Free CE Courses for Members of the WAGD!! Look what’s coming up in Free CE!!
Dear Doctor, As the only organization focused exclusively on the field of general dentistry, the Academy of General Dentistry (AGD)’s goal of advancing the value and excellence of general dentistry has made it a leading organization for the general dentist.
The AGD has your best interests in mind and serves as a strong voice advocating on behalf of the general dentist. I would like to invite you to join us in our mission and to take advantage of the resources we can offer you and your practice.
Not a member yet? To become an AGD member today, complete and return the enclosed application, or visit www.agd.org to join online. We look forward to serving you as a member. Join now and go above and beyond in your dental career! Washington AGD Approved PACE Program Provider #219331. FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry, AGD or WAGD endorsement. Washington AGD PACE Provider (6/1/2010-5/31/2014).
As a thank you for membership, the Washington AGD will offer FREE continuing dental education courses!!
Look what’s coming up; Free Courses for Members of the Washington AGD:
Page 2...............Directory Page 3...............AGD Credits for Study Clubs Page 3...............The Sky is Falling Page 4...............Insanity Page 5...............Federal Way Dentist Elected Page 6...............Legally Mine Page 7...............Orthodontic Program Page 8...............Invisalign Page 9...............Facebook/Reputation Page 10.............Clinical Complications Page 11..............Clinical Complications, cont. Page 12.............Gingival Dental Connection Page 13..............Gingival Dental Connection, cont. Page 14.............Mastertrack Program Page 15..............Dr. Dan Fischer & Carol Jent Page 16.............Pacific NW Dental Conference Page 17..............QR Barcodes Page 18.............Membership Application
A newsletter providing dentistry with the latest news and information Issue 26, No. 1 Winter/Spring 2012
Thursday, September 20th, 2012 Future Strategies “Preparing Dentists for the Future” Register online www.washingtonagd.org A forum on the significant changes occurring in the dental industry that directly impact private practice and the future for dentist-owners 6:30pm-9:00pm Speaker-Dr. Marc Cooper Registration must be done no later than September 17th, 2012 to reserve your space. There is NO registration at the door. Thursday, November 8th, 2012 “STICK to the Basics! – The Secrets to Predictable Adhesive Dentistry” -Register Online www.washingtonagd.org 6:30pm-9:00pm Speaker-Dr. Ed Hewlett
Take Yourself Off The Target
Registration must be done no later than November 5th, 2012 to reserve your space. There is NO registration at the door available! Please contact Valerie Bartoli to learn more about registering for these courses and getting involved in the Washington AGD’s upcoming events. Registration will be opening soon and space is limited so email firstname.lastname@example.org to hold your space now!! These FREE courses are open to WAGD members only!!
Understanding Legal Tools The key to Lawsuit Protection and Tax Reduction The Washington Academy of General Dentistry Invites you to a seminar presented by Legally Mine Spouses Encouraged to Attend
Date: 4/19/2012 Speaker: Daniel J. McNeff, CEO Place: Sea Tac Airport Marriott 3201 S. 176th Seattle, WA 98188
Time: 6:30pm – 9:00pm
2012 WAGD DIRECTORY OFFICERS
President Jim Cunnington, DDS
E. Ricardo Schwedhelm, DDS, MSD (206) 543-5948 email@example.com
Puneet S. Aulakh, DDS (425) 255-6476 firstname.lastname@example.org
Continuing Dental Education Gary Heyamoto, DDS, MAGD (425) 485-8885 email@example.com
President-Elect Steven Thomas, DMD, FAGD (206) 713-0101
Secretary/Treasurer Stephen Russell, DDS
Legislative Bryan Edgar, DDS, MAGD (253) 838-9333 firstname.lastname@example.org
Stephen Russell, DDS (360) 943-8182 Steverussell42@hotmail.com
Membership Dr. Kishore Shetty (713) 517-2252 email@example.com
Todd Haworth, DDS, MAGD (360) 457-5152 firstname.lastname@example.org
(360) 943-8182 email@example.com
Immediate Past President
David Keller, DDS, MAGD, ABGD (360) 690-5676 firstname.lastname@example.org
Editor Valerie Bartoli (253) 306-0730
Student Program Coordinator E. Ricardo Schwedhelm, DDS, MSD (206) 543-5948 email@example.com
Steven Thomas, DMD, FAGD (360) 659-5007 firstname.lastname@example.org Jeanine McDonald, DDS, FAGD (509) 891-7770 email@example.com
Pace/Sponsor Approval Linda Edgar, DDS, MAGD (253)-838.9333 firstname.lastname@example.org
Joseph F. Sepe, DDS, FAGD (360) 576-0647 email@example.com
(253) 891-4053 Fax firstname.lastname@example.org
BOARD MEMBERS Teresa K. Kang, DDS (425) 821-8411 email@example.com
Dental Care Joseph Schneider, DDS, FAGD firstname.lastname@example.org (206) 878-1237
Teresa Kang, DDS (425) 821-8411 email@example.com Tar Chee Aw, DDS, MS (206) 543-5948 firstname.lastname@example.org
Webmaster Puneet S. Aulakh, DDS (206) 790-1485 email@example.com
Kishore Shetty. DDS. MAGD (713) 517-2252 Tar Chee Aw, DDS, MS (206) 543-5948 firstname.lastname@example.org
Tar Chee Aw, DDS, MS (206) 543-5948 email@example.com
C/O Membership Chair Dat Giap, DDS (206) 332-1861 firstname.lastname@example.org
NATIONAL AND REGION XI OFFICERS 2012
AGD Vice President
Region XI Trustee
DDS, Med, MAGD, LLSR WAGD PACE CHAIR Sponsor Approval
Executive Director WAGD Executive Director CDA, ED
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 2
900 Meridian E STE #19-361 Milton, WA 98354 253-306-0730 Fax-253-891-4053 email@example.com
Public Information Officer At Large Board Member Sang Bae, DDS (425) 485-8885 firstname.lastname@example.org Constitution & By-laws Comm. Chair Todd Haworth, DDS, MAGD (360) 457-5152 email@example.com
The Sky Is Falling! The Sky Is Falling! By Jim Cunnington II DDS Puyallup, WA
I sat through a presentation the other day where a respected dental advisor painted a colorful portrait of his expectations of the near future of dentistry. He described entrepreneurial investors with hundreds of millions of dollars making contractual associations with large dental insurance firms to control access to patient care. He said they would swoop down to a town near you, snatch away your nest egg of good will, and leave you nakedly shivering in the dark while your smoldering wreck of a practice rots in the ditch of America’s business highway. Many moons ago, I was a hyperactive preacher’s kid. My dear mom would drag this wiggle-worm down to the corner drug store and climb the stairs to an unobtrusive second-floor office where our family dentist held forth. He would check and clean my teeth, then do a filling or two if I needed it. Mom would write him a check. He would give her a receipt. Dad would mail the receipt to the regional church administration where a secretary would mail back a check for a set percentage of the fee. This would all take about a couple of weeks. I suspect the dentist’s overhead hovered around thirty percent at the time. In the seventies, our august leader,
REPRESENTATIVE Dental Student Dean Whiting (425) 609-3288 firstname.lastname@example.org Dental Student Seth Perrin (206) 954-5150 email@example.com
Senior Student Chair S. Brady Bates (509) 868-1623 firstname.lastname@example.org Junior Student Chair Rachael “Tyler” Smoot email@example.com
Dental Student Charmaine Felix (206) 849-3651 firstname.lastname@example.org Dental Student Josh Manchester email@example.com President Richard Nixon, announced he was going to fix the tragedy of costly medical (and dental) care by flooding the market with doctors. The medical/ dental schools were encouraged to admit students before they graduated from college. The four year program was shortened to three, and many of the class sizes were increased by fifty to one-hundred percent! The dental schools implemented a federally funded program called T. E. A. M. It was formed to teach the dental students the modern technique of four-handed, multi-chair, expandedfunction dentistry. Coincidentally, dental insurance was then becoming popular. At that time, the annual insurance limit was far beyond the cost of a crown, and patients rarely reached their max. The overhead for a practice drifted upward past fifty percent. The staffing hassles were certainly more pronounced, but the schedule was still solid and the net felt good. In the nineties, demand for care seemed to be slipping a bit. Holes started showing up in the schedule. Insurance benefit restrictions became a little more entertaining. Experts lectured us to “thrive by going up market,” and the overhead was now creeping past seventy percent. As we now approach the teens of our century, the scheduling potholes sometimes look like a bombed out war zone. Seven figure CEOs of mega insurance companies run multi-million dollar advertising campaigns while managing hordes of insurance processors to creatively deny basic care. Overhead is becoming nosebleed. (How
do you cook a frog? Put ‘em in cold water, slowly crank up the heat, and voilá!) Through all of these decades, I was fortunate enough to come in contact with a few dentists who swam against the tide. One is a prominent dentist in Arizona. He’s very energetic, thoughtful, studious, and a great communicator. For a time, he became convinced of the benefits of the “modern” office. He spent four years doing a careful study trying to prove that a multi-chair, expanded-function office was more financially viable than a small office. The stats came back proving the opposite. Even with a little bit of the inevitable down time, the inherently high overhead during those times crashed through the net totally destroying any efficiency of scale. So he has spent the past several years both practicing and teaching the merits of doing excellent dentistry with just one chair. He now has vastly less overhead and much more satisfaction. For some unexplainable reason, however, the equipment reps don’t seem to be sponsoring his lectures. An Australian dentist wrote a book on how to do low overhead, high quality dentistry with a few assistants and no front desk. The assistants split out the charts. Each created one-on-one relationships thereby, and thus they “owned” their patients. The doctor was just there to “help out.” I visited with a dentist in a small town in Norway a few years back who worked quite happily doing all phases of dentistry with one chair, and one employee. He did quite well for himself as well. He told The Sky is Falling continued on page 4
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 3
The Sky is Falling continued from page 4
me that many European dentists tend to have their ops set up so they can work alone most of the time. A few years ago, a well respected dentist here in Seattle gave a demonstration to the WAGD on how his practice slowly evolved to just one employee – his wife. He did great work, had many high-end patients, and was very satisfied due to the extremely low overhead. Maybe it’s due to my naivety, but I do not believe a mega-dental institution, with investors expecting to skim a sizable profit from their millions invested, could equitably compete with an experienced dentist who is well trained in the disciplines and who carefully manages his/her low overhead business. Nor do I believe a truly savvy CFO would prefer the pervasive umbrella of a big-name dental insurance company over the simplicity and financial efficiency of direct reimbursement. It seems to me that the evolution has gotten so far out-of hand that a semblance of sanity should somehow sneak back into the picture. So my personal view of a future outlook is, in a word, diversity. If one wants to hang back, let someone else run the business and focus solely on clinical care. It’s possible. If one wants to simply manage passive income, that’s possible, too. And if one should desire to be the captain his/ her smaller boat with all its simplicity and flexibility, this, too, is not without its financial reward and peace of mind. This brings me to the WAGD. No matter which way one wants to do dentistry, loading one’s quiver with the arrows of improved and expanded clinical skills will empower him/her to rise above the rumbling herd. We have many programs available to get wet-fingered participation courses that can empower our potential. Don’t worry! Be happy! Every generation has brought its inexorable change to dentistry. Fortunately, the sky has not altogether fallen for low overhead dentistry which remains a satisfying option that can yet be highly rewarding.
Insanity, as the saying goes, is doing the same thing over and over while expecting different results. In the practice of dentistry, this adage is played out clinically by seeing the same failures over and over, and wondering “Why is this happening?” We may see it show up in the same friction between staff members, repeated charting errors, and angry patients confused about their bill.
These pages are filled with opportunities to move toward a better, saner place. It is said that once you step out the front door, your journey is half done. If you haven’t done so already, we urge you to avail yourself of these wonderful courses offered. Step out the door. Make that decision. You will meet some extraordinary people and make new friends along the way.
Not long ago I heard a corollary to the above definition of insanity: Wanting things to be different, but being unwilling to change ourselves. Now perhaps insanity is too strong a word. For most of us, the image of a person suffering from a true DSM-IV mental illness does not fit with a successful doctor of oral medicine. If the word insanity is too strong, that’s okay. Thank goodness that’s not the kind of insanity to which I am referring. Personally, I have done the same things over and over expecting that it will be different this time. I have also wanted my world to be a little different, but have been unwilling to change myself. From these experiences, I have changed, sometimes quickly and sometimes slowly. I don’t think I’m unusual. I’ve seen my colleagues behave the same way. It’s a normal part of the human condition to some extent. The practice of dentistry entails growth, both clinically and personally. We are often confronted with our failures more immediately as few other professionals are. We want things to be different and better, but often are too comfortable or lack the enthusiasm to change ourselves. The WAGD is all about growth. It’s all about making your world a little better. Ultimately, it’s about delivering the best dentistry to your patients.
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 4
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DR. DAVID HOUTEN INTERVIEWS DR. LINDA EDGAR 1) What has your year as AGD vicepresident been like? Over the past four months since my election for AGD Vice President on July 28, 2011, I have been to Chicago three times for council and executive meetings, Philadelphia to see the site for the 2012 AGD Annual Meeting, Destin Florida for a Board meeting and Las Vegas twice for the week-long ADA meeting and our new Practice Management meeting that we started this year. I have also participated in 28 conference calls. Since I am still Seattle King County Past President, a Washington State delegate and an ADA delegate from Washington this year, it has also been exciting to be involved in the Access progress we have had in our state as well as the efforts to bring synergy to the profession by the ADA and AGD collaboration of projects with the help of outside companies who have been so generous. 2) What has been your biggest accomplishment this past year? Both the ADA and AGD have a mission of helping patients and advocating and educating the profession. It is my desire to help synergize all parties interested in attaining these goals because together we will make the profession stronger. One of my passions is to help those who have no money get access to dental care and help new graduates get work to help pay off their huge school loans. Thanks to a very involved Seattle King County Access Committee, creative ideas offered by Drs. Bart Johnson and Amy Winston and the help of Swedish hospital, Pacific Hospital Preservation and Development Authority (PHPDA), WDS, Burkhart and possibly Pierre Fauchard Foundation donations we have helped develop a program that helps eliminate dental emergency visits which saves costs for the state. It started with a “Golden Ticket”
which was given to every patient that came to the ER in pain. Swedish saw the potential of cost savings and with the help of those listed above funded a three-chair dental clinic that will help take care of patients with dental pain and “leave no abscess behind.” The Seattle King County Foundation which gets most of its money from the annual auction has agreed to partner and help fund a navigator-scheduler-assistant and a parttime practitioner 2 days a week who will help coordinate volunteers for the program. We are also helping the Northwest Kidney patients who can’t afford dental work get their work done and be ready for their kidney transplant. At the ADA house of delegates, and through collaborative efforts of many states, we proposed that ADA look at a resolution to help the funding of dentists in underserved clinics that have no other source of funding. It is only through the collaboration and synergy of “MANY” that we will really “MAKE A DIFFERENCE”. 3) What has been your biggest challenge this past year? The biggest challenge besides finding time to “fit it all in” and practice dentistry is the frustration I have felt with the PEW and Kellogg support of the funding of another dental professional who will be allowed to do extractions and prepare teeth for fillings and will not have a dental degree. The feasibility of a program like this to succeed is questionable and my concern is that the millions of dollars spent will be wasted. It would make more sense to me for these foundations to look at a program of setting up endowments that might spin off thousands of dollars a year forever with NO ADDITIONAL INVESTMENT which could be used to fund dentists to work in under served clinics—helping the access problem for those that have some f the most complicated treatment needs we see and who are usually systemically compromised. 4) How are the goals and visions of AGD and the ADA similar and where do they diverge? I believe the goals and visions of AGD and ADA are very similar. Most AGD leaders are also involved at least as ADA members. Many are involved as members and Chairs of ADA Councils. Working together we can accomplish much
more synergistically than we can if we are duplicating efforts. In Washington we have even offered courses through AGD that are FREE if the dentist is BOTH a member of AGD and ADA because we feel strongly about the efforts of BOTH organizations. Because AGD is focused on the General Dentists—their education and the needs they have to be successful in practice—our focus is more “specialized.” ADA members come from all specialty areas and their needs and focus, depending on the issue, may vary from the needs and focus of the general dentist. I personally believe we are all connected through referrals and the need to collaborate on patient treatment. It is vital to be connected and have open communication so that differences and similarities can be explained and respected. 5) What is on the horizon facing you as AGD president-elect? Several states are also facing insurance company decreases in reimbursement which are threatening the viability of the dental practice as we know it. The repeal of the McCarren Fergusion Act is vital to help with the antitrust issues dentists find themselves in when they try to counter these activities. Student debt is on the rise and we need to educate the students in efficient practice management systems early, along with the concept that saving is vital to their long—term professional success. Corporate dentistry may “appear to be the only answer” to some new graduates. Dental Schools are losing more and more state funding. We have an excess of dental students graduating with no positions, yet “for profit” schools are being started. PEW and Kellog continue to suggest that non-dentists can do dentistry and are willing to pour money into their training, leaving the states or other programs to pay new provider’s salaries. An increase in oral health literacy early on is needed to create a “tipping point” to decrease dental disease in our country. ADA and AGD and other organizations, both dental and non-dental, could synergize to bring this important information to the public. Together we must be creative so that we can start solving some of these problems now. “Many Baby steps make one giant footprint” Interview with Dr. Edgar continued on page 14
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 5
Understanding Legal Tools:
A Down to Earth Guide to Lawsuit Protection, Prevention and Tax Reduction
Thursday April 19, 2012 6:30pm-9:00pm At the Sea Tac Airport Marriott 3201 S. 176th Seattle, WA 98188 Please join us for an evening that you cannot afford to miss! Today, successful professionals are faced with many challenges, especially financial challenges. Heavy tax burdens as well as legal assaults by trial attorneys are some of the most dangerous and time consuming battles fought by today’s professionals. We will be discussing, in a down to earth manner, proper legal structuring for a dental practice and how it will ease the burden of taxes as well as protect your personal as well as professional assets from any lawsuit. We look forward to spending the evening with your society and teaching you how to legally keep what you have worked hard to earn. This is a FREE Course for Washington AGD Members!! ***See Registration Details to attend for Free***
Registration for Continuing Dental Education Courses Washington Academy of General Dentistry 2012 WAGD Fellowtrack Registrations Form
Fax back to: Valerie Bartoli, WAGD Executive Director (253) 891-4053 Name:________________________________________________________AGD#_________ Staff Attending:______________________________________________(Please Provide Names) Tel:_________________________________Cell:_____________________________________ Fax:_________________________________Email:___________________________________ Address:_____________________________City_________State_____ Zip:_________ *Important Information (Please Read & Initial) Please Circle Credit Card: Visa MasterCard Amex Express Name on Credit Card (if different than above)____________________________________________ Exp Date:_______ Security Code#________ Card #:________________________________________ $3.50 Credit Card Processing Fee will be added. Please Initial_____ Total $___________ Tuition:WAGD Member: Free WAGD Member Staff with DDS: $50 AGD Member from another state: $100 AGD Member Staff from another state with DDS: $75 Non-AGD Member DDS: $399 Non-AGD Member Staff with DDS: $199 Dinner is included with Registration. Parking is not included with registration
You must RSVP your attendance two weeks in advance. There are no refunds with the Fellowtrack or AGD Membership. All of the courses are limited attendance.
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 6
ADVERTISE IN THE WASHINGTON ACADEMY OF GENERAL DENTISTRY NEWSLETTER
First of all, our thanks to you as a loyal advertiser in the WAGD quarterly newsletter. These publications reach the almost 4500 member dentists practicing in Washington. Here are our 201213 plans: We will publish our quarterly newsletter in November, February, June and September. We’re also offering classified advertising. If you would like to share an article please email email@example.com. Note: We are continuing our popular 5% discount to those who commit to all 4 publications! You will also receive a complimentary copy of the Newsletter. If you have questions, please e-mail our publisher, Bill Newcomer, firstname.lastname@example.org or call him at
503.318.5916 or 360.573.1201
DO YOU HAVE OFFICE SPACE TO LEASE, EQUIPMENT TO SELL, PLACE AN AD IN THE NEWSLETTER.
SAVE THE DATE!!
Washington AGD Announces its 1st “Husky Football Dental Study Club”!!! Starting September 15th, 2012
More to come......
Washington AGD Hands-On Orthodontic Program Register Now! Space is Limited!!! Where: Comfort Dental Office of Binh Tran, DDS, FAGD 1014 South 320th street Federal Way, WA
Space is limited to 10 participants. Register today!! Course Location: Comfort Dental 1014 South 320th street, Federal Way, Wa. 98003 Course providers: Dr. Binh Tran DDS, Lily Stefoglo, CDA Course Date, Time, Length: Second weekend of each month for 12 months. Starting Jan 2012. Fridays are lectures and Saturdays are patient treatment. Maximum attendees: 10, Interview by Dr. Tran for acceptance. Contact: Dr. Binh Tran 206-276-6179 for Interview or email email@example.com
Course Content/Objectives: Starting Date: Friday January 11th & 12th, 2013 Add to my calendar Course Tuition: $10,000 for 12 sessions AGD Member Dentist $2,000 for 12 sessions for CDA with AGD Member Dentists $12,000 for 12 sessions for Non-AGD Member Dentist $4000 for 12 sessions for CDA with Non-AGD Member Dentists * Payment Plans are available Material Costs: $3,000 dentist supplies/ instruments to treat 10 cases in their own office. $120 Tip Edge Orthodontics Dr. Parkhouse Text book Speaker-Binh Tran DDS Washington AGD Approved PACE Program Provider #219331 FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry, AGD or WAGD endorsement. Washington AGD PACE Provider (6/1/2010-5/31/2014). Disclaimer *As a Non-Profit entity, Washington AGD does not endorse, partner or solely support companies, products or speakers, but rather recognizes speakers, products and sponsors for their their services to our Washington AGD educational programs. The views and opinions of the speaker expressed during the educational program, do not necessarily state or reflect those of the Washington AGD.
• Training from initial consultation to final retainer delivery and monitor: • Initial orthodontic examination and comprehensive treatment plan. • Orthodontic records and management system • Photography and Case presentation • Orthodontic Office and Financial management system • Ceph Analysis and FACE principles • Orthodontics Principles and Mechanics for Angle class 1,2, and 3 • Clinical Orthodontic practice: from banding to debanding. • Orthodontic supplies ordering and managing inventory • Post treatment retention and monitor • Surgical and TAD in Orthodontic. • Pediatric to Geriatric orthodontics. • A training manuals and related reference papers is included. • Attendee will be trained in how to start orthodontic service in their office. • Attendee will treat and present a minimum of two of Dr. Tran patients. • Attendee is requested to start treatment in their own office and present those cases. • Monthly quiz and a final exam will be given to confirm learned concepts • Final Plaque and Certificate presentation with Dinner (spouse invited) Course Goals: At the completion of this course, attendees will be able to confidently identify orthodontic problems and provide treatment solutions in their own office. This course will provide additional office income while enhancing all other treatment results that the doctor is providing. Course requirement: Attendance, Office capacity, patients’ availability, supporting staff. The doctor is encouraged to select one CDA from the office to attend a staff training course if possible. However, past doctors have trained their own staff to provide care. Registration for Continuing Dental Education Courses Washington Academy of General Dentistry 2012 WAGD Fellowtrack Registrations Form Fax back to: Valerie Bartoli, WAGD Executive Director (253) 891-4053 Name:________________________________________________________AGD#_________ Staff Attending:______________________________________________(Please Provide Names) Tel:_________________________________Cell:_____________________________________ Fax:_________________________________Email:___________________________________ Address:_____________________________City_________State_____ Zip:_________ Course tuition: $10,000 for 12 sessions AGD Member Dentist • $2,000 for 12 sessions for CDA with AGD Member Dentists $12,000 for 12 sessions for Non-AGD Member Dentist • $4000 for 12 sessions for CDA with Non-AGD Member Dentists * Payment Plans are available Material Costs: $3,000 dentist supplies/instruments to treat 10 cases in their own office. $120 Tip Edge Orthodontics Dr. Parkhouse Text book Please Circle Credit Card: Visa MasterCard Amex Express Name on Credit Card (if different than above)_____________________________________________________ Exp Date:_______ Security Code#________ Card #:________________________________________________ $3.50 Credit Card Processing Fee will be added. Please Initial_____ Total $___________ *As a Non-Profit entity, Washington AGD does not endorse, partner or solely support companies, products or speakers, but rather recognizes speakers, products and sponsors for their services to our Washington AGD educational programs. The views and opinions of the speaker expressed during the educational program do not necessarily state or reflect those of the Washington AGD. Washington AGD Approved PACE Program Provider #219331 FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry, AGD or WAGD endorsement. Washington AGD PACE Provider (6/1/2010-5/31/2014).
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 7
Invisalign I am a general dentist, and when it comes to orthodontics, I am limited to Invisalign. Don’t get me wrong, Invisalign is a great treatment option, but sometimes it can be really frustrating when there is a minor tweak you need to accomplish slight rotation, slight diastema, slight tilt. The option is to do a refinement or settle for the result. In the end, the patients are happy, but I’m not. I know a better result is possible. I can do better. This was the primary reason for signing up for the hands-on WAGD Orthodontics, taught by Dr. Binh Tran. I remember learning about orthodontics was one of the toughest things I did in dental school. Not because it was difficult, but because it was so boring and the furthest thing from practical. It was very hard learning about theories and tooth development because the whole time you were thinking, “how am I going to use this?” I have known Dr. Tran for the past 4 years and I know him to be a hands-on and a very practical person. I knew I would be gaining knowledge that I could use Monday morning. I signed up for class in December, and from the day I signed up, he was in contact with me. We had homework: identify teenage patients that are in class 1 molar, with crowding, crossbites, or spacing. Inform the patient and parents that they could benefit from orthodontics. Don’t push, just inform. Let them know that you are taking the course and if you qualify, we will do the treatment for half price. With just a simple sign in the reception area, and a few minutes of talking to the patients and parents, I had five patients. For each of the patients, I took photos and emailed Binh about the case. He would go over what to tell the patients and parents, what type of treatment, and what to expect. Next was taking ortho models and sending the patients to NW Radiology for a pan, ceph, and a ceph analysis (tracings). The first day of class was the complete opposite of dental school. From the beginning, it was all practical information. After a quick overview about orthodontics, we discussed the basics, what we were trying to accomplish, and how we were going to get there. There were actual patient cases. It was like a big jigsaw puzzle, and Binh showed us what the results would look like. We just had to put the pieces together. It is a lot easier to do a puzzle
with a group of people. The second day of class was hands-on at Dr. Tran’s office. Dr. Tran had patients for us to work on. We were broken in groups of two and each one of us got to band and bracket a patient. I brought my assistant to the course and we each did one side. After finishing with our patient, we went and saw what everyone else was doing. Talk about hands on! After the patient portion, Binh took us back to his office and we went over our individual cases. I don’t know if there is another ortho course where you get so much hands-on experience, let alone have one-on-one sessions with the teacher, who is also on-call for any help you might need. You are welcome to follow the course on our class blog: www.wagdortho.wordpress.com. You get so much hands-on experience in addition to having one-on-one sessions with the teacher, who is also on-call for any help you might need. Bannerwood Family & Cosmetic Dentistry (425) 378-DENT www.factoriadental.com
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Through AGD Benefits Plus, various organizations provide exclusive offers or member discounts on a variety of high-quality products and services. For more information about the AGD Benefits Plus programs, visit the Membership section at www.agd.org, or contact our Member Services Center at 888.243.3368. Be sure to identify yourself as an AGD member when you contact these Benefits Plus Providers to take advantage of these exclusive offers or member discounts. AGD Benefits Plus programs are subject to change without notice.
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 8
Can Facebook fix your practice? As social media makes a larger and larger impact on the lives of our patients, many practices are wondering how they can use that technology to better serve their patients. While I am not an expert, I believe a dialogue about the pros and cons of social media is beneficial to our members. In doing so, however, I will limit my discussion solely to Facebook, the most popular and best known social media outlet. There are over 800,000,000 active Facebook users, more than 1 out of every 9 humans on the Earth! More than 50% access their account on a daily basis. An average active user has 130 friends and is connected to over 80 community or business pages and events. (1) These staggering statistics make it completely obvious that if you’re not on Facebook, you are missing a chance to serve your patients, because they definitely are on Facebook! Stop resisting and check it out. For resisters I ask you to consider two things: first, imagine Facebook as a virtual discussion, for it truly is. If you’re not at the table, how will you know what your patients want or need? Second, consider a business page as a virtual storefront, like the sign you have right now out on the street in front of your office beckoning patients to come and see what you have to offer! What are some pros to Facebook? Well, you
can communicate quickly (immediately) with your patients! When I launched the Facebook page for my brand new dental practice, Granite Dental, in less than five minutes I had advertised my new practice to over 1,000 friends for free! More importantly, within 24 hours I had 32 people “like” my practice, which sent a notification to all of their friends that they like my dental practice. Assuming each of them has 500 friends, 17,000 people were aware of the launch of my page within 24 hours! What else can Facebook do? It gives me a chance to blog, which is an online journal entry I create to serve my patients. Blogs can include topics like how third party financing will allow my patients to receive the care they want and deserve, how IV sedation will allow them to finally get the care their fear has prevented, or something as simple as where I like to eat lunch! What I really like is when I have a patient that comes through that owns a restaurant, I can blog about it, “like” their Facebook page, and then my patient gets a little free advertisement from us! I love helping my patients enjoy success in their professions just like they help me! Other great things Facebook can do: you can offer discounts or sweepstakes on your page. You can post links to informational sites like the AGD’s “Know Your Teeth.” You can explain what the letters after your name mean, include bios of your team, post photos of some complicated cases you’ve completed. Truly you can do almost as much in your virtual office waiting room as you could in your real one.
But, that leads to the primary con for Facebook: Facebook will not create itself, nor will it maintain itself. Unfortunately, if you’re looking for something you can just put up and neglect, social media may not be the right answer because, just like your website, a lame page might communicate a lame doctor to your friends, family, and patients. It will take time, perhaps 1 hour/week, to keep your site current, interesting, and relevant. It is wise also to remember that it truly is a virtual waiting room, so spamming your friends with “Free bleaching with exam and x-rays” every week, like every other dentist, will probably drive people away, not towards your page. Instead, I encourage you to demonstrate that you care, that you’re willing to listen, that your patients are people, and you’ll find that for no money down and a little investment of time your patients are more loyal, more compliant, and that they’re sending you their friends and family! If you want to learn more, take advantage of yourmembershipbyattendingagreatupcoming CE course offered by the WAGD on February24th:“SocialMediaandYourPractice.”. Details can be found on our website: www.washingtonAGD.org
efficient and more profitable. I think when I go fast, I eventually miss things. Certainly, some dentists simply produce faster, with superb results, but what I am talking about is going fast and generating results that are short of what we are capable of producing when we take our time to do it right. We must decide early in our career whether we want to be “fast” or “fine.” The question is do we want to be about the business of dentistry or about the profession of dentistry? What about the patient? We must decide if we want to diagnose and treat patients based on our needs or the patients’ needs. Is your practice a patient-centered practice? Many dentists say this is where practice satisfaction truly lives. When our dentistry is at a mastery level, then our staff, existing patients, and new referrals truly know that our mandate is treatment that means value to them. Like attracts like. It is cosmic law. If you are at your best, then you will attract staff and patients that are at their best. Patients will readily accept treatment because they have already sought a best dentist, not a least expensive dentist. And so, reputation can be a delicate thing.
It is perhaps the most important professional possession that we own. It must be nurtured, developed, and designed with intention. The late L.D. Pankey is quoted as saying, “It is not hard to be the best. There is no competition.” Do you have a reputation that represents you and your special sets of skill, care, and judgment? If not, perhaps today is the day to begin. Your reputation will happen no matter what. The question is will it be by default or by design? The answer is in the mirror. My niece Grace knows I like quotes so she offered one to me a couple of weeks ago that seems to perfectly fit with each of our unique reputations: “Be yourself…because everyone else is already taken.”
Dr. David A. Keller, DDS, MBA WAGD Immediate Past President Granite Dental firstname.lastname@example.org (1) retrieved from http://www.facebook.com/press/info.php?statistics 01 FEB 2012 @ 11:12am
REPUTATION Reputation. It’s a funny thing. Everyone has one. In many ways it is our most valuable asset. Today’s day to day signatures of our purpose and behavior become tomorrow’s reputation and today’s reputation will become our tomorrow’s legacy. This legacy is our only intentional way to influence our future and even the future beyond our lifetime. If we do it right, each of us has an opportunity to make a difference even after our passing. What a trip! What a gift... life beyond dentistry. Dentists have reputations like all people. Large groups of people also have reputations. For example, Italy has a reputation for great wine and France has a reputation for great food. What is your reputation as a dentist? A reputation doesn’t just show up. It is by design but sometimes that design is unconscious. A reputation takes time to create and it takes time to change. Choosing a reputation, like writing a vision statement of your purpose as a dentist, could be the single most significant event of a dental practice. This is where you make your declaration to your staff and patients. We are at another crossroads in dentistry. There is a trend to do everything faster, be more
Respectfully submitted by,
John West, DDS, MSD
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 9
Clinical Complications in Fixed Prosthodontics: Cause, Prevention, & Management Speaker-Charles J. Goodacre, DDS, MSD 7 Hours of CDE for $99
May 11th, 2012 Time: 9:00am-4:00pm (Lunch is included with tuition) 10th Annual William Howard Memorial Lecture SeaTac Airport Marriott 3201 S. 176th, Seattle, WA 98188 Hotel #206-241-2000 Hosted by: Seattle-King County Dental Society (SKCDS) & Washington Academy of General Dentistry (WAGD)
This presentation will identify the most common causes of failure and the most common complications encountered in fixed prosthodontics (conventional single crowns, conventional fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, post and cores, and implant prostheses). Causes of the complications will be identified along with methods of minimizing or preventing their occurrence. Synopsis: A knowledge of the factors that produce failure in conventional and implant prosthodontics enhances our ability to develop effective treatment plans, facilitates success, promotes optimal doctor-patient communication regarding anticipated treatment outcomes, and provides early diagnosis of problems encountered during long-term maintenance. Objectives: Following the presentation, attendees will be able to: 1. Identify the types of complications that occur in fixed prosthodontics and implant dentistry. 2. List the factors that are most likely to cause complications. 3. Develop strategies that can be used to minimize or eliminate failures. 7 Hours of CDE for $99 to members of both the Seattle-King County Dental Society & Washington Academy of General Dentistry The William Howard Program: This inaugural program is named in honor of Dr. William Howard, long-time AGD Editor and person who made a difference in the lives of thousands of people.
*Important Registration Information (Please Read)
This course is $99 to members of the SKCDS & Washington AGD. You must be a member of both organizations to register at $99. To guarantee entry, you must Pre-Register and bring the confirmation email provided to you from the Seattle-King County Dental Society to the course. No confirmation sheet means no entry into the course. If you are a member of only one of the organizations, there is an additional registration fee (see next page).
You must RSVP your attendance two weeks in advance The SKCDS & WAGD reserve the right to cancel or alter a course. There will be no at the door registrations or walk-ins allowed.
All courses have limited attendance. Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 10
May 11th, 2012 Time: 9:00am-4:00pm (Lunch is included with tuition)
May 11th, 2012-ATTENDEE REGISTRATION
SPEAKER-DR. CHARLES GOODACRE
___________________________________________________________________________________________________________________ NAME ADA & AGD# (Required for Free Entry) ___________________________________________________________________________________________________________________ EMAIL ADDRESS (REQUIRED FOR COURSE CONFIRMATION) FAX ___________________________________________________________________________________________________________________ CREDIT CARD BILLING ADDRESS qWORK qHOME ___________________________________________________________________________________________________________________ CITY STATE ZIP ADDITIONAL ATTENDEES ___________________________________________________________________________________________________________________ NAME POSITION CARD ACCOUNT NUMBER EXPIRATION DATE ___________________________________________________________________________________________________________________ FULL NAME (AS IT APPEARS ON CARD) ___________________________________________________________________________________________________________________ CARDHOLDERS SIGNATURE
Type Qty Before 5/4/2012 After 5/14/2012 Total Both AGD & ADA Member
AGD & ADA Member Staff
AGD OR AGD Member $199 $210 $ AGD OR ADA Member Staff
Non-Member $399 $410 $ Non-Member Staff $175 $185 $ TOTAL $
qVISA qMasterCard qCheck enclosed (Checks should be made out to Seattle-King County Dental Society) _____________________________________________________________________________________________ Please send this form to: Or fax to: Seattle-King County Dental Society Seattle-King County Dental Society 2201 Sixth Avenue, Suite 1210 (206) 443-9308 Seattle, WA 98121-1832 Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 11
The Gingival Dental Connection Why do we care so much about the gingiva? Why is the gingiva so important? We will take a step back and start with biology. The attached gingiva is pale pink, has a firm texture, and in 40% of adults has stippling, which is the orange peel surface, due to the presence of rete ridges of collagen that crown into the keratinized epithelium. The mucogingival junction delineates the oral mucosa, which is vascular, has loose collagen, elastic fibers and muscle. It is covered by a thin layer of nonkeratinized epithelium and this permits movement and stretching associated with mastication, speech, and facial expression. The outer surface of the gingiva is covered with a thick layer of keratinized stratified squamous epithelium with finger-like projections, which are rete pegs, into the dense collagen underneath. The strong attachment of collagen to the epithelium between the rete pegs causes the gingiva to have a stippled surface when it is normal. Not all individuals have evident stippling and this does not mean that the tissue will be inflamed. Rete ridges grow only into the keratinized layer, not into the mucosa. The attached gingival is firm, resists forces, it is pale pink, and it is keratinized from the mucogingival junction to the free gingival margin. It is a keratinized, stratified, squamous epithelium that is firmly attached to the cementum and the alveolar bone through connective tissue fibers. The mucosa is loose, highly vascularized, nonattached tissue that has loose collagen, muscle fibers, and vessels. It is not keratinized. Based on its loose nature, its function is to allow movement and stretching for speech and facial expression. The major group of gingival fibers are the gingival dental group, which is embedded in cementum and fanning out to the gingival margin. The coronal half of the gingival sulcus is line based sulcular epithelium. This is a nonkeratinized stratified squamous epithelium that is thinner than the outer gingival epithelium and it serves as a protective barrier. The apical half of the gingival sulcus is lined by junctional
epithelium, which acts as a seal against the tooth’s surface. The junctional epithelium depends on intact epithelial and strong collagen fibers that keep the gingiva in contact with the tooth. The junctional epithelium is present on natural teeth and implants. The junctional epithelium has ten to twenty cells and its turnover is one to six days. Its adhesion is through hemidesmosomes. The function of the gingiva is different from that of the oral mucosa. The gingiva must resist the mechanical stimuli of food particles impinging on it during mastication as well as having large accumulations of plaque, bacteria, and direct contact with the gingival sulcus. The gingival tissue must act as a seal in the sulcus that protects the underlying tissue from sub gingival plaque and prevents loss of tissue fluid. In the classical periodontal literature, Dr. Lang and Dr. Loe, from the Journal of Periodontology 1972, found that all surfaces that exhibit less then 2mm of keratinized gingiva presented inflammation and varying amounts of exudate. Inflammation is not the result of only mechanical irritation, but from a mobile (nonkeratinized gingiva/mucosa) which facilitates the introduction of microorganisms. Gingival health is compatible with narrow gingiva, but despite excellent home care, inflammation persists on areas with less then 2mm of keratinized gingiva. The areas with the narrowest gingiva are the linguals of the low anterior incisors and the buccal of the lower canines and first bicuspids. Both Drs. Lang and Loe in 1972 and Drs. Steller and Bissada in 1987 agreed that 4mm or more of keratinized tissue is ideal for RPDs and 2mm of keratinized attached gingiva is recommended for the health of natural teeth and subgingival restorations. The volume of keratinized gingiva helps us improve the aesthetics and protects better than the mucosa from abrasive agents, such as restorative procedures, trauma from brushing, flossing and mastication. This is also true for implants. Gingival Recession – The Etiology of Recession Why do we have recession in the first place?
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 12
Primary factors: 1. Thin periodontium 2. Position of the teeth (root prominence) 3. Frenum attachments and the vestibular depth 4. Seconary etiology factors such as trauma from brushing, restorative trauma, occlusal trauma, or orthodontics All recession should be covered as long as the ideal periodontal support is present. The prime reason to treat recession is to prevent bone loss and concomitant gingival recession. Teeth at a high risk for recession are those that are facially placed or prominent root forms, those that already have recession, and those with minimal gingival volume. When speaking of restorative margins, when we are packing cord for restorative dentistry on areas of thin biotype (areas with inadequate keratinized gingival thickness), recession will likely occur. Currently there are multiple techniques and materials that can be utilized to augment the gingiva. The techniques and materials have to be chosen based on the patient’s needs. Today we also have procedures such as periodontally accelerated osteogenic orthodontics, which is based on the regional accelerated phenomenon (RAP). As far as materials, we have accellular dermal matrix (ADM/ AlloDerm), enamel matrix derivative (EMD/Emdogain), platelet derived growth factors (PDGF plus BTC – beta-tricalcium), and a combination of techniques and materials should be chosen based the patient’s needs. From the literature, GTR membranes plus dental tissues and coronally positioned flaps do not improve the gingival thickness by themselves. Thickness is increased with free gingival grafts when the soft tissue grafts (autogenous connective tissue grafts, acellular dermis grafts, bovine collagen, and PAOO-periodontally accelerated osteogenic orthodontics). An example of the advances in soft tissue grafting procedures is taken from the research of Dr. Mike McGuire who compared a xeno graft with collagen matrix with a connective tissue graft both in Gingival Dental Connection
continued on page 13
Gingival Dental Connection
continued from page 12
combination with coronally positioned flaps. This showed how a bovine graft is successful, but not as successful as the traditional connective tissue graft. This is a great advance in research. On his study, he found that autogenous connective tissue grafts had the greatest percentage of root coverage, which varied on the 6-month and 12-month post-operative period between 95.6% to 100% comparison to the xenograft, which was between 83% and 88% coverage. It is important to point out that in his study he followed up at four years and for autogenous connective tissue grafts he found stability with root coverage of 99% compared to 86% for the bovine grafts. Drs. Bruno and Bowers published in the International Journal of Periodontics and Restorative Dentistry in the year 2000 an article that was called “Histology of a Human Biopsy Following the Placement of Subepithelial Connective Tissue Graft.” They looked at the type of attachment that was gained with an autogenous connective tissue graft. Contrary to what was thought in the past—that we would obtain a long junction epithelial attachment—they found a connective tissue attachment against the roots. Based on the study by Dr. Bowers, we know that the width of the attached gingiva on the buccal surfaces has the broadest zone in the area between the lateral and central incisors, then the maxillary first bicuspid and canine, followed by the buccal of the lower anterior lateral and central incisors, followed by the buccal of the second molars, and the smallest width was found on the area of the mandibular first bicuspid and canine. This is relevant as we need to be very detailed when doing an evaluation for the area of deficiency. Regarding the width of the attached gingiva on the lingual surfaces, Dr. Voight and company found that the second and first molars had the greatest lingual band and the lingual of the lower anterior sextant had the narrowest band of keratinized tissue. Physiological Dimensions Significant to Restorative Dentists Maintaining healthy periodontium is critical to the prognosis of the teeth. There
are three different dimensions. a. Superficial b. Crevicular c. Subcrevicular The superficial dimension is the extent from the mucogingival junction to the gingival margin, which is in charge of preventing the pull from the frenums and muscle fibers of the mucosa, therefore preventing the retraction of the free gingival margin, which could cause recession. How much gingiva is adequate for restorative procedures? Drs. Mainer and Wilson concluded that 5mm is adequate and we need to have 3mm of attached gingiva and 2mm of free gingiva. With regard to the thickness, we know that is very important to have thickness to prevent recession and for good health. From the biological standpoint, we would like to ideally wait at least eight weeks after a crown lengthening procedure or periodontal surgery before restorative margins are prepared. The reason for this is to allow the sulcus to re-establish. We know that the sulcus will establish itself by coronal migration of the free gingival margin and not by apical migration of the epithelium. At week one post-surgery, we have a long junctional epithelium re-established. At week four postsurgery, we have the connective tissue re-established. At week eight, we have complete re-establishment of the sulcus. For anterior preparations, it is recommended to wait twelve to sixteen weeks to ensure that there is gingival margin stability in the anterior zone. This allows the gingival sulcus/crevice to develop. Biological width The initial studies by Dr. Gargiulo in 1961 concluded that there is a proportional relationship between the crest of bone, the connective tissue attachment, the epithelial attachment, and the sulcular depth. They describe the biological width as the sum of the epithelial attachment (0.97mm, but could vary from 1.0 to 9.0mm due to the long junctional epithelium) and the connective tissue attachment (1.07mm). This measurement is constant; therefore, the biological width
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 13
is on average 2.04mm +/- depending on the epithelium thickness. To be accurate, they recommend bone sounding in preparation for crown lengthening. Subtraction of the sulcular depth will then provide us with the individual patient’s biological width. It is important to note the mucogingival relationship to orthodontics. When doing an orthodontic evaluation, it is important to look for aberrant frenums that will prevent the closure of diastemas and that are causing pull of the gingival margin. Is there a lack of keratinized gingiva (see-through mucosa)? Are there any impacted teeth? Are there any pre-existing areas of recession? Is there soft tissue overgrowth either induced by plaque and/ or medication that could restrict access or home care for the patient? Are there any supraerupted teeth (especially in posterior bite collapse patients) that need extra anchorage? What is the width of the keratinized gingiva before and during orthodontic therapy? There was a study by Dr. Coatman that concluded that teeth with < 2mm of keratinized gingiva had a greater incidence of complete loss of keratinized gingiva than those with 2mm or more. It was concluded that mucogingival problems noted after orthodontic treatment are often the result of preexisting mucogingival defects. Remember, patients can better maintain health on attached gingiva. For best results, management of recession should be done in its early stage. Recession is not just the loss of soft tissue, but the loss of bone. Silvia La Rosa, D.D.S. Diplomate of the American Board of Periodontology
Washington AGD Mastertrack Program Open to ALL Dentists-Register Today *Hands-On Program 16 different disciplines* Where: SeaTac Airport Marriott 3201 S., 176th Street Seattle, WA 98188
Starts: Thursday September 20, 2012 at 8:00 AM PDT -toSunday September 23, 2012 at 12:00 PM PDT Add to my calendar *Fours Session per Year & always months of September, November, January & April. Time: Always Thursday thru Saturday 8:00am-5:00pm & Sunday 8:00am-12:00. Includes Light Breakfast, Lunches and all Materials Tuition per year $5000 for AGD Members. $5500 for Non-AGD members. Payment Plans are available.
Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. Washington AGD PACE Provider (6/1/2012-5/31/2014)
Masters Case Presentations
The Washington AGD is offering a program that showcases courses in at least 16 different disciplines. This program will give each participant over 5 years, 600 hours (with protocol) of PACE approved continuing dental education credits, of which 400 hours are participation hours. *For those dentists seeking a well balanced hands-on interdisciplinary education, this study club program will answer that call! *For those dentists seeking Fellowship in the AGD, This program contains all of the requirements to reach this goal. *For those seeking Mastership in the AGD, this program over 5 years contains all of the requirements to achieve Mastership. Check out our Speaker Line Up Below for 2012-2013
Application for Washington Academy Courses Send to: Valerie A. Bartoli, Executive Director Name ______________________________________ AGD Number________________ Address_____________________________ City________ State________ Zip________ Phone ___________________________________ Fax____________________________ Email ___________________________________________________________________ Total Enclosed $________ (Make Checks out to “WAGD”) Credit Card Payment: (Please Circle) American Express, MasterCard or Visa Name__________________________________________________________________ Card Number_________________________ Total Enclosed $_____________________ Exp. Date_______ Signature for Credit Card Authorization_______________________
Fax Your Registration Today!! How It Works Washington AGD will be accepting the first 30 applicants who contract for the year. There will be four sessions per year, each consisting of a 28+credit. Washington AGD FREEZES your yearly tuition ($5000 for AGD Members, $5500.00 for Non-AGD Members) for each remaining four years. Payment Plans are available to participate in the program each year. Speaker Line Up for 2012-2013 Speaker Line Up for 2012-2013 September 20-23rd, 2012 September 20-23rd, 2012 Dennis Braunston-Digital Photography Dennis Braunston-Digital Photography Dr. Sergio Kuttler-Endodontics Dr. Sergio Kuttler-Endodontics Dr. David Clark-Fixed Prosthodontics Dr. David Clark-Fixed Prosthodontics Masters Case Presentation Masters Case Presentation November 8-11th, 2012 November 8-11th, 2012 Dr. Greg Gillespie-Fixed Prosthodontics Dr. Greg Gillespie-Fixed Prosthodontics Dr. James Brudvik-Removable Prosthodontics James Moquin-Heartstart Medical Masters Case Presentation January 24-27th, 2013 Dr. Richard Winter-Esthetics Dr. John Gammichia-Operative Dr. Michael Johnson-Removable Prosthodontics Masters Case Presentation April 25-28th, 2013 Dr. Bart Johnson-Special Needs/Medically Complex Patients Dr. Silva LaRosa-Perio (Pending) Dr. Ariel Raigrodski-Prosthodontics Masters Case Presentations
Payment Plans are Available-Please Contact: Valerie Bartoli, Executive Director Tuition for Mastertrack Sessions $5,000 for AGD Members $5,500 for non AGD Member (AGD Membership $399) *U.S. Dollars Three Easy Ways to Register Mail:
900 Meridian E. Suite #19-361 Milton, WA 98354
Cancellation Policy: Due to the nature of this course, no refunds of the yearly tuition will be given. Organizers will not be liable for any expenses incurred by participants due to missed sessions. The WAGD reserve the right to cancel a course if the minimum registration expectations are not met. Registrants will be notified and full tuition refunds will be issued.
Application for Washington Academy Courses
Send to: Interview with Dr. Edgar continued from page 5 Valerie A. Bartoli, Executive Director
6) What is going on with you personally? 7) How do you juggle all of your activities I had a new granddaughter- 7 weeks (AGD, SKCDS, ADA, an active practice, Address_____________________________City________State________Zip________ early- last June , 2011 – there is no greater family (granddaughter), etc.?” Gym Time Phone --______________ Fax_____--_______________ gift!!___Time with her is a priority. My husband, “ is gone but “It is amazing what you can Email______________________________ Bryan, is also heavily involved with organized accomplish when you don’t know what you Total Enclosed $________ (Make Checks out to “WAGD”) dentistry as ADA state treasurer, AGD can’t do” Credit Card Payment: (Please Circle) American Express, MasterCard or Visa Investment Committee and also his work Name_______________________________ on the Dean’s search for the University of 8) Anything else you want to cover?!! Washington. My son is a Fed Pilot$____________ and I Favorite quote: “Excellence is the result Card Number_________________________ Total Ex Enclosed have 2 great golden retrievers that I bought of caring more than others think is wise, at our Seattle King County Auction several riskingmore than others think is safe, dreaming years ago. more than others think is practical and expecting more than others think is possible” I want to thank those leaders and friends who have been my mentors and continue to help me develop as a leader-and given me the courage to assume this new role. Name_______________________________AGD Number_______________________
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 14
Helping Dentists Pursue Their Financial Goals David Wilson,Jr. Jr. David G. Wilson,
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Dr. Dan Fischer and Carol Jent, RDH, BA Dr. Dan E. FischEr graduated from Loma Linda University in 1974. Following graduation, he was an instructor in the restorative department at Loma Linda. Dr. Fischer maintained a full-time private practice for fifteen years, working after hours on research and development. Since 1990 he has worked extensively in research and development but still maintains a part-time practice with an emphasis on esthetic dentistry. He is president and chief executive officer of Ultradent Products, Inc. and extensively involved in the research and development of many products used widely in the dental profession, with numerous U.S. and foreign patents granted/ pending. He currently serves as an adjunct professor at Loma Linda University and the University of Texas at San Antonio. He was awarded the Lifetime Achievement Award from the AACD in 2005. ULTRAdEnT InC.College sAvE THE In October, 2011, Dr. Fischer was inducted intoPROdUCTs the American of dATE Dentists (ACD), the oldest national honorary organization for dentists. Its members have exemplified excellence through outstanding leadership and exceptional contributions to dentistry and society. Long regarded as the Join uS! earn uP to ce creditS “conscience of dentistry,” the ACD serves to elevate the standards of dentistry, encourage graduate study, and grant fellowship to those who have done meritorious work.
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It demonstrates how the use of techmaintains a busy lecture schedule, authors dental and dental hygiene articles, registration is nology enables you to provide affordable, quality treatments principles of quality adhesives and esthetic nology enables you to provide affordable, quality treatments • The important principles ofuP quality adhesives andcreditS esthetic • The importantspace, Join uS! earn toyour that your patients’ lives and bottom ce line. It also resins for direct reconstruction of the anterior fractured tooth and serves on the resins boards ofimprove numerous organizations, including Dimensions that improve your patients’ lives and your bottom line. It also for direct reconstruction of the anterior fractured tooth• More about tooth emphasizes minimally invasive, repairable esthetics and early whitening/bleaching andclinical the minimum age limited to 2 of Dental Hygiene magazine, Sealants forintervention. 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Thankfully she no longer flies small planes. posterior teeth • The of the peroxide whitening process Join uS! earn u • Techniques for the direct reconstruction of mutilated Join uS! earn uP posterior teeth doctor’S Lecture Dr. Fischer’s one-day course provides an abundance of ideas This course will focus on practical information that can be doctor’S Lecture and techniques to enhance your practice while accommodating utilized in your practice. Course topics will include: Lessons of the Downturn: Positioning for the Future Lessons of the Downturn: Positioning for the Future the needs of all patients. It demonstrates how the use of techDr. Fischer’s one-day course provides an abundance of ideas This course will focus on pract Staff Lecture andFischer’s techniques to enhance your practice accommodating utilized in your Dr. one-day course provides an while abundance of ideas This course willpractice. focus onCours practi nology enables you to provide affordable, quality treatments • The important principles of quality adhesives and esthetic the needs of all patients. It demonstrates how the use of techand techniques enhance while accommodating utilized in your practice. Course © 2011 Ultradent Products, Inc. All Rights Reserved. Ultradent Products, Inc. is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education.toADA CERP your doespractice not approve nology enables you to provide affordable, quality treatments • The important principles of qu needs of all patients. It demonstrates how the use of techthat improve and yourofbottom line. also AGD - Accepted Programresins direct reconstruction of#the anterior fractured tooth the or endorse individual your courses orpatients’ instructors, nor lives does it imply acceptance credit hours by boards It of dentistry. Provider. for FAGD/MAGD. Credit 5/1/11 to 6/30/13. Provider 209016. that improve your lives and your quality bottom treatments line. It also resins for direct reconstructio enables youpatients’ to provide affordable, • The important principles of qu Improving Your Effectiveness as a Dentalnology Professional emphasizes invasive, esthetics andIt early • More toothreconstruction whitening/b emphasizes minimally invasive, repairable esthetics and early • More about tooth whitening/bleaching and the minimum age that improveminimally your patients’ lives repairable and your bottom line. also resins about for direct childhood preventative intervention. one can bleach emphasizes minimally invasive, repairable esthetics and early • More about tooth whitening/b Cancelation fees applywants to improve their effectiveness 800.520.6640 | www.ultradent.com/bellevue childhood preventative intervention. Everyone on the job. Take more common than asthma and seven times more common onemay can bleach • The best treatment options for childhood preventative intervention. one can bleach Staff Lecture The best mechanism of options the peroxid •• The treatment for thistreatment opportunity to learn about and true dental products than hay fever. Is there a “magic pill” to prevent tooth decay? • The best options fortried fluorosis • The Techniques for the direct reco • mechanism of the peroxid and techniques from Ultradent’s R&D clinical hygienist, Carol Possibly. Learn about products that can help your patientsposterior teeth • Techniques for the direct recon • The mechanism ofbreak the peroxide process Jent. Carol will the day intowhitening two of the following three overcome this preventable disease. posterior teeth informative and engaging sessions: • Techniques for the direct reconstruction of mutilated tooth Whitening: Your Questions answered posterior teeth seven Products Every hygienist needs to Know about. Did you know Americans spend approximately $1.4 billion Learn thethan ins and outs of some the most essential products Everyone wants to improve their effectiveness on the job. Take more common asthma and ofseven times more common on tooth whitening every year? Keep up to date on this hot Staff Lecture to hygienists today. Carol will to cover a few oftooth the as Carol discusses the history and theory of tooth this opportunity to learn about tried and true dental products than hayavailable fever. Is there a “magic pill” prevent decay? topic Staff Lecture “must-haves” in her hygiene tool kit, including some very whitening, safe and efficacious treatment strategies, how to and techniques from Ultradent’s R&D clinical hygienist, Carol Possibly.unique Learn aboutdeveloped products that cantohelp patients match Improving Your Effectiveness Dental Professional products by hygienists makeyour their jobs the right product to the right patient,as thealatest research Improvingand Your Effectiveness as a Dental Professional breakthroughs, the their all-important Jent. Carol will break the day into two of the following three overcomeeasier. this preventable disease. Everyone wants to improve effectiveness pre-whitening on the job. Take exam. more common than asthma and this opportunity learn about tried and true dental than hay fever. than Is there a “magi Everyone wants to improve their effectiveness on theproducts job. Take more common asthma and informative and engaging sessions: and opportunity techniques from Ultradent’s R&D hygienist, Carol Possibly. LearnIsabout this to learn about tried andclinical true dental products than hay fever. thereproducts a “magi Putting an End to Dental caries: Wishful thinking or Jent.techniques Carol willfrom breakUltradent’s the day into two clinical of the following overcomeLearn this preventable disea and R&D hygienist,three Carol Possibly. about products tooth Whitening: Your Questions answered Potential reality? Dental caries is the most common chronic informative andbreak engaging sessions: Jent. Carol will the day into two of the following three overcome this preventable disea tooth Whitening: Your Quest children in the United States. It is five timesbillion informative and engaging sessions: seven Every hygienist needs to Know about. Did you disease know affecting Americans spend approximately $1.4 StaffProducts Lecture seven Products Every hygienist needs to Know about. Did you know Americans spend tooth Whitening: Your Quest Learn the ins andEvery outs ofhygienist some of the mosttoessential products on tooth whitening every year? Learn the ins and outs of some of the most essential products on tooth whitening every year? Keep up to date on this hot seven Products needs Know about. Did you know Americans spend available today. cover a few products of the topic as Carol discusses his Learn the to inshygienists and outs of someCarol of thewill most essential on tooth whitening everythe year? TO REGIsTER PLEAsE available to hygienists today. Carol will cover a few of the topic as Carol discusses theCALL: history and theory of tooth “must-haves” in her hygiene including whitening, safediscusses and efficacious available to hygienists today. tool Carolkit, will cover a some few ofvery the topic as Carol the hist unique products developed hygienists to make their jobs match the right product to the r “must-haves” in her hygienebytool kit, including some very whitening, safe and efficacious “must-haves” in her hygiene tool kit, including some very whitening, safe and efficacious treatment strategies, how to 1-800-520-6640 Ultradent Seminars easier. products developed by hygienists to make their jobs breakthroughs, and the all-impo unique match the right product to the ri breakthroughs, and the all-impo unique products developed by hygienists to make their jobs match the right product to the right patient, the latest research easier. Putting End to Dental caries: Wishful thinking or Note: Due to limited space, registration is limited to 2 clinical staff members perandoctor. Everyone wants to improve their effectiveness on the job. Take more common than asthma and seven times more common Potential Dental caries is Wishful the most thinking common chronic Putting anreality? End to Dental caries: or easier. breakthroughs, and the all-important pre-whitening exam. disease affecting children the United States. It is fivechronic times reality? Dentalin caries is the most common this opportunity to learn about tried and true dental products than hay fever. Is there a “magic pill” to prevent tooth decay? Potential disease affecting children in the United States. It is five times and techniques Ultradent’s R&D clinical hygienist, Possibly. Learn about products that can help your patients TO REGIsTER PLEAsE CALL: Putting an Endfrom to Dental caries: Wishful thinking orCarol TO REGIsTER PLEAsE CALL: Jent. Carolreality? will break the day intoistwo the common followingchronic three overcome this preventable disease. 1-800-520-6640 Ultradent Seminars Potential Dental caries the of most Cancelation fees may apply 1-800-520-6640 Ultradent 800.520.6640 Seminars | www.ultradent.com/bellevue informative and engaging sessions: Note: Due to limited space, registration is limited to 2 clinical staff members per doctor. disease affecting children in the United States. It is five times Note: Due to limited space, registration is limited to 2 clinical staff members per doctor. tooth Whitening: Your Questions answered seven Products Every hygienist needs to Know about. Did you Academy know Americans spend approximately billion Washington of General Dentistry$1.4 • Issue 27 • 2012 • www.washingtonagd.org • 15 Learn the ins and outs of CALL: some of the most essential products on tooth whitening every year? Keep up to date on this hot Cancelation fees may apply 800.520.6640 TO REGIsTER PLEAsE Cancelation fees may apply 800.520.6640 available to hygienists today. Carol will cover a few of the topic as Carol discusses the history and theory of tooth
Lessons of the Downturn: Positioning for the Future
Improving Your Effectiveness as a Dental Professional
Improving Your Effectiveness as a Dental Professional
© 2011 Ultradent Products, Inc. All Rights Reserved. Ultradent Products, Inc. is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. AGD - Accepted Program Provider. FAGD/MAGD. Credit 5/1/11 to 6/30/13. Provider # 209016.
© 2011 Ultradent Products, Inc. All Rights Reserved. Ultradent Products, Inc. is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. AGD - Accepted Program Provider. FAGD/MAGD. Credit 5/1/11 to 6/30/13. Provider # 209016.
© 2011 Ultradent Products, Inc. All Rights Reserved. Ultradent Products, Inc. is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality p or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. AGD - Accepted Program Provider. FAGD/MAGD. Credit 5/1/11 to 6/30/13. Provider # 209016.
PArtial list of speakers · get the complete list at: www.wsda.org/pndc-schedule Dr. Gordon Christensen ........Restorative
Dr. Dolphine Oda ................Oral Lesions
Dr. Bart Johnson ................Anesthesia/ Pharmacology
Ms. Eva Grayzel.................Oral Cancer Survivor
Ms. Amy Kirsch..................Marketing/ Customer Service Dr. Edward Zuckerberg ........Technology/ Social Media
Ms. Mary Osborne .............Communication
Mr. Kirk Behrendt ..............Practice Management Ms. Jennifer Blake ..............Dental Assisting
Dr. Joan Otomo-Corgel ........Perio Hygiene/ Women’s Health
Dr. Art DiMarco..................Anesthesia
Mr. Gary Zelesky ...............Team Motivation
Dr. Martha Anne Keels.........Pediatrics
Ms. Rachel Mele ................Social Media
Dr. Frank Milnar .................Esthetics
Dr. Betsy Bakeman .............Occlusion
Dr. Brian Novy...................Caries
Dr. Jeff Brucia....................Restorative
Dr. Marty Zase ..................Cosmetic Dentistry Dr. Olya Zahrebelny ............Dental-Medical Coding Ms. Cheri Wu ....................Ultrasonics Ms. Tricia Osuna.................Dental Hygiene Dr. Mark Ryder..................Periodontics Dr. Sonia Leziy and Dr. Brahm Miller.................Implants
Ms. Tina Calloway ..............Assistants Mr. Art Cole ......................First Aid/CPR Dr. Timothy Hess ................Implant Restoration
Ms. Anna Marie Hauser, Ms. Mary Johnson, and Ms. Gail Liberman ..............Radiography
Dr. Charles Gerba ...............Germ Control
Dr. Sam Kratchman .............Endodontics
Ms. Kristy Menage Bernie ....Dental Hygiene
REGISTER AT: www.wsda.org/pndc
Earnc up to It was 1960 and the World’s Fair was coming to Seattle. Looking to capitalize in on the futuristic theme, WSDA members created Dr. Wes Day, S.A.P.D. to promote the 1962 Scientific Session (which later became the PNDC). Wes Day was conceived as an alliteration of WSDA, and his fancy title was Space Age Pioneer Dentist.
SAVE $1,585! CDE Credits over two days!
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Early Bird FEES: (Before April 30)
WSDA members: $165 Non-ADA Members: $1,750 Staff: $115
PNDC Pacific Northwest Dental onference June 14 & 15, Seattle, Washingtonc
Need more info?
www.wsda.org/pndc · firstname.lastname@example.org · 800-448-3368 Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 16
January 2012 PCDS.indd 1
“Goodbye Seattle!” 3/12/12 10:05 AM
delay or effort, bringing the viewer to the advertiser’s site immediately, QR Code (abbreviated from where a longer and more targeted Quick Response Code) is the sales pitch may continue. trademark for a type of matrix I found this link to be very barcode (or two-dimensional code) useful in developing barcodes for first designed for the automotive different companies I work with. industry. More recently, the system has become popular http://qrcode.kaywa.com outside of the industry due to its fast readability and large Once your barcode is created, The Key to Asset Protection storage capacity compared to click on the image and then right & Tax Reduction click to save it as a .png file to your standard UPC barcodes. The code consists of black modules computer. Look in the market on April 19th, 2012 arranged in a square pattern on a your smartphone for the barcode 6:30pm-9:00pm Legally Mine-Daniel McNeff white background. The information scanner application encoded can be made up of four Future Strategies “Preparing Dentists for the Future” standardized kinds (“modes”) of data (numeric, alphanumeric, Thursday, September 20th, 2012 byte/binary, Kanji), or through 6:30pm-9:00pm Speaker-Dr. Marc Cooper supported extensions, virtually any kind of data. Invented by “STICK to the Basics! the Toyota subsidiary Denso Wave The Secrets to Predictable in 1994 to track vehicles during Adhesive Dentistry” the manufacturing process, the November 8th, 2012 QR Code is one of the most www.washingtonagd.org Thursday, 6:30pm-9:00pm popular types of two-dimensional Speaker-Dr. Ed Hewlett barcodes. It was designed to allow its contents to be decoded at Register Online high speed. www.washingtonagd.org Formerly confined to industrial uses, they have in recent years become common in consumer advertising and packaging, because the dissemination of smartphones “has put a barcode reader in everyone’s pocket” for the first time. As a result, the QR code has become a focus of advertising strategy, since it provides quick and effortless access to the brand’s website. Beyond mere convenience to the consumer, the importance of this capability is that Find us on Facebook www.facebook.com/ReferralBuildersLLC it increases the conversion rate (that is, increase the chance that contact with the advertisement 10% off all apparel orders through May 31, 2012. will convert to a sale), by coaxing qualified prospects further down the conversion funnel without any
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 17
2012 Academy of General Dentistry
For more information: Call us toll-free: 888.AGD.DENT (888.243.3368) Or join online: www.agd.org
If you were referred to the AGD by a current member, please note information below:
City, State/Province, or Federal Services Branch
Designation (e.g. DDS, DMD, BDS)
Date of birth (mm/dd/yyyy) Required for access to the members-only AGD website
Do you currently hold a valid U.S./Canadian dental license? q Yes q No _______________________________________________________________________________________________________ License number State/Province Date renewed (mm/yyyy) Type of membership (See back page for definitions): (check one) q Active general dentist q Associate (Dental specialist) q Resident q Dental student q Affiliate If you are not in general practice, please indicate your specialty: _______________________________ Current dental practice environment: (Check one) q Solo q Associateship q Group practice q Hospital q Resident q Corporate q Other____________________________ q Faculty _________________________________________________________________ Please indicate institution
q Federal Services ___________________________________________________________________ Please indicate branch
If you are a member of the Canadian Forces Dental Service, please indicate your preferred constituent: q U.S. Military counterpart q Local Canadian constituent
Your AGD constituent (local chapter) is determined by your business address, unless one is not available.
Preferred billing/mailing address: q Business q Home Preferred method of contact: q Email q Mail q Phone q Text
Name of business (If applicable)
Are you a graduate of an accredited* U.S./Canadian dental school? q Yes q No q Currently enrolled
Date of graduation (mm/yyyy)
Are you a graduate of (or resident in) an accredited* U.S. or Canadian post-doctoral program? q Yes q No q Currently enrolled Type: q AEGD q GPR q Other ____________________________________________________________________________________________________________________________________ Post-doctoral institution State Start date (mm/dd/yyyy) End date (mm/dd/yyyy)
*See back of form. For information on qualifying for the residency dues discount, please refer to the description on the back.
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Please check membership type applying for:
q Active General (in Canadian dollars) Dentist ....................$354.00 ............$288.00 ...........$296.00 q Associate ....................354.00 ..............288.00 .............296.00 q Affiliate ......................177.00 ..............144.00 .............148.00 q Resident ......................71.00 ................57.00 ...............59.00 q 2011 Graduate ............71.00 ................57.00 ...............59.00 q 2010 Graduate ..........142.00 ..............115.00 .............118.00 q 2009 Graduate ..........212.00 ..............173.00 .............178.00 q 2008 Graduate ..........283.00 ..............231.00 .............237.00 q Student ........................16.00 ................16.00 ...............16.00
q Check (Enclosed) q VISA q MasterCard
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Note: Payments for Canadian members can only be accepted via VISA, MasterCard, or check.
Expiration date Please print name as it appears on the card I hereby certify that all of the above information is correct, and that by signing this application agree to all terms of membership including completion of 75 hours of continuing education every three years for Active General Dentist and Associate Members.
1. AGD Headquarters Dues .............................. _________ 2. AGD Constituent Dues ................................ _________ Please refer to back side for constituent dues
Total Amount Enclosed: ................................. _________
Return this application with your payment to: Academy of General Dentistry, 211 E. Chicago Ave., Ste. 900, Chicago, IL 60611-1999 For applicants paying with credit cards, fax to: 312.335.3443 (secure fax number)
Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 18
What happens when WISHA walks in? It’s no secret that WISHA inspectors are investigating dental offices throughout the state at record numbers. More dental offices were randomly selected for a WISHA inspection in the first three months of this year than were randomly inspected in 2008 and 2009 combined. And, according to the Division of Occupational Safety and Health (the folks from Labor and Industries who do the inspecting), they’re not done yet. Being ready when the inspector walks through y our door is crucial. Each regulation has a different mandate and a variety of rules and making sure you’re in compliance can be confusing and frustrating. HARRISBIOMEDICAL has been helping dentists navigate the compliance maze for years. In times like these a call to the “Compliance Company” is a good first step. HARRISBIOMEDICAL
1035 Andover Park West, Suite 120 Seattle, Washington 98188
“The Compliance Company”
As one of the country’s leading dental compliance firms since 1989, HARRISBIOMEDICAL™ provides the full range of compliance services including preparation of your written programs, WISHA, HIPAA, AND BLS/CPR staff training, free facility compliance reviews, answers your questions, and expert hands-on support.
“It’s like having a full-time compliance expert on staff.”
WISHA programs and staff training I think Dr. Weiler needs to handle this one.
HIPAA programs and staff training I’m not sure that’s what HIPAA had in mind,
1st Aid / BLS CPR staff training
Yes, Chrissie, I’d call that a needlestick. ©
Telephone: 866-548-2468 ** FAX: 206-575-8177 ** www.harrisbiomedical.net ** email@example.com Washington Academy of General Dentistry • Issue 27 • 2012 • www.washingtonagd.org • 19
Constituent of the Academy of General Dentistry Valerie A. Bartoli, Executive Director
PRSRT STD US POSTAGE PAID PORTLAND OR PERMIT NO 243
900 Meridian E. Suite #19-361 • Milton, WA 98354 p. 253.306.0730 • f. 253.891.4053
Scan with the bar code scanner app on your smartphone, or visit www.agd.org/membership/QRCE to access your FREE Self-Instruction exercise!
Your voice for excellence through education and advocacy
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