 2016 351
Trustee’s Address to the Texas Dental Association House of Delegates—May 8, 2016
Photo by Paul Schlesinger
Richard C. Black, DDS American Dental Association 15th District Trustee
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Thank you Mr Speaker, President Armstrong, honored guests, and all my colleagues gathered here as the House of Delegates. I have sat where you are sitting, preparing to spend important time with the policies of the Texas Dental Association. My comments today will be brief, as I know you have important work ahead of you over the next 2 days. I have had just a little experience up here addressing the House, first as your TDA president, and then as your CLRA chair. Now, I have a new responsibility that your 15th Delegation has entrusted to me, that of the office of 15th District Trustee. What a wonderful honor it is to be with you in that capacity! I follow in the footsteps of people that you have sent to the Board of our tripartite partner, the American Dental Association, who did the work of keeping our organization strong and able to serve our most important clients, our members. And, for the last twelve years, Drs Findley, Long, and Israelson have served you with distinction and have strived to do the right, and sometimes painful, thing. I salute all of Texas’s past Trustees, but especially those three that I have just named for their duty of care to bring the ADA into the 21st century and most importantly to be once again your trusted partner. It has not been an easy road, and of course there are new challenges today and as there will be in the future. Most of the word Trustee involves letters that spell “trust.” As your new Trustee, when it comes to this subject of trust, I don’t expect it to be given to me, frankly I expect to earn it. It is my personal goal that together, as member leaders, we can achieve new and even greater things for organized dentistry. I think Americans today have lost faith in who they
Oprah Winfrey said “We cannot become what we need to be by remaining who we are.” It is no longer possible for us “to remain who we are.” “Becoming who we need to be” in this rapidly changing economic climate means taking risks, embracing change, and being innovative.
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of dental practice. Licensure and portability for students and new dentists. Benefits that all members want and can use. Putting patients in all our members chairs. Having a national legislative policy presence in Washington. Increasing the number of our members. Dealing with new practice models. The work is challenging and demands engagement!
Photo by Paul Schlesinger
My responsibilities as your Trustee to the ADA Board are many and varied. They involve many strategic and operational duties, however the most important are these three;
have asked to do the hard work of governance. I think they crave serious leadership from their national leaders, just as our members from our home districts want and need our leadership today. I have no doubt that you all here in Texas are doing just that. As you all know, good leadership means making hard decisions, sometimes not the most popular, and sometimes controversial. Earlier in this House, and from our visiting ADA candidates, you have heard some of the issues and strategies for today on a national basis. They are relevant to all stages
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1. To have an understanding of strategic duties. That means to identify and select the strategic issues that the ADA should address, and set priorities for the strategic initiatives for the Association. Our organization has a vision for the future and it includes focusing our message to connect with individual members and potential members. It also includes simplifying and standardizing how each level of the ADA operates and interacts with members actively and in the best interest of the member rather than the organization. 2. To have a firm grasp on our governance issues. That means to continuously ask what we know right now, today, about the current realities and evolving dynamics of the members’ marketplace and make sure the capacity and core
capability is there for them. The culture change that the ADA must continue is member over organization. 3. To be the best Ambassador for you that I can be. That means engaging in ongoing dialogue with everybody in organized dentistry. To know the pulse of our rank and file members (what’s keeping them up at night; what do they think about various issues) and to transmit those cares and concerns back to the ADA. We cannot solve all of our problems alone. We have to work together as a dynamic local, state and national organization. The opposite is a leadership vacuum, an absence of new ideas, and a resistance to change. I want to be a part of processes that brings some risks to the status quo, but in doing so to help us all to be living and thriving in our great profession. The business of the ADA comes down really to these core issues. The ADA is dedicated to serving our members; protecting and promoting the health of the public; operating with integrity; following the best available scientific evidence; and pursuing excellence in all areas. I am pleased to serve as a permanent member of three important committees of the Board. They are Budget and Finance, Information Technology, and Business Innovation. Service on these committees puts me in an excellent position to achieve those goals that I have just talked about.
Most importantly today, I am here to make a compact, a covenant if you will, between all of us. I am asking for you to understand service on a national level means great diversity of ideas and solutions. I am asking you to help the Tripartite to function as a unified team of equals in what is best for all our members. I am asking for you to help me identify smart leaders here in Texas that can be appointed to councils and commissions to further our association. I am also asking for your great ideas as well as your honest communication with me when there are issues that we can solve together. In return I promise to always be as transparent with you about our world of organized dentistry that I am legally able to share with you. I will be available and I will be responsible. I will agree to engage in difficult discussions and agree to disagree respectfully, however, I will always engage in open communication that is supported by factual information. I also pledge to you that I will always remember where I have come from, the great organization that is the Texas Dental Association. If you have not met me, please take the time to talk with me about important issues anytime! As many of you know, I admire Oprah Winfrey as a person who had an extremely difficult life on her way to becoming who she is today. On several occasions you have heard me quote her. She said, “We cannot become what we need to be by
remaining who we are.” It is no longer possible for us “to remain who we are.” “Becoming who we need to be” in this rapidly changing economic climate means taking risks, embracing change, and being innovative. The ADA and the TDA both believe in putting our resources to work to help every member succeed. I hope I have made a case for that today. My thanks to this House for your time today, and to the Texas Dental Association for the opportunity to serve this great, grand organization, and the profession of dentistry. Thank you!
The ADA is dedicated to serving our members; protecting and promoting the health of the public; operating with integrity; following the best available scientific evidence; and pursuing excellence in all areas.
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146th Annual Session of the Texas Dental Association
Incoming President’s Address to the Texas Dental Association House of Delegates— May 8, 2016 Rita M. Cammarata, DDS Texas Dental Association President Mr Speaker, Board of Directors, Members of the House of Delegates and esteemed guests: Here we are. May 2016. It is indeed an honor to be inducted as your president today. It is an honor and a responsibility that I take seriously as we must continue to build on the momentum created by Craig Armstrong. Craig is not only a dear friend, but one of the great leaders TDA has been fortunate to have as time and time again, Craig has stepped up during difficult times and led us with commitment, passion, and vision. The past 16 months have not been easy but your leadership has not only put us on solid footing, it has given us renewed energy. For that, Craig, we thank you. Today, I humbly take this office as only the second female president in the history of the Texas Dental Association. This fact is only relevant in that it highlights the need to focus on the many “only’s” in our Association. For example, on the one hand, TDA is the only organization dedicated to protecting all of the dentists of this great state. On the other hand, according to the ADA, TDA only represents 57% of practicing dentists in Texas. Now that’s an “only” that should be getting all of our attention, because only 4 years ago, our market share was 67%. While there is good news in that our raw numbers are increasing with a current membership of 9,200 dentists, we are not yet close to including all of the approximately 13,500 dentists in Texas registered with the State Board.
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It is my belief and my most ardent appeal to all of you that the only successful path forward is through our commitment to a diverse, inclusive and proactive professional association. We need to spread the word that the “only� association that represents all Texas
All dentists need TDA. TDA needs all dentists.
Photo by Goen South Events
Photo by Paul Schlesinger
dentists is the TDA. Our message is clear:
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It is my belief and my most ardent appeal to all of you that the only successful path forward is through our commitment to a diverse, inclusive and proactive professional association. We need to spread the word that the “only” association that represents all Texas dentists is the TDA. Our message is clear: All dentists need TDA. TDA needs all dentists. We have all heard the famous quote: “Ask not what your country can do for you, but what you can do for your country.” And so I say to each of you, let us not ask what dentistry can do for us, but what can we do for dentistry. My dream is that all dentists in Texas seek out ways to serve our profession so that those that come after us will have the same great opportunities we do. Being a TDA member is not about what’s in it for me. It’s about having served someone other than myself. It’s about giving back and experiencing the fulfillment that comes from participation and from leadership. So today, I am asking you to askothers to join us in giving back to dentistry. Because if you ask, they won’t turn you down. Just as none of us turned down the opportunity to give back when we were asked. But only, and this is a big only, if you ask—if we ask! We have to ask. Each of us know dentists we see as an asset to our valued TDA and in asking them to join us, we show them believe in them and in our future. As we all know, it is not about reaching out to only young or new dentists. We must reach all dentists in Texas. Perhaps you can help by reaching out to a dentist in a different
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practice setting or to a dental school faculty member or to a dentist that has just relocated here. I plan to help by personally inviting female dentists from across the state as to participate in The Texas Women in Leadership Conference at our 2017 Texas Meeting. My hope is to give young women an opportunity to learn how to juggle all aspects of their life, so dentistry can find its place in the mix. Together we can make sure our message gets heard: All dentists need TDA. TDA needs all dentists. We have great leaders all across organized dentistry in Texas. It is important that together we encourage all of our members to consider leadership within TDA. We all have our own story of that important moment when a respected colleague reached out to us because they believed we would be an asset to our association. And look, here we all are! Not a one of you said “no.” In our own unique way, we are each an asset to the TDA, to our valued patients and to our profession. An equally important priority as membership is advocacy. Governmental affairs is and always will be a large and essential component of the TDA. In my opinion, it is one of the most critical services we provide at TDA—protecting our profession and all the patients across this state that entrust us with their oral health. Once again we are on the cusp of another legislative session and another sunset review of our State Board of Dental Examiners. These are times when in fact we are being asked. We are being asked to provide our time and our insight. We are being asked to share our unique perspective to ensure that Texas remains the best place in the country to practice
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dentistry. We each are being asked and I hope you will not turn down the opportunity to participate and to advocate. Governmental policy affects all of us. We each became a player in the political game when we were issued a dental license. We must be engaged in the process and now we are back to membership and why those market share numbers are so important. TDA has always been, and let me say, will always be, the only voice of dentistry in Texas that represents all Texas dentists. We have spent time this past year conducting a member survey to determine what our members want for their dues dollars. The survey results clearly indicate that our members want their membership in TDA to represent their commitment to being the best they can be in their chosen profession. To honor our members wishes, I have asked that all of our leaders from the different components of TDA make every effort to attend our Leadership Conference in June and it is my only charge for all of our councils and committees this coming year. In addition, we have asked viable component member growth programs from around the state to further develop initiatives that will increase membership. This is one of the only times TDA has given back monies to component societies to fund programs to grow their member base. Success will come not only from funding these programs; but also from each of us asking our peers to join. People are more likely to become a member when asked to join by someone they look up to. So, if you are in this room today you are the leader others are looking to; ask
Photo by Goen South Events Photo by Goen South Events
Dr Cammarata’s associate doctors and staff. Back Row: Dr Adam Shisler, Ana Sanchez, Jessica Alba, Dr Rita Cammarata, Angela Aquil, RDH, Vilma Saravia, Yeraldin Morales. Front Row: Migdalia Gonzalez, Mary Fitzgerald, Jessica Fitzgerald, Yuditth Garcia, Dr Brenden Taylor.
Dr Cammarata’s family. Back Row: Vincent Snyder, Jackson Snyder, Dr Rita Cammarata, Dottie Maggio, Christian Snyder, Jacob Snyder Front Row: Tracy Snyder, Donald Snyder, Cole Snyder, Mattie Snyder, Connor Snyder, Casey Snyder
them to join, chances are they won’t turn you down. Their thoughts are important and we need to hear what they have to say to see if we can address their needs and continue to make TDA a desirable commitment for them to make. Some only need to be asked.
I plan to do so. I plan to ask and ask again. And, I will start with asking you. You are the TDA. You are the Voice of Dentistry in Texas.
Because: All dentists need TDA. TDA needs all dentists. My thanks to you all.
Ask others to add their voice to ours. For TDA. For our patients. For our profession. www.tda.org | June 2016
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In MEMORIAM Those in the dental community who have recently passed
Eugene W Brock Wichita Falls, Texas February 18, 1923–April 26, 2016 Good Fellow: 1974 Life: 1988 Fifty Year: 2000
MEMORIAL and HONORARIUM Donors to the Texas Dental Association Smiles Foundation
IN MEMORY OF: Dr Stacey Michelle Carawan West Len & Genevieve Sheets First Street Church of Christ Karen Mader
James Norman Cunningham
Rudolph & Freda Kenney
Menard, Texas March 22, 1929–May 3, 2016 Good Fellow: 1988 Life: 1994 Fifty Year: 2012
Michael & Brenda DeBons
John Warren Hart Texas City, Texas October 11, 1924–May 12, 2016 Life: 1989 Fifty Year: 2001
Myles & Sheryl Frische Annchen Knodt
Dr Hershall B Leinneweber Baylor Class of 1971
Lloyd McDaniel Dr Jean Bainbridge
Sterling R Schow Dallas, Texas September 14, 1941–May 14, 2016 Good Fellow: 2013
James D Wester Lindale, Texas August 3, 1923–April 21, 2016 Good Fellow: 1972 Life: 1988 Fifty Year: 1998
Your memorial contribution supports: • educating the public and profession about oral health; and • improving access to dental care for the people of Texas. Please make your check payable to: TDA Smiles Foundation, 1946 S IH 35, Austin, TX 78704
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Dental care in Texas: An opportunity for implementing a comprehensive and patient-centric approach with special emphasis on cancer patients and survivors Irene TamĂ-Maury, DMD, MSc, DrPH Aditya J. Wagh, BDS Nathalie E. Abou Khalil Ellen R. Gritz, PhD Mark S. Chambers, DMD, MS
Introduction Many chronic conditions have intra-oral manifestations. Diseases like HIV-AIDS, diabetes, herpes infection, leukemia and others present various intra-oral pathologies (1-4). About 40% of patients who undergo cancer treatment may also be affected by certain adverse oral changes (5). Some of the common oral complications that may arise throughout and following cancer treatment are oral mucositis, fungal infections, xerostomia, and mandibular osteoradionecrosis (6).
Abstract OBJECTIVE: To examine practices of dentists in Texas providing dental/oral care to cancer patients. METHOD: Dental providers in Texas were invited via email to participate in an exploratory cross-sectional study. A non-probability voluntary convenience sampling procedure was used to recruit the sample. The online, anonymous, self-reported survey included questions to capture demographics, type of dental practice, services provided, and number of cancer patients. The study was approved by the Institutional Review Board of The University of Texas MD Anderson Cancer Center. RESULT: A total of 655 dentists completed the questionnaire items. Results revealed that 62% of the respondents were 51-65 years old, predominantly (68%) male, Caucasian (81%) with their dental degrees awarded in the state of Texas (77%). 91% of the dentists provide dental care to patients who are currently undergoing cancer treatment or have a history of cancer. However, 80% of the dental providers do not teach oral self-exam to their patients, which may include cancer survivors or those undergoing cancer treatment, while 32% dentists do not deliver brief interventions for effectively motivating and assisting tobacco users to quit. CONCLUSION: Because Texas, especially Houston, is known for world-class cancer care, dentists in the state are more likely to provide dental care to oncologic patients, especially emergency dental procedures in cancer patients facing some of the side effects of cancer treatment. Careful monitoring of oral health and reducing tobacco use are especially important during and after cancer therapy to prevent, detect, and treat complications as soon as possible. A further step in oral care for cancer patients and survivors is to train patients how to perform regular oral self-examination and to provide tobacco users with cessation counseling as part of their dental/oral treatment. These simple but comprehensive approaches, along with regular dental visits, will positively impact the health-related outcomes for cancer patients, enhancing both survival and quality of life.
Keywords
dentist, cancer, tobacco, oral screening, quality of life
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Various factors can lead to these oral ailments including tobacco consumption. In the developed world, tobacco is considered as a leading cause of preventable illness and mortality. It is known that tobacco consumption is the leading cause of cancer. It is also the primary cause of many adverse oral conditions such as halitosis, teeth discoloration, dysgeusia, gingivitis, periodontitis, oral precancerous conditions (eg leukoplakias and erythroplakias) as well as oral cancer (7,8). Compared to those who quit smoking, patients who continue using tobacco products during or after dental therapy experience unfavorable treatment outcomes, greater complications and comorbidity, reduction in survival rates and deterioration in overall quality of life (9,10). These adverse effects can be prevented or reduced by implementing tertiary prevention techniques which include smoking and tobacco cessation, reduction in alcohol consumption along with regular cancer screening (11). Comprehensive examination of the oral cavity is an essential component of a regular dental visit. During this intraoral screening examination, dental care professionals perform an evaluation of the oral hard and soft tissues and conduct head and neck palpation, allowing early identification of any intraoral pathology (12). Additionally, dental providers have the opportunity to educate their patients about oral selfexamination, which may help them to identify whether there is any suspicious lesion in the mouth, pain in the teeth and gums, or discomfort in the head and neck or oral region. Such teaching of oral self-examination to patients can provide an effective means to create awareness about identifying oral cancer and other lesions in early stages (12,13). However, it is not known whether regular oral selfexamination is being taught and encouraged by dentists to their patients, who are at high risk of developing oral conditions associated with various diseases and cancer treatment (8). Studies in the United States have shown that some dentists reported failing to provide information about oral diseases, including oral cancer, due to paucity of time; other
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About the Authors Irene Tamí-Maury, DMD, MSc, DrPH, assistant professor, Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas Aditya J. Wagh, BDS, Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas Nathalie E. Abou Khalil, Cancer Prevention Trainee (undergraduate student), Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas Ellen R. Gritz, PhD, Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas Mark S. Chambers, DMD, MS, Department of Head and Neck, Oncology Dentistry Section, The University of Texas MD Anderson Cancer Center, Houston, Texas
Reprint requests: Irene Tamí-Maury, DMD, MSc, DrPH, Department of Behavioral Science–Unit 1330, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., CPB3.3202. Houston, Texas 77030; itami@ mdanderson.org; phone: 1-713-563-1264; fax: 1-713-794-4730 This research was supported in part by funds from the Texas Tobacco Settlement (Houston, Texas) for Dr Irene Tamí-Maury; by discretionary funds from Dr Mark Chambers (Houston, TX); by a cancer prevention fellowship for Nathalie Abou supported by the National Cancer Institute grant R25E CA056452-21A1, Shine Chang, PhD, Principal Investigator (Bethesda, Maryland); and by the National Institutes of Health MD Anderson Cancer Center Support Grant CA016672 (Bethesda, Maryland). The authors have no declared potential conflicts of financial interest, relationships and/or affiliations relevant to the subject matter or the materials discussed in the manuscript. This manuscript has been peer reviewed. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.
dentists indicated it is not important to provide such services while a few others reported not being paid for these services (14,15). Even more, for those cancer patients and survivors who are tobacco users, the dental office has proven to be an ideal setting to implement a tobaccocessation intervention, where a brief and simple protocol can be integrated by a team approach minimizing disruption in the practice routine. As members of the healthcare field, dental care professionals have a acknowledged responsibility to address tobacco related ailments (16).
Data Collection
Therefore, the purpose of this study is to examine practices of dentists in Texas providing dental/oral care to patients suffering from various chronic conditions including cancer.
Survey Measures
Methods Study Population
A non-probability voluntary convenience sampling procedure was used to recruit dental practitioners in the state of Texas for completion of an online, anonymous questionnaire. This cross-explanatory descriptive study was conducted from January 2013 to May 2013. The research team contacted 6,588 members of the Texas Dental Association (TDA) and 2,461 members of Texas Academy of General Dentistry (Texas AGD). The participating dentists were informed that completion of the survey provided authorization to partake in the study. The study was approved by the Institutional Review Board of The University of Texas MD Anderson Cancer Center.
An invitation email with the access link to the survey was distributed through email-blast, an electronic mailing. Two reminder emails were delivered to the potential respondents, who had open access to the survey for a period of four months, along with technical support via email or phone calls. The study’s data collection instrument was a self-administered, confidential, online questionnaire available on SurveyMonkey© platform. A small pretest was conducted with 10 dentists prior to the start of the study.
The data collection instrument (online survey) was designed by the research team and inquired about general demographic information, respondent’s smoking status (as well as use of other tobacco products), type of dental practice, services provided (including teaching oral self-examination to patients and delivery of brief tobacco cessation interventions), perceptions related to providing dental care to oncology patients, and willingness to attend oral oncology continuing education courses.
Compared to those who quit smoking, patients who continue using tobacco products during or after dental therapy experience unfavorable treatment outcomes, greater complications and comorbidity, reduction in survival rates and deterioration in overall quality of life
Statistical Analysis
Data was downloaded from the SurveyMonkey© platform as a Microsoft Excel file and transformed into a PASW database for analysis. The PASW Statistics 17© software package was used for the analysis. Study variables were summarized using standard descriptive statistics. The distributional characteristics of relevant variables were examined www.tda.org | June 2016
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Table 1. Descriptive characteristics of the dental professionals who participated in the study. Characteristics Age groups <21-30 31-40 41-50 51-65+ Gender Female Male Race/Ethnicity African-American Asian/Pacific Islander Hispanic/Latino Caucasian Other Degree(s) earned1 DMD/DDS or equivalent PhD/DrPH MS/MSD/MPH or equivalent Other (including any specialty training) Dental degree from an institution in Texas Other US state or territory International institution Interval since the last completed CE course in oral or general cancer Within the past 12 months 2-4 years 5 or more years Never taken a course Type of practice Private practice (solo) Group practice Academic practice Hospital-based practice Public health/government Rural practice2 Yes No Other Performs head and neck/oral exam Yes No Teaches oral self-exam to patients Yes No Delivers brief cessation interventions for assisting tobacco users to quit in practice3 Yes No Sees patients currently undergoing cancer treatment or who are cancer survivors3 Yes No
n (%) 42 (6%) 116 (18%) 89 (14%) 406 (62%) 209 (32%) 443 (68%) 16 (3%) 47 (7%) 46 (7%) 516 (81%) 12 (2%) 642 (98%) 3 (1%) 54 (8%) 65 (10%) 502 (77%) 128 (19%) 24 (4%) 198 (30%) 288 (44%) 108 (17%) 56 (9%) 429 (66%) 153 (23%) 31 (5%) 8 (1%) 30 (5%) 99 (15%) 550 (84%) 5 (1%) 580 (72%) 109 (19%) 128 (89%) 74 (11%) 432 (68%) 197 (32%) 574 (91%) 55 (9%)
Percentages do not add up to 100% due to overlapping of categories (this was a multiple choice question) 2 Rural practice was defined as any dental practice in those geographic areas located ten or more miles from a population center of 50,000 or more 3 Percentages do not add up to 100% due to missing data 1
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using box plots and histograms to ensure normality assumptions. Logistic regression analysis was conducted in order to identify factors related to teaching oral selfexamination to patients. A second logistic regression analysis was performed to examine the factor association with delivering brief tobacco cessation interventions. The independent variables considered in the models were age, advanced degree, place where degree was awarded, continuing education, type of practice, having a rural practice, and providing care to cancer patients.
Results Descriptive Statistics
A total of 655 dentists practicing in the state of Texas completed the online questionnaire. Of the respondents, 62% were 51-65 years old, 68% were male, 81% were Caucasian, and 77 % received their dental degree in Texas. The results revealed that 91% of the dental providers treat patients undergoing cancer therapy or with a history of cancer. However, a predominant portion of the participants (80%) reported that they do not teach oral self-examination to their patients and almost one third (32%) do not deliver tobacco cessation interventions in their practice.
Multivariable logistic regression analyses
Table 1 shows the results from the logistic regression analysis, which indicated that multiple factors play a significant role in the likelihood
Table 2. Characteristics associated with teaching oral self-exam to patients among dentists in Texas (only significant variables retained in the model are shown in the table).
Independent variable
Bivariate Analyses
Multivariate Analyses
Crude OR
Adj OR
95% CI
Dental degree Texas (ref) 1.00 1.00 Other US state 1.11 0.96 0.546-1.675 International 3.31 3.18 1.280-7.911 Continue education Never (ref) 1.00 1.00 Previous year 13.04 10.10 2.39-44.33 Within 2-4 year 5.48 5.11 1.188-21.97 â&#x2030;Ľ5 years 3.67 3.32 3.319-0.704 Type of practice Academia/Hospital/Gov. (ref) 1.00 1.00 Solo 0.50 0.45 0.257-0.785 Group 0.33 0.26 0.124-0.535 Seeing cancer patients No (ref) 1.00 1.00 Yes 2.64 2.92 1.065-8.030
p-value
0.875 <0.05
<0.01 <0.05 0.129
<0.01 <0.01
<0.01
Variables included in the model: age, advanced degree, place where degree was awarded, continue education, type of practice, having rural practice, treating cancer patients.
of teaching oral self-examination to patients. An international dental degree (adjusted odd ratio [OR adj] = 3.18; 95% confidence interval [Cl] = 1.280-7.911; p<0.05), continuing education in the previous year (OR adj = 10.10; CI = 2.39-44.33; p < 0.01), or within 2-4 years (OR adj = 5.11; CI = 1.188-21.97; p < 0.05), and seeing cancer patients (OR adj = 2.92; CI = 1.065-8.030; p < 0.01) are associated with greater odds. In
contrast, dentists practicing in solo (OR adj = 0.45; CI = 0.257-0.785; p < 0.01) or group practice (OR adj = 0.26; CI = 0.124-0.535; p < 0.01) are significantly less likely to teach oral self-examination than those who work in academia, hospital, or government settings. Table 2 presents the second logistic regression analysis, revealing a significant relationship between
continuing education and delivering brief interventions for effectively motivating and assisting tobacco users to quit. Practitioners who received education in the previous year (OR adj = 2.33; CI = 1.226-4.421; p < 0.05) or within the past 2-4 years (OR adj = 2.10; CI = 1.139-3.859; p < 0.05) are considerably more likely to deliver tobacco cessation interventions than those who never continued their education. www.tda.org | June 2016
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Discussion In our effort to further understand the practices of Texas dentists, we observed that although 91% of the participating Texas dentists provide care to cancer patients, the majority do not teach their patients oral self-exams, and many do not deliver tobacco cessation interventions. Our findings suggested multiple factors associated with teaching oral selfexams, such as international dental degree, continuing education (CE)
within the previous 4 years, type of practice, and treating cancer patients. A significant relationship was also found between delivering tobacco interventions and CE in the previous 4 years. Our findings correlate with previous studies’ emphasis on the influence of CE on dental providers’ cancer prevention practices and knowledge. Although there are no reports of the factors associated with teaching oral self-exam from prior studies in the United States, a study conducted
A majority of dentists fail to deliver tobacco intervention techniques and do not encourage oral self-exams to their patients who may be suffering of chronic conditions, such as cancer, where oral complications are often associated with cancer therapy and can be worsened by tobacco use.
with dentists in a western United States multistate practice group evaluated their knowledge of oral cancer early detection and thoroughness of oral examination performed by the dentists, reporting a significant association with recent CE17. Silverman Jr. et al reported similar observation and stated that CE courses have a positive impact on dentists’ attitudes and knowledge about oral cancer and its prevention (14). A study of the feasibility of oral selfexamination supported its viability as an early cancer detection method (18). Our findings indicated that although oral screening is performed by the majority of dentists (89%), most providers (80%) do not teach oral self-exams to their patients. A study conducted in New York in 2005 also found a deficiency in providing oral cancer risk behavioral counselling, as only 12% of the participating dentists reported delivering tobacco cessation interventions (19). It was also observed that some dentists feel unprepared or lack formal training in cessation counselling (20). A study in the United States found that CE courses are overall beneficial for dentists as they modify the behavioral approach of these health care professionals towards oral cancer, including tobacco prevention and control (14,21). The study’s limitations to be considered when interpreting the findings include a low response rate of 7.2%, which is lower than
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Table 3. Characteristics associated with delivering brief interventions for effectively motivating and assisting tobacco users to quit among dentists in Texas (only significant variables retained in the model are shown in the table).
Independent variable
Bivariate Analyses
Multivariate Analyses
Crude OR
Adj OR
95% CI
Continue education Never (ref) 1.00 1.00 Previous year 2.36 2.33 1.226-4.421 Within 2-4 year 2.07 2.10 1.139-3.859 â&#x2030;Ľ5 years 1.44 1.42 0.717-2.791
p-value
<0.05 <0.05 0.317
Variables included in the model: age, advanced degree, place where degree was awarded, continue education, type of practice, treating cancer patients, having rural practice.
the response rates reported by other dental studies (25-55%) (17,19,21,22). This may be due to the online administration of the survey, as supposed to the higher response rates of paper surveys (23). However, it is possible that some study participants were members of both the TDA and the Texas AGD, as we were not able to cross-check the lists nor identified potential duplications among members of these professional associations. Therefore, a higher response rate is possible due to a smaller number in the denominator. The findings must be interpreted with caution as the sample of 655 respondents may not be representative of the total of 9,049 Texas dentists that were contacted. Although the questionnaire was conducted anonymously, its selfreported aspect may have affected
the results as respondents may have felt inclined to provide socially acceptable answers on their knowledge, awareness, and practices related to treating cancer patients and conducting tobacco cessation interventions, instead of reporting their actual perceptions and practices.
aspects for their members. A multidisciplinary approach through collaboration with patientsâ&#x20AC;&#x2122; physicians and understanding of oral oncology and prevention practices is essential to effectively provide care to patients suffering from chronic conditions including cancer and therapy oral complications.
Conclusion
ACKNOWLEDGMENT
A majority of dentists fail to deliver tobacco intervention techniques and do not encourage oral self-exams to their patients who may be suffering of chronic conditions, such as cancer, where oral complications are often associated with cancer therapy and can be worsened by tobacco use. Dental organizations and schools may organize continue dental education courses to address these 2 important
This research was supported in part by funds from the Texas Tobacco Settlement (Houston, Texas) for Dr Irene TamĂ-Maury; by discretionary funds from Dr. Mark Chambers (Houston, TX); by a cancer prevention fellowship for Nathalie Abou supported by the National Cancer Institute grant R25E CA05645221A1, Shine Chang, PhD, Principal Investigator (Bethesda, Maryland);
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and by the National Institutes of Health MD Anderson Cancer Center Support Grant CA016672 (Bethesda, Maryland). The authors want to express their gratitude to Judy Hong for providing help in the literature review and the design of the data abstraction instrument and to Diana Urbauer and Bryan Fellman for their assistance with the initial statistical analyses. Also, the authors want to thank the Texas Dental Association and the Texas Academy of General Dentistry for the support provided during data collection. REFERENCES 1. Reznik DA. Oral manifestations of HIV disease. Topics in HIV medicine: a publication of the International AIDS Society, USA. Dec-2006 Jan 2005;13(5):143148. 2. Al-Maskari AY, Al-Maskari MY, Al-Sudairy S. Oral Manifestations and Complications of Diabetes Mellitus: A review. Sultan Qaboos University medical journal. May 2011;11(2):179-186. 3. Gupta S, Sreenivasan V, Patil PB. Dental complications of herpes zoster: Two case reports and review of literature. Indian journal of dental research: official publication of Indian Society for Dental Research. Mar-Apr 2015;26(2):214-219.
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4. Elitsa G. Deliverska AK. Oral signs of leukemia and dental management—literature data and case report. Journal of IMAB —Annual Proceeding (Scientific Papers). 2013;19(4):388-391. 5. Saito H, Watanabe Y, Sato K, et al. Effects of professional oral health care on reducing the risk of chemotherapy-induced oral mucositis. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. Nov 2014;22(11):2935-2940. 6. Hancock PJ, Epstein JB, Sadler GR. Oral and dental management related to radiation therapy for head and neck cancer. Journal (Canadian Dental Association). Oct 2003;69(9):585-590. 7. Albert D, Ward A, Ahluwalia K, Sadowsky D. Addressing tobacco in managed care: a survey of dentists’ knowledge, attitudes, and behaviors. American journal of public health. Jun 2002;92(6):997-1001. 8. Ford P, Tran P, Keen B, Gartner C. Survey of Australian oral health practitioners and their smoking cessation practices. Australian dental journal. Mar 2015;60(1):43-51; quiz 128. 9. Tseng TS, Lin HY, Moody-Thomas S, Martin M, Chen T. Who tended to continue smoking after cancer diagnosis: the national health and nutrition examination survey 1999-2008. BMC public health. 2012;12:784.
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10. Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP. Successes and failures of the teachable moment: smoking cessation in cancer patients. Cancer. Jan 1 2006;106(1):17-27. 11. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. Dec 1 2005;23(34):8884-8893. 12. Elango KJ, Anandkrishnan N, Suresh A, Iyer SK, Ramaiyer SK, Kuriakose MA. Mouth self-examination to improve oral cancer awareness and early detection in a high-risk population. Oral oncology. Jul 2011;47(7):620-624. 13. Martins AM, Barreto SM, Santos-Neto PE, et al. Greater access to information on how to prevent oral cancer among elderly using primary health care. Ciencia & saude coletiva. Jul 2015;20(7):2239-2253. 14. Silverman Jr S, Kerr AR, Epstein JB. Oral and pharyngeal cancer control and early detection. Journal of Cancer Education. 2010;25(3):279-281.
15. Gajendra S, Cruz GD, Kumar JV. Oral cancer prevention and early detection: knowledge, practices, and opinions of oral health care providers in New York State. Journal of cancer education: the official journal of the American Association for Cancer Education. Fall 2006;21(3):157-162. 16. Carr AB, Ebbert J. Interventions for tobacco cessation in the dental setting. The Cochrane database of systematic reviews. 2012;6:CD005084. 17. LeHew CW, Epstein JB, Kaste LM, Choi YK. Assessing oral cancer early detection: clarifying dentists’ practices. Journal of public health dentistry. Spring 2010;70(2):93-100. 18. Mathew B, Sankaranarayanan R, Wesley R, Nair MK. Evaluation of mouth self-examination in the control of oral cancer. British journal of cancer. Feb 1995;71(2):397-399. 19. Cruz GD, Ostroff JS, Kumar JV, Gajendra S. Preventing and detecting oral cancer. Oral health care providers’ readiness to provide health behavior counseling and oral cancer examinations. Journal of the American Dental Association (1939). May 2005;136(5):594601; quiz 681-592.
20. Prakash P, Belek MG, Grimes B, et al. Dentists’ attitudes, behaviors, and barriers related to tobaccouse cessation in the dental setting. Journal of public health dentistry. 2013;73(2):94-102. 21. Coan L, Windsor LJ, Romito LM. Increasing Tobacco Intervention Strategies by Oral Health Practitioners in Indiana. Journal of dental hygiene: JDH / American Dental Hygienists’ Association. Jun 2015;89(3):190-201. 22. Saleh A, Kong YH, Vengu N, Badrudeen H, Zain RB, Cheong SC. Dentists’ perception of the role they play in early detection of oral cancer. Asian Pacific journal of cancer prevention: APJCP. 2014;15(1):229-237. 23. Nulty DD. The adequacy of response rates to online and paper surveys: What can be done? Assessment & Evaluation in Higher Education. 2008;33(3):301-314.
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Provided by TDA Perks Program
value for your
profession
Illustration by Freepik.com
STERILIZER MONITORING
How it should be done, and what to do if you get a positive test result By OSHA Review, Inc.
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W
hy monitor your
BIOLOGICAL MONITORING (SPORE TESTING)
sterilizer? To
Tests for Sterilization
verify infection
control, of course. Regular sterilizer monitoring—when properly implemented—is an important part of an effective
Biological monitoring—or spore testing—is the standard for assuring proper sterilization of dental instruments. Texas Administrative Code states that “sterilization equipment and its adequacy shall be tested and verified in accord with American Dental Association (ADA) recommendations.”
infection control program in a
ADA recommends that dental offices monitor sterilizers at least weekly with biological indicators.
dental office.
How does spore testing work?
But proper monitoring requires you and your team to understand and correctly implement the factors (a combination of process parameters) leading to successful sterilization. These components need to be in place to evaluate the conditions of the sterilizing process in your office, and your sterilizer’s
Biological indicators impregnated with highly-resistant, nonpathogenic bacterial spores test a sterilizer’s function. Specific spores (Geobacillus stearothermophilus for steam/chemical sterilizers, and Bacillus atrophaeus for dry heat sterilizers) are inoculated onto strips of specialized filter paper. This paper is packaged in a peel-open, glassine-paper pouch. (Glassine paper is permeable to sterilant, but resistant to moisture and air at ambient temperature and pressure.)
How should spore testing be conducted?
The glassine-bound spore strips should be placed according to the sterilizer manufacturer’s instructions. (Note that lot number and expiration date are printed on each glassine.) If there are no instructions, place the spore test strip within a wrapped set of instruments in the most difficult area to be sterilized—normally the lower front area of the sterilizer.
effectiveness.
It’s a good practice to place the strips in a different location of the sterilizer each week to help identify any “cold spots.”
We’ll cover two tools you
CHEMICAL INDICATORS
should be using in your office to monitor your sterilizer, and give you a few related and important tips.
Tests for procedural errors or inadequate physical conditions (for sterilization) Chemical indicators help assess physical conditions, and identify procedural errors. They let you know a package has been placed through a sterilization cycle. Correct readings don’t prove that sterilization occurred. However, incorrect readings can help identify a problem with the sterilization cycle. It’s recommended that your office includes chemical indicators in each load. www.tda.org | June 2016
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There are two types of chemical indicators: •
•
External chemical indicators: These change color when a specific parameter is reached, and should be applied to the outside of sterilization packages. Internal chemical indicators: These should be placed inside each package (next to the instruments) to ensure the sterilizing agent reached inside it.
NOTE: Aside from chemical indicators, physical parameters should also be checked by you and your staff. Gauges and displays on the sterilizer should be monitored for cycle time, temperature, and pressure. As with chemical indicators, though correct readings don’t verify sterilization, incorrect readings can help identify a problem with the sterilization cycle.
WHAT IF A SPORE TEST RESULT IS POSITIVE? A single positive spore test probably does not indicate sterilizer malfunction—especially if the process indicators demonstrate sterilizer effectiveness. But when improper sterilization does occur, common factors are: • • • • • • •
Chamber overload Excessive packaging material Inadequate exposure time Incorrect temperature/pressure settings Failure to preheat the sterilizer (if indicated) Interruption of the cycle Expired chemical solution (chemiclaves only)
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So what should you do if a process indicator turns positive (you receive a positive spore test result)? Follow these steps: • • • • •
Ensure the process indicator hasn’t expired. Ensure testing protocol was met. Check the sterilizer for obvious inconsistencies. Retest with the process indicator immediately. Contact your biological monitoring service immediately for assistance.
TDA Perks Program partner OSHA Review Inc.’s Spore Check System lets you know whether or not your sterilizer is working properly, week by week. The system costs $159 per sterilizer/year ($3.05 per test). OSHA Review’s in-house lab, fulltime microbiologist and years of experience deliver accurate results quickly, and can help you track down any problems. For more information regarding OSHA Review, call 800-5556248 and mention TDA Perks Program.
TDA Journal | Vol 133 | No. 6
General tips • All staff members who operate the sterilizer should receive training on proper sterilizer operation procedures and instrument processing techniques. • Your offic should perform general sterilizer maintenance: regular cleaning and checking of door gaskets, vents, and internal and external surfaces of the sterilizer. Follow the sterilizer manufacturer’s instructions.
CALENDAR OF EVENTS JULY2016
OCTOBER2016
9
20-24 The American Dental Association will host its annual convention in Denver, CO. For more information, visitada.org/en/meeting.
The TDA Smiles Foundation will hold a 14-chair, 1-day Texas Mission of Mercy in Brady, TX. For more information, please contact Missions Coordinator Sara Harney at TDASF, 1946 S IH 35 Ste 300, Austin, TX 78704; Phone: 512-448-2441; Email: sara@ tda.org.
SEPTEMBER2016 17
The TDA Smiles Foundation will hold a 14-chair, 1-day Texas Mission of Mercy in Childress, TX. For more information, please contact Missions Coordinator Sara Harney at TDASF, 1946 S IH 35 Ste 300, Austin, TX 78704; Phone: 512-448-2441; Email: sara@ tda.org.
28-29 Dentists Who Care will host its 20th Annual Charity Dental Conference at the South Padre Island Convention Center in South Padre Island, TX. For more information, please visit dentistswhocare.us/charity.asp.
THE TEXAS DENTAL JOURNALâ&#x20AC;&#x2122;S CALENDAR will include only meetings, symposia, etc., of statewide, national, and international interest to Texas dentists. Because of space limitations, individual continuing education courses will not be listed. Readers are directed to the monthly advertisements of courses that appear elsewhere in the Journal.
23-24 The Academy of General Dentistry will host its annual Lone Star Dental Conference at the Westin Austin at The Domain. For more event information, please contact education director Lindsey Robbins at Lindsey@tagd.org. Texas Academy of General Dentistry is located at 1016 La Posada Drive, Suite 200, Austin, TX 78752. Phone: 512-371-7144. Fax: 512-3717178. Website: www.tagd.org.
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ORAL
and maxillofacial pathology diagnosis and managementâ&#x20AC;&#x201D;from page 338
Odontogenic Myxoma Discussion The histopathologic diagnosis for this lesion was an odontogenic myxoma with secondary subacute inflammation. This lesion is benign but potentially aggressive. The inflammation noted in areas of the lesion is most likely the cause of the local pain as the myxoma is not a symptomatic neoplasm. The recurrence, size, and multilocular appearance with thinning of the overlying cortices are all frequent features of the odontogenic myxoma. With this clinical presentation, other lesions have to be taken into consideration. The differential diagnosis of a maxillary multilocular radiolucency in a patient of this age include several aggressive but benign lesions: 1) odontogenic keratocyst (OKC, keratocystic odontogenic tumor); 2) ameloblastoma; and 3) odontogenic myxoma. Additionally, the 4) central giant cell granuloma (CGCG) and 5) ameloblastic fibroma are included in the differential diagnosis as the initial lesion appears to have developed during the teen years. All of these, with the exception of the CGCG, are most often found in a more posterior location and primarily located in the mandibleâ&#x20AC;&#x201D;the CGCG tends to occur in the anterior mandible. The odontogenic keratocyst is much less expansile in its more typical mandibular third molar location. The ameloblastoma is usually seen in a somewhat older patient, but cases have been reported even in the first decade of life. Cortical perforation and secondary inflammation are quite unusual features of all of these lesions with the exception of the odontogenic keratocyst.
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It is widely believed that the odontogenic myxoma arises from the odontogenic ectomesenchyme, which, in turn, is derived from the neuroectoderm that creates most of the maxillofacial structures. This theory is supported by the fact that myxomas are not seen in the extragnathic skeleton. The average myxoma patient is between 25 and 30 years old, but they may occur at any age; there appears to be no sex predilection, although some studies have shown a slight female predominance. Though this lesion can occur in any part of the jaws, it occurs more commonly in the mandible when compared to the maxilla. These lesions are usually asymptomatic and may be only discovered via routine radiographic examination (1-3). In our case, the patient developed a rapid expansion of the maxilla, a pattern which is not uncommon for this neoplasm. The expansion is believed to be caused by accumulation of ground substance (4). As aforementioned, the myxoma typically presents as a multilocular radiolucency; however, some lesions present as a well-demarcated unilocular radiolucency. A unique radiographic feature, not obvious in our case, is the arrangement of thin trabeculae radiating internally from the border of the lesion at right angles (5-6). As was noted in our case, gross examination of the myxoma invariably shows a loose, gelatinous mass. The histopathology reveals a myxoid stroma with small to moderate numbers of haphazardly arranged, stellate-shaped, spindled, or round cells. Inert odontogenic rests may or may not be readily noticeable (7-8). It should be mentioned that some odontogenic myxomas have a less myxoid and more fibrotic appearance; some pathologists prefer to call these odontogenic fibromyxomas. Treatment for odontogenic myxomas varies according to size and ranges from curettage to resection. No matter the treatment, the patient should be re-evaluated for recurrences. Because they lack a capsule, myxomas are able to infiltrate extensively into surrounding marrow spaces despite their benign nature. Lesions of the posterior maxilla require more aggressive surgery. The recurrence rate is as high as 25% (9-10).
References 1. Simon ENM, Merkx MAW, Vuhahula E, et al: Odontogenic myxoma: a clinicopathological study of 33 cases, Int J Oral Maxillofac Surg 33: 333-337, 2004. 2. Kaffe I, Naor H, Buchner A: Clinical and radiological features of odontogenic myxoma of the jaws, Dentomaxillofac Radiol 26:299-303, 1997. 3. Noffke CEE, Raubenheimer EJ, Chabikuli NJ, et al: Odontogenic myxoma: review of the literature and report of 30 cases from South Africa, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:101-109, 2007. 4. Zhao M, Lu Y, Takata T, et al: Immunohistochemical and histochemical characterization of the mucosubstances of odontogenic myxoma: histogenesis and differentia diagnosis, Pathol Res Pract 195:391-397, 1999. 5. Friedrich RE, Scheuer HA, Fuhrmann A, et al: Radiographic findings of odontogenic myxomas on conventional radiographs, Anticancer Res 32:2173-2178, 2012. 6. Peltola J, Magnusson B, Happonen R-P, et al: Odontogenic myxoma – a radiographic study of 21 tumours, Br J Oral Maxillofac Surg 33:333-337, 2004. 7. Li T-J, Sun L-S, Luo H-Y: Odontogenic myxomas: a clinicopathologic study of 25 cases, Arch Pathol Lab Med 130: 17991806, 2006. 8. Martínez-Mataa G, Mosqueda-Taylorb A, Carlos-Bregnic R, et al: Odontogenic myxoma: Clinico-pathological, immunohistochemical and ultrastructural findings of a multicentric series, Oral Oncol 44(6):601-607, 2008. 9. Leiser Y, Abu-el-Naaj I, Peled M: Odontogenic myxoma – a case series and review of the surgical management, J Craniomaxillofac Surg 37:206-209, 2009. 10. Neville B, Damm D, Allen C, Chi A: Oral and Maxillofacial Pathology: 4th Ed. St. Louis: Elsevier, 2015:679-681.
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ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS AREA: 2 general dentistry practices available (1 practice in Dallas and 1 practice in Richardson); NORTH TEXAS: 1 general dentistry practice available. HOUSTON AREA: 2 general dentistry practice available (1 northeast of Houston and 1 southeast of Houston and 1 in Pearland); CORPUS CHRISTI AREA: 2 general dentistry practices available. EAST TEXAS AREA: 1 general dentistry practice available. WEST TEXAS AREA: 1 general practice available. BRYAN/ COLLEGE STATION AREA: 1 general dentistry practice available; SAN ANTONIO AREA: 1 general practice available; SOUTH TEXAS: 1 general dentistry practice available; SANTA FE, NEW MEXICO AREA: 1 general dentistry practice available. For more information and current listings, please visit our website at www.adstexas. com or call ADS Watson, Brown & Associates at 888-419-5531. ARGYLE: Dental practices for sale in Dallas, Richardson. Austin, Houston, San Antonio, Waco, Corpus Christi, College Station, East and West Texas. For more information, call 888-429-5531 or visit ADSTexas.com.
ADVERTISING BRIEF INFORMATION SUBMISSION AND CANCELLATION DEADLINE: 20th, 2 months prior to publication (eg, November 20th for January issue). MONTHLY RATES: First 30 words = $60 for ADA members; each additional word = $0.10. Ads must be submitted via e-mail, fax, or web through tda.org and are not accepted by phone. Journal editors reserve the right to edit copy of classified advertisements. Advertisements must be not quote revenues or gross or net incomes; only generic language referencing income will be accepted.
AMARILLO, ARLINGTON, DALLAS, FORT WORTH, SAN ANTONIO GENERAL/SPECIALTY PRACTICES FOR SALEâ&#x20AC;&#x201D;GARY CLINTON: DFW MID-CITIES PERIODONTIC PRACTICE (PE1): Retiring Doctor near hospital; long term staff. PARKER COUNTY (FW1): fast-growing general family practice. Doctor wishes to relocate to be near family. Well-established practice. Nice office building to lease or purchase. AMARILLO (A90): Family practice sale; established for 37 years; 5 operatories; digital. Over 40 new patients per month average in 4 days a week. Excellent recall; will transition. High visibility shopping center which faces major interstate. ARLINGTON MIDCITIES AREA (A97): Family restorative practice sale requiring very specifically and well-trained personable dentist; large high socioeconomic patient base. Long term excellent staff; 4 days a week. Hygiene profit covers all debt. Pampered patients are loyal; no marketing or PPOs. SAN ANTONIO (SA101): Solo dentist family practices. Two locations; mid to low socioeconomic patient base; Flexible transition. Over 30 years established practices. Doctor wishes to spend more time with family and to do mission filled dentistry. DALLAS AREA MID-CITIES (05176): Oral surgery practice for sale. Northwest Denton area. Seven year old practice in a very fast growing area; rated one of the best places to live in Texas. Fully digitally equipped 4 operatories. Cone Beam; high tech complete. Established referral base. Will transition; great staff. WEST CENTRAL TEXAS (07): Orthodontic practice for sale. High six figure practice. Retiring orthodontist will flex transition. Beautiful facility owned by doctor in high visibility location. WEST TEXAS (08): Oral surgery practice complete sale; doctor will; transition PRN. New building adjoining hospital. Seven figure gross. More patients than one can handle. Doctor will www.tda.org | June 2016
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ADVERTISING BRIEFS work as an associate. His profits will more than pay for the practice. Contact Gary Clinton (all kept confidential), Professional Certified Practice Appraisers, LLC. Senior Appraiser, transition, practice broker. 43 years of experience. My personal experience is extensive in this critical area of expertise. It is the most structurally complex business deal in which you will ever be involved. The appraisal sets the stage for a fair and balanced transaction. Comprehensive assetidentified certified appraisal. If not, it can be most costly to a buyer and/ or a seller and neither one is acceptable. For more information, please call Gary Clinton at 972-317-9756. AUSTIN, CORPUS CHRISTI, SAN ANTONIO & OTHER DDR DENTAL LISTINGS (See also HOUSTON for Houston Area DDR Dental listings): Contact Jim Dunn or Chrissy Dunn at 800930-8017. Visit www.DDRDental.com or for full details. AUSTIN (MOPAC AREA): DDR Dental. New listing. General practice, high-6 figure gross collections and high-6 figure net income. Highly sought after location. Very attractive and fully updated equipment and facility. Five operatories (3 dental and 2 hygiene in use) and 2 more plumbed, digital X-ray and paperless charts, 2,600 sq ft in retail center. Larger office that easily serves 2 dentists. Contact Jim Dunn or Chrissy Dunn at 800-930-8017 or Chrissy@DDRDental.com. Visit www.DDRDental. com for full practice details. CORPUS CHRISTI: DDR Dental. New listing. Great general practice with low 6-figure gross collection, so appropriately priced. Well established practice with high local reputation. Very well respected dentist retiring early to teach. Approx. 1,500 sq ft with great location, in high traffic area. Four fully equipped operatories (2 dentist/2 hygiene) with Adec chairs updated (2014) and a great patient
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base. Robust hygiene program with 2 full-time hygienists. Located in freestanding condominium that is available for purchase with practice. Contact Jim Dunn or Chrissy Dunn at 800-930-8017 or Chrissy@DDRDental.com. Visit www.DDRDental. com for full practice details. ODESSA: DDR Dental. Exceptional big-city general/ cosmetic practice with small town atmosphere and country club living. Great for raising family. High-6 figure gross collections and very high net income on only 3 day workweek. Excellent recall program and stable patient base. Over 2,000 sq ft using 4 operatories (2 dental and 2 hygiene), well maintained with latest equipment, digital X-ray and paperless charts. Contact Jim Dunn or Chrissy Dunn at 800-930-8017 or Chrissy@DDRDental. com. Visit www.DDRDental.com for full practice details. AUSTIN, SAN ANTONIO & SOUTH TEXAS AREA PRACTICE OPPORTUNITIES: McLerran & Associates. HILL COUNTRY WEST OF AUSTIN (ID #T304): This is an opportunity to purchase an established, turn-key practice located approximately an hour west of Austin in an iconic town in the heart of the Texas hill country. The practice boasts a large 100% fee-for-service patient base, healthy new patient flow and has realized a healthy revenue in each of the past 2 years. The turn-key facility has 4 equipped operatories (with the ability to add a 5th operatory), digital x-ray sensors, intraoral cameras, CAD/CAM, computers throughout the office and paperless charts. If you are looking for an excellent opportunity in the Texas hill country, this is the opportunity for you. AUSTIN (ID #T301): This is a rare opportunity to purchase an established, fee-for-service family practice located in the heart of an affluent community in Austin. The practice features a large fee-for-service patient base, consistent annual
ADVERTISING BRIEFS revenue, strong hygiene production, and solid cash flow. The turn-key facility features 5 operatories (4 fully equipped), high end finishes/decor, digital radiography (sensors and pano), and paperless charts. This opportunity won’t last long! NW OF AUSTIN (ID #T300): This is an opportunity to purchase an established pediatric dental practice with an excellent location in a rapidly growing community just 30 minutes Northwest of Austin. The practice features 6 equipped operatories (open bay with 4 chairs and 2 quiet rooms), a large patient base, health new patient flow, low overhead, and tremendous upside potential. You can purchase this established practice for less than the cost of a start-up. AUSTIN (ID #T297): The
owner doctor is seeking a motivated dentist to join this established, predominately fee-for-service general family practice initially as a part-time associate with a sale occurring no later than the summer of 2017. Details of the transition, including purchase price and closing date, will be agreed upon up front. The practice is located in an attractive free-standing building in an affluent area of NW Austin. The facility has 5 fully equipped operatories with 2 additional plumbed operatories, digital radiography, and computers throughout. The practice boasts a strong recall program, excellent cash flow, and solid upside potential given the lack of involvement in PPOs and amount of specialty work being referred out of the office.
DDR Dental Trust
Serving Texas Dentists for more than 40 Years
• Practice Appraisals • Practice Sales • Associate Agreements
800-930-8017
James L. Dunn, Trustee
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ADVERTISING BRIEFS For more information on this opportunity, please send a copy of your current CV to texas@dentalsales.com. AUSTIN (ID #T294): A busy, predominantly fee-for-service private practice in South Austin is searching for an experienced associate dentist to work 2.5-3 days per week. The doctor must be proficient in the following areas of practice: general dentistry, molar endo, implant placement, and oral surgery/wisdom teeth extraction. Please send us your CV or Resume if you are interested in exploring this opportunity. AUSTIN (ID #T293): If you are considering purchasing or starting an oral surgery practice in Austin, this is a must see opportunity! An established oral surgery practice with exceptional annual revenue is currently winding down their operations in anticipation of the two owners retiring from private practice in 2016. The sellers are currently in the process of consolidating their 2 location office into their state-of-the-art facility in south Austin, which is located in a beautiful office condo featuring high end finishes, 2 fully equipped treatment rooms, and a cone beam 3D X-ray unit. The practice and real estate are both being offered for sale. This is a unique and attractive opportunity for an oral surgeon to acquire an established practice with a significant revenue level, large referral base, and excellent facility for far less than the cost of starting a practice from scratch. AUSTIN (ID #T278): This is a unique opportunity to purchase a practice located in a busy retail center in Austin. The practice is ideal for a buyer looking for a large facility to establish a multiple doctor/ hygienist office for significantly less than the cost of starting a practice from scratch. The practice has a total of 18 plumbed operatories with 6 operatories currently equipped. Serious inquiries only, as this is a unique opportunity not suited for most solo practitioners. AUSTIN (ID #T271): If you are an endodontist, periodontist, or oral surgeon
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who is considering starting a practice or opening a satellite office in the Austin area, this opportunity is a must see. This turn-key dental office is located in a highly desirable area of Austin known as Westlake Hills. The facility is located in a high-end, professional condominium complex and features 3 fully equipped operatories (with 2 additional operatories available for expansion), high end finishes, computers throughout the office, and digital radiography. This is an excellent opportunity to start a practice or establish a satellite office for a fraction of the typical cost of doing a scratch start-up. KILLEEN/TEMPLE (ID #T292): This is an opportunity to purchase an established pediatric dental practice with an excellent location in a growing community approx. 1 hour north of Austin. The office is located in a beautiful 3,000 sq ft, free-standing building with good signage, ample parking, 5 fully equipped treatment rooms, and room for expansion. The practice is collecting 6 figures annually with the doctor working a parttime schedule, providing for tremendous opportunity for growth via increasing operating hours, implementing an external marketing plan, and developing new referral relationships. This is an excellent opportunity to purchase an established, turn-key practice (and the building) for far less than it would cost to start a practice from scratch. SAN ANTONIO (ID #T303): This general, family practice is located in a high traffic retail center in a town located just outside of the San Antonio area. The practice serves a mixed patient base (FFS, PPO and Medicaid) and realized an exceptional revenue in collections in 2015 with very strong net cash flow of over 50%. The newly built-out, 4 operatory office space is well-equipped with digital radiography, a panoramic/ceph digital X-ray machine, intraoral cameras, and computers throughout the office (with paperless charts). This is an excellent opportunity that wonâ&#x20AC;&#x2122;t last long!
ADVERTISING BRIEFS SAN ANTONIO (ID #T291): This established general dentistry practice is located in Northeast San Antonio and features a predominantly fee-forservice patient base, low overhead, consistent annual revenue of 6 figures, and strong upside potential. The newly built-out office space encompasses 1,950 sq ft and features 3 fullyequipped operatories (with room for expansion), computers throughout, digital X-ray units, digital pano, and intraoral cameras. You can purchase this established, turn-key practice for less than the cost of starting a practice from scratch! SAN ANTONIO (ID #T289): Located on San Antonioâ&#x20AC;&#x2122;s north central side of town, this general family practice boasts a newly remodeled office with 3 fully equipped operatories (and room for a fourth), FFS/PPO patient base, strong hygiene production, and consistent revenue of 6 figures over the past 2 years. This is an ideal opportunity for a motivated dentist looking to acquire a stand-alone or satellite location. SAN ANTONIO (ID #T288): This is an opportunity to purchase an established general dentistry practice with an excellent location in Northeast San Antonio within a busy retail development anchored by a Walmart. The facility features 5 fully-equipped operatories, digital radiography, digital Pano, and computers throughout. The practice realized annual revenue of mid-6 figures in 2013, but has experienced a decline in revenue over the past 2 years due to a reduction in operating hours. Take advantage of this opportunity to purchase a turn-key dental office with positive cash flow and tremendous growth potential at a much lower cost than starting a practice from scratch. SAN ANTONIO (ID #T285): This general family practice was established in 2008 in an affluent and desirable area of NW San Antonio and is located in a modern, turn-key facility with enough space to accommodate multiple doctors and hygienists. The
practice has a fee-for-service/PPO patient base that reflect the middle to upper-middle income demographics of the area. The practice is on pace to collect high-6 figures in 2015 and presents a new owner with solid upside potential given the location and size of the facility. The practice is priced at less than it would cost to build-out and equip the office. SOUTH OF SAN ANTONIO (ID #T235): This established general dentistry practice is located on a main thoroughfare in a quaint, rural town located approximately 90 miles southeast of San Antonio. This practice is in a high growth, low competition area in the Eagle Ford Formation. The practice has realized consistent annual 6 figure revenue over the past 2 years while maintaining low overhead, strong profitability of 50%, and solid new patient flow (currently averaging 27 new patients per month). The office space of the practice encompasses 1,200 sq ft and has 3 fully equipped operatories with digital x-ray units and computers (one additional plumbed operatory for expansion). The building is also being offered for sale. SOUTH TEXAS (ID #T283): This established oral surgery practice is located in an area of South Texas with low competition and an increasing population of general dentists, providing the buyer with a tremendous amount of upside potential. The practice boasts very high annual revenue and very strong net income. The seller is available for a transition and will personally introduce the buyer to his major referral sources. CORPUS CHRISTI (ID #T295): This general family practice is located in the growing coastal community of Corpus Christi. The practice features 4 fully-equipped operatories, serves a FFS/PPO patient base, and has realized annual revenue of 6 figures over the past few years on a limited schedule. The practice is poised for growth through expanding doctor hours, increasing marketing, and retaining specialty work currently being referred out by the seller. This is an www.tda.org | June 2016
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ADVERTISING BRIEFS excellent opportunity for a doctor looking to acquire a stand-alone or satellite practice for less than the cost of a start-up. Contact McLerran & Associates: David McLerran, Brannon Moncrief or Kristyn Wilkerson in Austin 512-900-7989 or San Antonio 210-737-0100. Practice appraisals, practice sales, transition consulting, partnership structuring, and lease negotiations. To request more information on our listings, please register at www.dental-sales.com or contact us via email at texas@dental-sales.com. AUSTIN: Pediatric dentist. Progressive pediatric dental practice in Austin is looking for an energetic pediatric dentist to join our team. We offer a comprehensive compensation package. New grads welcome to apply. Please email CV to dentalresume27@yahoo.com. CONROE/MONTGOMERY: General dentist, pediatric dentist and orthodontist needed for growing practices in Conroe and Montgomery. Practices treat all ages in a comfortable, modern setting with highly trained staff. We are looking for a dentist who excels at communication and is selfmotivated. Compensation depends on specialty and experience and includes an incentive program, 401k benefits and a uniform allowance. Email CV to tim@consolidated.net. CORPUS CHRISTI: General practice for sale. Mid-6 figure 20 hrs/wk. 5 ops. Great staff will stay. Priced right and doctor will help transition and owner finance. Email drmom210@gmail.com or call 361960-3928.
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CORPUS CHRISTI: Pediatric dentist needed for multi-discipline group practice. Nice environment, minimal responsibilities, high earning potential. Contact Dr Paul Kennedy 361-992-9500 office, or 361-960-6484 cell, or email pakjr68@gmail.com DALLAS: Oral surgery practice in well established 4 operatory practice in healthcare professional building available for purchase. Transition to be provided based on needs on successor. One surgical suite. Kodak digital. Mixed FFS and PPO. Implant and oral surgery blend. Contact Lewis Health Profession for more information. Info@ lewishealth.com or 972-437-1180. DALLAS, AUSTIN, HOUSTON, and SAN ANTONIO: Phase II Associates, LLC is your comprehensive resource for general/restorative and specialty dental practice sales, associateships, partnerships, mergers, and transitions consulting. We assist dentists with all phases of their dental careers. Restorative practices: Demand is high in Texas and practices are generally sold before they can be advertised. Please call us for current practice listings. DALLAS AREA: General dental practice emphasizing in restorative /cosmetic services for saleâ&#x20AC;&#x201D;FFS, 4 operatories, assignable lease, highly desired area. FORT WORTH AREA: OMS practice with 5 operatories, average revenues in high 6 figures, state-of-the-art technology! HOUSTON AREA: Endodontics practice with extremely high profit, low overhead, upscale office with 5 operatoriesâ&#x20AC;&#x201D;6th plumbed. HOUSTON SUBURB: Endodontics practice with extremely high revenues over the last 3 years, low overhead, 4 operatories, 2 additional plumbed for expansion, space and equipment new in 2011. To request more information on our listings, please register at www. phasetwoassociates.com or contact us via email at info@phasetwoassociates.com.
ADVERTISING BRIEFS EDINBURG: Falcon Dentistry PA, dba Falcon Dental Center seeks dentist in Edinburg. Doctor of Dental Surgery degree required. Texas dental license required. Qualified applications may submit resume directly to Atlantis Gloria Moya, office manager, via fax at 956-287-4926 or via email at falcondentistry@gmail.com. EL PASO: Full-time position for general dentist. Do not waste your best years at dead end jobs. Great earning potential and future partnership option. Affordable El Paso Dental is looking for a Texaslicensed dentist to work full-time in our office in El Paso. Applicant must be licensed in the state of Texas and have 1 year experience. If interested please submit a resume with an accurate contact number and email address to the following: mimi@drdarj.com. EL PASO: Moderate sized west side full-fee cosmetic and restorative practice, 4 treatment rooms in a professional building available for sale or lease. Motivated seller. Call 214-460-4468. FORT WORTH: Practice for sale in the fast growing Southwest area. Average gross; 6 operatories; Excellent lease. Seller is relocating. Need to move quickly on this one. DFW 214-503-9696. WATS 800-583-7765. GARLAND: Equipped dental office for lease. Downtown Garland. Dental office, 4 ops, chairs, pano, digital scanner, X-ray unit, etc. Available for immediate release. Please call 214-415-9096. GARLAND: We are currently searching for the right pediatric dental professional to join us in our beautiful state-of-the-art, brand new modern dental facility. We are specifically looking for a highly qualified skilled, caring pediatric dentist
to lease the pediatric suite in our building. The suite is 2,334 sq ft usable space and about 3,200 sq ft total space. In addition a conference room, common area, and waiting area are available for you and your patients in this 18,000 sq ft building. This facility has combined clinical and educational space for patient care, continued education seminars and workshops. The office is built directly on George Bush Highway. Has excellent visibility, ample parking, and is in a thriving area of town convenient to banks, restaurants, and shopping centers. We invite you to explore this opportunity as we search for a pediatric dentist to join our family of established specialists in the North Garland area. Contact Information: Dr Maheeb Jaouni, Firewheel Center for Dental Specialties, PH: 504-261-6969 Email: drjaouni@ firewheeldentalspecialties.com. HOUSTON AREA: DDR DENTAL LISTINGS (See also AUSTIN for other DDR Dental listings around Texas): Contact Jim Dunn or Chrissy Dunn at 800-930-8017. Visit www.DDRDental.com or for full details. HOUSTON: Clear Lake area. Established, expanding office looking for general practice associate / partner opportunity. Office has sufficient patient base to support a full-time doctor. Dentist should be proficient in all areas of dentistry with a positive attitude. Office is modern, state-of-the-art and fully staffed. Mostly fee for service and a few PPOs. Contact 281-488-2483. HOUSTON (HUMBLE-KINGWOOD AREA): DDR Dental. New listing. (Must sell quickly!) General practice with newly renovated facility. Experienced dentist providing comprehensive general dentistry but must retire early due to hand injury, so priced to sell quickly. Great patient flow with over 2,600 www.tda.org | June 2016
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ADVERTISING BRIEFS sq ft and room for expansion; 4 fully-equipped operatories (2 dental and 2 hygiene), very high collection ratio; robust hygiene program with 2 full-time hygienists; over 800 active recall patients with 45% of patients age 45 to 65. Draws from upper-end Kingwood community; at this location for over 18 years; Avg. 12 new patients per month on a 4-day work week (Mon-Thr) Owner moving but able to stay on after closing. Contact Jim Dunn or Chrissy Dunn at 800-930-8017 or Chrissy@ DDRDental.com. Visit www.DDRDental.com for full practice details. HOUSTON (CLEAR LAKE AREA): DDR Dental. New listing. General practice, medium 6-figure gross collections. Great location fronting a busy street with high visibility. Highly trained dentist at this location for over 15 years. Well established hygiene recall program. Practice occupies over 1,700 sq ft with 4 operatories (2 dental and 2 hygiene), reception, business, dentist office, a sterilization area/ lab area; Fully equipped with updated equipment; 3 additional operatories are plumbed but not in use for further expansion; digital X-rays and practice software. Building also available for purchase or attractive triple-net lease. Very active recall program with over 600 active patients and favorable ages with 45% age 51 to 70. Draw from affluent local neighborhoods seeing 10 new patients per month on only a 3 day workweek (Mon-Wed). At this location for over 30 years. Contact Jim Dunn or Chrissy Dunn at 800-930-8017 or Chrissy@DDRDental.com. Visit www.DDRDental. com for full practice details. ROSENBERG-RICHMOND (Sugar Land Area): DDR Dental: New listing. Great general practice; larger but very well-designed flow with 12 fully equipped operatories (7 dental and 5 hygiene) and room for expansion; 7 figure gross and high net income; fully renovated facility and updated equipment
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(in 2008); fully digital X-ray and Pano. Experienced dentist providing comprehensive general dentistry. Great patient flow with over 3,300 sq ft and room for expansion; very high collection ratio; robust hygiene program with 2.5 hygienists; over 1,200 active recall patients with 50% of patients age 40 to 65. Draws from upper-end Sugarland and Katy communities; at this location for over 35 years; Avg. 15 new patients per month on a 5-day workweek (Mon-Fri). Owner available as associate after closing. Building may be available for purchase or attractive triple-net lease. Contact Jim Dunn or Chrissy Dunn at 800-930-8017 or Chrissy@DDRDental.com. Visit www.DDRDental. com for full practice details. HOUSTON (MEMORIAL AREA): Practice for sale. Established 3 operatory, fee-for-service practice near expanding city center area. Annual gross in mid-6 figures, on a two and a half day week. Exceptionally low rent and overhead. Dentist/ owner leaving to take a teaching position at UT. If interested leave message at: jacksbyte@sbcglobal. net. HOUSTON/KINGWOOD: Orthodontist retiring. Short associateship leading to sale of practice and 3,400 sq ft building. Text: 713-898-9013. HOUSTON: Great opportunity for specialist. An endodontic practice in southwest Houston is seeking to share space with a part or full time periodontist, oral surgeon or orthodontist in a state of the art dental office. Four operatories fully equipped with digital X-rays and microscope. For more information, contact 713-932-1913. HUMBLE: Carus Dental, established in 1983 in Austin, has always been committed to the
ADVERTISING BRIEFS traditional doctor-patient relationship and to the highest quality in dental care and service. We currently have 55 doctors on staff across our 21 practices in Austin, Houston and central Texas. We offer dental services in general dentistry, oral surgery, orthodontics, pediatric dentistry, endodontics, and periodontics in some or all of our practices. We are seeking a part-time endodontist for our Humble, TX, practice, three days every other week. To learn more about American Dental Partners and Carus Dental please visit us at www.amdpi.com and www.carusdental.com. If interested, please send CV and cover letter to kateanderson@amdpi.com. KILLEEN: Endodontist. Full time. Carus Dental, established in 1983 in Austin, has always been committed to the traditional doctor-patient relationship and to the highest quality in dental care and service. We currently have approximately 48 doctors on staff across our 21 practices in Austin, Houston and central Texas. We offer dental services in general dentistry, oral surgery, orthodontics, pediatric dentistry, endodontics, periododontics and prosthodontics in some or all of our practices. Carus Dental has been accredited by the Accreditation Association of Ambulatory Health Care since 2000. We offer a competitive salary and excellent benefit package including a 401k, health insurance and a professional work environment. To learn more about American Dental Partners and Carus Dental please visit us at www.amdpi.com and www.carusdental.com. If interested, please send CV and cover letter to kateanderson@amdpi.com. LEAKEY: Not quite ready to completely retire but tired of that busy multiple operatory high volume practice? Would you like to move from
the crowded city to the beautiful hill country? This part time bread and butter practice is for sale at a very reasonable price. Fully-equipped, 2 treatment rooms, low rent and close to the Rio Frio and Garner State Park. Call 830-279-2528. NORTH WEST/CENTRAL TEXAS: Abbeville Dentistry. Associate with partnership opportunities within a year. We are a doctor-run and doctor-lead group practice with over 12 practices. We provide amazing patient experience, excellent benefits and tremendous doctor-patient autonomy. If you are seeking an opportunity where you can focus on the patient without administrative headaches give us a call. Benefits include: stock ownership, high earning potential, 401K, profit sharing, CE reimbursement, health insurance, paid malpractice. due to growth, we are currently searching for a few dentists to join our team in Abilene, Brownwood, Odessa, Lubbock and Amarillo. We have a large patient base. Enjoy the instant patient flow, amazing facilities and technology. Please call Dr Britt Bostick, 806-4385745 or email him at bbost35821@aol.com. Weâ&#x20AC;&#x2122;d love you to see our facilities and speak with our doctors. PLANO: Endodontic practice seeks clinically experienced associate. Ideal candidate will come with a caring, patient focused perspective. Owner is seeking an associate with a high level of interpersonal skills who is quality driven. Current owner is a solo practitioner desiring to add an associate interested in becoming a future equity partner. Paperless charting, Dexis digital radiography, Zeiss microscopes. Please send introductory letter and CV to Info@lewishealth. com. Please reference DP#425.
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ADVERTISING BRIEFS PRACTICE OPPORTUNITY: We are a Texas-based family group dental practice serving patients of all ages. With a busy workload and high traffic, our needs extend to general dentists, orthodontists, pediatric dentists, and endodontists. Qualified, compassionate and motivated doctors interested in opportunities to provide high quality care in communities in Texas may contact us. Our offices provide: State-of-the-art, high-tech facility; in-house digital X-rays; paperless charting; 3-D models; digital tracing and imaging. Work alongside in-house board certified pediatric dentists, oral surgeons, endodontists and general dentists, allowing one to provide the absolute best care possible to even the most challenging cases. To join our team, please forward your CV to tx.dentistrygroup@gmail.com. SAN ANTONIO: A well-established pediatric practice is seeking an energetic, dedicated fulltime pediatric dentist. We have an extensive client base with continued growth. Our office is a leader in all aspects of pediatric dentistry including sedation and anesthesia dentistry. We are looking for the right fit for our practice. Ideally, someone who is looking for a long-term opportunity. New grads are welcome to apply. Please email resume to gkirkusg@aol.com. SAN ANTONIO: Associate needed for traditional family practice in north San Antonio. New facility, built in 2012. Great team, digital X-ray, intraoral cameras and digital impressions. PPOs, no HMO, and not a DSO or chain practice. Please send resume/CV to: dentalteammember01@gmail.com. SAN ANTONIO: Associate position with excellent location (Alamo Heights) in new stand alone state-of-the-art facility. Position would focus on surgery, implants, perio and endo with restorative
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in support of the owner/doctor who focuses on Invisalign and restorative work. Oral sedation credentialing needed, IV sedation a plus. Contact the office at 210-804-1558 or 210-296-8400 after hours. SAN ANTONIO: General dentists and Pediatric dentists needed for expanding office. Practice treats all ages in a modern relaxing setting. Office offers all digital advanced technology and a friendly staff. We are looking for clinicians with exceptional communication skills who are looking to contribute to personal and practice growth. Compensation dependent on specialty and experience and includes a bonus program, retirement investment opportunities and 401k, continuing education reimbursement, uniform allowance, health club membership and FSA. Visit our website www.smilestructure.com to see the Smile Structure difference today! Email: info@ smilestructure.com. SAN MARCOS: Immediate associate dentist position available for in a well-established general dentistry practice. Candidate should be interested in creating an exceptional experience for their patients and working in a dynamic office environment. Office is equipped with all digital X-rays, CT scan and pano, in-room screens for patient education, and intraoral technology. San Marcos has been named the fastest growing city in the US over the last few years, so there is definitely a great opportunity in this area for growth. Duties and responsibilities include: maintain our culture and brand in all aspects of the business, efficiently manage productivity and profitability, properly diagnose treatment plan and discuss alternative solutions for all patients, provide comprehensive dental care for all patients while creating a welcoming and comfortable environment.
ADVERTISING BRIEFS Qualifications: current Texas dental license, leadership skills and professional demeanor, excellent communication skills, open to personal development and coaching. Interested applicants, please, email your resume to: dental_resumesm@ yahoo.com. SEGUIN: Healthy smiles enhancing lives. Tier One Dental, a progressive, growing private practice is seeking an enthusiastic general dentist; who is committed to embracing our motto of creating healthy smiles while enhancing the lives of our patients. The perfect associate for our established team should be sensitive to patient needs while performing high quality dentistry utilizing the advanced dental technology that our fee-forservice practice offers. If you fit this profile and are looking for a long term position with future buy-in potential, please contact us at sam@tieronedental. com. We look forward to hearing from you. SPRING: Terrific opportunity for an associate dentist! We have just opened our second location and, due to a wonderful outpouring of new patients, we are in need of another associate dentist who would like to work with a highly seasoned team and a very well run dental practice. Both facilities are paperless and very high tech with the latest in equipment. We believe our practice has a “boutique” feel; while our mission is centered on taking exemplary care of our patients. Finding an individual with outstanding communication and listening skills who is willing to learn our proven systems for optimal patient care is a must. Our practice focuses on all phases of dentistry. Please email your resume to: robinstephens555@gmail.com or text Robin Stephens at 713-829-2864.
TEXARKANA: Associate position available. Reply or send resume to: amandamiot@eagledentaltxk. com. TEXAS: Texas Practice Transitions, Inc. Rich Nicely has been serving Texas dentists since 1990. Visit www.tx-pt.com or call at 214-460-4468; Rich@ tx-pt.com. HOUSTON: Large practice in north Houston/Spring area. PPO and cash patient base; free standing building with 8 treatment rooms; long term staff; 9 days of hygiene per week. TYLER (east Texas area), large full-fee practice in free standing building, 8 days of hygiene, digital X-rays, 5 treatment rooms. EAST TEXAS: Large full-fee practice in a large east Texas community. Free standing building with 4 treatment rooms. EAST TEXAS: Small full-fee practice in free standing building, modern facility with digital X-rays. EL PASO: East side; very large practice; PPO patient base, 7 treatment rooms. EL PASO: Moderate sized west side full-fee cosmetic and restorative practice, 4 treatment rooms in a professional building available for sale or lease. Motivated seller. CENTRAL TEXAS: Moderate sized practice located between Austin and Houston. Free standing building with 4 treatment rooms. AMARILLO: Large full fee cosmetic and restorative practice. Free standing building with digital X-rays. THE HINDLEY-BURGMAIER GROUP, LLC—Dental Practice Sales and Associateships: AUSTIN: New listing! Orthodontic practice for sale. Located on busy thoroughfare with good visibility, this 31-year-old practice has been located in its current location since 1988. In a facility of 2,100 sq ft, this practice has 4 fully computerized and chairs in an open bay. The practice is fully digitized including a digital Pan/Ceph. Very experienced and knowledgeable staff. This is an excellent opportunity for a newly graduating orthodontist www.tda.org | June 2016
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ADVERTISING BRIEFS or an established doctor who desires a satellite location! Call 800-856-1955 or email norton@ thehindleygroup.com. DFW MID-CITIES: New listing! General practice for sale. Located on a highly trafficked thoroughfare, this 32-year-old practice operates from 7 treatment rooms in a 3,550 sq ft, free standing practice facility. A well-coordinated doctor and hygiene team generate high FFS revenues and above average profits. Utilizing direct-sensor X-rays and Eaglesoft, optimum treatment is provided to all patients. In addition to the approximate 8,000 active patients, the practice attracts 25 new patients per month. As the owner doctor is desirous for the success of his successor, he is committed to remaining with the practice for 1-2 years. Call 800-856-1955 or email norton@ thehindleygroup.com. HOUSTON: General dental practice for sale. Located east of Houston in a most desirable and recently decorated facility. Seven-figure revenues with strong profit margin on 4 days per week. Originally established in 1971 and located at present location for 41 years. Six treatment rooms, 2 of which are specifically for hygiene. Digital radiology. Over 7,000 active patients. Very loyal and knowledgeable staff! Doctor is open to a 1-2 year transition period that is acceptable to purchaser. Call 800-856-1955 or email norton@ thehindleygroup.com. SAN ANTONIO (WEST): General dental practice for sale. Established rural community practice has exhibited significant growth over past 4 years due to low competitive environment. Seven-figure revenues and strong profit margin on 4 days per week! 5 fully-digitized operatories. Experienced, dependable staff. Great opportunity for an individual that wants to live in the country but be in striking distance of San Antonio. Call 800-8561955 or email norton@thehindleygroup.com.
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WEST TEXAS: General dental practice for sale. 28-year-old well-established family dental practice with strong revenues and profit margin. Due to lack of competiveness, this practice has 4 new patients per day. Open 4.5 days per week; 2,400 sq ft building with 4 fully-equipped digitized operatories. CEREC unit for one-day crowns. Outstanding staff. Doctor is selling for health reasons, but wants to assure purchaser success through his mentorship. Building also for sale! Call 800-856-1955 or email norton@thehindleygroup. com. EAST TEXAS: General dental associateship with pre-determined buy-in/buy-out terms. This doctor wants to associate with an individual who has an entrepreneurial spirit and who desires to own his/ her own practice within 5-10 years. Seller has agreed to pre-determined buy-in â&#x20AC;&#x153;triggersâ&#x20AC;? and price valuation methodology to be included in the associate agreement from the outset of the relationship. With 30 new patients per month in a rapidly expanding area, this 22-year-old practice can grow significantly over the term of the partnership. Operating from 5 fully-digitized treatment rooms, near 7 figure revenues and strong profits are generated by a highly productive dental team. If you want to own a large practice in the future and desire mentorship over the near term, this is a wonderful opportunity! Call 800856-1955 or email norton@thehindleygroup.com. WACO: Great associate opportunity. Waco practice looking for motivated associate with a desire to join a PPO/fee-for-service practice. Great pay, great work environment with two other dentists and top notch staff. Please contact Dr Johnson at 435-237-2339 or email at johnson.2978@gmail. com.
ADVERTISING BRIEFS OFFICE SPACE LUBBOCK: Dental space for lease. 1,200-1,780 sq ft available in a newly remodeled office building with other dental offices. Waiting/reception area, 3 operators, nurse station, work room, and private office. A shared X-ray room is available. Ideal for a new practice or specialty office. View online ad here: http://westmarkcommercial.com/people/ alison-blalock-ccim. Call Alison Blalock, WestMark Commercial Realtors at 806-776-2821 or email ablalock@westmarkcommercial.com.
FOR SALE EQUIPMENT FOR SALE: 3 New Platinum Dexis sensors for Dentrix software. 4 New Kavo MASTERtorque Mini LUX M8700 L handpieces with couplers. Everything is still in original packaging. EQUIPMENT FOR SALE: New handheld portable X-ray unit. New intraoral wall X-ray unit, new mobile X-ray on wheels. New chairs/units operatory packages, new implant motors. Everything is brand new, with warranty. Contact nycfreed@aol.com. FOR SALE: Existing dental facility 1,824+/-sq ft on 1 acre zoned B-5 commercial. Great first dental practice, great visibility, Elms Rd. in Killeen across from Ellison High School and will consider seller financing. Details: 254-699-8300/254-289-2400, Broker, John Reider Properties II, Ltd. www.johnreider.com.
INTERIM SERVICES HAVE MIRROR AND EXPLORER, WILL TRAVEL: Sick leave, maternity leave, deployment, vacation or death, I will cover your office. Call Robert Zoch,
DDS, MAGD at 512-263-0510 or drzoch@yahoo. com.
MISCELLANEOUS DALLAS CE EVENT: August 27. Lectures on antibiotics, taxes, surgical extractions, social media marketing, and elevating flaps. 8 hours AGD Accepted CE Website: www.weteachextractions. com Email: drtommymurph@yahoo.com Phone: 843-488-4357. Tuition: $649. LOOKING TO HIRE A TRAINED DENTAL ASSISTANT? We have dental assistants graduating every 3 months in Dallas. To hire or to host a 32-hour externship, please call the National School of Dental Assisting at 800-383-3408; Web: schoolofdentalassisting-northdallas.com. PLACE A CLASSIFIED AD IN THE
TEXAS DENTAL JOURNAL Itâ&#x20AC;&#x2122;s a member benefit! Reach more than 9,000 of your dental colleagues. COST
PRINT: $60 for the first 30 words for ADA members. 10 cents per word after that. ONLINE: $10 a month (no word limit). $60 one-time additional fee to post online immediately.
CONTACT
For more information, please visit tda.org or contact Hannah Atteberry at 512-443-3675 ext 124 or by email: hannah@tda.org.
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TDA Journal | Vol 133 | No. 6
Waller, Joe..............................................................337 Warschaw Learning Institute................................331
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June 2016
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3 3 Accident Accident Forgiveness Forgiveness
No No premium premium increase increase due due toto anan initial initial accident accident
The Texas Dental Journal
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For Fora afree freequote, quote,call call 88888-83-2332-31-210 27 07 ororvisit visitwwww .L.iLbiebretrytM yM utuutaula.cl.ocm om /T/D TD AA Client Client # 110024 # 110024
1 Discounts Discounts andand savings savings are are available available where where state state lawslaws andand regulations regulations allow, allow, andand maymay varyvary by state. by state. To the To the extent extent permitted permitted by law, by law, applicants applicants are are individually individually underwritten; underwritten; notnot all applicants all applicants 2 2 maymay qualify. qualify. Average Average annual annual savings savings based based on countrywide on countrywide survey survey of new of new customers customers from from 01/27/2014 01/27/2014 to 01/16/2015 to 01/16/2015 whowho reported reported their their prior prior insurers’ insurers’ premiums premiums when when they they switched switched to Liberty to Liberty 3 3 For For qualifying qualifying customers customers only. only. Accident Accident Forgiveness Forgiveness is subject is subject to terms to terms andand conditions conditions of Liberty of Liberty Mutual’s Mutual’s underwriting underwriting Mutual’s Mutual’s group group auto auto andand home home program. program. Savings Savings do not do not apply apply in MA. in MA. 4 4 guidelines. guidelines. NotNot available available in CA in CA andand maymay varyvary by state. by state. Optional Optional coverage. coverage. Applies Applies to ato covered a covered total total loss.loss. Deductible Deductible applies. applies. Does Does notnot apply apply to leased to leased vehicles vehicles andand motorcycles. motorcycles. NotNot available available 5 5 in NC. in NC. With With the the purchase purchase of optional of optional Towing Towing & Labor & Labor coverage. coverage. Applies Applies to mechanical to mechanical breakdowns breakdowns andand disablements disablements only. only. Towing Towing related related to accidents to accidents would would be covered be covered under under your your Collision Collision or Other or Other Than Than Collision Collision coverage. coverage.
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Auto Auto coverage coverage provided provided andand underwritten underwritten by Liberty by Liberty County County Mutual Mutual Insurance Insurance Company, Company, 2100 2100 Walnut Walnut Hill Hill Lane, Lane, Irving, Irving, TX. TX. Home Home coverage coverage provided provided andand underwritten underwritten by Liberty by Liberty Insurance Insurance Corporation, Corporation, 175 175 Berkeley Berkeley Street, Street, Boston, Boston, MAMA 02116. 02116. Valid Valid through through August August 18, 2016. 18, 2016.
Vol. 133, Issue 6
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