October 2014
Journal of the Georgia Dental Association
Seeing The Body From the Mouth: Systemic & Oral Health Connections
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GDACONTENTS OCTOBER 2014 VOLUME 33, NO. 10
COMMENTARIES 5 • Editorial
Dr. David Bradberry on remodeling our “cottages” and connecting.
7 • ADA Commentary
Dr. Chuck Norman on finding success on every practice path.
9 • GDA Commentary
Dr. Byron Colley on connecting with the Council on Dental Health to plan for Children’s Dental Health Month.
COLUMNS 11 • Endorsed Services
Connecting with family on financial planning: Tips from UBS Financial.
15 • Politics & Dentistry
Connect with legislators at your district receptions.
20 • Mouth and Body Connections
Oral health is a window into a patient’s overall health. Dentists are trained to look for signs of potential systemic problems within the oral cavity and in the head and neck area, and how to treat the oral manifestations of certain systemic conditions. This update on oral and systemic health connections includes guidance on how to communicate to patients the value of having a dentist as their partner in maintaining their optimal oral and overall health.
17 • Practice & Legal Issues Dental Records 101: Answers to frequently asked questions.
19 • Leadership Pathways
Tips on how dentists can share oral health information with physicians. This November, the American Diabetes Association challenges America to Get Cooking to Stop Diabetes!
30 • MILESTONES
Visit us online each week and get tips on staying healthy throughout the holiday season, learn how to host a special, food-themed event and vote for your favorite recipes to help create the perfect holiday meal! Visit us at diabetesforecast.org/adm or call 1-800-DIABETES.
America Gets Cooking to Stop Diabetes is presented by
33 • PROMOTIONS 35 • CALENDAR 36 • CLASSIFIEDS
24 • DEEP DIVE In his first 180 days, GDA Executive Director Frank Capaldo discovered a solid foundation, challenges to overcome, and a significant amount of opportunity. Read about the efficiencies in place and products and services on the way.
30 • MILESTONES
33 • PROMOTIONS
Member news and views featuring a report from the TeamSmile charitable care event with the Atlanta Falcons (Dr. Trushar Patel, above left, was a volunteer), as well as updates on Dr. Carol Wolff as NDDS Dentist of the Year.
November is American Diabetes Month. Visit the website www.gadental. org for materials to share with patients about how healthy eating and having a healthy mouth has a positive impact on creating a healthy body. October 2014 • 3
ABOUTGDA GDA ACTION (ISSN 0273-5989; USPS PE-590290) The official Journal of the Georgia Dental Association is published monthly. POSTMASTER: Send address changes to GDA Action, 7000 Peachtree Dunwoody Road N.E., Suite 200, Building 17, Atlanta, GA 30328. Dr. Doug Torbush (President) 1000 Iris Dr SW Conyers, GA 30094 torbush@gmail.com Dr. David Bradberry (State Editor) 1070 Woodlawn Dr NE, Ste 250 Marietta, GA 30028 drbradberry@bellsouth.net Delaine Hall (Managing Editor) 7000 Peachtree Dunwoody Rd NE Ste 200, Bldg 17, Atlanta, GA 30328 hall@gadental.org GDA Executive Office 7000 Peachtree Dunwoody Road Suite 200 Building 17 Atlanta, GA 30328-1655 Call (800) 432-4357 Call (404) 636-7553 Fax (404) 633-3943 www.gadental.org GDA ACTION seeks to be an issuesdriven journal focusing on current matters affecting Georgia dentists and patients accomplished by disseminating information and providing a forum for commentary. Closing date for all editorial and advertising materials: First of the month preceding publication month. Subscriptions: $17 of GDA membership dues is for the journal; all others, $75 per year. Periodicals postage paid at Atlanta, GA. © Copyright 2014 by the Georgia Dental Association. All rights reserved. No part of this publication may be reproduced without written permission. Publication of any article or advertisement should not be deemed an endorsement of the opinions expressed or products advertised. The GDA expressly reserves the right to refuse publication of any article, photograph, or advertisement, and illustrate, reduce, or revise any article submitted.
4 • October 2014
YOUR PARTING SHOTS GDA Office Staffing Updates The GDA thanks Associate Executive Director Nelda Greene for her 22 years of dedicated service. She served as interim executive director for one year before the GDA hired Frank Capaldo in March. Nelda retired at the end of August. Meanwhile, the GDA welcomes three new employees! Carol Galbreath, APR, is your senior director of public relations and marketing. The GDA looks forward to entering a new era of public and media outreach with Carol’s help. Stephanie Lotti is your director of professional member services. Stephanie will handle Medicaid and PeachCare issues, Give Kids a Smile Day planning, third party issues, and oral health in institutional settings coordination among other issues. She brings with her a wealth of research and lobbying experience. Fatimot Ladipo joined the GDA in October as our director of government affairs. Fatimot is an accomplished government and community relations executive with extensive experience in policy analysis, coalition building, and
the coordination of outreach activities. She, General Counsel Melana McClatchey, and Executive Director Frank Capaldo, backed up by Stephanie Lotti, will ensure that the GDA is well-represented under the “Gold Dome” during the 2015 legislative session.
DEA Reclassification and Medicare Opt In and Opt Out The GDA office continues to receive questions on the DEA reclassification of hydrocodone combination products, such as Vicodin, from Schedule II drugs to Schedule III drugs that went into effect on October 6. Dentists with a Schedule III DEA registration who wish to keep prescribing these products must amend their registration to include Schedule II prescriptive authority. Many dentists also have questions about the requirement for dentists to either opt in or opt out of Medicare by June 2015. Dentists are especially concerned about their future ability to write prescriptions for their Medicare patients. Dentists are encouraged to visit the GDA website www.gadental.org for the latest information.
OCTOBERADS ADS South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 AFTCO Transition Consultants. . . . . . . . . . .10 Center for TMJ Therapy . . . . . . . . . .. . . . . . .38 Craniofacial Pain Center of Georgia . . . . . . 8 Dental Care Alliance. . . . . . . . . . . . . . . . . . . . . 6 Dr. John Harden . . . . . . . . . . . . . . . . . . . . . .. . 28 Dr. Mark Padolsky—TMD Dentist. . . . . . . 38 Fyffe Construction . . . . . . . . . . . . . . . . . . . . . 14 GDA Dental Recovery Network . .. . . . . . . .14 Georgia Dental Insurance Services. . . . . . 40 Hospital Dentistry—Dr. Kurtzman. . . . . . .. 6 Law Office of Stuart J. Oberman . . . . . . . . 18 Map Laboratory. . . . . . . . . . . . . . . . . . . . . . . . 16 Medical Protective . . . . . . . . . . . . . . . . . . . . . . 2 Officite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Paragon Dental Practice Transitions. . . . . 14 Southeast Transitions . . . . . . . . . . . . . . . . . . .16 UBS Financial Services . . . . . . . . . . . . . . . . . .12
October 2014
Journal of the Georgia Dental Association
Seeing The Body From the Mouth: Systemic & Oral Health Connections
Advertise in GDA Action! Email Skip Jones at jones@gadental.org for rates.
Our Cottages: A Time for Remodeling
GDA Editor Dr. David Bradberry.
“The world is changing and we have to change with it ... we must engage 100 percent of dental practitioners to have a hand in defining what the new model will be.”
DR. DAVID BRADBERRY State Editor Phone (770) 977-8644 drbradberry@bellsouth.net DELAINE HALL Managing Editor Phone (404) 636-7553 hall@gadental.org SKIP JONES Advertising Manager Phone (404) 636-7553 jones@gadental.org
To date we have lived as professionals in a village of cottages. That is to say, we are a cottage industry. What do I mean by that? Of the group of dental professionals in Georgia there are the majority who are providing care to the general population in a type of private practice model and there are those who primarily educate the future members of the profession. There have been many different outside groups, both private and governmental based, who have and are trying to modify the various principles of practice that affect delivery of care and business operations. The fact is, we are two different entities in one — a point of health care delivery and a business. Ultimately, we are interdependent. It takes people and revenue to both operate a business and deliver care to the populace. There is no free lunch as the old axiom says. There is a price for everything no matter what the system is. Roughly two-thirds to three-quarters of all dental practitioners belong to organized dentistry at every level of the tripartite, which is district, state, and national. Not bad as statistics go, but what about the one-third to one-quarter who do not belong? I have to ask what causes them to not want to be a part of something that represents them. Ultimately most people in our society vote for or against something with their pocketbook or their feet or both. The ones who choose not to participate are literally voting with both against organized representation. This leads naturally to several questions that need answers. Why are they voting against the majority who do see the need? What are their reasons? Is it as simple as a vote to refuse dollars or is there something else? Why would they rather “opt out” and let others carry the burdens associated with a representative group? So I have been asking a question lately. What might our world look like if more than 150 years ago the people who came together to start the Georgia Dental Society, which became the GDA, had never done so? What if the GDA and the American Dental Association were never a reality? Think of it — what if every dentist was out there on their own? Whether they practiced alone or in groups, what if the only
reality was whatever interaction they had with colleagues they know, likely limited to their geographic vicinity? Picture in 2014 if there were no meetings beyond what may be done on a local level between friends. What if in 2014 all aspects of society had advanced as history has shown with one exception — dentists never came together and organized on any level anywhere? How different might our world look? For starters we could look at licensing. The first licensing in Georgia came from early members of the Georgia Dental Society. But if they didn’t organize, would there be licensing or care standards at all? If so, would the standards have come from state or federal government individuals who had no knowledge of the practice of dentistry? If we had no representation in any organized manner this might be likely. Yes, individuals could stand up to voice their opinion, but they would be seen in the halls of government as just that — individuals. Let’s assume that government did decide to “license” dentists so they could know how many and where they were. Then a bill comes along in Congress that mandates that all licensed dentists must, as a condition of licensure, participate in all public and private health insurance plans. What if there were no organization there with the best interests of the patients and practitioners in mind? No one, save a hearty few individuals, to argue for enough reimbursement to maintain the business part of our symbiotic model? Food for thought. This is just one tiny part of one point in the larger picture. It makes you think just a little. The argument may be that it didn’t happen, so why concern ourselves with it? Then I ask, what if the membership numbers reversed and 65-75 percent became the non-member number? Knowing what we do about business, the organization would become financially unsustainable.
DR. DAVID BRADBERRY Continued on page 13
October 2014 • 5
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2/5/14 2:43 PM
Connecting with Success on Every Practice Path
Immediate Past ADA President Dr. Chuck Norman.
“If you want to shape ... changes and define the role of dentistry in the delivery of health care, you need to be engaged as members of your professional organization.”
DR. CHARLES NORMAN Immediate Past President American Dental Association www.ADA.org
Dr. Chuck Norman, immediate past president of the American Dental Association, recently spoke to the Class of 2014 of his alma mater the University of North Carolina School of Dentistry. As ADA president, Dr. Norman focused his efforts on providing the ADA with a clear vision, motivated leadership, and a dynamic strategic plan. His three-pronged plan includes keeping the organization on solid financial ground through growing membership; solidifying the ADA as the preeminent voice of dentistry; and advancing initiatives that help the profession and the public. The remarks he offered, generalized here, focus on what dentists can do as a part of organized dentistry to strengthen the profession. I am honored to be here tonight to share this special occasion with you and your family and, more importantly, to congratulate you on this tremendous achievement. You are joining a relatively small, collegial profession of just over 235,000 dentists nationwide. I know firsthand what you are feeling tonight as you graduate because in 1977, I was sitting where you are, listening to the keynote speaker, eager for him to finish, wanting to walk across this stage and receive the diploma for which I, like you, had worked so hard for these last four years. Then in 2010, I had the honor of sitting where your parents and families are tonight to celebrate my son Matt’s graduation from dental school. As an alumnus, colleague, and president of the American Dental Association, I wish to share a few of my thoughts about our profession and the role that each one of you will play in shaping our future. As you transition from student to practitioner, you will face an environment very different from the one that I faced in 1977: • Decay trends have decreased in 80 percent of population • Decreasing covered lives by dental insurance • Decreasing utilization • Increasing numbers eligible for public assistance • Increase in student debt as a percent of net income • Endless opportunities for career choices:
private practice partnerships and associateships, group practice, academics, research, public health, military, specialty training, and administration and sales with industry.
Whichever route you choose, it is up to you to determine your success. I chose private practice and for the last 37 years, I have enjoyed every minute. While your career may be very different than mine, I have several pieces of advice that will serve you well regardless of your career choice or the state of the dental environment.
Dream Big and Surround Yourself with Advocates and Mentors
Let me tell you a story about a 2002 movie, “The Rookie,” about a man named Jim Morris. He moved around as a military child. He started playing baseball at age three and dreamed of playing in the majors. He moved to Texas after freshman year in high school, graduated in 1982, and played six seasons in the minors. During his career, he suffered with injuries and surgeries, so he went back to school, earned a teaching certificate, and began coaching baseball in Texas. In 1999 he made a bet with his team. He was signed by Tampa Bay, played in AAA for the Durham Bulls, and was called up and pitched one season in the majors. He achieved his dream. His career was not a Cinderella story; he only played one year. That was not the point. The take away was to always surround yourself with mentors and people who empower you to reach for your dreams and give you positive support.
Commit to Lifelong Learning
What you learn from here forward is what makes you an exceptional dentist. When I began practice there were no implants, or posterior composites, or CAD/ CAM. Who then would have envisioned I would be able to take digital impressions for C&B, mouth guards, and surgical guides, or that we would have the ability to see teeth
DR. CHUCK NORMAN Continued on page 13
October 2014 • 7
Have your patients complained about face pain?
HEADPAIN Forehead Temples Migraine type Sinus type
Face Pain
EYES
Myofascial pain and toothaches.
Pain behind eye, above eye, below eye Sensitive to light
EAR
Many disorders in the head and neck region are known to refer pain to dental structures and imitate dental pain. Due to the location of the perceived pain dental clinicians are often involved in the diagnosis and management of the pain. Myofascial pain (MFP) is widely believed to be the most frequently occurring orofacial pain of non-odontogenic origin. It has long been known that MFP could mimic pulpitic symptoms. Past studies have shown that MFP is a relatively prevalent condition among the general population and the one that is most often misdiagnosed by dentists. Aust Endod J, 2005 vol. 31(3) pp. 106-10. Kim, ST
Ear Pain Ringing in ears Dizziness Vertigo Fullness
TEETH
Clenching/Grinding at night Looseness and soreness of back teeth Unexplained tooth pain
NECK
Lack of mobility/stiffness Neck pain Tired/sore muscles Arm/finger numbness
JAW
Clicking, popping jaw joints Pain in cheek Limited opening Face pain Muscle stiffness
Mayoor Patel DDS, MS D.ABDSM, DABOP, DABCP, DAAPM, FICCMO, FAACP, FAGD
1505 Mount Vernon Road, Suite 150 • Dunwoody, GA 30338
P: 678 899 6076 • F: 678 899 6075 W: www.cpcgeorgia.com E: office@cpcgeorgia.com Dental Sleep Medicine and Craniofacial Pain are not recognized as specialty areas by the ADA. Adjunct Clinical Instructor Tufts University, Boston, MA & Georgia Regents University, Augusta, GA
HEADACHES
8 • October 2014
FACIAL PAIN
NECK PAIN
TMJ DISORDERS
SLEEP APNEA
Connect with Your Council on Dental Health The Council on Dental Health works to improve the oral health of all Georgians by addressing matters and programs concerning dental health services. This report gives you an update on some of our activities, and alerts you to important deadlines and news.
Children’s Dental Health Month & Give Kids A Smile Day
GDA Council on Dental Health Chairman Dr. Byron Colley.
“Dentists who want to participate in a district GKAS event, or have questions about Children’s Dental Health Month resources, should contact their district Council representative.”
DR. BYRON COLLEY Chairman (912) 355-5901 hacolley@gmail.com COURTNEY LAYFIELD GDA Staff Support layfield@gadental.org STEPHANIE LOTTI GDA Staff Support (800) 432-4357 lotti@gadental.org
Children’s Dental Health Month is February, and Give Kids A Smile (GKAS) Day is on Friday, February 6, 2015. The Council’s goal is for each district to host their own GKAS event as well as assist dentists who may want to host individual oral health events during the month. Dentists who want to participate in a district GKAS event, or have questions about Children’s Dental Health Month resources, should contact their Council representative. Start planning now! Dr. Amy Loden (Central) amylodendmd@bellsouth.net Dr. Andy Chandler (Eastern: Augusta) andy.chandler@comcast.net Dr. Jennifer Wells (Eastern: Athens) docwells8@yahoo.com Dr. Ryan Vaughn (Northern) ryvaughn@att.net Dr. Aaron Schwartz (Northwestern) aschwartzdds@gmail.com Dr. Chris Shim (Northwestern) skim312@comcast.net Dr. Stephanie Skinner (Southeastern) skinnerdmd@gmail.com Dr. Amanda Merritt (Southwestern) amandasmerritt@hotmail.com Dr. Alex Cranford (Western) alex@cranfordbraces.com
Fluoridation Opposition
Elected officials in Jesup, Hinesville, and Fayette County are questioning the value of fluoridating their local water supplies. GDA dentists in those areas are working with local officials on the issue. The GDA, through our Fluoridation Liaison, Dr. Joe Alderman, continues to monitor events in these areas and stands ready to assist as requested. There is still no word from Federal officials regarding the proposed change in fluoride levels to 0.7/mg/L for community
water systems throughout the United States. Once the government formulates recommendations, look for information from your ADA and GDA.
Medicaid & PeachCare for Kids
GDA staff members testified in support of streamlined credentialing for dentists at the Senate Medicaid Care Management Organization Credentialing Study Committee hearing in Moultrie on October 6. The GDA has heard from several members about the problems they have experienced due to delays and administrative hurdles caused by the Medicaid CMOs. Thanks to our GDA for advocating on behalf of our members who care for Medicaid and PeachCare patients. Thanks as well to the GDA for regularly informing our GDA member providers about changes to claims submission and Electronic Funds Transfers requirements. The Department of Community Health (DCH) and HP will host a Medicaid Providers Fair on Thursday, December 4, in Macon. Representatives from DCH, HP, Avesis, DentaQuest, and Scion will be available in person to discuss issues dental offices may have, as well as review claims or credentialing applications. Call the GDA office for details. Kudos to DCH Board member Dr. Donna Thomas Moses for being appointed as interim DCH board secretary. We appreciate this GDA member’s work. We understand from her reports and reports of GDA staff that the DCH Board approved budget requests for 2015 and 2016 which do not include any cuts to Medicaid or PeachCare. These budgets will be incorporated into the Governor’s budget proposal to go to the General Assembly in January 2015.
Special Olympics & TeamSmile
Thanks to our GDA members who volunteered to provide dental screenings and oral health education during the Special Olympics Masters Bowling tournament in August and TeamSmile event with the Atlanta Falcons in September. These volunteers made a positive impact on the oral health of hundreds of Georgians. Turn to page 30 for photos from the TeamSmile event and look for a report next month on Special Smiles. October 2014 • 9
U.S. Postal Service Statement of Ownership, Management, and Circulation GDA Action, The Journal of the Georgia Dental Association
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Georgia Dental Association, 7000 Peachtree Dunwoody Road NE, Suite 200, Building 17, Atlanta, GA 30328-1655
(404) 636-7553
Georgia Dental Association, 7000 Peachtree Dunwoody Road NE, Suite 200, Building 17, Atlanta, GA 30328-1655
Georgia Dental Association, 7000 Peachtree Dunwoody Road NE, Suite 200, Building 17, Atlanta, GA 30328-1655
Georgia Dental Association (GDA)
Georgia Dental Association (GDA)
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X October 2014
October 1, 2014
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Reidsville, Georgia
AFTCO is pleased to have represented all parties in these transitions.
Helping dentists buy & sell practices for over 40 years. 10 • October 2014
WWW.AFTCO.NET
SPOTLIGHT ON GDA ENDORSED SERVICES AND THEIR BENEFITS:
CONNECTING VIA FAMILY FINANCIAL PLANNING Begin before the end: Why families need to have inheritance conversations now. Content provided as part of the
GDA/UBS Wealth Management Program.
The traditional view of inheritance is changing. When parents include their children in their inheritance plans, families are much happier with the outcomes, with nine out of ten heirs being highly satisfied when they know the details ahead of time. And yet, neither benefactors nor heirs feel comfortable having this difficult conversation. This reluctance is driven by emotional barriers on both sides. Benefactors feel it’s not a pressing issue and want to avoid creating a sense of entitlement in their heirs. Heirs feel it is not appropriate to bring up their parents’ money and they don’t want to look greedy. But both sides agree: the responsibility lies with the parents to start the conversation.
Inheritance is no longer about waiting until the end
Families frequently avoid discussing this thorny topic until it is too late to address unresolved matters, leading to dissatisfaction and disagreements among heirs. However, when benefactors begin inheritance planning early and include heirs in the process,
As part of the GDA/UBS Wealth Management Program, UBS can provide members with guidance about inheritance planning. Please contact Wile Consulting Group at UBS: (404) 760-3000 or www.ubs.com/team/wile.
it leads to fewer disagreements among heirs and everyone is more satisfied. Families are starting to change their traditional approach to inheritance planning. Most benefactors have an up-to-date will and about half claim to have discussed plans with their children. But they are reluctant to divulge too much information, with only half saying their heirs know where the wealth is, and only about a third having disclosed their wealth to their heirs. Yet, good inheritance planning is much more than having a static will; it requires starting well before the end and including family members in the process. And benefactors are starting to recognize the importance of this issue, with about half saying they would like to discuss their inheritance plans more with their heirs. __________________________________ While most benefactors have a will, they have not engaged in inheritance planning with their heirs. Question: “Which of the following do you have, or have you done?” • An up-to-date will: 83% • Discussed plans with children: 54% • Let heirs know about wealth: 34%
Key barriers get in the way of open discussions on inheritance planning
Heirs indicate that the biggest barrier that kept their family from discussing inheritance plans was that they just didn’t talk openly about financial issues. They also did not want to bring up the topic for fear of appearing greedy. Benefactors, regardless of age, tend to feel that it’s not a pressing issue. They also worry about their children counting too much on the inheritance or developing a sense of entitlement. Three in four view it
as highly important that their children use their inheritance wisely and don’t squander it. Benefactors feel strongly that they want the inheritance process to go as smoothly as possible. The vast majority consider it highly important that the transfer of assets to their heirs goes smoothly, and two out of three consider it highly important that there are no bad feelings among their heirs about the inheritance. While nobody wants to start the conversation, both sides agree it is generally up to the benefactor to do so. When asked about what could help ease the barriers to inheritance plan discussions, each constituency favors the parents raising the issue. Ultimately, it’s the parents’ money and their decision about what to do with it, so it is also up to them to decide when and what to share with their heirs. __________________________________ Benefactors care deeply about having a smooth inheritance process. Question: “How important are the following to you?” • The transfer of assets goes smoothly from me to my heirs: 84% • There are no bad feelings among heirs over who got what or how much: 66%
Inheritance planning is only part of the wealth transfer process
Increasingly, wealth transfer planning includes not only a will, but also giving while living, managing taxes, and providing support for multiple generations. Most
GDA Endorsed Services Continued on page 12
October October 2014 2014 •• 11 11
GDA Endorsed Services
Families are happier when parents include heirs in planning
Continued from page 11
benefactors prefer to begin passing on wealth to their heirs while living, with four out of five providing financial support to their adult children for a variety of reasons, including financial need and a desire to see their children succeed. Benefactors often give with multiple generations in mind. Nearly half of grandparents say it’s highly important that their assets also support their grandchildren. And nearly a quarter of them plan to leave part of their wealth directly to grandchildren. This sentiment is already at work. The number one way parents offer financial support to their adult children is by putting money into college funds for the grandchildren. __________________________________ Benefactors prefer giving while living, rather than passing on wealth posthumously. Question: “Which of the following best describes how you would prefer to pass on wealth to your heirs?” • Prefer to pass on wealth while living: 60% • Prefer to pass on wealth posthumously: 40%
While it may not be an easy conversation to have, talking about inheritance planning makes a huge impact among heirs. When heirs know the details of the inheritance ahead of time they are much more satisfied with the distribution process. However, when heirs do not know the details ahead of time, they are more than twice as likely to have disagreements among themselves about the inheritance distribution. The situation is even worse when there is a known unresolved issue prior to a parent’s passing, such as who will get the house. In these cases, satisfaction plunges among heirs and the likelihood of disagreements about the inheritance distribution skyrockets from 11% to 82%. Sensitive topics may not be easy to resolve, but it will only get harder once a parent passes. __________________________________
• If no unresolved topics: 85% • Knew inheritance details: 89% • Had unresolved topics: 37% • Did not know inheritance details: 65%
Break the silence
Ultimately, successfully managing inheritance requires families to overcome the awkward silence, so that they can engage in open dialogue and more comprehensive planning. As part of the GDA/UBS Wealth Management Program, UBS is available to help guide you in these difficult conversations. For more information or guidance about inheritance planning, please contact Wile Consulting Group at UBS: (404) 760-3000 or visit www. ubs.com/team/wile.
Visit the GDA website www. gadental.org and click the green “Insurance/Products” button to learn more about all of the products Transparency and conclusiveness in and services endorsed by your Asinheritance planning yields satisfied heirs. sociation. Save on shipping services, Question: “How satisfied were you with the process for the distribution of your parents’ credit card processing, credit cards, estate when they passed away?” computers, and much more.
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DR. CHUCK NORMAN Continued from page 7
and supporting structures in 3D for better diagnosis? All of those things are common place in my practice today. In 35 years, you will look back at the advancements made from now until then and be astonished how much change will occur in our profession. Don’t get left behind.
Take Responsibility for Your Profession. Be a Leader in Your Professional Organization
Just as there has been tremendous change in the science of dentistry, there has been significant change in the dental environment and marketplace in the last 37 years. You can rest assured that those changes will continue. If you want to shape those changes and define the role of dentistry in the delivery of health care, you need to be engaged as members of your professional organization. Some of you will be leaders at the local, state, or national level of the ADA. Even if you are not, however, all of you should be members and voice your opinion. Opportunities do not happen by chance. Be assertive and offer your time and skills at your district level. You can work on some project in an area of interest to you, go through the officer chairs, or volunteer your time with community outreach like GKAS and MOM. Whether or not you are interested in leadership with organized dentistry, you all should accept the responsibility of being leaders in your communities. You become the voice of dentistry with the lay public and an advocate for the patients we serve. Collectively, we can influence policy, but individually you can change lives.
Ethics, Excellence, Leadership, and Advocacy Should Be as Much a Part of Your Career as Placing an Occlusal Restoration
Having spent the last two years traveling the country, I am excited about the future of dentistry. Looking out at this graduating class, I know our profession is in good hands. I envision dentistry playing a much larger role with our medical colleagues in the early diagnosis and control of chronic diseases such as diabetes and cardiovascular disease, as well as the prevention of other diseases by
providing vaccinations. Your responsibilities within the health care community will certainly expand and you must advocate for the full use of your knowledge and skill. Before I close, I want to leave you with a final thought. When I gave my presidential address last year, I referenced the career of Dean Smith, an icon and much revered coach here at Chapel Hill. His leadership and uncanny ability to mold impressionable young men into a team and an extended family was at the heart of his success. Similarly, as an organization, the ADA operates like a team servicing our members and patients as though we all belong to an extended family. But Coach Smith’s most important trait is one that most people are not aware of. In the late sixties, Coach Smith quietly did his part to forward civil rights for all people regardless of race. Years later when his efforts were made public, he responded, “You should never be proud of doing what’s right. You should just do what’s right.” Remember, when you embark on your careers and you have been entrusted with the responsibility of your patients’ health, remember those wise words from Dean Smith: “Just do what’s right.” Best wishes on a successful future and I am honored to call all of you colleagues.
DR. DAVID BRADBERRY Continued from page 5
We have become comfortable with our “cottage style” business model and generally happy with our representation that continues to work for the best interests of patients and all dental practitioners, both member and non-member alike. After all, six or seven out of 10 voted for it. It’s not perfect as there are no perfect people. The world is changing, and we have to change with it. The age of cottages is likely evolving into something else and we must engage 100 percent of dental practitioners to have a hand in defining what the new model will be. They must be shown what their vote is saying. Failure to do so could bring on scenarios similar to the far-fetched one we just dreamed about. There are recent business models that failed to adapt, failed to maintain sufficient representation, failed to heed the messages, and failed to improve their vision for the future—Borders and Kodak come to mind. Where will organized dental representation be in 10, 20, or more years? What will our cottages look like?
EXPRESS YOUR OPINION TO THE GEORGIA DENTAL ASSOCIATION The Georgia Dental Association invites GDA member dentists to submit comments and commentaries regarding Association and dental issues to GDA Action for possible publication. The Editor reserves the right to edit all submissions for clarity and length. Unpublished submissions will not be returned. Published commentaries are the authors’ opinions, and do not necessarily reflect adopted policies of the Georgia Dental Association. Questions, comments, and submissions may be directed to: Dr. David Bradberry Delaine Hall GDA State Editor GDA Managing Editor drbradberry@bellsouth.net hall@gadental.org 1070 Woodlawn Dr NE Ste 250 7000 Peachtree Dunwoody Marietta, GA 30068 Road NE Ste 200 Bldg 17 Atlanta, GA 30328 October 2014 • 13
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POLITICAL ISSUES FROM THE DENTAL POINT OF VIEW:
CONNECT WITH LEGISLATORS AT YOUR GDA DISTRICT LEVEL The GDA district legislative receptions kick off this month. Throughout the fall and winter, the districts will host a total of 10 receptions. Unlike at a GDA LAW Day, when dentists are talking to legislators in the crowded halls at the State Capitol, receptions give dentists, dental spouses, and legislators the chance to socialize on a personal level in a low-stress, friendly environment. Take the opportunity to attend one of these receptions and build bridges before the session starts. Please sign up for a LAW Day as well and impact legislation affecting your patients and profession! See the schedule at right (Photo from a 2014 LAW Day).
District Legislative Receptions October 28: Eastern District in Augusta at the West Lake Country Club with a social at 6 p.m. and dinner at 7 p.m. Contact Dr. Brian Olson at (706) 364-7668. November 6: Southwestern District in Albany at the Doublegate Country Club with a social at 6 p.m. and dinner at 7 p.m. Contact Dr. Jessica Watson at (229) 883-1306. November 11: Western District in Columbus at the Green Island Country Club with a so-
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cial at 6 p.m. and dinner at 6:30 p.m. Contact Dr. Mark Zwickey at (706) 596-1757. November 13: Southwestern District in Valdosta at Friends Grille & Bar starting at 6:30 p.m. Contact Dr. Greg Morris at (912) 338-0033. November 18: Eastern District in Athens at the Athens Country Club with a social at 6 p.m. and dinner at 7 p.m. Contact Dr. Brian Hall at (706) 549-8737 for details. December 3: Northwestern District Fish Fry at the Clarence Brown Conference Center in Cartersville starting at 6 p.m. Contact Dr. Christopher Rautenstrauch at (770) 9283055 for details. December 2: Hall County Branch (Northern District) at the Chattahoochee Country Club from 6 to 8 p.m. Contact the Northern District Executive Office at (770) 271-8743 or lmcgowan@pami.org for details. December 4: Central District in Macon at The Brickyard at Riverside Golf Club from 7 to 9 p.m. Contact Dr. Amber Lawson for details at (478) 741-0046. December 10: Northern District in Atlanta at 103 West on West Paces Ferry Road in Buckhead from 6 to 8 p.m. Contact the Northern District Executive Office at (770) 271-8743 or lmcgowan@pami.org for details. December 18: Southeastern District at the Savannah Golf Club starting at 6:30 p.m. Contact Dr. Donihue Waters at (912) 3543474 for details.
2015 LAW Day Schedule Jan 28: Students from the GRU College of Dental Medicine Feb 4: Georgia Dental Society and North Georgia Dental Society Feb. 11: Southwestern District and Alliance Dental Spouses Feb. 18: Northern District (Central & Southern Branches) Feb. 25: Northern District (Hall County Branch) Feb 26: Southeastern District* Mar. 4: Northwestern District Mar. 11: Eastern District Mar. 18: Western and Northern Districts (Northern and Eastern Branches) Mar. 25: Central District *This is a special Thursday-only LAW Day. The rest of the LAW Days are scheduled for Wednesday mornings. Email willich@gadental.org to RSVP.
October 2014 • 15
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A GDA PERSPECTIVE ON PRACTICE LEGAL AND ETHICS ISSUES:
ANSWERS TO QUESTIONS ON PATIENT DENTAL RECORDS This article will attempt to answer some of the most frequently asked questions regarding dental records which the GDA office has received from member dentists. Exceptions to each of these answers may exist in such cases as mental incompetence of the patient, mental health records, substance abuse treatment, child abuse, or subpoenas issued in criminal and civil cases. If you have additional questions, please contact the GDA office at (404) 636-7553 or (800) 432-4357.
Q: How long must a dentist maintain dental records? A: In 2002, the Georgia Health Records law was amended and requires that dental records be maintained for a period of at least 10 years from the date the record was created.
Q: How long must a dentist maintain the dental records of minors?
A: Again, the minimum time period for maintaining any patient record would be 10
The Legal Center on the GDA web site has a wealth of information on topics such as the ACA excise tax, sales sites like Groupon.com, Botox(R) use in the dental practice, collecting past due accounts, allowable dental staff duties, and much more. Visit www.gadental. org, click the green For Members button, then choose Legal Issues from the drop down menu.
years from the date the record was created. However, it is strongly recommended that dental practices contact the risk management department of their malpractice insurance carrier to determine if they want dentists to maintain the minor’s treatment record for longer than 10 years. Malpractice carriers do differ on their recommended retention period for those patients under the age of 18. Additionally if a dentist believes that there is a good chance that a malpractice claim may be filed, it may be wise never to discard that particular patient’s treatment record.
Q: Upon the sale of a dental practice, must the selling dentist maintain copies of the dental records after the practice is sold?
A: Provisions added to the Georgia Health Records law in 2002 created an exception from the requirement that dental records must be maintained for 10 years from the date created in the cases of dentists who retire or sell their practices. Two requirements must be met. First, the selling or retiring dentist must notify the patients of the retirement or sale. Second, the notice must contain an offer to provide the patient’s dental records to another dentist of the patient’s choice or to the patient. The intent of this law is to ensure that no dentist transfers a patient’s dental records after retirement or in a sale without the consent of the patient.
Q: If a child’s parents are divorced, may the dentist release the dental records to both parents? A: Both Georgia and federal laws state that parents or guardians have the same right to access the dental records of minor children
as if the parent were the individual. Usually, when parents are divorced the parent having sole legal custody of the child has the right to access dental records. When parents have joint legal custody over a child, both have equal rights and responsibilities with regard to health care decisions of the child. (Please be aware that joint legal custody is distinct from joint custody.) However, divorce decrees or separation agreements may also set forth the rights of each parent to access medical records. Again, exceptions exist for cases in which parental rights have been terminated, such as in cases of child abuse.
Q: If a dental practice maintains records in electronic format, must the practice also maintain a tangible printed copy?
A: Both federal and state laws and regulations permit dentists to create, maintain, transmit, receive, and store records in an electronic format. In 2005, the Georgia General Assembly passed a law which states that if a dentist permanently converts his or her patient records to an electronic format, the dentist does not need to maintain a separate tangible copy of the electronically stored records. However, this Code section does not extinguish a patient’s right to access his or her dental records. Dentists should also be aware that if they transmit protected health information in electronic format, they become covered entities and are subject to the guidelines of the Health Insurance Portability and Accountability Act (HIPAA). Once
LEGAL AND PRACTICE ISSUES Continued on page 29
October 2014 • 17
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HELPING DENTISTS LEAD PERSONALLY & PROFESSIONALLY
CONNECTING WITH MEDICAL PROFESSIONALS IN YOUR TOWN The causes of the dental health crisis are varied and complex. The American Dental Association Action for Dental Health aims to prevent dental disease before it starts and reduce the proportion of adults and children with untreated dental disease. The goal is to help all Americans attain their best oral health. As part of the Action for Dental Health, the ADA created a series of 10-step plans that are part of a comprehensive approach to provide care now to people suffering with untreated disease, strengthen and enhance the public-private safety net, and bring disease prevention and dental health education into underserved communities. To compliment the article on page 20 that discusses the systemic conditions that dentists can help to identify in the dental office, this leadership article discusses “10 Steps to Medical-Dental Collaboration” that dentists can consider taking in their communities. Step 1: Contact a local physician or county medical society director to attend a meeting of the local medical society. Discuss with the medical society officers the possibility of an opportunity to present dental issues to the membership.
For more information about the ADA’s Action for Dental Health: Dentists Making a Difference campaign, visit ADA.org/action. Share your leadership articles or ideas with Delaine Hall at hall@ gadental.org or call the GDA office at (800) 432-4357.
Step 2: Contact your local hospital continuing education coordinator to offer a “Grand Rounds” or “Dental 101” CE offering. You could also offer an introductory “Dental Issues” course for local physicians and chiropractors. The ADA-endorsed Smiles for Life oral health curriculum (www.smilesforlifeoralhealth.org) could be a useful resource. Step 3: Invite the president of the local medical society and/or hospital board president to a district dental society meeting for communication and networking opportunities. Step 4: Invite the dental director and executive director of a local community health center (CHC) to a district dental society meeting to meet local dentists and specialists. Discuss the possibility of local dentists serving on health center committees or a CHC board to create a bridge of communication between medical and dental departments. Remember, approximately 70 percent of health center dentists are ADA members. Step 5: Schedule a dinner meeting with local OB-GYN physicians and staff to share information about the importance of oral health for pregnant women. Offer written materials and support to encourage pregnant patients to seek a dental home. Module 5 of Smiles for Life addresses “Oral Health and the Pregnant Patient.” You may also wish to investigate the Alliance of the American Dental Association’s Healthy Smiles from the Start program. This pre- and post-natal dental care education toolkit is ideal to share with professionals from birthing centers or hospitals. Visit www.adaalliance.org for information.
Step 6: Visit a local pediatrician’s or family practitioner’s office and schedule a luncheon in-service with the office staff. Bring dental health educational materials to reinforce the opportunities for medical staff to encourage the importance of oral health as part of overall health. Stress the first dental visit by age one. Step 7: Schedule a luncheon in-service with hospital radiation and oncology staff. Discuss the role of proper dental care with restorative and rehabilitative needs for patients with cancer. Provide dental health education samples and written materials and offer to be a referral source for oral health questions. Step 8: Schedule a luncheon or dinner in-service with local periodontists and internal medicine specialists. Discuss the role of periodontal disease in maintaining optimal hemoglobin A1C levels for diabetic patients. Elaborate on the patient satisfaction possibilities with comprehensive patient care. Step 9: Meet with physician assistants and nurse practitioners to perform a “Dental 101” type continuing education meeting. Discuss dental emergencies and signs of oral cancer and the role these individuals can play in collaboration with the dentist in facilitating resolution of patient’s dental pain needs. Step 10: Attend a hospital ER department and senior nurses’ meeting to discuss dental issues. Advise them on the role they can play in collaboration with dentists with regard to dental disease management. October2014 2014••19 19 October
20 • October 2014
ORAL & SYSTEMIC CONNECTIONS: SEEING THE BODY FROM THE MOUTH Dentists learned the lesson in dental school that oral health is a window into a patient’s overall health. Dentists are trained to look for signs of potential systemic problems within the oral cavity and in the head and neck area, and how to treat the oral manifestations of certain systemic conditions. This article reviews some ways that oral health and systemic health are (and are not) connected and offers guidance on communicating to patients the value of having a dentist as their partner in maintaining their optimal oral and overall health.
ENDOCARDITIS
Endocarditis can occur when bacteria from another part of the body, such as the oral cavity, travel through the bloodstream and attach to damaged areas of the heart. Untreated endocarditis can damage or destroy heart valves and lead to life-threatening complications. Individuals at greatest risk of endocarditis have damaged heart valves, artificial heart valves, or other heart defects. Antibiotic prophylaxis with dental procedures is now recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including prosthetic cardiac valve or prosthetic material used in valve repair, previous endocarditis, unrepaired cyanotic congenital heart disease (including those with palliative shunts and conduits), completely repaired congenital heart disease with prosthetic material or device (whether placed by surgery or catheter intervention, during the first six months after the procedure), repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization), and cardiac transplantation recipients with cardiac valvular disease. Patients who took prophylactic antibiotics in the past but no longer need them include those with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, congenital heart conditions not listed above, such as ventricular septal defect, atrial septal defect,
and hypertrophic cardiomyopathy. Consider having materials on hand to educate patients who previously received pre-medication about the latest research and show them that their dentist is concerned for their overall health. Consult www.ada.org for additional details and links to materials to share with patients and to have available in the office.
LOW BIRTH WEIGHT AND PRETERM BIRTH
Preterm birth and low birth weight are considered the leading perinatal problems in the U.S. Periodontal disease MAY contribute to adverse outcomes of pregnancy as a consequence of a chronic oral inflammatory bacterial infection, but research continues in this area. For instance, one study published in the March 2013 Journal of Periodontology found a significant association between periodontal disease and low birth weight. There are other studies that point to the possibility of a connection with preterm birth, but the research continues. In any event, dentists should consider sharing materials with expectant families about the signs of periodontal disease and other oral conditions that pregnancy may cause. Periodontal factors of concern are tender, red, or swollen gums; gums that bleed with tooth brushing or eating; gums that pull away from the teeth; bad breath; and even loose teeth. Dentists can reassure expectant families that dental visits are safe for mothers and babies, and dental visits are very important to make and keep. The website www.MouthHealthy.org has a fun “Fact or Fiction Pregnancy Quiz” that dental offices can share with expectant families about the importance of keeping a healthy mouth throughout pregnancy.
DIABETES
Recent research suggests that the connection between gum disease and diabetes goes both ways. On the one hand, because of lowered resistance and a longer healing process, periodontal disease appears to be more frequent and more severe among those with diabetes. Conversely, it appears that treating
gum disease in people with diabetes can help improve blood sugar control. Since diabetes compromises the immune system, diabetic patients may be prone to developing fungal infections. Symptoms include painful sores and difficulty swallowing. The ADA website www.MouthHealthy. org features these tips from “Manage Your ABCs from the National Diabetes Education Program” that dentists can share with patients with diabetes and those who exhibit risk factors for the disease: • Control your blood sugar, blood pressure, and cholesterol — also known as the ABCs of diabetes — to take care of your teeth and your overall health. Teach your family about your diabetes and the ABCs so they can help you, too. • A is for A1C: The goal set for many people is less than 7 percent for this blood test, but your doctor might set different goals for you. • B is for Blood pressure: High blood pressure causes heart disease. The goal is less than 140/80 mmHg for most people, but your doctor might set different goals for you. • C is for Cholesterol: LDL or “bad” cholesterol builds up and clogs blood vessels. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels. Ask what your cholesterol numbers should be.
HIV/AIDS
Individuals with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), are at special risk for oral health problems. Many of these problems arise because the person’s immune system is weakened and less able to fight off infection. Some of the most common oral problems for people with HIV/AIDS include: oral warts; fever blisters; hairy leukoplakia; oral
ORAL SYSTEMIC HEALTH Continued on page 22
October 2014 • 21
ORAL SYSTEMIC HEALTH Continued from page 21
candidiasis (thrush); and aphthous ulcers, often called canker sores. People with HIV/ AIDS may also experience dry mouth, which increases the risk of tooth decay and can make chewing, eating, swallowing, and even talking difficult (www.nidcr.nih.gov). Communicate to HIV and AIDS-infected patients about the importance of regular dental visits. Some studies have shown that in spite of the high rate of oral disease in persons with HIV, many such persons do not utilize dental care regularly. Consult the website www.HIVDent.org, founded by GDA member Dr. David Reznik, for additional information on treatment considerations for persons with HIV and AIDS.
OSTEOPOROSIS AND OSTEONECROSIS
Antiresorptive agents—medications that help strengthen bones in patients with osteoporosis—have been associated with a rare but serious condition called osteonecrosis of the jaw (ONJ) that can cause severe damage to the jawbone. Patients taking antiresorptive agents for the treatment of osteoporosis typically do not need to avoid or postpone dental treatment. The risk of developing osteonecrosis of the jaw is low. By contrast, untreated dental disease can progress to become more serious, perhaps even involving the bone and associated tissues, increasing the chances that a patient might need more invasive treatment. However, individuals taking antiresorptive agents for cancer treatment should avoid invasive dental treatments, if possible. Ideally, these patients should have a dental examination before beginning therapy with antiresorptive agents so that any oral disease can be treated. Some antiresorptive agents, such as Fosamax, Actonel, Atelvia, Didronel, and Boniva, are taken orally to help prevent or treat osteoporosis (thinning of bone) and Paget’s disease of the bone, a disorder that involves abnormal bone destruction and regrowth, which can result in deformity. Others antiresorptive agents, such as Boniva IV, Reclast, or Prolia, are administered by injection. Higher and more frequent dosing of these agents is given as part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels 22 • October 2014
in the blood) associated with metastatic breast cancer, prostate cancer, and multiple myeloma. While osteonecrosis of the jaw can occur spontaneously, it more commonly occurs after dental procedures that affect the bone or associated tissues. More than 90 percent of individuals diagnosed with ONJ associated with these medications are patients with cancer who are receiving or have received repeated high doses of antiresorptive agents through an infusion. The other 10 percent diagnosed were receiving much lower doses of these medications for treatment of osteoporosis. Encourage patients who will be starting osteoporosis treatment with antiresorptive agents to schedule a dental appointment before beginning treatment. This way, the patient and dentist can ensure that the patient has a foundation of good oral health going into treatment and develop a plan to keep the oral cavity healthy during treatment (www. MouthHealthy.org).
SJöGREN’S SYNDROME
This syndrome is one of the most common autoimmune diseases affecting as many as three million Americans. The disease is characterized by the body’s immune system mistakenly attacking its own exocrine glands, which include saliva and tear glands. While Sjögren’s occurs in all age groups and in both sexes, the average age of onset is in the late 40s and the disease affects females the vast majority of the time. Sjögren’s syndrome belongs to a family of autoimmune disorders including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, dermatomyositis, and vasculitis and ranks as the second most common rheumatic disease after rheumatoid arthritis. Symptoms vary from person to person but some of the most common symptoms of Sjögren’s are keratoconjunctivitis sicca and xerostomia (http://dental.ufl.edu). Carefully monitor the oral health of persons with Sjogren’s syndrome. Because the condition causes reduced saliva in the mouth, a patient’s chances of developing dental cavities are increased.
ORAL HPV INFECTION
A 2013 University of Texas-Houston study identified poor oral health as an independent
risk factor for oral human papillomavirus (HPV) infection, which is associated with a variety of oral lesions and a subset of oral and oropharyngeal cancers. The study was published online in the journal Cancer Prevention Research. The study looked at data from over 3,400 adults who participated in the 20092010 National Health and Nutrition Examination Survey, and who also had data available on oral health measures and oral HPV infection. Researchers found a higher prevalence of oral HPV infection among individuals with poor oral health, including a significantly elevated risk of oral HPV in adults with self-reports of poor-to-fair oral health or possible gum disease. The research team determined that selfrated poor oral health was an independent risk factor for oral HPV infection regardless of the study participants’ smoking or oral sex practices. Exposure to HPV occurs commonly through sexual contact, and papillomaviruses can induce a wide range of cutaneous or mucosal epithelial lesions, mostly benign hyperplasias such as papillomas (warts). The study authors assert that individuals with poor oral health could have ulcerations, chronic inflammation, or other disruptions of the oral mucosa, which “may increase susceptibility to and infectiousness of HPV.” Given HPV’s proclivity to infect epithelial basal cells in the oral cavity and other mucosal surfaces, individuals with poor oral health could have a higher susceptibility to oral infection with HPV, which could gain access to the oral cavity through epithelial wounds or other oral lesions. The incidence of HPV-associated oropharyngeal cancer is increasing, particularly among men, who accounted for over 10,000 HPV-positive head and neck cancers in 2009. HPV-associated oropharyngeal cancers typically develop near the base of the tongue and in the tonsils, and are often difficult to detect in their earliest stages. Dentists are encourarged to stay aware of the increasing incidence of HPV-associated oropharyngeal cancer, and promote optimal oral health in patients to minimize the risk of oral disease or infection. You can obtain and share materials about the signs and symptoms of oral HPV infection from many sites, including www.ada.org, www. cdc.gov, and www.oralcancerfoundation.org.
OTHER ORAL CANCERS
Routine, careful examination of patients for oral and pharyngeal cancer, in addition to obtaining updated health histories, can easily be achieved during a regular dental visit. The American Dental Association recommends that dentists visit the National Institute of Dental and Craniofacial Research website for tips on providing an examination (http:// www.nidcr.nih.gov/imagegallery/oralhealth/ OralCancerExam.htm). The stage at which an oral or pharyngeal cancer is diagnosed is critical to the course of the disease. When detected at its earliest stage, these cancers are more easily treated. Some facts that dentists should know about oral and pharyngeal cancer include that the malady strikes an estimated 39,000 Americans each year. An estimated 8,000 people die of these cancers annually. The disease occurs more than twice as often in men as in women. The five-year survival rate nearly doubles for white men over African American men (the difference in survival rates between women is not significant). An estimated one in 92 adults will be diagnosed with oral or pharyngeal cancer in their lifetime. The median age at diagnosis is 62 years (that figure may drop to 52 to 58 years for people who have oral or pharyngeal cancer associated with human papillomavirus infection). Signs and symptoms of oral cancers can include leukoplakia or erythroplakia, a lump or thickening of oral soft tissues, or swelling that affects the fit and comfort of dentures. Patients may complain of difficulty chewing or swallowing, or moving the jaw or tongue; a sore throat or feeling that something is caught in the throat; numbness; hoarseness; or a change in the voice. Signs and symptoms that persist for two weeks or more merit further investigation, such as a biopsy or referral to a specialist (www.ada.org).
OBSTRUCTIVE SLEEP APNEA
Are your patients feeling sleepy without the benefit of nitrous oxide administered by your capable professional hands? Odds are good that at least one patient in your practice may suffer from one or more health issues caused by a sleep disorder. Dentists can play a significant role in helping to identify patients, both adult and pediatric, who may benefit from a sleep disorder diagnosis from a physician, but building a knowledge base about sleep disorders and learning about Georgia laws and rules governing
sleep apnea treatment are important actions to take before talking to your patients. Visit the GDA website www.gadental.org for a Q&A that discusses how Georgia dentists can incorporate sleep disorder identification into their practices.
EATING DISORDERS
More than 10 million Americans are affected by eating disorders such as anorexia, bulimia, and binge eating, according to the National Eating Disorders Association. While anyone can suffer from an eating disorder, they are most common in teenagers and young adult women. Without proper nutrition, soft tissues of the mouth may bleed easily. The glands that produce saliva may swell and individuals may experience chronic dry mouth. When strong stomach acid repeatedly flows over teeth, tooth enamel can be lost to the point that teeth change in color, shape, and length. The edges of teeth become thin and break off easily. Eating or drinking hot or cold food or beverages may become uncomfortable. The symptoms of eating disorders include bad breath; tender mouth, throat, and salivary glands; eroded tooth enamel; teeth that are worn and appear almost translucent; mouth sores; dry mouth; cracked lips;
bleeding gums; and sensitive teeth (www. MouthHealthy.org).
CARDIOVASCULAR DISEASE
Although some studies suggest a possible connection, no conclusive evidence exists that preventing gum disease can prevent heart disease or that treating gum disease can lessen atherosclerosis, according to the American Heart Association. Periodontitis and heart disease share risk factors such as smoking, age, and diabetes, and both contribute to inflammation in the body. The trouble, experts say, is that the research isn’t strong enough to suggest that gum disease treatment will lessen the risk of heart attack or stroke. However, research in this area continues (www.heart.org). Meanwhile, dentists who have heart patients as dental patients should be aware of a number of other factors of concern. Stroke patients taking anticoagulants may experience excessive bleeding during oral surgery, or dry mouth. Some medications used to treat heart failure can also cause dry mouth. Angina patients taking calcium channel blockers may experience gum overgrowth. Some high blood pressure drugs can cause dry mouth or alter a patient’s sense of taste.
In honor of Health Literacy Month this October, The Georgia Alliance for Health Literacy encourages dentists to give patients and caregivers the information they need to take charge of their own health. Dentists should assume that EVERY patient may have difficulty understanding terms used by the dental team and recommendations made by the dentist. Patients with limited health literacy, regardless of their educational level, are less likely to ask questions, seek out health information, or understand clinical terminology. These patients often leave a dental office with a different idea of what they are supposed to do than what was communicated to them. Consider improving communication with patients via the “teach-back” method. Teach-back involves asking patients to repeat in their own words what they need to know or do. This is NOT a test of the patient, but a test of how well the health care professional explained a concept. See www.teachbacktraining.org for additional tips on educating patients. Teach-back is simple! Try this approach which elicits more than a yes or no: 1) Let’s be sure I explained everything clearly. Can you please explain it back to me? 2) Tell me what you are going to do when you get home. 3) What are the normal things to expect after today’s procedure? October 2014 • 23
HOW A “DEEP-DIVE” STUDY OF THE GDA IS CREATING BETTER MEMBER DENTIST VALUE Over the past six months I have had the pleasure to Frank J. Capaldo GDA Executive Director meet many of you in person, including at district meetings and the Annual Meeting, as well as over the CEO, GDIS and GDHC telephone and through various other communication vehicles. Going forward, and in addition to the report I plan to present at the House of Delegates, I will provide you, our GDA members, with a semiannual report on the state of your Association. Other short briefing communications will continue during the year on a selective basis to avoid creating information overload. This is a first effort to provide such a semi-annual report.
24 • October 2014
The First 180 Days
Your GDA leadership and I began in March with the development of a plan of action to review in a “deep dive” the entire Association and its subsidiaries. That deep dive found a nice foundation to build upon as well as challenges to overcome and a significant amount of opportunity. Through the concerted efforts of your leadership, the GDA has already become more cost effective and efficient. We will continue to look at more ways to improve, add products and services, and analyze any new offerings continuously.
At the July 2014 House of Delegates meeting I reported my findings and recommendations going forward. Much of my report to the House of Delegates is covered in this communication.
Philosophy of Servant/ Service Leadership: The GDA is Member Driven
Our approach is one in which YOU, the member, is at the top of the inverted pyramid. Everything we do at the GDA is for the best interests of oral health, dentistry, and you, now and into the future. That philosophy informs everyone that the executive office staff and I serve you and therefore we will always strive to be member driven. From my experience, I can help you recognize and lead you to a “shared vision” and subsequently implement that vision for the membership. However, that vision must belong to the members and be your vision.
Expanding the Vision of GDA Advocacy to Emphasize Public and Media Relations
Our deep dive revealed that as an organization we are primarily single focused. We were and are the premier dental legislative advocate under the “Gold Dome” in Atlanta. That means that the majority of our resources and focus are targeted at legislative efforts. However, we have to some extent neglected the broader definition of “advocacy” for our members. Going forward, your GDA will add public and media relations to our advocacy charge and elevate these two additional pillars to the same level as the legislative advocacy pillar! Why? Because each pillar is required for a firm advocacy foundation. The legislature is only one audience that must be influenced to protect oral health best practices, patient safety, and the educational standards and effectiveness of the profession. The fact is, we have outstanding good news to convey to both the public and the media. When you cannot get the legislature to hear you, by informing the public and/ or the media, they will in my experience put the needed pressure upon the legislature to do the right thing. The public and media become our advocates. Further, our Association must combat bad or incorrect information in the media that misinforms the public.
Update on Legislative Initiatives the Georgia Dental Association Will Pursue in 2015 Your Governmental Affairs Committee and GDA leadership have identified several key initiatives that the GDA will pursue during the session. These include, but are not limited to: • Seeking an appropriation to create a dental student loan repayment program. • Seeking tax credits for dentists who practice in rural areas. • Monitoring state funding in the Department of Community Health as it relates to Medicaid and the Board of Dentistry. • Continuing to advocate for access to care for adults in Medicaid and promoting basic preventive and restorative care coverage for adults in dental Medicaid. The GDA anticipates possibly working with the Medical Association of Georgia and other health care provider groups to: • Advocate for legislation that would alleviate the uncertainty providers have regarding insurers’ ability to change reimbursement rates at any time and for any reason. • Address “all-products” clauses that appear in insurance plans and require a provider, as a condition of participating in any of the health plan’s products, to participate in all of the health plan’s products. The GDA legislative advocacy team will continue to watch for movement on issues such as dental laboratory registration and disclosure by dentists of the material content of dental appliances, corporate dentistry, the creation of a universal definition of surgery, and changes to dental team supervision and scope of practice regulations.
Reorganization of Your Association Office and Staff
In order to achieve the continuation of our legislative advocacy, and elevation of our public and media relations efforts, we also needed to refocus our talent, as well as replace talent. As you may know, we were without a Director of Government Relations when I arrived. What I did not know when I was hired was that Associate Executive Director Nelda Greene would retire at the end of August and Director of Membership Services Courtney Layfield would be moving to Alabama the same month! However, through two planning sessions as well as a needs assessment associated with the deep dive we have as of this writing reorganized and are fully staffed. As a result of placing all pillars of advocacy at the top of our member services offer-
ings the GDA Public Relations Committee and Patient Protection Task Force recently held individual planning sessions. Both resulted in plans of action. To implement these plans we have hired Carol Galbreath as our senior director of marketing and public relations. We have also hired Stephanie Lotti as our point person on Medicaid and PeachCare issues as well as a host of other member services. We are pleased that Courtney will continue to concentrate on the Georgia Mission of Mercy clinic scheduled for June 2015 from her location in Alabama. Finally, we welcome Fatimot Ladipo as our Director of Government Affairs just in time for the full round of district legislative receptions and preparations for the 2015 legislative session.
GDA DEEP DIVE
Continued on page 26 October 2014 • 25
GDA DEEP DIVE
Continued from page 25 I hope you take a moment to read about the initiatives that the GDA will pursue and monitor during the 2015 session on page 25.
Updates on the Department of Community Health and Medicaid
The Department of Community Health (DCH) Board meets monthly to discuss issues pertaining to Medicaid and PeachCare, the State Health Benefit Plan, facility regulations, and other health care related items. Over the last few months rural hospitals, ABD (Aged, Blind, and Disabled) Medicaid Care Coordination, and the Georgia Families 360 program (foster care transition to managed care Medicaid) have been the primary topics of discussion, along with the budget. The GDA thanks member dentist Dr. Donna Thomas Moses for her active service on the DCH board.
Our deep dive into GDA activities revealed the need to plan for the future and help create an Association that is responsive to the needs of all members. We look forward to reporting the progress of these Ad Hoc Committees: 1. Our Governance Committee chaired by Dr. Marshall Mann will examine how we govern ourselves now and into the future and how we can get more dentist members involved in leadership roles at all levels: district, state, and national. 2. The Future of Dentistry Committee chaired by Dr. Evis Babo will examine what dentistry will look like in the future, the profession’s challenges, and what we must do to prepare for these challenges. 3. Our Strategic Planning Committee chaired by Drs. Doug Torbush (exofficio), Ed Green (Finance), and Jim Hall (Holding Company) will develop a long term comprehensive plan for the GDA. 26 • October 2014
Proposed Regulations from the Board of Dentistry
Being aware of the rules and regulations that affect the profession is imperative for any dentist. To assist our members in keeping abreast of issues being addressed by the Georgia Board of Dentistry (Board), the GDA has a presence at each of the Board’s monthly meetings. Most recently the Board handled issues involving non-dentists performing tooth whitening procedures, mobile and corporate dentistry, advertising, fee-splitting, conscious sedation permits, and even whether pets can be allowed in the dental office. A number of amendments and new regulations have been proposed by the Board including the requirement for dentists with sedation permits to begin utilizing a capnography machine to monitor end tidal CO2. It was noted that the cost of such a machine is approximately $4,500. Both the American Association of Oral and Maxillofacial Surgeons and the American Society of Anesthesiologists have updated their sedation standards to require the use of a capnography machine. The American Dental Association’s Council on Dental Education and Licensure will begin a comprehensive review of the ADA’s anesthesia guidelines in early 2015, which will include consideration of a capnography machine. Other proposed Board rule changes address the use of chlorohydrate in pediatric patients, advertising, and continuing education credits. In addition, former State Senator and former Vice President of the GDA Dr. Greg Goggans was appointed this summer to fill a seat on the Board of Dentistry.
Appeals Court Overturns Georgia’s Prompt Pay Law
After considering the parties’ briefs and hearing oral argument regarding America’s Health Insurance Plans v. Hudgens a judge in the Northern District Court for the Northern District of Georgia found that the new portions of Georgia’s prompt pay law are preempted by ERISA. That decision was appealed to the 11th Circuit Court of Appeals. A three-judge panel heard oral argument from counsel for America’s Health Insurance Plans and state Insurance Commissioner Ralph Hudgens on November 21, 2013. A decision from this panel was issued on February 14, 2014, affirming the District Court’s
decision to strike down Georgia’s “prompt pay” law on ERISA preemption grounds. The Georgia Attorney General’s Office has opted not to appeal this decision.
North Carolina Dental Board Arguing FTC Ruling Before Supreme Court
The North Carolina Board of Dental Examiners is challenging a lower court ruling over North Carolina Board of Dental Examiners v. Federal Trade Commission and an order by the Federal Trade Commission (FTC) which said that the North Carolina board engaged in unfair competition in the market for tooth-whitening services by excluding individuals not licensed to practice dentistry from providing tooth-whitening procedures. On March 3, 2014, the U.S. Supreme Court agreed to hear this case. Essentially, the Supreme Court will be determining the scope of the state-action doctrine, which exempts state actors (such as licensing boards), from federal antitrust scrutiny. The case was heard by the Supreme Court on October 14, 2014, and the GDA will keep members updated on the Court’s ruling.
Georgia Board of Dentistry Facing Tooth Whitening Lawsuit
A federal lawsuit, Trisha Eck v. Tanja D. Battle, et. al., was filed in the U.S. District Court for the Northern District of Georgia on April 1, 2014, that challenges the Georgia Board of Dentistry’s position that tooth whitening is the practice of dentistry and should only be performed by a licensed dentist. The lawsuit was filed by Trisha Eck, an individual who owned a tooth whitening business in Warner Robins, Georgia, and the Institute for Justice, which is a national law firm.
Trends Involving Mid-Level Providers
In 2014, 13 states had legislation or significant policy discussions surrounding the “mid-level” dental model. In Kansas, New Mexico, Ohio, Vermont, and Washington, the Kellogg Foundation played an instrumental role in driving the discussion regarding mid-level providers. The Foundation budgeted $16 million for a three-year program to push this effort in those five states. The other primary foundation working in this arena is the Pew Center for the States. As a result of their efforts, legislation has
been introduced in Maine, New Hampshire, and North Dakota and they may be seeking champions of the mid-level provider model in Colorado and Michigan. Other states that have had legislation or legislative discussions regarding alternative dental workforce models include Connecticut, Massachusetts, and South Dakota. Of these endeavors the only measure that was enacted into law was LD 1230 in Maine. LD 1230 creates the position of “dental hygiene-therapist.” However, as a prerequisite for licensure, a candidate must already be licensed as a dental hygienist in Maine. Two trends were observed nationally in the states considering alternative workforce legislation during 2014: 1) Bills were modified to incorporate dental hygiene into the proposal to garner legislative support from that sector; and 2) Efforts were renewed to establish “midlevel” programs on tribal lands in the lower 48 United States.
In Conclusion: I Look Forward to Talking With and Meeting You
Please call me at (404) 636-7553 or email me at capaldo@gadental.org if you have any questions about this report. I hope you enjoy this information. Let me know if you have any recommendations and please keep inviting me to attend your district meetings and other events. I will attend every GDA officer visit and legislative meeting in every district this fall, so please come out and say hello.
PLAN TO VISIT AN EVENT! Details at www.gadental.org GDA Officer Visits to the Districts Oct 21: Western District, Columbus. Oct 27: Northern District, 103 West, Atlanta. Jan 16: Southwestern District, Tifton. Jan 23: Southeastern District, Savannah. District Legislative Receptions Oct 28: Eastern District (Augusta). Nov 6: Southwestern District (Albany). Nov 11: Western District. Nov 13: Southwestern District (Valdosta). Nov 18: Eastern District (Athens). Dec 3: Northwestern District. Dec 4: Central District. Dec 2: Hall County Branch (Northern). Dec 10: Northern District. Dec 18: Southeastern District.
Creating a Healthy GDA Medical Plan and Additional Association Member Services During the deep dive the GDA leadership found both challenges and opportunities in the services arena. We have some fine insurance products offered through Georgia Dental Insurance Services (GDIS), but they have not been fully utilized or leveraged to your benefit. For a more in-depth look at all member services I would encourage everyone to go to and browse the GDA website www.gadental.org or call us if you need help finding a service. We offer members discounts and special deals on credit card and check processing, personal credit cards, shipping via UPS, office staff scrubs, patient account collections, office and personal appliances, Mercedes-Benz automobiles, dental record systems, patient financing, website design and online reputation monitoring, legal services, retirement planning, and more.
Health Insurance: GDIS Has Coverage You Need at Costs That Work
YES, going forward, the GDA will continue to provide a Health Insurance Program for the membership. We will introduce some new wonderful health insurance plans for the upcoming renewal. Our deep dive assessment revealed the health insurance program as previously constituted had exceeded its life cycle. However, we have revamped the program to give YOU more choices based upon your lifestyle and pocketbook. In addition, the plans will be more flexible, because GDIS and the GDA will be able to include you in a group program or individually write a plan that is custom tailored to YOUR needs. We are also adding additional staff to assist and walk you through what works best for YOU! We believe that these changes will not only be beneficial to those currently in the program, but will entice other member dentists to participate to grow this valuable member service. Just make certain that you call your GDA FIRST when you are looking for personal medical coverage or coverage for employees in your practice. Call (800) 432-4357 or email Victoria Lemaire at lemaire@gadental.org.
How GDIS is Beefing Up Other Insurance Products and Services
Over the next six months Georgia Dental Insurance Services will beef up incentives for you with medical malpractice as well as the retirement benefit program. You will have no reason not to utilize your Association services going forward. Visit www. gadental.org and contact the GDA office at (800) 432-4357 for additional information.
New GDA Member Services on the Horizon
The GDA is exploring adding new services to our stable of member benefits. These include health care supplemental plans, practice payroll processing, group purchasing co-operative programs, district back office management services, marketing services, and more! And while our continuing education programs are well received our offerings are limited because CE is not a primary GDA focus. Instead the need for dentist and staff CE is filled by other more focused providers, such as the Hinman Dental Society. While the GDA will continue to offer CE as we move forward, we will invest in a “new niche” in business-oriented courses. Our topics will address business margins, budgeting, buy-sell, balance sheets, investment planning and wealth management, and personal and practice retirement planning among other issues. The GDA believes this niche will assist all members in improving their bottom line and margins.
October 2014 2014 •• 27 27 October
HOSPITAL DENTISTRY for the FEARFUL and MEDICALLY COMPROMISED PATIENT – John W. Harden, Jr., D.M.D.
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550 Peachtree St., NE
sonic Medical Center/University of Illinois,
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Atlanta, GA 30308-2241
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We have treated patients with a vast array of acute/chronic diseases in the operating room.
Procedures include minor oral surgery, extensive dental procedures, dental phobic's, the medical compromised patient, gaggers and those with back and/or TMJ pain.
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We turn no patients away as procedures are performed in a teaching hospital for a major university/ medical school. We can handle any patient irregardless of their physical status or level of fear.
28 • October 2014
http://www.jhdmd.com 404-523-6236
LEGAL AND PRACTICE ISSUES Continued from page 17
a dentist is considered a covered entity, he or she must also comply with certain HIPAA privacy and security provisions to ensure the security of patient information while used, stored, or transmitted in electronic format.
Q: May a dentist’s office accept a request for copies of dental records over the phone?
A: No. The Georgia Health Records law requires that requests for dental records be made in writing from the patient or a person authorized to have access to the patient’s record. At a minimum the written consent should include the name of the patient, the name of the dentist to whom the request for records is being made, the name and address of the health care practitioner to whom the records will be sent, the date the request is being made, the reason for the release, and the signature of the patient or a parent or guardian if appropriate.
Q: What may a dentist charge his or her patients for medical records?
A: The Georgia Health Records law outlines the specific amounts a dentist may charge for the retrieval, certification, and copying of medical records. However, the statute also permits the Office of Planning and Budget to adjust the permitted charges for inflation. The rates effective July 1, 2014, are as follows: • Search, Retrieval, and Other Administrative Costs Up to: $25.88 (not permitted under HIPAA). • Certification Fee: Up to per record: $9.70. • Copying Costs for Paper Records (Per Page): Pages 1-20: $0.97; Pages 21-100: $0.83; Pages over 100: $0.66. As noted in the first bullet point, HIPAA prohibits dentists from collecting fees for search or retrieval of dental records, whether the search was manual, mechanical, or electronic. Finally, while a dentist may charge for copies of dental records, the law does not permit a dentist to withhold dental records because a patient has failed to pay for their dental treatment.
Q: Does a patient have an ownership interest in his or her dental records?
A: Very simply, no. Neither Georgia nor federal laws or regulations create an ownership interest for a patient in his or her dental (or any medical) records. In fact, Georgia law specifically states that despite the patient’s right to access and obtain copies of dental records no right of ownership is granted to the patient. The dental records are owned by and are the property of the dentist.
Q: Are X-rays, diagnostic models, billing records, and insurance claim forms considered part of the dental record? A: Board Rules state that X-rays, diagnostic models, billing records, and insurance claim forms are part of the dental record.
Q: What procedures should be followed when destroying dental records?
A: Under Georgia law, dental practices are responsible for dental records from creation through ultimate destruction. In 2005, the Georgia General Assembly adopted a law that outlines the steps dental practices must follow when discarding records containing a patient’s medical condition, account balance, or which could be associated with a particular patient. Information that could be associated with a particular patient includes photographs, Social Security numbers, disability information, driver’s identification numbers, dates of birth, and under certain circumstances addresses and telephone numbers. In order to comply with the law, dental practices must take one of the following steps prior to disposal of a patient’s record: (1) Shred the document;
Please be aware that this article is for informational purposes only and is not intended to provide legal advice. Dentists must consult with their private attorneys for such advice.
WHAT COMPRISES A DENTAL PATIENT RECORD? The Georgia Board of Dentistry defines dental records as items that furnish documentary evidence of the course of the patient’s medical/dental evaluation, treatment, and response. Dentists are required to maintain a patient’s complete dental record, which may include, but is not limited to, the following: treatment notes, evaluations, diagnoses, prognoses, X-rays, photographs, diagnostic models, laboratory reports, laboratory prescriptions (slips), drug prescriptions, insurance claim forms, billing records, and other technical information used in assessing a patient’s condition.
(2) Erase the patient’s information from the record; (3) Modify the personal information to make it unreadable, or; (4) Take action the dental practice reasonably believes would ensure that no unauthorized person will have access to the patient’s information in the record. October 2014 • 29
GDAMILESTONES GDA Dentists Volunteer with TeamSmile in Atlanta
1.
On September 9, several Georgia dentists, including Drs. Kristina Dawson, Edward Mohme, Judy Greenlea Taylor, Tracy Rada-Johnson, Ryan Vaughn, Wesley Powell, Vivian Hudson, Nancy Geller, Trushar Patel, Elisha Buckley, Tammy Zeineddin, Ron Wilson, and Meredith Dempsey participated in a TeamSmile charitable event at Bethune Elementary School in Atlanta. TeamSmile is a nonprofit organization whose mission is to create connections between children’s service groups, dental professionals, professional sports organizations, and athletes to provide underserved children with a positive, affirming dental experience. Volunteers provided students with oral health education, screening, cleanings, and/or restorative services. Atlanta Falcons linebacker Jonathan Massaquoi was the NFL ambassador to the event. He talked with volunteers, signed autographs for the children, and even stayed to have his teeth cleaned. Thanks to all of the volunteers who took part. 1. Dr. Ryan and Julie Vaughn with Becca Baldwin, Ada Royle, Lauren Ballenger, Pam Hardman, Brittany Martin, Lauren Nichols, Kateri Larios, and Doris Jovel.
2.
2. Dr. Judy Greenlea Taylor (c) with Kristopher Crawford and Tina Harrell. 3. Atlanta Falcons player Jonathan Massaquoi receives a cleaning from dental hygienist Abboss Sharifzadeh. 4. Volunteers Drs. Kristina Dawson (l) and Edward Mohme (r) with Kristy Watson and Stephanie Kurzon.
GDA and GRU Faculty Social is a Smash Hit 3.
4. 30 • October 2014
(Excerpted from “Filling in the Details” by the GRU College of Dental Medicine.) The GDA co-hosted a faculty social night at the CDM in September, and several GDA members attended the event. These included GDA President Elect Dr. Tom Broderick, Dr. Mike Rogers, Dr. Chris Hasty, Dr. Richard Weinman, Dr. Annette Rainge, Dr. Brian Hall, and Dr. Grant Loo. CDM faculty members can certainly let their hair down and have some fun and vice versa. The CDM atrium became a dance floor and the first, second, and third-floor lobbies held blackjack and poker tables, a roulette wheel, and a friendly game of craps played with hands more often wrapped around dental instruments than dice. The CDM thanks the GDA, especially faculty liaison Dr. Celia Dunn, for their collaboration of and support for the evening. Thanks as well to the Faculty Social Committee of Drs. Nancy Young, Kevin Frazier, Jan Mitchell, and Elizabeth Schappell for their hard work in making this fun event a success.
Dr. Wolff Named NDDS Dentist of the Year Dr. Carol Wolff, a Northern District past president and chair of the GDA Delegation to the American Dental Association House of Delegates, was honored as the Northern District Michael T. Rainwater Dentist of the Year in August. Dr. Wolff is a graduate of the Emory University School of Dentistry and past member and president of the Georgia Board of Dentistry. She is a GDA Honorable Fellow and maintains a thriving general dentistry practice in Atlanta. Kudos to Dr. Wolff on her award!
Thanks to Our First LAW Day Participant Kudos to Dr. Steve Drescher. He is the first person to sign up for a GDA LAW Day! You too can personally impact laws affecting your patients and profession. See the schedule of LAW programs on page 15 and call the GDA office at (800) 432-4357 or email Phyllis Willich at willich@ gadental.org to sign up. Enjoy breakfast and an issues overview, then talk to legislators about dentistry.
Member Names in the News GDA member Dr. Mark Shurett of Northern District will be honored by Voices for Georgia’s Children in November. Since 2007, this advocacy organization has annually recognized five to seven outstanding child advocates at their Big Voice for Children Awards Dinner. Dr. Shurett is the founder of Help a Child Smile, a mobile dental program that travels to school systems across the state. Voices
for Georgia’s Children will thank Dr. Shurett for raising awareness of oral health within the communities the program visits. Dr. Hank Cook, a general dentist in Fitzgerald in the Southwestern District, was named to the advisory board of Colony Bank. Kudos for making an impact in your community! Dr. Angela Canfield, a general dentist in Rincon of the Southeastern District, donated 110 custom-made maroon and white mouthguards to the Benedictine Military School football team. She and four staff members spent a Saturday taking impressions of the football players’ teeth. Dr. Canfield selects an area sports team each year for a similar project. Thanks Dr. Canfield for helping these football players protect their mouths and teeth! GDA President Dr. Doug Torbush of Northern District donated his time with A Voice for Hope on Labor Day weekend to help conduct oral cancer screenings and education at Atlanta Motor Speedway. The speedway was hosting the Oral-B USA 500 NASCAR race that weekend. Oral-B and GDA volunteers were on hand to help educate race fans about the signs and symptoms of mouth and throat cancer. Thanks to all of the volunteers who donated their time on this holiday weekend.
IN MEMORIAM The GDA extends sympathy to the family and colleagues of Curtis C. Reding, DDS, of Northern District. He died July 1, 2014, at the age 97. Dr. Reding was a 1945 Emory University School of Dentistry graduate who retired in 1982 after practicing general dentistry in Decatur. He was a GDA Honorable Fellow and an American Dental Association Life Member. He served in the U.S. Navy during World War II and was a former chairman and president of the Hinman Dental Society. Donations may be made to The Howard School in Atlanta or the Allen Memorial Library of the First Baptist Church of Decatur.
5.
6.
7.
Central District Officer Visit The Central District welcomed Dr. Doug Torbush and Executive Director Frank Capaldo in September during the first state officer visit of the year. The GDA duo shared news and information and answered questions. Say hello at your district state officer visit! See the schedule on page 27 of this journal.
5. (L to r): GDA Executive Director Frank Capaldo, GDA President Dr. Doug Torbush, and Central District President Dr. Vin Bhasin during the GDA Officer Visit to the district in September. 7. Volunteers from Oral-B joined GDA President Dr. Doug Torbush (far right) at Atlanta Motor Speedway on Labor Day weekend to help educate NASCAR fans about oral cancer. 7. GDA President Elect Dr. Tom Broderick with Linda Broderick, Dr. Richard Weinman, and Dr. Brian and Jill Hall during the GRU/GDA faculty social event in September. October 2014 • 31
kly!
ee W d re e v li e D s w e N l Read Breaking Denta
Get the Weekly GDA E-Connect The Georgia Dental Association is piloting GDA Connect, a new weekly e-newsletter just for you, the members. The GDA office will distribute the email every Monday. The purpose of GDA Connect is to send members an email that is timely and easy to read as well as reduce the number of separate emails the GDA office sends to members. Content will include GDA and district announcements, upcoming deadlines, legislative action items, links to events, member news, and special promotions. Please provide the GDA office with the email address you check the most often so you don’t miss the news you need! Email Delaine Hall at hall@gadental.org and say, “I want GDA Connect!”
32 • October 2014
GDAPROMOTIONS Visit the website www.gadental.org to find promotional materials you can use in your practice and community this Novemberto talk about the connection between diabetes and poor oral health, and the importance of all Georgians having a dental home. The vision of the American Diabetes Association is a life free of diabetes and all of its burdens. Raising awareness of this disease is one of the main efforts behind the mission of the Association. American Diabetes Month® in November is an important element in this effort, with programs designed to focus attention on the issues surrounding diabetes and the many people who are impacted by the disease. Here are just a few of the recent statistics on diabetes: • Nearly 30 million children and adults in the United States have diabetes. • Another 86 million Americans have prediabetes and are at risk for developing type 2 diabetes.
This November, the American Diabetes Association challenges America to Get Cooking to Stop Diabetes! Visit us online each week and get tips on staying healthy throughout the holiday season, learn how to host a special, food-themed event and vote for your favorite recipes to help create the perfect holiday meal! Visit us at diabetesforecast.org/adm or call 1-800-DIABETES.
• The American Diabetes Association estimates that the total national cost of diagnosed diabetes in the United States is $245 billion. According to the American Dental Association (www.MouthHealthy.org), the high blood sugar caused by diabetes can cause problems with the eyes, nerves, kidneys, heart, and other parts of the body. Diabetes can lower resistance to infection and can slow the healing process. A dental patient with diabetes is at greater risk of developing some oral health problems. The most common oral health problems associated with diabetes are periodontal disease, fungal infections, and infection and delayed healing. American Diabetes Month is a time for dentists to become part of the wider community to Stop Diabetes®! The GDA has compiled a number of resources from the Diabetes Association as well
America Gets Cooking to Stop Diabetes is presented by
Start planning today: 1) Visit the GDA website www.gadental.org. 2) Click the green “GDA Services” button. 3) Click “Practice Promotions” in the drop down menu. 4) Review the information and download materials. 5) Email admin@gadental. org or call (800) 432-4357 for help.
as the American Dental Association at the GDA website www.gadental.org. Check out the site for practice builders you can use. There are links to educational videos; tips you can share with patients from the Na-
tional Diabetes Education Program about controlling blood sugar, blood pressure, and cholesterol; links to printable diabetes fact sheets; links to recipes; and much more. October 2014 • 33
34 • October 2014
GDACALENDAR GDA OFFICER VISITS TO DISTRICTS Oct 21: Western District, Columbus. Oct 27: Northern District, 103 West, Atlanta. Jan 16: Southwestern District, Tifton. Jan 23: Southeastern District, Savannah. LEGISLATIVE RECEPTIONS Oct 28: Eastern District (Augusta). Nov 6: Southwestern District (Albany). Nov 11: Western District. Nov 13: Southwestern District (Valdosta). Nov 18: Eastern District (Athens). Dec 2: Hall County Branch (Northern). Dec 3: Northwestern District. Dec 4: Central District. Dec 10: Northern District. Dec 18: Southeastern District.
January 11: The GDA Winter House of Delegates will meet in Atlanta this January on the Sunday before the state legislature opens. All members are invited to attend the House as guests.
CONTINUING EDUCATION EVENTS Oct 15: Northern District, Dr. Wayne Kerr. Jan 14: Northern District, Dr. Dan Dunwody Feb 18: Northern District, Dr. Clayton Davis GDA & OTHER DENTAL MEETINGS Nov 3: Northern District Executive Council. Nov 9: Fisher Dental Education Foundation. Jan 5: Northern District Executive Council. Jan 10: GDA Board of Trustees Meeting. Jan 11: GDA House of Delegates. Mar 2: Northern District Executive Council. GDA OFFICE CLOSURES Nov 27-28: Thanksgiving Holiday. Dec 24-26: Christmas Holiday. Jan 1-2: New Year Holiday. SPECIAL DENTAL EVENTS Nov 14: GDA Spokespersons Training. Jan 12: Opening Day of State Legislature. Jan 28: LAW Day—GRU students, Gold Dome. Feb 4: LAW Day—Gold Dome, Atlanta. Feb 6: Give Kids a Smile Day, Statewide. Feb 11: LAW Day—Gold Dome, Atlanta. Feb 18: LAW Day—Gold Dome, Atlanta. Feb 25: LAW Day—Gold Dome, Atlanta. Feb 26: LAW Day—Gold Dome, Atlanta. Mar 4: LAW Day—Gold Dome, Atlanta. Mar 11: LAW Day—Gold Dome, Atlanta. Mar 18: LAW Day—Gold Dome, Atlanta. Mar 25: LAW Day—Gold Dome, Atlanta.
January 12: GDA and Alliance volunteers will distribute dental kits to legislators and staff members on this Monday as part of the Association’s legislative advocacy efforts. Join in! Email hall@gadental.org to say you will come.
Multiple Dates: The GDA Alliance dental spouses group (President Cindy Jernigan is above second from left) holds events throughout the year. Check out www.GDAalliance.com for the full calendar. October 2014 • 35
PLACING A CLASSIFIED AD 1.) AD FORM: Submit ads on a GDA Classified Advertisement Form. To obtain a form, call Skip Jones at (800) 432-4357 or (404) 636-7553, or email jones@gadental.org. 2.) DUE DATE: ALL ads and prepayments are due by the first of the month before the publication month (i.e., Dec. 1 for January). 3.) DENTIST RATES: ADA member dentists pay $75.00 per 60-word ad per month. There is a 50 cents perword charge for each word over 60. Non-ADA member dentists may not advertise in GDA Action. 4.) CORPORATE RATES: Non-dentistowned companies (real estate firms, banks, etc.) pay $195 per 60-word ad per month. There is a 50 cents perword charge for each word over 60. 5.) FORMS OF PAYMENT: Ads are payable by check (made payable to GDA), money order, Visa, or MasterCard. Per the GDA Finance Committee, a surcharge of $5 will be applied to any credit card transaction. 6.) PRINT ADS ON WEB SITE: Prepaid ads for the print GDA Action will appear on the GDA website www. gadental.org for the month the advertisement appears in print. There is no additional charge for the Web ad. 7.) BANNER ADS ON WEB SITE: Advertisers who purchase a classified or display advertisement may purchase an add-on banner advertisement on the GDA website www.gadental. org. See the advertising guide on the GDA web site for pricing and details.
36 • October 2014
GDACLASSIFIEDS DENTAL EQUIPMENT Equipment for Sale: 2 Adec operatory dental chairs plus 2 over-the-patient Adec delivery units, Model #1005. In good working order with updated upholstery. $1,000 / chair. $1,000 / delivery unit. All offers considered. Can see this equipment at our office as it is currently is use! Email offers and / or questions to sue@mygumdoc.com
DENTISTS AVAILABLE Dentist (Temp Fill In), DEA #, licensed and insured. GA, FL, AL licensed. Private practice (solo & group), military experience. E-mail: drglassdmd@yahoo.com or call cell# (770) 656-5269 or (770) 380-7487. Periodontist wants to work with GP performing SRP therapy. Metro Atlanta area. Part-time. Please respond to dentist5884@ gmail.com. Dentist will fill in for illness, vacation, or continuing education. Licensed, insured, DEA #. Call (404) 786-0229 or email breighard@gmail.com. DENTIST: Need Part Time Fill In? Vacation, Illness, Maternity? GENERAL DENTIST SOLD LONG ESTABLISHED PRACTICE. GA & DEA LICENSED. (Available Expanded Atlanta Area.) Cell: (404) 219-4097. Home: (404) 842-1196. Jesse Hader, DDS. Dentist available during emergencies, vacation, CDE courses. I have a current license, DEA certificate, and insurance. Contact me at (706) 291-2254 or cell (706) 802-7760. I hope I can be of service to you. Patrick A. Parrino, DDS, MAGD.
DENTAL POSITIONS Savannah / Rincon GA: Dentist seeking long term associate for busy General Family Practice. Please email resume to molar799@ yahoo.com. Are you looking for a great opportunity? Our high quality, 2 doctor dental practice is adding an associate. We practice all types of general dentistry including reconstructive, implant, cosmetic, family and sedation dentistry. Candidates for our position should
have a minimum of 2 years experience and be able to practice at a high level with little supervision. We are offering a competitive salary and commission as compensation. Interested? Email: greatdentaloffice14@ gmail.com. Outstanding associate opportunity for a General Dentist (Seasoned & New Grads Welcome) to join our highly successful, well established practice in Woodstock, GA. This is a non-chain dental practice with lucrative income potential. Our success comes from doing what is best for our 30 year (+) patient base. Great practice environment & culture; Continually trained & dedicated staff to support you; Lucrative income potential; Fully Digital; Well-established 30(+) year patient base & growing. Please email Regina at reggieworkws@yahoo.com with your resume or questions. Family Dental Practice is interested in adding an associate. GPR experience, Endo experience a plus. Interested in great personality to match great skill with ownership / partnership potential. Digital office grossing over $1 million a year. Fax CV to (770) 529-2712 or email to familydental@ outlook.com. General Dentist needed in Atlanta Area. Seeking long term associate for busy general family practice. Please email resumes to: drofdentalsurgery@gmail.com. Busy, modern, fully comprehensive family dental practice seeking Endodontist. Insurance friendly. In-house general dentist referral base. Part-time with growth to full-time. Please contact Anthony @ (706) 993-6488 and / or email resume / CV to anthony@atlanta-rootcanal.com. Associate dentist needed for busy general dentistry practice in Northwest Georgia. Outgoing, friendly, well-trained staff. Cerec CAD / CAM system training available. Great office environment to work and grow professionally. Please call (404) 797-4373. Need a part-time Endodontist, Oral Surgeon and General Dentist. Great compensation. Please call (678) 620-5001 or (770) 565-1010.
Orthodontist, Periodontist, Endodontist and Oral surgeon: Lucrative opportunities for part or full time Dental Specialists to join a growing high end dental group practice with locations throughout North Atlanta. Schedule can be flexible or set days, strong patient base, modern facilities and well trained team. Please email resume to: frontdesk6615@gmail.com. Part-Time Associate Dentist Needed: We have an outstanding Part time opportunity for a general dentist in our successful, well respected, quality oriented private dental practice in the Alpharetta / Canton area. We are seeking a special, motivated, enthusiastic, personable general dentist to join our practice. This opportunity can transition into a full time position with potential partnership opportunities for the right candidate. We offer excellent compensation and benefits. For additional information, please send CV to resumesdental@yahoo.com. Smile Programs is looking for Georgia dentists who love working with children and enjoy daily travel. The program runs Monday-Friday. No evenings or weekends, Holidays and summers off. We offer an excellent compensation structure and have both full and part-time opportunities. Help us make a difference in the lives of children! For more information and to apply, visit www.smileprograms.com. GEORGIA—ATLANTA. Multiple pediatric dental offices in Metro Atlanta are seeking pediatric dentist and general dentist to work in an extremely successful, expanding business. We offer a team motivated working environment and a competitive salary. We believe in a high level of patient and parent education and making sure that children have an excellent dental experience at each visit. Our practice provides all levels of care, including oral sedation, IV sedation, and general anesthesia at local hospitals. Candidate must have excellent communication skills, be enthusiastic and motivated. For more information please call (678) 923-4466 or email brian.friedman@ dentistry4children.com. Visit our web site at www.dentistry4children.com. ATLANTA — ASSOCIATE DENTIST, ENDODONTIST, and PERIODONTIST NEEDED: We currently have three positions available in our quality-oriented, well-established group practice with multiple locations. This is a very lucrative opportunity for an experienced candidate with good interper-
sonal skills. Large patient / referral base with abundant new patients each month. Well appointed, beautiful office including CAD / CAM and the latest technology for general dentistry, state of the art surgical suites for Periodontics, and new microscope for endodontics. We have successful systems in place, including an exceptional team of assistants and support staff. Come be a part of our team and join us in creating an atmosphere of excellence, fun, and productivity. Email resumes to 1careerinfo@gmail.com. Full-time associate needed for busy General Dentist office in Warner Robins, Georgia (1.7 m). Opportunity for a motivated Dentist to join our team with option to buy. Email resume to ceadds1@gmail.com. Expanding Dental Group Seeking Dentists for our Atlanta-Based Practices! We want you to join our growing team and enjoy a large, built-in patient referral base, clinical autonomy, advanced technology, a professional support team, paid time-off, competitive compensation and signing bonuses! We provide specialty & general dentistry to patients of all ages and offer pediatric conscious IV sedation and adult sedation dentistry. Immediate openings available for recent grads, general dentists and / or pediatric dentists in our expanding Lilburn, Dacula, and Gainesville pedo practices. Potential for more hours if willing to travel. FT / PT positions available now. Immediate opening for an experienced general dentist in our adult and teen zone Lilburn and Gainesville locations. PT position available now but potential for FT. Immediate openings for an experienced general dentist & endo / perio specialists in our Lilburn & Gainesville locations. PT available now. Please email cover letters and CVs to hr@tebodental.com. For more information, please visit us at www. tebodental.com. Alpharetta, GA: Responsible for the review and final adjudication of claims, pre-treatment estimates. Pre-determinations and reevaluation request for orthodontic treatment that require professional review. Provides assistance to managing Dental Consultant and Dental Director. A DDS or DMD degree from a accredited dental school. A minimum of 5 years of private practice dentistry. Holds active and unencumbered license. Email inquiries to kcrisamore@deltadentalpa.org.
WEST GA ASSOCIATE NEEDED #8906. Candidate must love working with adults as well as children. Must be able to do extractions on adults and basic restorative on children. For more information, call Dr. Earl Douglas (770) 664-1982 or email earl@adssouth.com. Full-Time Associate Dentist Needed: Busy general practice with locations in Locust Grove and Stockbridge area. Excellent career opportunity. Wonderful, stable staff and modern facilities. Contact the owners for more information at (404) 992-8760 or fax resumes to (770) 477-0032.
SPACE AVAILABLE Pedo Practice for Sale in Middle GA (#GA 1059). Great opportunity for a Pediatric Dentist who wishes to own an established, high production practice ready for immediate expansion. 5 ops, can be expanded to 7. Located in a regional medical center. Collected over $900,000 per year with doctor working 3 days / week. Long-term, proven business and management record. Well trained staff, paperless, and EHR compliant. Doctor / owner is willing to work 2 days/week during transition. Please call (678) 482-7305 or email info@southeasttransitions.com for details using listing ID #GA1059. Cobb County GA Practice for Sale (#GA 1063). Great opportunity to purchase a Cobb County, fee for service practice that has been in its current location (near the proposed new Braves stadium) for 36 years. This 2000 sq. ft. office has 6 treatment rooms and is open 5 days / week. Please call (678) 4827305 or email info@southeasttransitions.com for details using listing ID #GA1063. Practice for Sale Northwest of Atlanta (#GA 1062). Well established, general practice collecting $700K annually with a strong hygiene department, 4 equipped ops with room to expand! Many procedures referred out. Don’t miss out on this great opportunity! Please call (678) 482-7305 or email info@ southeasttransitions.com for details using listing ID #GA1062.
GDA CLASSIFIEDS Continued on page 38
October 2014 • 37
GDA CLASSIFIEDS
Continued from page 37 FOR SALE: North Georgia: Grossing $390K, 4 operatories, only 15 minutes from beautiful Lookout Mountain in Chattanooga; motivated seller selling due to health reasons. I-75 Corridor: Grossing $563K; freestanding building, easy access from Marietta, Kennesaw, Acworth, and more. Richane Swedenburg, New South Dental Transitions: (770) 630-0436 or info@newsouthdental. com. Check new listings at www.newsouthdental.com. Dental Space for Specialist in Greater Atlanta! Stockbridge, Fayetteville, Duluth, Dunwoody, Woodstock, Stone Mountain, and Riverdale locations. Ideal for Pediatric Dentist, Periodontist, Endodontist, or Oral Surgeon looking to add satellite location or new startup. Already plumbed & fully equipped with 5 operatories and room for 2-3 more. Save time & build-out costs! Contact us at: dentalspecialist2@gmail.com Gwinnett Pediatric Dental office for sale or transition, established 1989. In 2013 did 633K in 2-3 day work week with no PeachCare patients. Six chairs, @3500 square feet, digital x-rays and Pan, fully computerized in 11 year old modern building owned by seller, with adjacent ortho office in building. Stable, well trained staff. Please reply with your background and goals to pingricken@ aol.com. Space for possible future lease adjacent to Gwinnett Pediatric Dental practice. Space is @2500 square feet that has been an ongoing Orthodontic practice for almost 10 years. Space may become available in February, 2015. Great spot to move existing office or open a satellite practice. Would also be good location for a General Dentist or other specialist perhaps. Newly renovated. Please reply with your background and goals to pingricken@aol.com.
38 • October 2014
Do your patients suffer from any of these symptoms? Head Pain
Forehead • Temples Migraine-type Sinus-type
Ear Ear pain • Ringing in ears Dizziness • Vertigo
Eyes
Jaw
Pain behind eye Blood-shot eyes Sensitive to light
Clicking, popping jaw joints Pain in cheek • Limited opening
Teeth
Neck
Clenching/grinding at night Looseness and soreness of back teeth
Lack of mobility/stiffness Neck pain • Tired/sore muscles Arm/finger numbness
Visit us online at w w w.tmdatlanta.com to download a referral form and learn more about our services! Manoj Maggan DDS, DABDSM, DABCP, DAAPM, FICCMO, FAACP
3590 Old Milton Parkway, Alpharetta, GA 30005
Center for TMJ Therapy
770.521.1978 phone • 770.521.9936 fax www.tmdatlanta.com • office@tmdatlanta.com
If your patients have any of these symptoms and are not responding to treatments, they may be suffering from a TMJ disorder. Problems within the jaw can produce a myriad of symptoms that, at first glance, might appear to be totally unrelated to the temporomandibular complex. Our dedicated team of professionals have years of training and are happy to assist you in the diagnosis and treatment of possible craniomandibular/ temporomandibular disorders.
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Journal of the Georgia Dental Association 7000 Peachtree Dunwoody Road NE Suite 200, Building 17, Atlanta, GA 30328 INSIDE THIS ISSUE: A “Deep Dive” Look at Your Association Answers to FAQs About Dental Records November Practice Promotions
GDIS listens! Our new medical plans offer great benefits members have asked for! Call GDIS for a free quote or visit www.MyGDIS. com for details.