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ACT ION

THE JOURNAL OF THE GEORGIA DENTAL ASSOCIATION

SEPTEMBER 2010


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VOLUME 30, NUMBER 9 • SEPTEMBER 2010

ACTION

on the cover

ACT ION

THE JOURNAL OF THE GEORGIA DENTAL ASSOCIATION

GDA ACTION (ISSN 0273-5989) The official publication of the Georgia Dental Association (GDA) is published monthly. POSTMASTER: Send address changes to GDA Action at 7000 Peachtree Dunwoody Road N.E., Suite 200, Building 17, Atlanta, GA 30328. Phone numbers in state are (404) 636-7553 and (800) 432-4357. www.gadental.org. Closing date for copy: first of the month preceding publication month. Subscriptions: $17 of membership dues is for the newsletter; all others, $75 per year. Periodicals postage paid at Atlanta, GA. Dr. Jonathan Dubin GDA Editor 2970 Clairmont Rd Suite 195 Atlanta, GA 30329

Delaine Hall GDA Managing Editor 7000 Peachtree Dunwoody Rd NE Suite 200, Building 17 Atlanta, GA 30328

SEPTEMBER 2010

Value on display every moment! That was what many dentists expressed about the 2010 Annual Meeting. From stellar CE to a packed Exhibit Hall to outstanding social and sporting events, dentists and their family members offered compliment after compliment about the meeting. Read about meeting business, awards, and more starting on page 10.

2010-2011 Georgia Dental Association Officers John F. Harrington Jr., DDS, President Michael O. Vernon, DMD, President Elect Sidney R. Tourial, DDS, Vice President James B. Hall III, DDS, MS, Secretary/Treasurer Jonathan S. Dubin, DMD, Editor

other features

sections

9

GDA Access White Paper: Read It, Use It, Share It

4

Parting Shots

5

Editorial

Established Benefits of Community Water Fluoridation Facing Criticism

6

News and Views

8

Calendar of Events

26

Minutes

GDA Action seeks to be an issues-driven journal focusing on current matters affecting Georgia dentists, patients, and their treatment, accomplished through disseminating information and providing a forum for member commentary.

29

Classifieds

© Copyright 2010 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 Association expressly reserves the right to refuse publication of any article, photograph, or advertisement.

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Breaking the Mold

GDA/GDIS/PDRS Executive Office Staff Members Martha S. Phillips, Executive Director Nelda Greene, MBA, Associate Executive Director Delaine Hall, Director of Communications Skip Jones, Director of Operations (PDRS) Courtney Layfield, Director of Member Services Victoria LeMaire, Medical Accounts Manager Melana Kopman McClatchey, General Counsel Denis Mucha, Director of Operations (GDIS) Margo Null, Property and Casualty Accounts Manager Phyllis Willich, Administrative Assistant Pamela Yungk, Director of Membership & Finance

20 24

Becoming PCI-Compliant If You Accept Credit Cards in Your Practice

Member Publication American Association of Dental Editors

index of advertisers Note: Publication of an advertisement is not to be construed as an endorsement or approval by the GDA or any of its subsidiaries, committees, or task forces of the product or service offered in the ADS South . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 AFTCO Transition Consultants . . . . . . . . . . . . .30 Atlanta Age Management Medicine . . . . . . . . . .8 Atlanta TMD Dentist—Dr. Padolsky . . . . . . . . .28 Center for TMJ Therapy . . . . . . . . . . . . . . . . . . .7 Crown Tenant Advisors . . . . . . . . . . . . . . . . . . .27 Dental Care Alliance . . . . . . . . . . . . . . . . . . . . .26

advertisement unless the advertisement specifically includes an authorized statement that such approval or endorsement has been granted.

Dentist Available—Dr. Mark Rabin . . . . . . . . . .28 Elite Dentistry—Dr. Clemans . . . . . . . . . . . . . .22 GDA Dental Recovery Network . . . . . . . . . . . . .7 Georgia Dental Insurance Services . . . . . . . . .36 Georgia Mission of Mercy . . . . . . . . . . . . . . . .35 Great Expressions Dental Centers . . . . . . . . . .27 Law Office of Stuart J. Oberman . . . . . . . . . . .25

New South Dental Transitions . . . . . . . . . . . . .33 Officite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Paragon Dental Practice Transitions . . . . . . . .31 Professional Debt Recovery Services . . . . . . .11 Professional Practice Management . . . . . . . . .33 Southeast Transitions . . . . . . . . . . . . . . . . . . . .32


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editorial perspective Junk Science

Jonathan S. Dubin, DMD

I should be dead. I went swimming within an hour of eating a meal. Surely, I should have cramped up and sunk to the bottom of the pool. Sounds silly, but that warning came out of the 1940s and it lasted a long time. I grew up in the 1960s and I remember hearing that admonishment then. This is just a small example of how ‘junk science’ comes to life. ‘Junk science’ is no different from an old wives’ tale except for the level of sophistication that can be draped around a falsehood today. Put junk in print and on the Internet and it surrounds itself with a modicum of believability. The purveyors of ‘junk science’ pander to the fears of the populace. Such outlandish claims would almost be funny except for the damages inflicted by those who would champion such rubbish: Frivolous lawsuits filed, desperate people grasping for cures of serious illnessess, and money sucked away from people duped by the charlatans of the day to name just a few. The scientific method was developed to carefully prove theories based on facts and true figures corroborated by carefully constructed experiments. ‘Junk science’ proponents may take a fact and twist it until it no longer resembles anything valuable and substitute anecdotal “b.s.” as the gospel. They often claim there is a great conspiracy in the scientific community to keep the “real truth” from society. There is not enough time or space here to go into the psychology of the ‘junk science’ people and their passion for their misguided dogma. The earth is really flat, my friends. There, that secret is out. One cross we bear in dentistry are the claims of the anti-fluoridationists, who lay such ills as cancer, heart disease, bone brittleness, anemia, diabetes, strokes, infertility, stillbirths, mongolism, premature aging, and even nymphomania on the effects of fluoride. Their ill-informed rhetoric should fall on deaf ears. The time period where we have experienced increased community water fluoridation is the same time period where we have seen steady health improvements and longer life spans in our nation.

Common sense has little to do with the stance that anti-fluoridationists take. A short history of fluoride discovery: In 1901 Frederick McKay moved to Colorado and noticed “Colorado Brown Stain,” as the fluorosis of the teeth was called then. In 1908, McKay wrote to G.V. Black noting that 87.5% of the children in his area had that brown stain. In 1928 McKay wrote that the mottled enamel often was free from caries. And in 1931 it was found that the water in Colorado was extremely high in fluoride. Also in 1931, the U.S. Public Health Service assigned H. Trembly Dean to survey the nation’s water supplies for fluoride. In his travels and studies he found that 1 part per million of fluoride in water did not cause staining. He studied communities with naturally occurring fluoride at 1 part per million and looked at caries incidence versus that in unfluoridated communities and found half the caries. A 1941 study found 25% of the caries incidence in naturally fluoridated areas versus unfluoridated ones. Countless volumes of credible and proper science and study have gone into the area of community water fluoridation and what is the proper dosage for optimal oral health benefits. Yet, there are small groups of individuals who throw bizarre claims against one of the shining accomplishments of public health in the nation. The point is that even with all the knowledge and facts that we as dentists possess, we must be vigilant and continue to educate all parties as to what is truth and what is legitimate science. (And as an aside, community water fluoridation isn’t the only dental success story under attack. Have you read the Georgia white paper on dental access? Our successful team delivery of oral health care is suffering some hits as well.) I just ate. Come join me for a swim.

GDA ACTION SEPTEMBER 2010

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general news EASTERN Eastern District GDA Past President Andy Allgood, DMD, of Augusta and his office staff recently raised $5,200 to benefit the Therapeutic Child Care (TCC) program at Hope House, Inc. This organization is a residential treatment facility that serves women 18 years and older who suffer from substance abuse and mental health disorders. The TCC program assists children whose mothers are in treatment, and helps pregnant residents learn healthy parenting skills. The practice raised the funds through a charitable tooth whitening program called “Smiles for Hope.” From March 1 through June 30, 2010, Dr. Allgood’s patients were able to brighten their teeth and help a child. Rick Waters, DMD, of Athens recently won an Award of Distinction from The Videographer Awards for a video he produced for Waugh & Allen Orthodontics

of Athens. The video, titled “Smile Maker,” spotlights Waugh & Allen’s practice using patient testimonials and team profiles. Dr. Waters began filming and editing videos in 1997. He also teaches video editing to adults in the University of Georgia’s non-credit community program and every summer to middle- and high-school students in the Summer Academy at UGA in Athens. The “Smile Maker” video may be viewed at www.waorthodontics.com.

NORTHERN Northern District Victor Koehler, DMD, and Brittany Thome, DMD, of Loganville’s Creekside Dentistry are hosting the “Creekside’s Ride to Give Back A Smile” on October 23. The intent is to raise funds for the American Academy of Cosmetic Dentistry’s Give Back A Smile program, which helps rebuild the lives and dignity of survivors of domestic violence through compassionate

Michelle Wood, Cady Gilmer, Dr. Andy Allgood, Barbara Jacobs, Stephanie Suarez, Blenda Myers, Pam Dixon, and Jeanie Huffman with a presentation check representing the $5,200 Dr. Allgood’s practice raised for the charitable organization Hope House.

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GDA ACTION SEPTEMBER 2010

cosmetic dental services. The doctors and office staff will start a motorcycle ride at their dental office, travel with a police escort through the town of Madison, and return to the dental office for an afternoon of music and food. Potential donors may contact the office at (770) 466-0474. And if you are participating in a Give Back A Smile fundraiser, or any dental charitable activity, please contact Delaine Hall at the GDA office at hall@gadental.org.

ADA American Dental Association The ADA helped push a bill that would incorporate dentistry into the federal disaster response framework through the House Committee on Energy and Commerce in June. Introduced by Rep. Bart Stupak, the Dental Emergency Responder Act (H.R. 903) would dramatically increase the number of health professionals able to respond to an emergency. The Act would: a) Incorporate dentists and allied dental personnel into the federal definitions of “public health worker” and “emergency response provider;” b) Incorporate dentists into the National Health Security Strategy and the operational plan for the National Incident Management System; c) Clarify that dental schools are eligible to apply for public health and medical response training grants under the federal Centers for Public Health Preparedness program; and d) Encourage the Department of Homeland Security’s chief medical officer to engage the dental community when addressing medical and public health preparedness issues. The bill will move to the full House for a vote after the August recess. The Senate has yet to take up the issue. The ADA in June informed members that the U.S. Securities and Exchange Commission (SEC) is investigating an investment program allegedly targeting American dentists and involving sales of interests in fine wines. The SEC has information that an offshore company has been cold-calling dentists to


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solicit wine investments, apparently describing the opportunity as more lucrative than investments in various stock indices and claiming that the wine investment is guaranteed to grow in value as the underlying wine ages and becomes more rare. Dentists who expressed interest in the program were mailed promotional materials. It then appears that, after making an initial investment, the company sent dentists a contract and invoice seeking payment of a much larger amount. The contract and invoice describe the initial investment as a down payment and indicate that, if additional payment is not received, the investor will forfeit his original payment and lose the opportunity to complete the investment. If you have been solicited to invest in this program, contact SEC investigators David Peavler at peavlerd@sec.gov or Jessica Magee at mageej@sec.gov. The SEC’s investigation does not mean that anyone has violated the law. In August, the ADA and the New York State Dental Association were served with subpoenas from the New York Attorney General’s office related to an investigation of patient credit financing practices. One of the companies being looked at is GE Money’s CareCredit, which is endorsed by ADA Business Enterprises, Inc. (ADABEI) as well as the GDA. As manager of the endorsement relationship with CareCredit, ADABEI has taken an active role with the ADA team in responding to all inquiries regarding the program. More specifically, ADABEI is now assisting with the subpoena. ADABEI has also been in contact with CareCredit, reporting that “They (CareCredit) have stated that they are surprised at the allegations and that they are continuing with business as usual. They stress that they have been fully cooperating with the NY Attorney General.” The ADA shares the concerns of the NY Attorney General’s office about patient credit financing practices. The ADA fully supports patients’ right to understand their treatment plans and the costs of treatment. Financing can greatly benefit patients when it comes to paying for their dental treatment, provided that patients fully understand the terms of any financing program. The ADA continues to encourage dental staff to advise patients to contact

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financing companies directly before signing an agreement if they do not fully understand how the program works. The ADA has stated that after investigating CareCredit it will continue its longstanding relationship with the company.

In Memoriam The GDA extends sympathy to the family and colleagues of the following individual: W. Marion Reed, DDS, who died August 6, 2010, at the age of 91. Dr. Reed was a member of the GDA through the Eastern District. He was a 1941 Atlanta-Southern Dental College (later Emory University School of Dentistry) graduate. Dr. Reed was a GDA Honorable Fellow and American Dental Association Life Member.

GDA ACTION SEPTEMBER 2010

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Upcoming Dental Events October 1: Alliance Student Spouse Event, Drisko Home, Augusta.

October 23: GDA Alliance Assemble Legislative Dental Kits, GDA Office.

October 6: Northern District CE Meeting, Villa Christina, Atlanta.

October 28: GDA Officer Visit to Northern District, Druid Hills Country Club, Atlanta.

November 17: Southwestern District (Albany) Legislative Reception.

November 1: Northern District Executive Council Meeting, GDA Office, Atlanta.

November 18: Southwestern District (Valdosta) Legislative Reception.

October 9-11: ADA Annual Session Exhibit Hall (Orlando).

November 2: Election Day.

October 9-12: ADA Annual Session CE Courses (Orlando).

November 9: Western District Legislative Reception, Green Island Country Club.

November 23: Eastern District (Augusta) Legislative Reception, West Lake Country Club.

October 9-13: ADA Annual Session House of Delegates (Orlando).

November 11: Central District Membership Meeting.

October 17: Fisher Dental Education Foundation Meeting, GDA Office.

November 12: GDA Spokesperson Training, GDA Office, Atlanta.

October 19: GDA Officer Visit to Eastern District / Jockey Club, Washington.

November 13: GDA Board of Trustees Meeting, GDA Office, Atlanta.

October 20: GDA Officer Visit to Northwestern District / Marietta Conference Center.

November 13: Alliance Holiday Party and G.M.O.M. Silent Auction. See www.gadental.org for details.

October 6: Northwestern District Planning Meeting, Marietta.

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GDA ACTION SEPTEMBER 2010

November 16: Eastern District (Athens) Legislative Reception, Athens Country Club.

November 25-26: GDA Office Closed for Thanksgiving Holiday. November 30: Central District Legislative Reception, Riverside Golf Club.


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Stop Proposed Plans to Overturn the Team Delivery of Dental Care

The GDA White Paper on Access to Care: Read It, Share It, Use It to Help Your Patients The

July

2010

GDA

House

of

Delegates approved the publication of the White Paper on Georgia’s Oral Health

Status,

Access

to

and

Utilization of Oral Health Care Services. This document, created by the GDA Patient Protection Task Force, addresses the numerous components that impact access to dental care in Georgia (oral health literacy, financing, health status, utilization, safety net, workforce, external influences, government programs, and innovative outreach) and offers several recommendations for

state-specific

solutions

that

ensure the health and safety of the public. This article addresses some of the

frequently

asked

questions

about the paper. It also encourages dentists to read the paper, become familiar with the complex access to care issue, and take action on attempts at the national level to change the way dental care is delivered in the name of solving access to care. The GDA believes that proposed attempts that involve creating new, lesser-trained dental providers will not help the issue but rather negatively affect patients and the profession.

What is the Patient Protection Task Force (PPTF)? The PPTF was created in 2009 by then-President Dr. Kent Percy. The charge to the group was to assess the oral health status of Georgians and to make recommendations on action plans to help improve their oral health. The Task Force Chair is Dr. Ty Ivey of Central District. Other district members are Dr. Jim Reynierson (Eastern), Dr. Richard Weinman (Northern), Dr. Jason Oyler (Northwestern), Dr. Mark Dusek (Southeastern), Dr. Ed Green (Southwestern), and Dr. Matt Adams (Western). Ex-officio members are Dr. Kent Percy, Dr. Jay Harrington, Dr. Donna Thomas Moses, Dr. Jim Hall, and Dr. Jack Bickford.

Why Did the Task Force Create a White Paper? The primary reason was to provide Georgia decision makers, legislators, advocacy groups, and patients with recommendations on improving access to and utilization of oral health care services in the state. These recommendations are based on thorough research conducted by the GDA and are also based on what is in the patient’s best interest. Another major reason was to convey the GDA’s concerns that the American Dental Association (ADA) is under pressure to change the core values and standard of care that Georgia’s professionals believe is necessary to protect the health and safety of patients who currently enjoy the best oral health care in the world. For instance, during a Workforce Reference Committee meeting scheduled for October 10 (see the editor’s note on page 23) at the ADA Annual Session in Orlando, Florida, some ADA members will seek to establish a pathway for high school graduates with two years’ training to “drill and

fill” teeth and do “simple extractions.” (These lesser-trained individuals are often called mid-level providers, or MLPs.) They will do this by recommending that the ADA relax a long-standing policy that “the ADA is opposed to nondentists making diagnoses, developing treatment plans, or performing irreversible procedures.” Your GDA Delegation to the ADA believes that under no circumstances should the ADA change its current workforce policy. If this key ADA policy on dentists performing irreversible procedures is relaxed, there will be no turning back. Therefore, Delegation members are sharing the GDA white paper across the nation ahead of the ADA meeting to provide a template for other states to use in analyzing their own access to oral health care. The GDA’s stance is that merely creating different types of providers to augment care from a dentist does not provide appropriate and accessible oral health care and will not solve the access to care issue. If the ADA adopts new policies on workforce, the GDA is concerned that states will be placed at a much higher risk of having their present rules and regulations overturned by entities who may argue that all states should conform to ADA policy (for example, legislatures or foundations).

Do All States Agree With Georgia’s Stance on Mid-Level Providers? Georgia believes in state’s rights and does not make a determination on the best way for a state to solve their own access to oral health care issues. However, dentists in Georgia and many other states recognize that no current data support the theory WHITE PAPER Continued on page 22 GDA ACTION SEPTEMBER 2010

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White Paper on Georgia’s Oral Health Status, Access to and Utilization of Oral Health Care Services

Health Status

Oral Health Literacy

External Influences Utilization

Innovative Outreach

ACCESS TO CARE Workforce

Safety Net

Financing Care

June 2010

Government Programs


Preface

The Georgia Dental Association’s White Paper is dedicated to the memory of Mark S. Ritz, DDS, Past President of the Georgia Dental Association (2008-09).

If not for his untimely death, Mark would have been an integral member of the Patient Protection Task Force. We missed his knowledge and his untiring energy and dedication. It is appropriate that this White Paper, which speaks to the importance of patient service and dental professionalism, be offered as a memorial to the high ideals that Mark sought throughout his career as a dentist and as a member and leader of the Georgia Dental Association.


White Paper on Georgia’s Oral Health Status, Access to and Utilization of Oral Health Care Services POSITION STATEMENT AND RECOMMENDATIONS

workforce needs in Georgia through the expansion of the Medical College of Georgia’s School of Dentistry. A May 2010 report from the Georgia Board of Dentistry indicates 5,541 dentists hold an active license to practice in Georgia. Georgia averages licensing approximately 250 additional dentists each year. Georgia also has an excellent and competent supply of dental assistants and dental hygienists who complete the dental team’s ability to provide quality dental care to Georgians.

Experts now recognize that the health of the mouth is critical to the health of an individual. Numerous studies confirm that many systemic adverse health conditions have manifestations in the mouth. Adverse oral health conditions affect three aspects of daily living: 1) Systemic health – periodontal disease has been proven to have a direct impact on heart disease, diabetes and low birth weight babies; 2) quality of life – edentulism (without teeth), soft tissue lesions, oral clefts and missing teeth affect the ability to eat and function; and 3) economic productivity–dental disease accounts for many lost work and schools days. Good oral health is essential to overall health and access to dental care is important for the health and well being of Georgians.

Recently, groups outside the dental profession entered into the discussion of improving access to oral health care. Most of these groups are single focused in their solution to the multifaceted problem of accessing oral health care. Some entities propose a new category of dental provider called a Mid-Level Provider (MLP) as the solution to access. This approach may be the result of frustrations from losing government funding battles for Medicaid and SCHIP programs and believing that some care is better than no care. While these groups may be well intentioned, their solution is not based on science or data that support adding MLPs to the dental workforce actually improves access or lowers the cost of care.

Numerous components impact access to dental care: oral health literacy, financing care, health status, utilization, safety net, workforce, external influences, government programs, and innovative outreach. Barriers may impact an individual’s ability to access oral health care services and solutions to overcoming those barriers must be multifaceted. Any solution that compromises the welfare and safety of the patient should not be considered, even in the spirit of “any care is better than no care.” There is no health or financial gain in compromising oral health care. Our goal must be to open the doors of access to care while ensuring the health and safety of the public.

Only two states’ (Alaska and Minnesota) decision makers created a dental MLP as a solution to access to oral health care. These decision makers looked to unproven solutions without considering quality of care, the potential ill-effect of the patient’s health or the potential additional cost. In good conscience they believe this to be a quick and an adequate response to the access to care issue. However, creating a new category of provider will not solve the complex issue of access; it will only create a two-tiered delivery system.

Accessing dental care is uniquely individual.According to the Academy of General Dentistry, solving the access problem requires that those who are interested in helping a person access care “recognize and address the unique barriers encountered by an individual seeking dental care, including the patient’s perceived need for care, oral health literacy, dentist and dental team distribution, financial circumstances, special needs, transportation, location, language, cultural preferences and other factors influencing entry into the dental care system.”1 Access to oral healthcare is far more complicated than a one solution response.

New Zealand has employed MLPs since 1921. However, reports indicate that this strategy has not solved access to dental care or improved the oral health of its citizens. If this strategy had been successful, New Zealand would not be experiencing pockets of oral health disease at the level of regions traditionally characterized by poor oral health status. Indeed, in some areas the severity is at the level of developing or Eastern European countries.2 The recent data prompted New Zealand to reconstruct its dental delivery system. What this information underscores is that merely creating different types of providers to augment care from a dentist does not provide appropriate and accessible oral health care. Georgia should not step backwards and expose patients to a lesser standard of care that has not worked in other countries.

The dental profession recognizes the importance of oral health and Georgians’ ability to access dental care. We took the lead in improving oral health literacy and advocating for government assistance programs for those who cannot afford care. The profession is the outspoken advocate for improving access to care for all population groups. The Georgia Dental Association’s Dental Home Initiative is geared toward educating dentists and patients about the importance of establishing a dental home, and our many volunteer supported dental clinics provide care to those in need. An adequate workforce is a key element in providing access to dental care. The determination of an adequate workforce is more than the number of dentists or dental auxiliaries within a state. From a workforce perspective adequate access is affected by the following: the geographic distribution of dentists and dental auxiliaries, the availability of specialty practitioners, and the number of dentists that participate in government-funded programs. A shortage of dentists may exist in a few states. However, Georgia’s current workforce is adequate and a plan is in place to expand to meet the future

Georgia has evidence that the creation of MLPs does not solve the problem of access to medical care. Despite the addition of physician extenders (MLPs), access to health care for many Georgians is limited or unavailable, especially in rural areas, and the cost of delivering health care continues to increase annually. Like most states Georgia is experiencing a shortage of primary care physicians, which may be exacerbated by the creation of MLPs. Decision makers and health care advocates who are interested in seeking a sustainable solution will recognize that lowering the standard

1


of care will not solve the problem of improving oral health, will not increase access and will not lower costs. The dental profession, decision makers and other interested parties must work together to examine what is broken, what works, and what we can do to meet the challenge to provide Georgians with quality dental care while increasing access to care for all. Many solutions are required, and the solution for one state is not likely to be the same for all states. However, we must be understanding of those who employ extraordinary measures in an attempt to solve their health care delivery issues, but we must never let their compromise set the standard of care. Other states’ solutions should not be adopted as the professional standard of care or accepted as Georgia’s solution to access.

molar teeth through appropriate school-based programs and through adequately funded government programs for these services. 2. Increase the number of high-risk children receiving dental screenings and referrals to dentists for care. 3. Increase the number of Georgians served by fluoridated community water systems with optimal levels of fluoride. 4. Advocate for more data collection and surveillance by the appropriate state agencies to determine the oral health status of Georgians, especially children. • Oral Health Literacy: 1. Educate children and parents on the importance of good oral health, how to have good oral health, and the importance of seeing a dentist. 2. Educate Georgians on the importance of annual oral cancer examinations performed by a dentist and educate Georgians on the dangers of tobacco use as it pertains to oral cancer. 3. Develop educational materials (written, visual, mixed media) that are at the appropriate education level and are culturally and linguistically appropriate for the target audience. 4. Pursue development of a comprehensive oral health education component for public schools’ health curricula in addition to providing editorial and consultative services to primary and secondary school textbook publishers. 3Target the at-risk groups first – poor children, racial and ethnic minorities, the elderly, rural residents, and individuals with disabilities or other special needs. 5. Provide information to dentists and their staffs on cultural diversity issues which will help them to reduce or eliminate barriers to clear communication and enhance understanding of treatment and treatment options. 4 6. Form collaborations and partnerships with other interested groups to develop and disseminate oral health education materials. Possible groups include community-based health centers, public health clinics, area health education centers, K-12 school systems, and hospitals among others. Promote the Dental Home concept. 7. Improve patient education and counseling in the dental office environment to help increase dental knowledge in patients with low oral health literacy levels. 8. Change perceptions of oral health by explaining in the simplest terms why oral health is important and what simple steps individuals can take to preserve their own oral health and that of their children, as well as recognize possible signs of trouble and when to seek out care. 9. Engage populations and community organizations in the development of health promotion and health literacy action plans. 10. Encourage more interdisciplinary collaboration and care among health care providers to manage the health-oral health of each person. 11. Encourage greater utilization of currently available resources for oral health, such as the Oral Health Literacy: An Annotated Bibliography of Materials for People with Limited Literacy Skills. (http://www.mdc.edu/medical/library/dentalbib.htm)

Georgia’s dental profession will stand firm on core principles. The performance of education appropriate procedures must be a minimum requirement. Education is the foundation of science. Dentists are doctors with an undergraduate degree and a minimum of four additional years of dental school. Many continue for advanced studies in a General Practice Residency or in one of the nine specialty programs. Contrast these requirements with a dental assistant who generally receives one year of training and works under the direct supervision of a dentist or a dental hygienist who works under the supervision of a dentist, has a minimum of two years of college and attains an associate degree before treating patients. Dental hygienists are highly trained and educated but a two or four year undergraduate program does not prepare them to diagnose or perform irreversible procedures. Proposals for a two year training program for a Dental Health Aid Therapist (a type of MLP) would allow under-educated individuals to diagnose disease and perform irreversible procedures. Taking a step back in education is not a solution; it is a problem that will adversely impact the oral health of future generations. Areas of the current dental delivery system could be improved, but lowering the education standards by creating a dental MLP is not one of them. The dental delivery system could work more effectively if not faced with the limitations of underfunded government programs or managed care plans (CMOs) that close panels and deliberately ration care to avoid utilization. These constraints hamper dental care from being delivered to the population that needs government assistance. Employer plans have some of the same problems. The dental benefit for most employees is capped at $1,000 annually and has not changed since the late 1960s. This is not consistent with medical benefits and can be a barrier for employees who seek care. Many Georgians with dental coverage do not go to a dentist because they do not understand the importance of oral health. We must put education programs in place to increase Georgians’ oral health literacy. In our quest to improve Georgians’ access to oral health care we must never compromise patient health or safety. We must look for ways to bridge the gaps between the “haves” and the “have-nots” by collaborating with those who truly want to work toward solutions that allow all Georgians to have the same quality oral health care that each of us wants for our families.

• Utilization: 1. Advocate that laws and/or regulations which prohibit children of state employees, who otherwise qualify, from being eligible for PeachCare for Kids be amended. 2. Initiate appropriate recruitment efforts to increase the numbers of under-represented minority anddisadvantaged students in dental schools. 3. Encourage providers to increase their cultural competency to create trust and comfort, thereby influencing utilization of oral health care. 4. Work with the federal and state governments to provide additional financial incentives for dentists to provide regular care in underserved areas.

Specifically, the Georgia Dental Association’s proposed solutions to improving the health status of Georgians by improving the access to and the utilization of oral healthcare include, but are not limited to, the following:

RECOMMENDATIONS • Health Status: 1. Increase the proportion of eligible low-income elementary school children who receive sealants on the chewing surfaces of permanent

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8. Streamline the Medicaid and PeachCare paperwork and claims processes to more closely mirror private sector plans. Reduce the number of Medicaid/SCHIP procedures that require preauthorizations. 9. Monitor the evolving health care reform legislation and advocate for appropriate dental benefits for children.

• Workforce: 1. GDA Workforce Committee should continue to monitor Georgia DHPSA designations and report inaccuracies so that the need for additional dentists is reported accurately and not exaggerated. 2. Advocate for solutions for access to care based on correct data and assumptions utilizing the experience of dental practitioners rather than the medical model or under trained providers. 3. Continue to monitor business trends that can impact the dental delivery system and educate dentists about opportunities to streamline and obtain economies of scale without compromising the quality of patient care. 4. Educate dentists in ways to maximize the use of the current workforce while maintaining dentist supervision. 5. Explore innovative ways to expand the capacity in current dental practices. 6. Encourage MCG School of Dentistry to collaborate with those states without a dental school to assist with meeting workforce needs. 7. Advocate for more loan forgiveness programs or monetary incentives that are tied to the dentist providing treatment in underserved areas. 8. Advocate for a state and federal tax deduction for dentists who provide well documented free care to the indigent population. 9. Establish a program with the Medical College of Georgia School of Dentistry to evaluate how the curriculum, recruitment and financial options could best be structured to provide for access needs in rural and underserved areas. 10. Advocate for resource grants and gifts to supplement the cost of dental education for those students willing to practice for four years in a designated area of need. 11. Advocate for DHPSA sites to become National Health Service Corps sites for loan forgiveness/repayment for new graduates. 12. Advocate for HRSA to evaluate and investigate DHPSA classifications so that funding of dental health care needs is based on accurate data. 13. Encourage the MCG School of Dentistry to structure General Practice Residency programs to encourage and target dental school residents for rural access slots of need.

• Financing Care: 1. Encourage a higher maximum dental benefit and the elimination of waiting periods and pre-existing clauses in all private dental insurance plans. 2. Encourage employers to consider a direct reimbursement model to allow the employer and the employee to be more actively involved in dental health decisions. 3. Encourage the increased use of flexible spending accounts for dental care. 4. Encourage offices to be flexible with payment plans in-house or utilizing the services of companies that provide financing services (with interest) for patient treatment to open treatment for more individuals. 5. Advocate that dental reimbursement fees for the Medicaid and SCHIP dental program be evaluated on a regular basis and that fees be established that are more competitive with market fees. 6. Adequately fund the Medicaid and PeachCare programs through state and federal funding. 7. Offer incentives to dentists to establish practices in rural, underserved areas of the state by providing sales tax breaks for the purchase of equipment necessary to set up a dental practice and/or to build a practice. • Safety Net: 1. Recognize the importance of oral health to overall health by providing adequate funding to maintain the public health safety net that provides much-need prevention services to Georgia’s children. 2. Increase starting and mid-point salaries for public health dentists and dental hygienists to the current maximum salaries. 3. Provide funding to expand dental clinics in all Federally Qualified Health Centers; encourage competitive salaries for dentists and dental hygienists to attract providers. 4. Continue to collaborate with stakeholders to maintain and to establish additional programs that are community-based solutions to access to care.

• Government Programs: 1. Advocate for government programs to eliminate wasteful middlemen (administrators) from Medicaid and SCHIP programs. 2. Advocate for the government to provide adequate funding of public dental programs. 3. Advocate to prevent Care Management Organizations from closing panels and limiting access to government funded programs. Require CMOs to re-open the closed provider panels in the Medicaid/SCHIP program to allow more providers in the network to see the patients seeking care. 4. Advocate for increased funding for Public Health that includes a plan on the most efficient use of the dollars. 5. Advocate for adult dental benefits in Medicaid. 6. To encourage Medicaid provider participation, simplify the credentialing process for dental providers by allowing applications to be completed online in their entirety. Currently providers must be credentialed by the DCH through the Georgia Health Partnership (GHP) system which can be done online or mailed in for the application. However, there are also several additional required documents that can only be mailed in to complete the application. If the provider also wants to treat patients in one of the CMO plans, the provider must then be credentialed by DentaQuest. The entire process can take two to six months before the provider is given a Medicaid number to begin seeing patients. Providers should only have to go through the credentialing process one time. 7. Encourage the Department of Community Health to work in partnership to improve access to care for the Low Income and Aged, Blind and Disabled population covered under government programs.

• Innovative Outreach: 1. Consider legislation that would provide state tax credits for donated dental services provided in volunteer clinics. 2. In communities where the population cannot support a dental practice, mobile dental vans could be an alternative for care. 3. Teledentistry is an emerging technology. Therefore, the GDA believes that appropriate oversight and regulations should be in place to assure patient safety .

INTRODUCTION Oral health is not only important for a healthy mouth, it is also important for overall health. The ability to access dental care is an essential element of a healthy population. Dentistry is a preventionbased profession and most dental disease can be eliminated or dramatically improved by seeing a dentist regularly. For every dollar spent on prevention there is a four dollar savings in treatment costs. 5 However, many Georgians do not understand the importance of seeking dental care. Some individuals have difficulty accessing the system because fewer dentists can participate in government programs

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because the program is inadequately funded and will not pay for the cost of providing the services. Others can experience barriers such as transportation, literacy, cultural issues, to cite a few. Numerous people purchase dental care with discretionary dollars and do not always see the importance of making oral health a priority in their personal budgets. Employer dental benefit plans have not kept up with the cost of care and many plans fail to pay first dollar coverage for preventive services.

Branch develops dental shortage designation criteria and uses them to decide whether or not a geographic area, population group or facility is a Dental Health Professional Shortage Area. Many federal programs depend on this designation to determine eligibility for funding (i.e., National Health Service Corps scholarship and loan repayment program, Area Health Education Centers, cost-based reimbursement for Federal Qualified Health Centers). Federally Qualified Health Centers (FQHCs) –A communitybased organization that provides comprehensive primary care and preventive care, including oral health care, to persons of all ages, regardless of their ability to pay. Services utilize a sliding fee scale with discounts based on family size and income.

Of the 9.8 million people living in Georgia in 2009 an estimated 4,512,941 were enrolled in a private dental plan and 1,162,900 were enrolled in a public plan, such as Medicaid/SCHIP.6 Almost half of Georgia’s population has no dental benefit and self-pays for dental services.7 Most dental insurance is purchased through employers and very few stand alone dental plans exist. The plans that do exist are generally not competitively priced based on the benefits they provide. Requiring insurance companies to offer a stand-alone competitively priced dental plan that covers preventive services could increase access to care and improve the oral health status of Georgians. Increased access to dental care could potentially save unnecessary costs incurred by patients seeking care from hospital emergency rooms and physicians who can only treat the symptoms of dental disease, not the underlying cause.

Mid-level Dental Provider (MLP) –An oral health care provider whose training and responsibilities would fall between those of a dental assistant and those of a licensed dentist who are under-educated and may be allowed to diagnose and perform irreversible procedures with less education than a dentist. Utilization of Oral Health Care Services – “The percentage of the population receiving oral health care services through attendance to oral health care providers, while taking into consideration factors including, but not limited to, health-related behaviors, oral health literacy, dentist and dental team distribution, financial circumstances, special needs, transportation, location, language, cultural preferences and other factors influencing entry into the dental care system.”10

Georgians who utilize dental care enjoy the highest quality of care in the world. It is the goal of the Georgia Dental Association for all Georgians to have access to dental care. The GDA is a leading proponent of educating Georgians on the need to seek dental care. We established a program to promote the “Dental Home” concept to dentists and patients. In addition, according to a GDA April 2010 survey, Georgia dentists provide approximately $4.3 million annually in donated dental care through private offices and volunteer-staffed dental clinics.

EXECUTIVE SUMMARY Numerous components impact Georgians ability to access dental care: health status, oral health literacy, utilization, workforce, financing care, government programs, safety net, innovative outreach, and external influences. Where possible, the following discussion portrays Georgia-specific data and information.

While the profession has enjoyed great successes in increasing access to dental care for Georgians, there is still much that needs to be done. The dental profession is eager to work with private groups, government entities, community organizations, teaching facilities and public health entities to help Georgians understand the need for regular dental care and to have access to that care. The following document outlines some of the current delivery system strengths and the challenges we need to address to reach optimal oral health for every Georgian. We encourage those who are interested to work with the Georgia Dental Association to make Georgians number one in optimal oral health.

Health Status: Data collection on oral health issues is somewhat limited in Georgia. Ongoing budgetary constraints have limited annual surveillance data and research must rely on periodic assessment of oral health status. The most recent information is from the report, “Status of Oral Health in Georgia -2007.”11 Oral health is critical to overall health and must receive the same attention and resources as medicine. According to the 2000 Surgeon General’s Report, dental caries is identified as the most common chronic disease of childhood, five times more common than asthma.12

DEFINITIONS Access to care - “The ability of an individual to obtain dental care, recognizing and addressing the unique barriers encountered by an individual seeking dental care, including the patient’s perceived need for care, oral health literacy, dentist and dental team distribution, financial circumstances, special needs, transportation, location, language, cultural preferences and other factors influencing entry into the dental care system.” 8

Georgians’ oral health has improved tremendously in the last 50 years, yet there is still more improvement that needs to take place. The oral health of Georgians does not meet the standards set in Healthy People 2010 objectives by the U.S. Department of Health and Human Services. Dental caries (cavities), both untreated and treated, have a major impact on young children. According to Georgia Head Start,13 low income children are affected more than affluent children. Hispanic children are affected more than Black children, and Black children are affected more than White children. Over one-quarter (27%) of third graders in Georgia have untreated dental caries, although over threequarters of children have been seen by a dentist in the past year. 14 The oral health of adults in the state of Georgia is also a concern. According to a 2006 report issued by the Georgia Behavioral Risk Factor Surveillance System157, 69% of adults visited a dentist or a dental clinic in the past year. White adults are significantly more likely to have visited a dentist than Black adults. The percentage of adults

Care Management Organizations (CMOs) – A private or ganization that has entered into a risk-based contractual arrangement with the Georgia Department of Community Health (DCH) to obtain and finance care for enrolled Medicaid or PeachCare for Kids members. CMOs receive a per capital or capitation claim payment from DCH for each enrolled member.9 Dental Health Professional Shortage Area (DHPSA) –The U.S. Health Resources and ServicesAdministration Shortage Designation

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who visited a dentist or dental clinic during the past year increased with increasing income levels. Overall 70% of adultswho had ever visited a dentist had their teeth cleaned in the past year. Adults aged 65-74 with an annual household income of less than $15,000 are most likely to have lost all of their natural teeth.

enrolled in a public plan, Medicaid/SCHIP.24 Georgia provides comprehensive dental benefits to eligible children under 18 but only provides emergency coverage for eligible adults.25 Federal regulations make a child ineligible for Medicaid if the child’s parent is a state employee.26 Some people speculate that as many as half the state employees in Georgia would be eligible for Medicaid based on income. State employees may be unable to afford dental insurance for their children yet the children of state employees are also denied access to PeachCare for Kids (SCHIP) coverage.

Cancer of the oral cavity or pharynx is the fourth most common cancer in Black males and the seventh most common cancer in White males in the U.S.16 Georgia’s oral cancer rate is higher in both race and gender when compared to national averages. 17 According to statistics from the Georgia Comprehensive Cancer Registry 2000-2004,18 males have a higher incidence of oral cancer than females and the incidence of oral cancer among males in Georgia is higher than the incidence of oral cancer among males in the U.S. The use of alcohol and tobacco is a contributing factor to oral cancer.

A patient’s income plays a large role in whether he or she seeks dental care. When family income was 200% to 400% of the federal poverty level, 41.9% of families had at least one dental visit whereas only 26.5% of families whose income was 100% or less of the federal poverty level had at least one dental visit.27 Children from high-income families were twice as likely to have a dental visit as poor children. 28

Water fluoridation helps to reduce the caries rate in children and adults. People are faced with more and more amounts of refined carbohydrates (sugars) in their diet. Optimally fluoridated water helps combat these increases of sugar in our diet and has been praised by the Centers for Disease Control and Prevention as one of the greatest public health measures of the 20th century. In Georgia 95.8 % of Georgians using public water systems are receiving optimally fluoridated water (around 9 million people). 19

Low oral health literacy can have a significant impact on a person’s ability to seek needed health information and to make appropriate health care decisions. The higher the individual’s education level, the more likely they are to have at least one dental visit. In fact, 54.5% of college graduates went to a dentist at least once as compared to only 21.9% of individuals with some or no school having a dental visit.29 While the older demographic has one of the greatest needs for dental care, they often have the fewest resources to obtain treatment. The elderly currently have little or no safety net for dental care. Government assistance is virtually non-existent and the facilities in which much of the older population resides, residential or nursing homes, often do not provide regular dental care for residents and may not provide transportation for off-site dental care. 30 National statistics show that 49% of adults (age 45-64) and 43% of older adults (age 65 and older) had a least one dental visit during 2004. 31

Oral Health Literacy:

Oral health literacy as defined by the U. S. Department of Health and Human Services in Healthy People 2010 is “the degree to which individuals have the capacity to obtain, process and understand basic oral and craniofacial health information and services needed to make appropriate health decisions.”20 Low oral health literacy can affect any population group and can have a significant impact on a person’s ability to understand instructions being given by the dentist or hygienist, difficulty understanding instructions on prescription bottles, appointment slips, or educational brochures affect their ability to seek out needed health information, as well as their ability to make appropriate health care decisions.

Cultural barriers can be a significant obstacle to care. While the Hispanic population is quickly growing to be 30% of the U.S. population, they comprise only 4.1% of actively practicing dentists. 32 A survey of Latino parents revealed that language issues were cited as the single greatest barrier to health care access for their children.33

The average American reads at an eighth or ninth grade level. However, most health information is written at a higher reading level.21 Limited literacy skills have been found to be a stronger predictor of an individual’s health status more so than other common factors, such as race, ethnicity, age, income or education level.22 Limited health literacy has been estimated to cost the U.S. between $100 and $200 billion each year.23

Many organizations have proposed to solve the access to care issue by creating new types of non-dentist, mid-level providers to treat patients or by expanding the services an existing dental auxiliary can provide with reduced or no supervision from a dentist. Neither of these approaches has been successful.

Increasing oral health literacy will take a concentrated effort. A good start at raising the dental IQ of our nation could be accomplished by targeting the two most significant circles of influence of our young people – schools and parents. It is critical to place accurate information about oral health into the school curriculum and reinforce this with information to help parents understand and support oral health education in the home. Educating parents on the dangers of carbonated beverages, sports drinks and processed sugars as well as how to properly teach a child to brush and floss is critical.Helping parents and educators to raise a generation that has good oral health is beneficial to our society and future generations of children.

Colorado sought to increase access by allowing dental hygienists to have independent practice. Stand alone dental hygiene offices had the same expenses for equipment, supplies and office space as dental offices and thus relatively comparable fees for preventive dental services. As a result, most of these independent hygiene practices were located in affluent or middle-income areas where their potential effect on access to care for the underserved was inconsequential. 34 It is possible that the independent practice of dental hygiene increased the overall cost of dental care and created a convenience issue when the patient could not access dental hygiene services and dental restorative services at the same time.

Utilization: Utilization of dental care is affected by potential barriers that are unique to each patient. Barriers can include insurance, financial resources, education and transportation, geographic limitations, a patient’s age, cultural background and fear of dental procedures. Of the 9.8 million people living in Georgia in 2009 an estimated 4,512,941 were enrolled in a private dental plan and 1,162,900 were

In New Zealand and Canada a new type of dental provider, called the dental health aid therapist (DHAT), was created. New Zealand attempted to utilize the DHAT to provide free care to all children. This proved to be financially unsustainable. According to New Zealand’s Ministry of Health, there continues to be pockets of children with oral disease at the level of developing or Eastern

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European countries.35 Canada also had little success with the DHAT. With only two years of dental training, the salaries for these mid-level dental providers were inadequate to entice them to practice in the remote areas where access is a problem.36 Efforts to increase access to care must be diverse to address the many barriers to care that exist. Merely creating different types of lesser educated mid-level providers has proven to be ineffective.

Over the last four years the workforce for government funded programs decreased dramatically. Some of this is due to dentists voluntarily leaving the Medicaid and PeachCare programs after 2006 when the Care Management Organizations (CMOs) were awarded the contract to administer the plans. The CMOs implemented excessive administrative changes, limitations on treatment procedures and draconian cuts in Medicaid and PeachCare reimbursements forcing about half the dentists out of the program. A previously robust program of over 1,800 participating dentists became a program with fewer than 900 dentists. Of the 900 dentists in the program, fewer than 300 dentists would be classified as “significant providers” treating approximately 80% of all the patients who receive care. The CMOs closed their dental panels within six months of their state contract and began to systematically weed out dentists who were high producers. In four years, 65% of these patients went from receiving at least one dental visit annually to about 30% accessing care. 40 Data substantiate that a large segment of the dental community was willing to provide care to this patient population prior to the entry of the CMOs. When inadequate funding and difficulties in administration evolve, inadequate numbers of providers result thereby compromising access to care.

Workforce: An adequate workforce is a key element in providing access to dental care. The determination of an adequate workforce is more than the number of dentists or dental auxiliaries within a state. From a workforce perspective, adequate access is affected by the following: the geographic distribution of dentists and dental auxiliaries; the availability of specialty practitioners; and the number of dentists that participate in government programs. The current workforce is adequate and the plan is in place to expand to meet the workforce needs in Georgia as the population increases. Other factors that influence the ability to maintain and recruit an adequate workforce can be directly related to having a dental school within the state, the number of dental hygiene and dental assisting training programs, the ability of a community to provide economic viability for a dental practice as well as the quality of life that can be offered to the practitioner. Any new category of provider will be faced with the same influences that create dentist shortages in certain areas and communities. It is impossible to alleviate distribution shortages by adding a new category of dental provider, such as the mid-level provider.

According to a 2007 report compiled by the Georgia Division of Health Planning, 20 counties have no dentist providing full time care within the county. 41 However, many counties have population numbers (10,000 or less) that make it difficult to sustain a dental practice. Access to a dentist is within a reasonable drive time for residents of these rural counties. Commercial mobile vans provide access to care for many of the counties listed as not having a dentist. Although the state department of public health in general has taken huge budget hits, the dental program continues to provide preventive services for children. There are 44 county dental clinics and 14 public health mobile vans. The mission of the Oral Health Unit is to prevent oral disease among Georgia’s children through education and early treatment.

Following the medical model is not the solution to access. The medical community struggles with access to medical care despite having created a plethora of physician extenders, which has not alleviated the mal-distribution or shortage in certain areas and has not lowered the overall cost of medical care. In fact, the use of physician extenders may have had a negative impact on the ability to recruit and train more physicians and may be a factor in increasing costs. Like most other states, Georgia is experiencing a significant shortage of primary care physicians.

According to data received May 2010 from the Georgia Board of Dentistry, there are 6,686 dental hygienists who hold an active dental hygiene license. There is no definitive information on how many of these licensed hygienists are actually working. Anecdotally, the GDA staff is hearing from the hygiene educators that a significant number of graduates are having difficulty finding jobs. Georgia programs graduate approximately 220 hygienists annually and with the current economy it is likely that hygienists who want to practice in certain locations may find it difficult to get a job. Dental hygienists render a valuable service and are an integral part of the dental team. Their skills are meant to be applied in concert with the broad skills and knowledge of the dentist. As part of the umbrella of care, dental hygienists improve access to care.

According to the American Dental Association, 4,167 dentists are actively practicing in Georgia or 4.30 dentists per 10,00037. Therefore, it appears that Georgia has an adequate number of dentists based on the dentist to population ratio. However, there may be rural areas where the economic viability of maintaining a dental practice precludes dentists from locating in these communities. A May 2010 report from the Georgia Board of Dentistry indicates 5,541dentists hold an active license to practice in Georgia. Of that number 973 dentists have a Georgia license but live or practice in another state. These practitioners come from all 50 states and Puerto Rico.38 Georgia’s dental school graduates about 60 dentists annually and since 1973, 85% of the graduates remained in Georgia. Georgia averages licensing approximately 250 additional dentists each year. The 2011 freshman class will have 80 students and class size is projected to be 100 by 2016. Advanced dental education residency slots for specialty areas and general dentists will go from the current 44 to 72 once the new dental school is in place.

There has been no report of a shortage of dental assistants in Georgia. Dental assistants are not licensed and their training can be accomplished on the job or through any of the more than 17 dental assisting programs in the state. The Georgia Board of Dentistry expanded the duties that can be performed by dental assistants. For a dental assistant to perform any of these expanded duties, he/she must take an Expanded Duty Dental Assistant course given by the schools or the Georgia Dental Association. Dental hygienists who are trained in the expanded duty functions can also perform these duties. The process of designating Dental Health Professional Shortage Areas (DHPSAs) has implications for access to care and proposed solutions to addressing access to care. Originally DHPSA designations were based on a goal of encouraging dentists to practice in remote locations, true shortage areas. Over time they have evolved into designations that are based on need, but the nomenclature has not been modified to reflect this change. Consequently, the nomenclature is now

Georgia’s age demographics are much more favorable for a stable and growing workforce than many other states. Thirty-five (35%) percent of Georgia’s actively practicing dentists are 55 or older. Of that number 11.89% are over the age of 65. Sixty-five percent (65%) of practicing dentists are under the age of 55 and the mean age is 49.5 years.39 These demographics suggest a vibrant work force for the next 20 years.

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illogical and implies that simple solutions (more dentists and/or expanded scopes of service) can solve a highly complex issue. The nomenclature does not address the intricate issues related to the demand for dental care (economics, oral health literacy, cultural barriers, transportation, etc.). The number of DHPSAs has increased dramatically to the point that the designation may now exaggerate the need for additional dentists and the benefits associated with the designation may no longer predictably target the areas of greatest dental under-service.

more than 200% of the FPL but less than or equal to 235% of the FPL. A sliding scale monthly premium is charged for kids ages five to 19 based on family income. Dental Medicaid and PeachCare for Kids represent a very small percentage of the annual state budget. In 2009 Georgia’s budget was $19,203,246,010 and the amount spent on dentistry in that same year was $217,339,391, making dentistry only 1.13% of the state budget. In that same year the budget for the Department of Community Health, which covers health care services for the Medicaid and PeachCare population, was $2,350,221,089 and dentistry was less than 10% of that budget.

There are distinct differences between the delivery of dental and medical treatment. Dental care delivery and financing systems emphasize prevention, primary care, cost containment and administrative efficiency. Approximately 80% of all dentists are generalists, compared to 40% in medicine. 42 Dentistry does not compete for the health care dollar; it usually vies for the discretionary dollar. Because of these differences, medical model solutions should not be artificially imposed onto the dental model.

Multiple options are available for private dental insurance. Health Maintenance Organizations (HMOs) offer dental plans that require the individual to choose a dentist from a limited list of providers. These plans contract with dentists to be paid at a capitated rate and the patient pays a copayment at the time of service. The premium for these plans is generally lower than Preferred Provider Plans (PPOs). PPO dental plans allow the individual to choose from a larger list of providers and allow for more freedom in their treatment; providers contract to be paid at discounted rates by service code. Indemnity plans provide the freedom of choice of dentist but has higher out-ofpocket expenses. Discount dental plans have a minimal annual fee whereby dentists in the “network” have agreed to discount standard fees for those on the plan. Indemnity and PPO plans generally have annual maximum benefits (standard is around $1000 per person per year). Most HMO plans do not have maximums but may limit services in other ways. Direct reimbursement is a fee-for-service, freedom of choice dental plan that is self-funded by the employer. Employees/patients pay for services and submit a receipt for reimbursement, which is based on dollars spent on dental treatment. According to the National Association of Dental Plans, in 2009 an estimated 4.5 million Georgians were enrolled in a private dental plan and most were in a dental PPO plan (3.4 million). 46

The following excerpt is taken from theAcademy of General Dentistry’s White Paper on Access to Care: 43 “One might contend that independent mid-level providers in medicine, such as advanced nurse practitioners, have benefited the health care system. However, independent mid-level providers in dentistry and advanced nurse practitioners differ fundamentally in the models by which they practice, or intend to practice… The medical model is driven by a first diagnosis at the patient’s ‘point of entry,’ and often a second or third diagnosis based upon the direction of referral. On the other hand, dentistry has served its patients quite well through the prevention-based ‘dental team concept’ rather than a ‘point of entry’ concept. The dental team concept serves the function of dentistry and patients’ access to care with its focus not merely on diagnosis of dental diseases, but rather on prevention and continuity of care through treatment. That is, in dentistry , the ‘point of entry’ is the point of prevention and treatment—it is not just a segue to further diagnosis and possible intervention—thereby saving both time and cost.”

Out of-pocket is the final option to pay for dental services. There are dental financing companies available that offer payment plans with interest for patients who need to pay over time. Dental school clinics and dental hygiene schools use students supervised by licensed faculty to provide services, which are generally 20-60% less than at a private dental office. However, there are often long waiting lists for care, longer overall appointment times, and there is only one dental school in Georgia (Augusta). Dentists may also offer fee reductions for payment in advance or offer their own payment plan within the office. For those who truly cannot afford care, there are also several low cost and free dental clinics in Georgia.

Financing Care:

A patient’s decision to seek dental care often depends on who pays for the care. Dental care financing options include Government Health Insurance Programs for those that qualify, such as Medicare, Medicaid and SCHIP; Private Insurance/Private Coverage including employer sponsored dental insurance (HMO, PPO), indemnity plans, discount dental plans, and direct reimbursement plans; and private pay. According to a publication by the Georgia Department of Community Health (DCH) in January 2009, 38% of Georgians are enrolled in a taxpayer funded government health program and approximately 17% of Georgians are uninsured.44 DCH also reported that health insurance premiums in Georgia increased 65%, and employer sponsored health insurance declined by 7% from 2000 to 2006 .45

Government Programs:

In Georgia government programs provide most of the funding needed to make basic oral health care available to low-income children and pregnant women as well as for those with certain disabilities through the Aged, Blind and Disabled Medicaid Program, the Low Income Medicaid Program and the SCHIP PeachCare Program for children under 18 whose family incomes are less than 235% of the FPL.

Government Programs include Medicare, Medicaid and SCHIP plans. Medicare does not pay for dental services, except for those that are an integral part of a covered medical procedure. Medicaid is available to people with limited incomes. In Georgia benefits are primarily available for individuals under age 21, with the exception of pregnant women and those whose family has an income of 100 – 200% of the federal poverty level (FPL) or less depending on the category the individual falls within. Medicaid covers most standard preventive and basic restorative services. SCHIP, known as PeachCare for Kids in Georgia, provides comprehensive health care, including dental benefits, to eligible children. Eligibility requirements include that the child be a U.S. citizen and Georgia resident, age 18 and under and have a family income that is

In FY2006, the Georgia Medicaid program served 1.5 million members with federal and state expenditures of $5.9 billion.47 The Georgia Medicaid program receives $1.63 in federal funds for every $1 in state funds.48 Funding for PeachCare is provided by the State of Georgia, the federal government (Title XXI funds), and premiums collected for children ages six through 18. Federal funds are available to subsidize nearly 73% of the benefit cost, less premiums, with the remaining 27% coming from the State of Georgia. The percentage of federal matching is adjusted annually.

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Enrollment in government plans tends to increase during times of economic down turns generally due to higher unemployment. State budgets are stretched to provide necessary services. Hence, many strategies are employed to reduce the financial burden to the state and yet attempt to meet federal requirements for matching funds. Georgia has sought to cap their risk by transferring the risk to private for-profit entities, such as Care Management Organizations (CMOs). Because the CMOs are risk bearers, they look for ways to minimize their risk and make a profit. These types of plans tend to limit the number of participating dentists, reduce reimbursement to providers, and/or eliminate certain treatment codes. The result is that fewer providers can afford to participate in the government program and access for this patient population can be challenging.

resource for restorative services for underserved populations in the Augusta area and for those patients willing and able to travel. GDA member dentists give of their time and expertise to help those in need to obtain care. According to a GDA April 2010 survey, approximately $4.3 million is given away each year in Georgia in pro bono dental care through various programs and in-office treatment. However, while donated care is helpful in providing dental care to the less fortunate, it does not constitute a health care system.

Innovative Outreach:

Georgia dentists have always been leaders in seeking innovative ways to provide care to disadvantaged patients. A few of the many innovative dental outreach programs supported by Georgia dentists are mentioned below.

Georgia’s Public Health Department offers limited dental services and some Federally Qualified Health Centers (FQHCs) also provide dental care. Better collaboration between public and private health delivery systems should be a high priority to obtain maximum efficiency in delivery of services. Appropriate federal funding must accompany federal mandates.

Cobb Assistance Program (CAP) This program matches low-income Cobb County public school students who have urgent dental needs with volunteer dentists. The dentist provides immediate care at no charge.

People 65+ represented 12.4% of the population in the year 2000 but are expected to grow to be 19% of the population by 2030. 49 Many will remain in the workforce longer. However, they will present greater health care demands, including demand for dental care. Efforts to improve dental care delivery must prepare for these demands.

Care for Survivors of Domestic Violence Many Georgia dentists voluntarily provide no- or low-cost care to survivors of domestic violence. The Partnership Against Domestic Violence (PADV) and The American Academy of Cosmetic Dentistry Charitable Foundation (AACDCF) Give Back a Smile are examples of these types of programs.

Safety Net:

Access to a dental care safety net for certain populations in Georgia is fragile. Dental care for the indigent, the working poor, developmentally and mentally disabled, and the elderly can be challenging to obtain. Even though Georgia’s Medicaid and PeachCare for Kids programs have helped mitigate children receiving care, some children are still experiencing difficulty in accessing care. Safety-net dental care for some adult populations is an even larger problem in Georgia. With the exception of emergency care for extractions of teeth, there are no Medicaid benefits for adults in Georgia, including the elderly in nursing homes. Therefore, Georgia’s safety net for care is even more critical for these populations.

Dentistry from the Heart (DFTH) DFTH volunteer dentists provide free dental care to those in need in their communities. DFTH has 250 events scheduled for 2010, including four in Georgia, and estimates volunteer dentists will help 30,000 patients. Free School Entry Oral Evaluation Program Approximately 450 GDA dentists annually participate in the GDA School Entry Free Oral Evaluation Program. This is a statewide service for children entering Georgia public schools for the first time. Give Kids A Smile (GKAS) GKAS occurs in February and GDA member dentists provide free preventive and restorative care to needy children. In 2010, the GDA sponsored GKAS programs in every GDA district (8 programs). Volunteers cared for 704 children and provided dental services valued at approximately $139,000.51

Georgia’s limited safety net is vastly smaller than in previous years. Government funded programs have continued to experience extensive budget cuts, especially in the past few years. State funding to the local health departments through the grant in aid program has had ongoing reductions for the past several years. In FY2008, a total 190,839 children received services from Georgia’s Dental Public Health Programs (prevention, education, and treatment services). 50 The State Oral Health Unit operates 44 county dental clinics and 14 public health mobile vans. Many of Georgia’s 159 counties have no public health dental services.

National Foundation of Dentistry for the Handicapped (NFDH) NFDH, a charitable affiliate of the American Dental Association, helps needy disabled, elderly, or medically compromised individuals arrange for dental care through a network of 15,000 volunteer dentists. Georgia dentists donated care for 12 DDS patients with care valued at $41,038.52

In Georgia Community Health Centers have been providing services for 29 years and assist approximately 238,000 individuals each year. There are 27 Federally Qualified Health Centers (or Community Health Centers) at 115 sites. Of the 27 FQHCs 13 provide dental services.

Smile for a Lifetime Foundation. Foundation dentist volunteers provide free orthodontic treatment for low-income patients. Special Smiles Dentist and other volunteers provide free dental screenings during Special Olympics events in the Special Olympics’ Special Smiles® program.

Currently in Georgia there are 14 schools, with one more coming on line in the near future, that educate and train students to become dental hygienists. The dental hygiene students have clinical training and provide basic preventive services for education purposes to patients in the school setting, but do not provide restorative care. The Medical College of Georgia School of Dentistry has a clinical program administered by faculty for the education and training of dental students and residents. The clinic provides an additional

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Volunteer–Driven Dental Clinics. A recent GDA membership survey revealed that 79.1% of responding dentists provided free or reduced fee services to indigent persons, and almost half stated that they provide between $1,000-$10,000 in donated services annually.53 One way that Georgia dentists donate their time is by volunteering at the 23 clinics statewide that provide no- or low-cost dental care to the needy. Many dentists not only volunteer personally , they also bring along paid staff members. GDA dentists also support the clinics financially.


External Influences:

END NOTES

Access to dental care is being influenced by factors that are extraneous to the dental delivery system. External forces are gathering stakeholders and others to reorganize the dental delivery system. Entities, such as the Institute of Medicine (IOM), the Health Resources and Services Administration (HRSA), numerous foundations and policy institutes are initiating oral health policy and advocacy discussions without involving organized dentistry as part of their planning and implementation. The current economic climate is also playing a role in these discussions since financing care is a large part of the ongoing discussion on access to dental care.

Academy of General Dentistry. White Paper on Increasing Access to and Utilization of Oral Health Care Services. July 2008. 2 New Zealand Ministry of Health. Good Oral Health for All, for Life: The Strategic Vision for Oral Health in New Zealand. Wellington, NZ: Ministry of Health, 2006. Available at: “http://www.moh.govt.nz.” Accessed May 5, 2010. 3 Academy of General Dentistry. White Paper on Increasing Access to and Utilization of Oral Health Care Services. July 2008. 4 Id. 5 A Market Report on Dental Benefits: America’s Oral Health, Delta Dental Plans Association, available at www.deltadentalins.com/ documents/market-report-dental-benefits.pdf. Accessed April 2010. 6 2009 NADP/DDPA Joint Dental Benefits Report on Enrollment 7 2009 NADP Survey of Consumers 8 Academy of General Dentistry. White Paper on Increasing Access to and Utilization of Oral Health Care Services. July 2008. 9 Definition from the Department of Community Health web site: http://www.dch.georgia.gov/vgn/images/portal/cit_1210/54/4/ 148505898Report 7 - Dental Application Analysis - 070809 - Final No Draft - 080409.pdf 10 Academy of General Dentistry. White Paper on Increasing Access to and Utilization of Oral Health Care Services. July 2008. 11 “Status of Oral Health in Georgia, 2007 – Summary of Oral Health Data Collected in Georgia” Georgia Department of Human Resources. http://health.state.ga.us/pdfs/family health/oral/ohinga07.pdf 12 U.S. Department of Health and Human Services. “Oral Health in America: A Report of the Surgeon General.” Rockville: U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2000. 13 Oral Health of Georgia’s Children – Results from the 2006 Head Start Oral Health Survey, “Georgia Department of Human Resources, http://health.state.ga.us/pdfs/familyhealth/oral/ Head Start Oral Health Report (FINAL).pdfld. 14 “Status of Oral Health in Georgia, 2007 – Summary of Oral Health Data Collected in Georgia” Georgia Department of Human Resources. http:// health.state.ga.us/pdfs/familyhealth/oral/ohinga07.pdf 15 Georgia Behavioral Risk Factor Surveillance System data, 2006. http://health.state.ga.us/pdfs/epi/BrfssReport2006 16 Rises LAG, Eisner MP, Kosary CL, Hanke BF, Miller BA, Cleg L, et al eds. SEER Cancer Statistics Review, 1975-2001, Bethesda: National Cance Insitute 2004. 17 Georgia Comprehensive Cancer Registry (GCCR). Data collected during 2000-2004 18 Id. 19 From the Georgia Oral Health Program web site. http:// health.state.ga.us/programs/oral/ 20 U. S. Department of Health and Human Services, Health People 1010, 2nd ed. Washington: U.S. Department of Health and Human Services, 2000. 21 American Dental Association, Council on Access, Prevention, and Interprofessional Relations, Health Literacy in Dentistry Action Plan 2010-2015. 22 Nielsen-Bohlman L. Panzer AM, Kindig DA, eds. Health Literacy: A prescription to End Confusion, Washington, DC; The National Academies Press; 2004. 23 Vernon JA, Trujillo A, Rosenbaum S, DeBuono B. Low Health Literacy: Implications for National Policy 2007. 24 2009 NADP/DDPA Joint Dental Benefits Report on Enrollment 25 Haley, J., Kenney, G., Pelletier, J. Access to Affordable Dental Care: Gaps for low income adults, July 2008. In addition to the 7 states providing full dental benefits, 18 states provided limited dental benefits, another 18 states provided emergency benefits only, and 8 states provided no dental benefits at all. Adult Dental Benefits chart: http://www.medicaiddental.org/docs/adultdentalbenefits2003.pdf 1

Dentistry is a small part of health care spending and the newly enacted federal health care reform legislation is unclear on what it will do to provide more care for children. It appears that it may actually offer less care in an effort to contain costs. Large corporate and retail dental clinics have sought to bring innovations to the dental delivery system through economies of scale, multiple locations and expanded hours. In the future, traditional private practitioners in dentistry may explore some of these modalities as ways to offer the patient a more flexible dental delivery system. Over the past several years more foundations are trumpeting the message that organized dentistry has been proclaiming for decades: oral health care is important, especially for children. Georgia’s dentists are pleased that many organizations are recognizing the need for individuals and families to find a ‘dental home’ and that oral health affects overall health. Our concern is not with the increased interest in oral health, but with the approaches that many foundations are taking in affecting change in public policy. Rather than focusing on the issue of underfunding of government based programs or focusing on programs to boost the dental IQ of the populace, some foundations are proposing programs to dismantle the current dental delivery model and promote the institution of lesser trained individuals (MLPs) providing dental services. The use of MLPs is not a solution. It is another problem and one that can compromise the health and safety of the patient. The GDA has grave concerns about the vast reach and implications of numerous organizations and foundations that are making decisions on dental care delivery and access to care based on faulty assumptions, inadequate data, and comparisons to the medical model. The profession believes that the health and safety of the patient is paramount. We believe that some of the proposed solutions being put forward by outside entities, in the name of access, do not place the health and safety of the patient first.

CONCLUSION The Georgia Dental Association is dentistry’s voice in our state and seeks to work with any and all groups willing to help promote and provide access to quality dental care for Georgians. We invite interested individuals to help the profession strive to find solutions to well documented problems that we know can be addressed by better funding, implementing oral health literacy programs, establishing more safety-net programs for those who fall through the cracks and simplifying third-party insurance plans, which allow dentists to be more productive. Time and valuable resources should not be wasted in pursuit of proposals that lower the standard of care by creating a two-tiered delivery system utilizing lesser educated individuals that has been proven not to work. Working together we can improve the oral health of all Georgians.

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http://www.peachcare.org/FaqView.aspx?displayFaqId=107 Garretto LP, Yoder KM. Basic oral health needs; a professional priority? J Den Educ 2006; 70(1): 1166-9. 28 Id. 29 Manski RJ, Edelstein BL, Moeller JF. The impact of dental coverage on children’s dental visits and expenditures, 1996 J Am Dent Assoc 2001; 132:1137-45. 30 Guay AH, Improving Access to Dental Care for Vulnerable Elders. 2005 J. Dent. Educ. 69(9), 1045-1048. 31 Manski, R. J. and Brown, E. Dental Use, Expenses, Private Dental Coverage, and Changes, 1996 and 2004. Rockville (MD): Agency for Healthcare Research and Quality; 2007. MEPS Chartbook No.17. http://www.meps.ahrq.gov/mepsweb/data_stats/ Pub_ProdResults_Details.jsp?pt=Chartbook&opt=2&id=827 32 The demographics of dentistry. J Am Dent Assoc 1996;127;13271330 [current as of May 2010] 33 G. Flores et al., “Access Barriers to Health Care for Latino Children,” Archives of Pediatrics and Adolescent Medicine 152, no. 11 (1998): 1119–1125. 34 Brown LJ, House DR, Nash KD. The economic aspects of unsupervised private hygiene practice and its impact on access to care. Dental Health Policy Analysis Series. Chicago: American Dental Association, Health Policy Resources Center; 2005. 35 New Zealand Ministry of Health. Good Oral Health for All, for Life: The Strategic Vision for Oral Health in New Zealand. Wellington, NZ: Ministry of Health, 2006. Available at: “http://www.moh.govt.nz.” Accessed May 5, 2010. 36 Papadopoulos, C. Dental Therapy in Canada, A Discussion Paper. May 2007. 37 American Dental Association Survey Center 38 Georgia Board of Dentistry list of licensed practitioners 39 Georgia Dental Association Membership Data Base 40 From the GDA Medicaid and PeachCare History; and Georgia EPSDT Review Report Dental Services, Centers for Medicare and Medicaid Services, Site Visit May 20-30, 2008. 41 Report prepared by: Data Resources and Analysis Section, Division of Health Planning 7.6.07 42 American Dental Association (ADA), Survey Center. 1997 survey of dental practice. Characteristics of dentists in private practice and their patients. Chicago: American Dental Association; 1998a. 43 Academy of General Dentistry “White Paper on Increasing Access to and Utilization of Oral Health Care Services, July 2008, page 5 44 Georgia Department of Community Health, A Snapshot of Georgia: Medicaid and the Economy, January 2009; http://www.georgia.gov/ vgn/images/portal/cit_1210/32/0/ 124512107Medicaid&Economy.1.2009.pdf 45 Id. 46 National Association of Dental Plans, Georgia 2010 Dental Benefits Fact Sheet 47 A Snapshot of Georgia Medicaid, Georgia Department of Community Health, August 2008; http://www/georgia.gov/ugn/images/ portal/cit_1210/60/52/70650176Medicaid-Fact_FYfin08Sheet.pdf 48 Georgia Department of Community Health, Division of Medical Assistance, Part II, Policies and Procedures for Dental Services, Publish April 1, 2010. 49 Department of Health and Human Services, Administration on Aging, http://www.aoa.gov/aoaroot/aging_statistics/index.aspx, accessed June 21, 2010. 50 Department of Community Health web site: referenced April 26, 2010 51 Give Kids A Smile feature stories, April 2003-2010, GDA Action, the Journal of the Georgia Dental Association 52 National Foundation of Dentistry for the Handicapped: http:// nfdh.org/joomla_nfdh/content/view/24/47 53 Analysis of the 2008 GDA Member Survey, December 2008, GDA Action, the Journal of the Georgia Dental Association 26

Patient Protection Task Force

27

Dr. Kent Percy, GDA President 2009-10 Dr. Ty Ivey, Chair Dr. Matt Adams Dr. Mark Dusek Dr. Edward Green Dr. Jason Oyler Dr. James Reynierson Dr. Richard Weinman Dr. Jack Bickford, Ex Officio Dr. John (Jay) Harrington, Ex Officio

Georgia Dental Association Board of Trustees 2009-10 Dr. Kent Percy, President Dr. John (Jay) Harrington, President Elect Dr. Michael Vernon, Vice President Dr. James Hall, Secretary/Treasurer Dr. Jonathan Dubin, Editor Dr. Sidney Tourial, Speaker of the House Dr. Mike Loden Dr. Erik Wells Dr. Richard Weinman Dr. Robin Reich Dr. Byron Colley Dr. Steve Sample Dr. Robert Carpenter, Jr. Dr. Kara Moore Dr. Grant Loo Dr. Jeff Kendrick Dr. Terry O’Shea Dr. Mark Dusek Dr. Jeff Singleton Dr. Jay Harris Martha S. Phillips, Executive Director

For additional information or documentation on the topics discussed in the White Paper, contact the Georgia Dental Association’s Executive Office. Georgia Dental Association 7000 Peachtree Dunwoody Rd #200-17 Atlanta, GA 30328 404.636.7553 www.gadental.org

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Annual Meeting Addresses Big Issues, Offers Family Fun Value on display every moment! That was what many dentists expressed about the Annual Meeting in Amelia Island. From stellar continuing education to a packed Exhibit Hall to outstanding social and sporting events, dentists and their family members offered compliment after compliment about the meeting. Thanks to every attendee for spending time with the GDA this summer. Here are some meeting highlights:

House of Delegates The House dealt with the big business of the moment, including mid-level providers, the GDA white paper on access, and the GDA Mission of Mercy. Everyone was interested to hear what ADA Executive Director Kathleen O’Loughlin had to say—and she said a lot! Read her comments on page 19. And catch up on the reaction to the GDA white paper on page 9. Kudos to Doug Torbush, DDS, on his election as the new Speaker of the House! The minutes of the House are on page 26 for your review, and are also available at www.gadental.org.

Business Meeting This Friday meeting is where the GDA elects state officers. Dr. Jay Harrington moved to the office of GDA President and Dr. Mike Vernon moved to the office of President Elect. Congratulations to new Vice President Dr. Sidney Tourial! Dr. Jim Hall and Dr. Jonathan Dubin continue as Secretary / Treasurer and Editor, respectively. The audience enjoyed hearing from dentist legislators Greg Goggans and Lee Hawkins. Read what Dr. Goggans has to say about issues affecting Georgia dentists on page 19.

Exhibit Hall A sold-out Exhibit Hall kept packing in visitors for the Welcome Reception, door prize and cash giveaways, the Minute to

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Win It kids games, Saturday’s breakfast (Ritz-Carlton caramel buns ring a bell?), and of course great deals from exhibitors! There were 20 first-time exhibitors, and four (Atlanta Dental Supply, Brasseler USA, Patterson, and Sunstar Butler) exhibitors who joined the GDA for the 26th consecutive year. See the full list at www.gadental.org, and see who signed up for 2011 in Hilton Head!

Continuing Education There were record turnouts to hear Dr. Gerard Chiche, Dr. Henry Gremillion, Dr. Tom McDonald, Mr. John Carl, and Ms. Kelli Vrla. Ms. Vrla also kept a huge turnout at the Kickoff Breakfast entertained and energized! Thanks to these incredible clinicians for visiting with the GDA.

Let the Good Times Roll! Friday Night was a complete blast for everyone of all ages. Great games and activities, tasty food, and a noholds-barred district competition (yes, we are looking at all of you who competed in the motorized toilet bowl races) kept everyone energized for hours. Congratulations to the Northwestern District who ruled as the champions, taking the crown after a spirited tug of war competition with second place Southwestern District. Kudos to bronze medallists Western District.

Mardi Gras Dinner Dance This event was a blast from the start! From the fantastic Cirque performances to the amazing dinner to the all-out dance fest that ran late into the night, this event had everyone raving, eating, and well, dancing. Never fear— the 2011 dinner dance planners have rolled up their sleeves and are planning another fantastic party!

Awards and Installation Breakfast Hope everyone caught Dr. Jonathan Dubin’s amazing video Memories Presentation about President Dr. Kent Percy’s year! If you missed it, you can view the video at www.gadental.org. Dr. Percy was pleased to honor several award winners Sunday morning, including 25 Year Members, 50 Year Members, ADA Life Members, Presidential Commendation Winners, Community Service Winners, and Honorable Fellows. See the awards feature on page 16 for all the names. Congratulations to the new district and Alliance presidents installed Sunday morning, and Dr. Jay Harrington who took the reins as GDA president. Read his induction speech, complete with project announcements, on page 14.


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Alliance Spouses The GDA Alliance spouses group had a great meeting! Thanks to President Linda Broderick and her officers for staffing a bustling booth in the Exhibit Hall (did everyone see the new Alliance Meth Mouth Mary educational exhibit?) and for hosting an incredibly successful Wine and Cheese Reception and breakfast. For more details on this dynamic group, visit www.gadental.org! The group is seeking volunteers to take the Meth Mouth Mary and Dipper Dan educational modules into schools, and assist with their October dental kit assembly and November G.M.O.M. silent auction projects!

Sporting Events During the fishing tournament, Cliff Crummey (son of Dr. Keith Crummey) caught the biggest fish—a 45-pound redfish. The tennis tournament top

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players were Dr. Stuart Loos and Dr. Cameron Watson. The Fun Run champions were Dr. Wilkie Stadeker and Mrs. Allison Andrews (wife of Dr. Lee Andrews). Dr. Brittany Thome was the runner who ran closest to an estimated time (no watches allowed on the run). The top golf tournament team was Steven Reich, Joseph Reich, Charles Baker, and Dr. Jack Bickford. The longest drive winners were Dr. Jim Hutson and Dr. Deena Holliman Smith. The closest to the pin winners were Dr. John Peacock, Dr. Bobby Shirley, Dr. Deena Holliman Smith, and Lee Smith.

Save the Date! The 2011 GDA Annual Meeting is July 21-24 at the

Visit www.gadental.org for Annual Meeting details and so much more!

Hilton Head Marriott Resort in South Carolina.

GDA ACTION SEPTEMBER 2010

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Enjoy More GDA Meeting Photos Online! View the many hundreds of GDA Annual Meeting photos at www.gadental.org on the Annual Meeting page! Click the link on the home page!

Alliance President Linda Broderick conducted a terrific meeting for dental spouses, and was recognized by Dr. Kent Percy after she addressed the Kickoff Breakfast. Dr. Linda King-Kohl and daughter Cadance. Dr. KingKohl won the $1,000 GDA Grand Prize giveaway in the Exhibit Hall.

King and queen of the Mardi Gras Dinner Dance: GDA President Dr. Kent Percy and his wife Mary.

Dr. Karyn Stockwell and her niece Lindsey Wright, RDH, were belles of the Mardi Gras ball on Saturday.

Dr. Billy Jamerson giving one of his memorable Awards and Installation Breakfast speeches. He ended three years of chairing the Awards Committee at this year’s event.

Dr. Wilkie Stadeker (r) and Dr. Alan Sanders racing for glory on bouncy horses during the district competition Friday. New President Dr. Jay Harrington smiles as Dr. Kent Percy fastens his new president’s pin on his lapel.

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Dental students and ASDA members Jack O’Neill, Wendy Cardenas, Chris DeLeon, Naz Majdi, Francesca Seta, and Cliff Baughman helped conduct the children’s Minute to Win It games in the Exhibit Hall with Dr. Robert and Marianne Moss.

New Southeastern District President Dr. Mark Dusek (r) brings every ounce of energy to singing onstage during the Saturday dinner dance. (SEDDS members—if you don’t ask him to do that at your next district meeting, you are missing out.)

Dr. Brett Helton and Dr. Chris Hasty maneuver their motorized toilets around the GDA race course during Friday’s district competition.

The Cirque performers during the Saturday Mardi Gras dinner dance had everyone spellbound, including this performer who balanced her body weight with her teeth.

Dr. Ronnie Weathers, Susan Leingang, Robanne Schulman, Dr. Troy Schulman, and Jean Weathers got into the spirit of Saturday’s Mardi Gras Dinner Dance.

Northwestern District won the district challenge during the Friday night event. Shown are Dr. Kent Percy, Dr. Stuart Loos, Dr. Karyn Stockwell, Dr. Jim Hutson, Dr. Wilkie Stadeker, Dr. Bruce Camp, Dr. Narisa Goode, Dr. Kumar Patel, Mr. Kent Percy (the son), Mr. Clinton Percy, and Dr. Chris Shim.

GDA ACTION SEPTEMBER 2010

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New President Dr. Jay Harrington Outlines Challenges, Sets Projects for His Year Dr. Jay Harrington looked at current challenges facing the profession and announced two GDA projects that need member involvement during his induction speech on July 25. More details on the projects will be available in future issues.

Protection Task Force and published in our new GDA paper on Georgia dental access to care. The GDA will use this valuable document to educate our fellow members, legislators, advocacy groups, and patients about real solutions to dental access to care issues.

“The GDA needs you at

The Economic Unsteadiness Challenge

a LAW Day to fight for funding of dental services because we are sure to see proposed budget cuts. We also hope to fight for our dental Medicaid single

administrator

legislation with support from a new governor.”

The Mid-Level Provider Challenge The development of mid-level providers is probably the most significant change we’ve seen in the practice of dentistry. Since the Dental Health Aide Therapist (DHAT) was allowed in Alaska, proposals involving non-dentist providers mostly from non-dentists have progressed at a rapid rate in the lower 48 states. This is really a state’s right issue. All states are not the same and they have different needs with workforce. Current statistics show that creating a new non-dentist provider in Georgia is not necessary. This conclusion is supported by research conducted by the Patient

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We’ve felt a slowdown in the economy for almost three years. Dentistry has felt the effects like all other areas. We all have had to re-evaluate our lives based on the economic environment in which we live and work. We have seen our patients lose their jobs and their benefits. Dentists have made uncomfortable changes— closed practices, reduced hours, let go staff. What can we do? We can give value to our services. Our patients want the best value for the dollars they spend. Are you explaining to your patients what services you provide at their visits? If you are not, start tomorrow.

The Legislative Challenge Some economists say it could be 2014 before the state gets back to some normalcy with its revenues. So, the 2011 legislature will see a budget battle tougher than the one we saw last year. The GDA needs you at a LAW Day to fight for funding of dental services because we are sure to see proposed budget cuts. We also hope to fight for our dental Medicaid single administrator legislation with support from a new governor. The GDA also expects to see legislation on scope of practice, and possibly legislation on telehealth that may involve the subject of teledentistry, a relatively new treatment concept for dentistry that purports to expand access to care while also providing cost effective delivery. Our Governmental Affairs Committee will monitor the legislative landscape to see if this is the year the GDA can pass legislation

Dr. Jay and Jean Harrington with their special daughter Lisa. Drawing on Lisa as an inspiration for his induction speech, Dr. Harrington told GDA members at his installation that “The Georgia Dental Association and its members are winners! We don’t quit!”

protecting the dentist-patient relationship from insurance companies that market dental plans that “cap” fees on non-covered services of dentists who are participating plan providers. There will be at least 42 new legislators elected for 2011. We will have a new Governor, Secretary of State, Attorney General, Insurance Commissioner, Labor Commissioner, and State Superintendent of Schools. With the significant changes that will occur, our Contact Dentist Program will be extremely important. The opportunity is now for us to establish new, strong relationships within our districts at the grassroots level.

Two Projects for 2010-11 I have two projects which I want the GDA to tackle starting this year. Many members of the public don’t understand what it takes to become a dentist. We need to eliminate that confusion and educate the public on what becoming a dental professional truly means. Dentistry also needs to work on how we are perceived by the public in terms of trustworthiness. While we work on promoting our image as dental professionals, I want us to begin helping the public regain their trust in the dental profession. I will ask our Public Relations Committee to make this


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their objective so we can begin this movement here in Georgia. Secondly, I want to re-establish a mentoring opportunity for the students at the MCG School of Dentistry. We’ll gauge the interest from our students and develop our plans accordingly. I want our GDA dentists to build relationships with these students to create good colleagues and supporters of organized dentistry.

Let’s Succeed Together We have a lot of challenges ahead of us, but a lot of opportunities. And we have a wealth of services provided by our GDA that we can call on to help us meet the challenges and take advantage of the opportunities. I am preaching to the choir, but the choir has a responsibility to deliver a message to the congregation. So this is your charge. When you return to your districts, start delivering the message of the valuable services our Association provides on behalf of its members. One of our responsibilities is to help our Association succeed. Members are the life blood, and it is vital for us to not only retain but to gain members. Four weeks ago I attended the funeral

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“I have two projects which I want the GDA to tackle … Many members of the public don’t understand what it takes to become a dentist. We need to eliminate that confusion and educate the public on what becoming a dental professional truly means ... Secondly, I want to re-establish a mentoring opportunity for the students at the MCG School of Dentistry. We’ll gauge the interest from our students and develop our plans accordingly.”

of my high school football coach. Melvin Charles was a man of character and a tough disciplinarian. To a group of teenagers, his standards were not always popular. But, it was more than football he was teaching, he was preparing us for life. One of his favorite quotes was “Quitters never win and winners never quit.” The

Georgia Dental Association and its members are Winners! We don’t quit! It is a great honor for me to be your President. I pledge I will work hard to do the right thing, and we will work together to keep the Georgia Dental Association the best in the country.

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GDA Honors Dentists Who Make a Difference The GDA was pleased to honor several special dentists on July 25 during the 2010 Awards and Installation Breakfast. Kudos to these deserving individuals.

Presidential Commendation Winners

Committee Chair of the Year

Dr. Karyn Stockwell was honored by Dr. Kent Percy for her outstanding Recruitment & Retention Committee leadership; her dedication to establishing a successful Mission of Mercy; and serving as an inspiration and example for her involvement at all levels of organized dentistry.

Dr. Ty Ivey, Patient Protection Task Force:

Dr. Jack Bickford was honored for his exceptional guidance of the GDA Governmental Affairs Committee, his outstanding service as 2010 Annual Meeting General Chairman, and his valuable support and friendship.

Dr. Kent Percy shares a laugh with 2010 Chairman of the Year Ty Ivey, who helmed the GDA Patient Protection Task Force (which produced the GDA white paper on access to care).

Committee Liaison of the Year Dr. Karyn Stockwell was presented with a presidential commendation for her Recruitment and Retention Committee and G.M.O.M. work.

Dr. Michael Yarbrough, Dental Recovery Network (see a photo of Dr. Yarbrough on page 18 as an Honorable Fellow)

25 Year Members Central Dr. Lynn Mullis Dr. Dennis Smith Eastern Dr. Bruce Holes Dr. Barbara J. Utermark Dr. William C. Wright

Dr. Jack Bickford was honored with a presidential commendation in large part for his governmental affairs work.

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Northern Dr. Thomas Brem Dr. Karl Burgess Dr. Bruce Carter Dr. John Eaton Dr. Bruce Edelstein Dr. Brad Greenway Dr. Calvin Huff Dr. Stephen Lipson Dr. Kaneta Lott

Dr. Wayne Miller Dr. Eric Swinson Dr. Robert Watson Jr. Dr. Rebecca Weinman Dr. Robert Williams Jr. Dr. Carol Wolff Northwestern Dr. Bruce Camp Dr. David Cassidy Dr. Barry Clower Dr. James Hutson Jr. Dr. Christopher Jernigan Dr. Wendy Katz Dr. Kenneth Kligman Dr. Robert Lee Dr. Joanne Miller Dr. David Olson


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Dr. Ralph Reese Dr. James Whitener Jr. Dr. Stephen Wilhoite Southeastern Dr. Thomas Broderick Dr. Robert Holovack Dr. Lawrence Schmitz Southwestern Dr. Darryl Chapman Sr. Dr. Keith Crummey Dr. Matt Smith Drs. Carol Wolff, Becky Weinman, Stephen Lipson, Jim Hutson, Brad Greenway, Keith Crummey, Bruce Camp, and Tom Broderick received engraved glass paperweights to honor their 25 years of membership. This was the first year the GDA recognized 25 Year Members. President Kent Percy is at far left.

Western Dr. Thomas Lee Dr. Terry Wilkey

50 Year Members Central Dr. Anne Hanse Dr. Howard Warren Eastern Dr. Duane Erickson Dr. Wade Hammer Dr. Carlton Hearn Dr. Joseph Konzelman Jr. Dr. Truett Watson Northern Dr. Joel Adler Dr. Robert Bretches Dr. Bobby Evans

Dr. Oliver Goettee Jr. Dr. Cleveland Jones Dr. Donald Maxwell Dr. George Sale III Dr. Allan Shaw Dr. John Sheffield Jr. Dr. Alvin Siegel Dr. Harley Smith Dr. Glenn Tatum Jr. Dr. Gordon Thompson Dr. Gerald Webb

Northwestern Dr. Billy Copeland Dr. Hendrick Cromartie Jr. Dr. James Ware III Southwestern Dr. Troy Bishop Dr. John Carden Jr. Dr. Omer McLean Western Dr. Mac Dorris Dr. Daniel Sanders Dr. John Smith

Dr. James Ware (l) made a special trip with his wife and daughter to be honored by Dr. Kent Percy as a GDA 50 Year Member.

2011 ADA Life Members Central Dr. Jon Barden Dr. Laurence Cubbage Dr. Turner Gaines Jr. Eastern Dr. Michael Billingsley Dr. Robert Comer Dr. Lawrence George Dr. James Moncrief Jr. Dr. Patricia Palmer Dr. Richard Putnam Dr. Michael Rogers Dr. Robert Ward Jr. Northern Dr. David Allen Dr. Jay Auerbach Dr. Robert Bays Dr. Robert Bruner Dr. Forest Butler Dr. Michael Carpenter Dr. Thomas Carroll Dr. Max Ferguson

Dr. Gordon Fleming Dr. James Goettl Dr. Sami Graham Jr. Dr. Raymond Johnson Jr. Dr. Robert Kakos Dr. James Kelley Dr. Paul King Dr. Jay Levitt Dr. Denny Malcom Dr. John Martin Dr. Thomas McDonald Dr. David Remaley Dr. Donald Rozema Dr. Richard Shapiro Dr. Craig Smith Dr. John Vilece Dr. Frank Waggoner Jr. Dr. Mae White Dr. James Williamson Northwestern Dr. Theodore Aspes Dr. Alan Belinky

Dr. Kent Percy with new Life Members Dr. Mike Rogers, Dr. David Remaley, and Dr. David Allen.

Dr. David Bowen Dr. John Doris Dr. David Garber Dr. Jack Hale Jr. Dr. David Haydon Dr. Mathias Kill Jr. Dr. Michael McCary Dr. James Prather Dr. Terry Schnare

Dr. Richard Schultz Dr. Paul Smith Dr. Ronald Wilson Southeastern Dr. John Good Dr. James Holland Jr. Dr. Michael Konter Dr. George Massey

Southwestern Dr. Louis Landau Jr. Dr. Wayne Maris Dr. Thomas Smith

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Thank You GDA Honorable Fellows for Your Service Honorable Fellows are dentists who have rendered more than usual service to the GDA. Distinguished service to the GDA, either through active participation in the GDA or at the district level, is the primary requirement for Honorable

Fellow designation. A dentist must also have held active membership in the GDA for at least 10 continuous years; demonstrated integrity, honesty of purpose, and adherence to the Code of Ethics of the ADA; and been actively

involved in their community. This award is one of the highest that the GDA can bestow. Congratulations to these Honorable Fellows honored at the 2010 Awards and Installation Breakfast on July 25.

Dr. Mark Lawrence Columbus, Georgia University of Tennessee College of Dentistry Western District Past President and Delegate and Alternate Delegate to the GDA House

Dr. Jason Oyler Rome, Georgia Medical College of Georgia School of Dentistry Northwestern District Give Kids a Smile representative, Membership Services representative, Delegate and Alternate Delegate to the GDA House, and district Continuing Education Chair

Dr. Beth Sheridan Savannah, Georgia Ohio State University School of Dentistry Southeastern District Past President and Delegate and Alternate Delegate to the GDA House

Dr. Michael Yarbrough Atlanta, Georgia Medical College of Georgia School of Dentistry Liaison, GDA Dental Recovery Network, GDA representative to ADA Wellness Conference, and Past Chair of GDA Chemical Dependency Program

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They Said It: Comments from the ADA Executive Director and a Georgia State Senator on Key Dental and Economic Issues ADA Executive Director Dr. Kathy O’Loughlin addressed the Summer 2010 House of Delegates on several key ADA matters. State Senator Greg Goggans, Vice Chairman of the State Appropriations Committee and Secretary of the Health and Human Services Committee, addressed the Business Meeting about Georgiaspecific economic issues. Following are some comments by both speakers:

Dr. Kathy O’Loughlin:

“Shame on us—we’ve made dentistry look way too easy for the public. We are under-appreciated as a profession by the public. We’re not informing the public of the rigorous nature of our education.” “This current environment feels like an all-out assault on autonomy of dentistry.” “We are re-organizing the ADA and increasing transparency. We resolved the ADABEI issue quickly and that company has contributed $2 million to non-dues revenue. Your ADA is not sitting still— we must be a well-run business.” “This has been a challenging year. But I hold optimism about the ADA makeover and that in the next six months you will see lots of progress.”

Dr. Greg Goggans:

“We have allowed other people to become a trusted resource on dentistry. We are trying to replace the foundations as the king of the hill regarding oral health expertise. For instance, the ADA is the primary agency that the Department of Health and Human Services is using as a resource for an oral health literacy campaign.”

“It would take two or three hours to discuss the behind the scene issues concerning the CMOs.” “We need a grassroots effort to support the ballot measure this fall concerning the issue of funding Trauma Care. Georgia’s death rate from traumatic injuries is 20 percent higher than the national average. Please, I need your support in passing this Constitutional Amendment.” “Tax breaks, cuts, deductions, and exemptions have been passed over the years with no oversight of the long term consequences.” “A special committee of business leaders (non-politicians) has been given the task of reviewing Georgia’s tax structure and policy. This committee will present their findings and recommendations to the General Assembly before January 1, 2011.”

“It is our job to get you as much information as possible to make decisions about workforce at the ADA House of Delegates. We’ve added a special Reference Committee for consideration of this issue.” “We cannot treat our way out of the access to care issue. We must get the government to understand that we must focus on prevention as a solution to access to care. And we must give our patients increased levels of oral health literacy.”

Presently, the Department of Community Health is running internal tests. If the state is not satisfied with its testing by October, the November 1 go-live date may be postponed. Please feel free to call me with any issues that you may have. I represent all of my fellow colleagues.”

“We had to cut $3 billion from the budget. We have also used up all of our reserves and most of the stimulus funds to balance our state’s budget.” “Some may object to the overall concept of federal stimulus dollars. But, without these funds, there would have been a very large provider rate cut. These are your tax dollars and if we had not accepted them, this money would have been given to other states.” “They have promised me that there would be no major hiccups in the switch to the new Medicaid Management Information System for processing claims.

“Every part of Georgia’s tax policy is on the table for review. A bill will be presented to us for an up-or-down vote. I believe that we have to fundamentally change our tax policy. I want to see the lowest possible rate spread out over the greatest number of people.”

“Georgia does not have a spending problem—we have a revenue problem. Georgia ranks 50th of all states in revenue per capita. We must find a better way to raise more revenue so that we can properly fund education, health care, and public safety.” “We, Georgia, will come out of this recession a better, leaner, and stronger state. Georgia is a great place to live, work, and play.”

GDA ACTION SEPTEMBER 2010

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Established Oral Health Benefits of Community Water Fluoridation Facing Criticism The fluoridation of Georgia’s community water systems is a public health success story. By optimally adjusting the level of naturally-occurring fluoride in drinking water, community water systems can ensure that Georgians who drink water from those systems have access to the “single most effective public health measure to prevent tooth decay and improve oral health over a lifetime,” according to former Surgeon General Richard Carmona. Since the inception of water fluoridation, the American Dental Association (ADA) has monitored scientific research regarding safety and efficacy. Based on that review, the ADA has continually reaffirmed water fluoridation as the most effective public health measure for the prevention of dental caries. Despite the ADA’s recommendation, and solid support for community water fluoridation from hundreds of other health care professional and scientific associations, opposition to fluoridation still occurs. The Internet has enabled anti-fluoridation groups to rapidly share their opinions across a broad spectrum of web sites and social media outlets. This widespread sharing of often distorted information about fluoride can easily confuse members of the public. The Georgia Dental Association (GDA) has a long history of supporting fluoridation efforts. The close relationship between the GDA and the state public health department and their joint efforts to educate legislators and other groups about the benefits of fluoridation means that a vast majority of Georgians on public water systems enjoy the protection of fluoridation. However, GDA members must continue to educate the public about fluoridation and be vigilant about efforts to oppose this effective public health measure.

Fluoride: A History of Success in Georgia The ADA and the U.S. Public Health Service began lobbying for the fluoridation of all public water supplies in the 1950s. But in Georgia, selling the benefits of fluoride to a skeptical public at the height of

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the Cold War was not easy. Despite ample evidence from scientific studies that adding fluoride to water supplies would improve the dental health of the state’s population, local and state officials and voters resisted the idea. At the government level, funding was a major concern. On top of that, many Georgia citizens didn’t see the necessity in spending any effort on something that generations of their families had done without for their whole lives. Even though proponents hoped the state of Georgia would one day require communities to fluoridate their water supplies, efforts were concentrated instead at the local level for many years. By 1962, 85 Georgia communities had fluoridated their water supplies, with GDA dentists wearing both health care professional and community leader hats often in the lead of the pro-fluoridation efforts. To speed efforts along at the state level, the GDA passed a 1966 resolution calling on the legislature to form a joint Senate-House committee to study the possibility of a statewide fluoridation requirement. In 1968, the voters of Atlanta and Fulton County approved the addition of fluoride to their water supplies, a huge victory for the GDA and public health. Buoyed by that success, the state public health department re-doubled efforts to press the state legislature to require the fluoridation of all public water supplies in the state. A first attempt to pass state fluoridation legislation fell nine votes short in the Georgia House. Most of the opposition came from counties that had no fluoridated water systems and saw no reason to require communities to incur the expense of creating them. But the 1973 Georgia legislature finally did what its predecessors would not and passed a law requiring fluoridation of all public water systems in the state subject to certain requirements. GDA dentist and State Representative John Savage sponsored the bill, which then-Governor and future President Jimmy Carter signed into law. (The desk on which Governor Carter signed the fluoridation bill into law now resides at the GDA office in Atlanta.)

Thanks to decades of hard work by GDA dentists and state public health officials in supporting fluoridation initiation, funding, and monitoring efforts, Georgia ranks fifth in the nation in the percentage of water systems fluoridated (CDC.gov). Currently, 95.8 percent of Georgia’s citizens have access to fluoridated water. In comparison, the CDC estimates that only 72.4 percent of the overall U.S. population who rely on public water systems enjoyed the same benefits.

GDA Lobbies to Keep Funding Flowing for Fluoridation Efforts Once the legislature implemented statewide fluoridation of Georgia’s public water systems a new hurdle appeared— ensuring funding for fluoridation and monitoring. The legislature failed to provide fluoridation funding in the first two budgets following the initial vote. Supporters had to obtain funds through state grants. Georgia’s Environmental Protection Division administered these funds, which totaled $400,000 in 1974. These funds enabled 40 public water systems that served 557,000 people to fluoridate their water. The following year, grants totaling $250,000 enabled 40 more systems serving 133,000 people to fluoridate water systems. The GDA and public health continued to face funding battles in the years to come. In 1991, the state Department of Human Resources suggested eliminating all state support for oral health and all support for fluoridation. In response, the GDA House of Delegates passed Resolution 91-25 “Support of Dental Public Health Care Program.” GDA dentists and other oral health advocates then helped pressure legislators into rejecting the idea. Two years later, the state Environmental Protection Division and Department of Natural Resources took their turn at suggesting legislators nix the fluoridation program because of budget constraints. Significant input from fluoridation’s supporters again derailed the effort.


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Another challenge arose in 1997, when Governor Zell Miller sought to cut the state’s budget by privatizing many state programs. Although many oral health proponents feared privatizing the fluoridation program would lead to problems, the dental public health department agreed to the creation of the Georgia Rural Water Association (GRWA). The current decade brought new responsibilities to Georgia’s dental public health infrastructure. The state’s public health lab took over testing of all fluoridated water systems from the GRWA in 2000. Today, the majority of the funds for water fluoridation in Georgia comes through a federal grant—the Preventive Health and Health Services (PHHS) Block Grant. Georgia officials have elected to keep the current allocation formula for this funding intact, so the monies provided through the PHHS Block Grant will remain the same through Fiscal Year 2012. However, the amount that the state allots for Community Water Fluoridation ($9,000) may be reduced by approximately $3,800 in 2010 due to a shortfall in state revenues. The GDA is carefully monitoring this budget situation. The state’s Oral Health Section began employing a Fluoridation Coordinator through funding from the Centers for Disease Control and Prevention (CDC) State-Based Oral Disease Prevention Grant in January 2010. The coordinator ensures the continued monitoring and surveillance of community water fluoridation programs, and provides education to water plant operators and the general public on the public health benefits of fluoridation. The coordinator assumed some of the reporting and education duties previously provided by the GRWA.

What Dentists Can Do to Keep Georgia Fluoride-Friendly A continuing effort to educate the public, legislators, and other groups about the benefits of fluoridation remains necessary. Several states have seen increasingly aggressive opposition to community water fluoridation, with anti-fluoride groups using the Internet to sway the public to their cause. In Georgia, there have been reports of questions being raised about the continuation of water fluoridation in the Athens-Clarke County and northwestern Georgia areas. There have been other

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With increased anti-fluoridation activity within Georgia, it is important for dentists and dental staff to be armed with talking points on the effectiveness and safety of water fluoridation. The following points are taken from the document Fluoridation Facts, which was published by the American Dental Association (ADA) in 2005. To access this and other documents on the topic of water fluoridation, consult the ADA’s web site (http://www.ada.org). Small amounts of fluoride occur naturally in all water sources, and varying amounts of the mineral are found in all foods and beverages. Fluoridation of community water supplies is the single most effective public health measure to prevent dental decay. Throughout more than 60 years of research and practical experience, the overwhelming rate of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe. Studies prove that water fluoridation continues to be effective in reducing dental decay by 20% to 40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D, and orange juice with vitamin C. Be aware of misinformation on the Internet and other junk science related to water fluoridation. Visit www.ada.org for assistance.

reports about water plant operators, particularly in smaller or rural towns, receiving threatening communications regarding continued fluoridation. The CDC itself, with headquarters in Atlanta, has been accused of hiding information about the effects of ingested fluoride on minority populations. Dentists are encouraged to become familiar with the facts about water fluoridation in case patients or other individuals in the community ask questions about the process. The American Dental Association (ADA) has a well-designed section of its new web site at www.ada.org/fluoride.aspx devoted to fluoridation facts and public education. The CDC has several pages of its web site at www.cdc.gov/fluoridation/index.htm

dedicated to providing balanced information about water fluoridation. Both sites also offer informative flyers that dentists may download and print at no charge. Should GDA district leaders or study club directors wish to educate their members more in-depth about current fluoridation issues, State Oral Health Director Dr. Elizabeth Lense is available to speak to groups of any size. She may be contacted at eclense@dhr.state.ga.us. Dentists are also asked to contact Nelda Greene at the GDA office at (404) 636-7553 or greene@gadental.org should they receive information about or hear about efforts to question or oppose fluoridation in their communities.

GDA ACTION SEPTEMBER 2010

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WHITE PAPER Continued from page 9 that implementing MLPs will solve access or utilization issues. These dentists also believe no state should try to change a national standard of care because of what is happening within their borders. The states that share similar beliefs with Georgia have formed a group known as the Austin Group, because of an initial meeting that took place in Austin, Texas, to discuss concerns over the mid-level provider issue. The Austin Group includes the states of Alabama, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Mississippi, New Jersey, North Carolina, Pennsylvania, South Carolina, Texas, and Utah. Several other groups have indicated an interest in joining the Austin Group; however, these states are the ones that sent dentist representatives to the first meeting. In comparison, there are several states whose leaders believe that workforce change and expansion is inevitable, even desirable. This group, known as the Boston Group, has also held meetings to discuss access to oral health

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care issues. (Their first meeting took place in Boston, Massachusetts.) The Boston Group includes the states of California, Connecticut, Maine, Massachusetts, Minnesota, Missouri, New Hampshire, New Mexico, Oregon, Rhode Island, Vermont, and Washington. The issue is highly contentious. The GDA hopes that the ADA House of Delegates can fairly debate this issue and come to an agreement that is positive for the profession and patients, and that the profession can move forward united.

Are Mid-Level Providers Used Successfully in Other Countries? They are used, but not necessarily with great success. New Zealand, for example, has employed MLPs since 1921. However, the use of MLPs, usually located in school clinics, has not solved New Zealand’s oral health issues. In fact, the country is still experiencing oral health disease in certain areas. Recent oral health data has prompted New Zealand to completely reconstruct its dental delivery system with more emphasis on delivering care via a team

led by a dentist. Australia has also historically implemented dental therapist services. However, the Australian Dental Association recently adopted a policy to phase out the training of dental therapists in favor of training more dental hygienists.

Is There a Push to Introduce Mid-Level Providers in Georgia? No. GDA research reveals that Georgia’s current dental workforce is adequate to address the oral health needs of its citizens. The GDA believes there is not a need to implement MLPs in Georgia. There are, however, access to care issues within the state that must be addressed, including raising the oral health literacy of Georgia citizens, dealing with the continuing administrative and financial issues associated with the Medicaid Care Management Organizations, and overall funding of oral health care services, including community water fluoridation. The GDA’s intent with the white paper is to educate all interested parties about the effectiveness of the current


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dental care system in Georgia, and recommend common-sense solutions that would truly make a difference on access to care issues.

Has The GDA White Paper Received a Lot of Attention? Yes. Copies of the document have been shared via the Internet across the nation and around the world, sparking a great deal of feedback as well as praise and criticism. The paper was mentioned in articles on ADA.org and the Drbiscupid.com web site (although the GDA did not agree with the conclusions drawn by Dr. Bicuspid), and organizations such as the Institute of Medicine have requested copies. The GDA also mailed a copy of the paper to every dentist in Georgia as an insert in the August GDA Action. (The paper is also available at www.gadental.org in a PDF format.) The GDA is pleased that the paper, although state-specific in its research and recommendations, is contributing to a national discussion about access to care. The PPTF is also pleased that the exposure of the GDA paper also raises awareness about a white paper on access to care created by the Academy of General Dentistry (AGD) in 2008. This paper offered a number of solutions for addressing access to care without implementing mid-level providers, and the GDA paper should be viewed as a state-specific adjunct to the AGD publication.

What Can GDA Dentists Do About the ADA Workforce Debate, and With the GDA White Paper? 1) GDA dentists are encouraged to read the white paper, and become familiar with the complexities of the access to care issue. Share the paper with colleagues in other states you believe may benefit from reading it. 2) After reading the GDA paper, dentists are encouraged to provide feedback to the GDA office about access to care (call 800-432-4357 or 404-636-7553), and participate in the GDA Membership Survey. The survey contains questions

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about access to care, and the answers will be invaluable to the GDA. 3) Members attending the ADA Annual Session this October are encouraged to attend and even speak at the Workforce Reference Committee meeting (see the editor’s note below).

4) Members are urged to attend a 2011 GDA LAW Day. While the GDA may not face MLP legislation, it will probably engage in budget, scope of practice, non-covered services, and telehealth issues just to name a few. Take a continuing education course in where your profession is headed! See a LAW Day schedule on page 4.

Editor’s Note: Attending the ADA Annual Session in Orlando? Take Action on Proposed Resolutions to Allow Non-Dentists to Perform Irreversible Procedures The ADA Annual Session is October 9-12, 2010, in Orlando, Florida. If you are attending this meeting, you are welcome to attend the Workforce Reference Committee meeting on Saturday, October 10, at 8 a.m. in the Orlando Hilton’s Orange Ballroom (Lower Level). If you have any concerns about your patients’ safety, the lowering of dental education standards, or the potential creation of a two-tiered health care system, testify at the Workforce Reference Committee meeting in Orlando. Alternately, contact your ADA representative or the ADA and voice your concerns: ADA Chicago Office Toll Free: (800) 621-8099

GDA Alternate Delegates Dr. Jack Bickford (NW) jbickford@jackbickford.com

GDA Delegates Dr. Tom Broderick (SE) thomas.broderick@comcast.net

Dr. Jonathan Dubin (N) jsdubin@aol.com

Dr. Robert Carpenter (W) rcarpent7@aol.com

Dr. Joe Dufresne (NW) joseph.dufresne@yahoo.com

Dr. Ed Green (SW) dr.green@mchsi.com Dr. Jay Harrington (C) jfhdds@windstream.net Dr. Chris Hasty (SW) cmhasty@gmail.com Dr. Kara Moore (C) drkaramoore@yahoo.com Dr. Donna Thomas Moses (NW) dthomasmoses@aol.com Dr. Jim Reynierson (E) Delegation Chair jaybo2th@aol.com Dr. Richard Weinman (N) weinmandmd@aol.com Dr. Carol Wolff (N) drcwolff@bellsouth.net

Dr. Tom Field (N) fieldortho@gmail.com Dr. Marshall Mann (NW) marshallmhm@aol.com Dr. Kent Percy (NW) percydds@yahoo.com Dr. Annette Rainge (E) larainge@bellsouth.net Dr. Doug Torbush (N) torbush@aol.com Dr. Pete Trager (NW) ptragerdds@bellsouth.net Dr. Mike Vernon (E) movdmd@hotmail.com

GDA ACTION SEPTEMBER 2010

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How to Become PCI-Compliant If You Process Credit Cards in Your Practice From GDA-endorsed TransFirst Health Services

Over the past several years the major credit card brands (Visa, MasterCard, Discover, and American Express) have formed a new standard of security focused on protecting cardholder information called Payment Card Industry-Data Security Standards, or PCI-DSS. The goal of the security standard is to prevent fraud at the merchant level. When you accept credit cards from your patients, you also accept the responsibility to protect and secure their information under this security standard. PCI-DSS compliance is concerned with two areas—if you accept credit cards via your web site, and how you handle credit card information within the walls of your practice. The companies have issued guidelines that merchants must use to protect cardholder information from theft including providing details on: • What terminals and pin pads can be used by card-accepting entities, • What software applications are used to run inside of card equipment, • How receipts are printed, • How cards are handled by staff, • How receipts and card data are held in your files and office, • How cardholder information is stored in your computers, • How data is transmitted or received over the Internet or wireless environments, and • How staff in offices are trained to adhere to these guidelines. At this point, all merchants who accept credit cards are expected to be PCI-DSS compliant. The credit card processors that you each work with should have taken time to update / upgrade your equipment and / or notify you of the need for such activities. If you are not using updated equipment now is the time to take care of that issue.

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Until July 2010 only high-volume merchants (PCI qualifies them as Level 1, Level 2, and Level 3 merchants) have been required to to go through formal certification that they are adhering to PCI-DSS requirements. Now the certification requirements are moving into the Level 4 realm, which is where millions of small to medium size merchants, including the majority of dentists, fall. Each merchant must work with their current credit card processor to manage their certification. This process is not as daunting as it sounds. Most processors are currently submitting their plans to the credit card brands outlining how they will assist merchants with the certification process. Communication about these programs is beginning to occur now. Processors realize this will be an ongoing project; merchants will not all certify on day one. In fact, merchants will likely not be shut off for non-certification for many years. When a merchant does begin to certify with help from their credit card processor (usually via a processor-recommended third party vendor), generally the process will start with the merchant completing a short survey that will validate that they protect patient data correctly. This survey can usually be completed on-line in 10 or 15 minutes. Your credit card processor or third party vendor should be able to provide you with information about your program to help you answer the survey questions. Some merchants, based on how they process credit cards, may also need a scan of their Internet connection. This is done virtually by the processor or third party vendor, does not require involvement by the merchant, and simply checks to make sure that the Internet connection is secure. Once the survey is complete, the credit card processor or third party vendor assesses that the merchant’s survey responses meet PCI-DSS requirements, works with the merchant on correcting any

items that do not meet all the requirements, and then formally certifies the merchant. The scan works the same way. Once a merchant is certified by the credit card processor, either directly or via a third party vendor, the process is complete for a specified period of time. PCIDSS certification is not a stagnant state— it’s a continual process. Depending on the type of merchant involved, the certification process will be repeated annually or quarterly. All credit card processors have the same PCI-DSS requirements and all processors should be contacting their merchant clients with the appropriate details on how to formally certify. Credit card processors are required to document that a program for certification is available to their merchant, not yet that every merchant is in fact certified. There are costs for the credit card processors to offer this service to merchants. Third party certification vendors working with the processors must be certified by the credit card brands to perform assessments and certify merchants. These vendors charge the processors and / or merchants for their assistance, systems, scans, and other services. Pricing may range, depending on the credit card processor, from $75 to $150 annually. If a merchant wanted to obtain certification individually, they could search out a vendor and contract with that vendor themselves. However, the costs would likely be considerably higher because a single merchant does not present the volume of business that each processor does. Dentist merchants who utilize the GDA-endorsed TransFirst for their practice credit card and check acceptance services may contact the company with questions at (800) 5778573 or GDA@TransFirst.com. You may also visit www.pcisecuritystandards.org for more information about the PCI-DSS process.


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What PCI-DSS Certification Involves The core of PCI-DSS is a group of principles and accompanying requirements, around which the specific elements of the DSS are organized:

Build and Maintain a Secure Network

Implement Strong Access Control Measures

Requirement 1: Install and maintain a firewall configuration to protect cardholder data.

Requirement 7: Restrict access to cardholder data by business need-to-know.

Requirement 2: Do not use vendor-supplied defaults for system passwords and other security parameters.

Requirement 8: Assign a unique ID to each person with computer access.

Protect Cardholder Data

Requirement 9: Restrict physical access to cardholder data.

Requirement 3: Protect stored cardholder data.

Regularly Monitor and Test Networks

Requirement 4: Encrypt transmission of cardholder data across open, public networks.

Requirement 10: Track and monitor all access to network resources and cardholder data.

Maintain a Vulnerability Management Program

Requirement 11: Regularly test security systems and processes.

Requirement 5: Use and regularly update anti-virus software.

Maintain an Information Security Policy

Requirement 6: Develop and maintain secure systems and applications.

Requirement 12: Maintain a policy that addresses information security. (From www.pcisecuritystandards.org)

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house minutes Unofficial Minutes of the July 22 House of Delegates Note: Only the persons present and resolutions passed at this meeting are printed here. For full minutes, visit www.gadental.org. If you do not have Internet access, contact Phyllis Willich at (800) 432-4357 for a copy of the minutes.

Special Guests President Kent Percy recognized the following guests: Dr. Kathleen O’Loughlin, ADA Executive Director; Dr. Don Seago, Fifth District Trustee; Dr. Connie Drisko, Dean, MCG School of Dentistry; Dr. John Harden, President, Fisher Foundation for Dental Education; Dr. Bill Calnon, District Two Trustee; Dr. Dennis Manning, District Eight Trustee; Dr. Mary K Smith, District Eleven Trustee; Dr. Russ Webb, District Thirteen Trustee; Senator Greg Goggans; Senator Lee Hawkins; ASDA Students: Chris DeLeon, Jimmy

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Cassidy, Jack O’Neill, Dustin Kilby, Francesca Seta, Wendy Cardenas, Nicole Youngs, Naz Majdi.

Speaker of the House Dr. Percy introduced the appointed Speaker of the House, Dr. Sidney Tourial. The elected Speaker, Dr. Kent Simmons, resigned his position due to family responsibilities. Dr. Tourial appointed Dr. Doug Torbush as Parliamentarian and Drs. Sarabess Baumrind and Jay Phillips as Sergeants at Arms.

Roll Call of Delegates Secretary / Treasurer Jim Hall called the roll for delegates and alternate delegates and declared a quorum. The following persons were present: Central (delegates) Drs. Shirley Fisher, Roy Lehrman, Amy Loden (for Kendrick Mathews), Paul Fraysure (for Craig McCroba), Deena Smith (for Alfred Peters); (alternates) Drs. Lindsay Holliday and Mike Loden; Eastern (delegates) Drs. Lee Andrews, David Brown, Celia Dunn, Brian Hall, Carole Hanes, Grant Loo, David Perry, Rhoda Sword; (alternates) Drs. Matt


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Elder, Craig Taylor, Erik Wells; Northern (delegates) Drs. Chris Adkins, Hank Goble (for Daren Becker), Donald Brown, James Granade III (for Brian Carpenter), Troy Schulman (for Chris Childs), Marie Schweinebraten (for Max Ferguson), Tom Field, Jim Granade Jr., Brad Greenway, Rebecca Weinman (for Kathy Huber), Tom Jagor, Ben Jernigan Jr., Jeff Kendrick, Paul Kudyba, Richard Sugarman (for Matt Mazzawi), Roy McDonald, Bob O’Donnell, David Pumphrey, David Remaley, Richard A. Smith, Brook Corbett (for Doug Torbush), Richard Weinman, Marvin Winter, Carol Wolff; (alternates) Drs. Evis Babo and Vivian Hudson; Northwestern (delegates) Drs. Bruce Camp, Nelson Conger, Wendy Mitchell (for David Drew), Stan Halpern, Jim Hutson, Howard Jones, Ben Knaak, Terry O’Shea, Jason Oyler, Robin Reich, Wilkie Stadeker; (alternates) Drs. Jack Bickford, Celeste Coggin, Stuart Loos, Dave Mason, Jimmy Talbot, Jason Young; Southeastern (delegates) Dr. Mark Dusek, Jay McCaslin VI, Sam Norris (for Walker Pendarvis), Matt Rosenthal, Julia Ann Routhier; (alternates) Dr. Matt Allen and Bob Vaught; Southwestern (delegates) Drs. Keith Crummey, Larry Black, Amanda Merritt, Steve Sample, Jeff Singleton; (alternate) Drs. Jay Phillips; Western (delegates) Drs. Matt Adams, Robert Carpenter, David Fagundes; (alternates) Drs. Nancy Gallagher, Jay Harris, Mark Lawrence; ASDA (delegate) Mr. Chris DeLeon; (alternate) Mr. Jimmy Cassidy III. Resolution 2010-16 Minutes (Passed) Passed by general consent: Resolved that the minutes of the January 10, 2010 House of Delegates meeting be approved.

Board of Trustees By general consent the House divided the question in Resolution 2010-17 to discuss BOT motion [10-6.03] related to the approval of the GDA White Paper on Georgia’s Oral Health Status, Access to and Utilization of Oral Health Care Services. Resolution 2010-17A (Passed): Passed on motion by Dr. Kent

MINUTES Continued on page 28 GDA ACTION SEPTEMBER 2010

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MINUTES Continued from page 27

Percy: Resolved that the actions of the GDA Board of Trustees as reported in the minutes of the January 9, April 17 and June 19, 2010 meetings (with the exception of motion 10-6.03) are ratified by the House of Delegates. Resolution 201017B (Passed): Passed on motion by Dr. Kent Percy: Resolved that the GDA House of Delegates ratifies BOT motion 10-6.03.

Patient Protection Task Force Dr. Ty Ivey presented the background information concerning the formation of the Patient Protection Task Force. He recognized the dedication and work product of the committee and subcommittees and stated that the intent of the White Paper is to make recommendations to protect the patients of Georgia. He also reported that Georgia’s white paper could be used as a template for other states. Resolution 2010-18 GDA White Paper (Passed): Passed unanimously on motion by Dr. Ty Ivey: Resolved that the House of Delegates approves the “White Paper on Georgia’s Oral Health Status, Access to and Utilization of Oral Health Care Services.”

Finance Committee Dr. Jay Phillips reviewed the GDA assets, short term and long term balances and current endorsements. Resolution 201019 Budget (Passed): Passed on motion by Dr. Jay Phillips: Resolved that the 201011 budget be approved as presented.

Committee to Nominate the Speaker of the House Dr. Ben Jernigan, Chairman of the Committee to Nominate the Speaker, reported that the committee nominated Dr. Doug Torbush for the Speaker of the GDA House of Delegates. Dr. Bruce Camp, President, Northwestern District, nominated Dr. Jimmy Talbot from the floor. A written ballot was taken and Dr. Doug Torbush was declared elected as GDA Speaker of the House.

GDA Foundation for Oral Health Dr. Robert O’Donnell stated concerns about confusion of the GDA’s name for its new foundation with the Greater Atlanta

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Dental Foundation (Northern District). Therefore, the Northern District offered the following resolution. Background: The Northern District Dental Society has a charitable giving foundation called the Greater Atlanta Dental Foundation or GADF. The GDA foundation is the Georgia Dental Association Foundation for Oral Health (GDAFOH) The mission of both of these foundations is worthy. Resolution 2010-20 GDA Foundation for Oral Health (Passed): Presented on motion by Dr. Robert O’Donnell: Resolved that the GDA Foundation for Oral Health shall adopt the ‘doing business as’ name of the GDA Mission of Mercy Fund. This name shall remain in place as long as the Mission of Mercy continues.

Adjournment Being no further business, the House of Delegates adjourned at 12:35 p.m. The next meeting is scheduled for Sunday, January 9, 2011, at 9 a.m. at the Marriott Perimeter Center, Atlanta, GA (same location as January 2010).


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classified ads How GDA members can place classified ads AD FORM: Submit all ads on a GDA Classified Advertisement Form. To obtain a form, call Courtney Layfield at (800) 432-4357 or (404) 636-7553, or email layfield@gadental.org. (Note: The GDA may accept or reject any ad for any reason and in its sole discretion.)

AD DEADLINE: Ads and ad check payments are due by the first of the month before the publication month (i.e., Dec. 1 for January).

AD RATES: ADA member dentists pay $75.00 per 60-word ad per month. There is a 25 cents per-word charge for each word over 60. Non-dentist-owned companies (real estate firms, etc.) pay $195 per 60-word ad per month (additional word charges as above). Non-member dentists may not place ads.

LATE FEE: Ads for which full prepayment is not received by the first day of the ad’s publication month (i.e.; Nov. 1 for a November ad) will incur a $25 late fee in addition to the ad rate.

FORMS OF PAYMENT: Submit a check or money order with the ad form. (Make checks payable to GDA.) Credit cards are not accepted as payment.

WEB SITE PLACEMENT: Prepaid ads will appear on the GDA Web site www.gadental.org for the month the ad appears in print. Non-prepaid ads will NOT be placed online.

Dental Related Services

Equipment For Sale

X-RAY SAFETY CERTIFICATION for assistants is required by Georgia law. This up-to-date take-home course has effectively certified thousands of x-ray machine operators. Send $149.99 per registrant with name(s) to: Dr. Rick Waters, 285 Pinewood Circle, Athens, GA 30606. Visit www.gaxray.com for credit card payment or to use the immediate-access online version. Call (706) 255-4499 for more information.

For SALE: Midwest Panoral X-Ray Sybron. Exact same model as I use in my office. 2nd Panoral was purchased but now relocated to only one office. This fully functional machine is now available for sale at $2500 OBO. Contact Dr. Bob at (770) 952-2677 or cell (770) 634-7007.

Is Your Marketing in Trouble? Learn how to avoid the most common dental marketing mistakes that lead to: 1. Below Average Case Acceptance; 2. Slow New Patient Acquisitions; 3. Perplexingly Poor Patient Retention Rates. Get Answers. Find Solutions. DOWNLOAD YOUR FREE REPORT at http://www.DentalMarketing911.info. A free gift from your friends at w w w. Ta r g e t D e n t a l M a r k e t i n g . c o m , Kennesaw, Georgia, (678) 466-6497.

Dentists Available for Locum Tenens Dentist Available Daily (DAD): Dentist available during vacations, emergencies and CE courses. Leave your practice in well-trained hands. I am licensed, insured and have a DEA registration number so I can write prescriptions. Call Dr. Richard Patrick at (770) 993-8838. 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.

Positions Available Associate Dentist. Established dynamic practice offers a unique opportunity for motivated professionals. Multiple locations available. No empty chairs … No insurance claims problems … With career high income potential and no daily office / overhead challenges. Contact Tina Titshaw at tina@myrockdale.com, call (678) 413-8130, or fax resume to (770) 760-1375. Special Dental Associate Opportunity: Are you looking for a place to grow and prosper? Our exceptional practice in West Cobb County is primarily fee for service and has a robust hygiene department. We have a dedicated and well trained team that provides family, cosmetic, sedation and implant dentistry in a modern facility. The senior doctor has 22 years of practice experience to enrich a unique opportunity for a special candidate who has similar goals and values. After an introductory period, an invitation to purchase a portion of this high quality practice may be extended, with more buy in potential in the future. Please only serious inquires for this once in a lifetime opportunity need to apply by email to: drmulkey@att.net. Busy, established practice in the Hamilton Mill / Dacula area is seeking an experienced general dentists to join our team. Excellent location in a fast growing area with a dedicated staff. Great opportunity. Call (770) 962-0515 or fax CV to (770) 962-1244.

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CLASSIFIEDS Continued from page 29

We have an outstanding part-time opportunity in our successful, well-respected, quality oriented private pediatric dental practice for the right candidate. We are seeking a special, motivated, personable individual to join in our success. General dentists would require a minimum of at least 2 years’ experience in pediatric dentistry. We are a booming practice with tremendous growth and earning potential. We offer in-office sedation. We offer excellent compensation and benefits. For more information, please contact Amanda Moseley (678) 352-1090 / (770) 720-0079 / (678) 429-9931.

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Practices/Office Space Available Buyer opportunity for sale of general practice in beautiful Coastal Georgia. No HMOs, PPOs, etc. Owner will transition to retirement. For more info, email coastalga10@cs.com. WEST CENTRAL GEORGIA: Ready to retire from a small town practice with lots of potential or growth. Turn-key with patients, equipment, and supplies. Purchase of building and large lot can be negotiated as well. Next to hospital. Could be a great satellite practice for a general dentist or specialist. Call evenings (706) 628-5484. Looking for an upscale, quality office in which to see your patients? New office with operatories to spare for Part-Time Dentist, one with kids or one looking to avoid hassles of ownership. Duluth / Suwanee. Dr. Bob Finkel—(770) 497-9111.

Well-established practice for sale in Northlake Tucker Area. Strictly fee for service, no managed care plans, 2300 sq. ft. at $10 / sq ft. Motivated seller due to disability. Send inquiries and resume to RMK1@bellsouth.net or call (770) 641-1666. Duluth, GA. Modern Pediatric Dental Office Space—2620 sq ft and lots of storage. With Lease Hold Improvements, Equipment, Furnishings. Easy start up with min. costs. High traffic area near Gwinnett Place Mall. Available August 2010. Tammy or Fran at (770) 497-9111. Kennesaw / Cobb County: Beautiful dental suite available immediately. There are 3 operatories plumbed. General dentist is looking to share space with a specialist. The suite is also available for sale / lease / rent to a dental specialist. Please contact Dr Kay Kalantari at (404) 452-0786.


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SPECIALISTS: North Georgia Mountains. Space available for rent in growing area. Five equipped operatories, business office and reception furniture in place, wired for your computer system, ready to move right in. Eye-catching two story glass building in high-traffic area. One general dentist and a government agency already in building. Great for satellite office, solo or shared, or full-time. (706) 745-6848. HOSCHTON / BRASELTON, GA: 20,000 square foot dental office building for lease w/ option to purchase in the #4 most economically developing area in the country! In the design phase and slated to be opened in June 2011 (perfect timing for graduating residents). Great lease rates & TI allowance available. Goal is create a “one-stop” dental facility in the fastest growing area around! ORTHO already committed … Looking for PEDO, ENDO, PERIO, ORAL, PROS, etc. in a highly visible area where NO specialists are located at this time! Be the first in the area for a promising long term career location. Whether you want 1,500 or 5,000 square feet, space will be tailored to each individual’s needs. Perfect location for a new practice

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startup or a 2nd satellite location! Close to the newly approved satellite location for Northeast Georgia Medical Center. Demographics are off the charts and schools are unbelievable … literally one of the most sought after locations around! Priority will be given on a first come / first serve basis. Please e-mail: SpoutSpringsProfessionalPark@gmail.com for more information.

Space Available: 3,000 SF of dental space available in a Class A building off of I-85 and Clairmont Road. Major traffic intersection with excellent visibility, across from Century Center. Very large employee base. Landlord willing to modify the space. Building already has a physician, attorneys, and other professionals. Space available for a specialist in Hiram also. Please call (678) 640-5466.

North GA Mountains: Well-established PRACTICE for sale in beautiful consistently growing area. Modern equipment. Computers in all operatories. Mountain views. Enthusiastic cross-trained staff. Ideal for solo or group practice. Also for sale ten year old eye-catching glass professional BUILDING available separately or with practice. National recognition for office design. 10,000 square feet housing this practice plus a state agency. Highly traveled highway frontage. The best of a big-city practice in a relaxed country atmosphere and a warm, friendly patient environment. (706) 745-6848.

SAVANNAH, GA. Well established practice for sale. There is a total of 6 operatories loaded with computers and digital x-rays. Practice is located in a free-standing building and seller may be willing to sell real estate. All FFS practice produced well over $1 million last year and is on track to do $1.4 this year. Seller will stay on to work for the buyer. Call Southeast Transitions at (678) 482-7305 or email michelle@southeasttransitions.com or visit www.southeasttransitions.com for more details on this and other opportunities.

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CLASSIFIEDS Continued from page 31 NORTH ALPHARETTA, GA. This AMAZING facility is all you could ask for and has 10 operatories. The practice is producing $2M and is FFS / PPO mix. Well-established practice with plenty of technology. There is an average of over 50 new patients per month. The seller is relocating. Call Southeast Transitions at (678) 482-7305 or email michelle@southeasttransitions.com or visit www.southeasttransitions.com for more details on this and other opportunities. CONYERS, GA. Terrific opportunity to buy an established practice and make it your own. Seller is currently referring out most procedures and is only open 2.5 days per week. Practice is on track to collect $450K this year and has a tremendous hygiene department of 40%! This practice accepts most insurance plans including Medicaid; no capitation plans. Call Southeast Transitions at (678) 482-7305 or email michelle@southeasttransitions.com or visit www.southeasttransitions.com for more details on this and other opportunities.

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Practices for Sale: ATLANTA #6276 Gross collections $240,015; 4 days; 3 operatories; 926 sq. ft. office space. ATLANTA #8575 Gross collections $456,922; 4 days; 5 operatories; 1,838 sq. ft. office space; additional plumbed but unequipped operatory. ATLANTA #8548 Great opportunity! At $197,000 it is less than ďŹ the price of a start-up! 6 operatories; 1,900 sq. ft. office space. ATLANTA #6689 Gross collections $1,623,532; 4 days; 7 operatories; 2850 sq. ft. office space. AUGUSTA AREA ORTHO #8681 1 operatory/2 chairs; Gross collections $268,032; 3.5 days, 960 sq. ft. office space. CARROLL COUNTY #8428 Gross collections $619,384; 4 days; 4 operatories; 2,000 sq. ft. office space; additional plumbed but unequipped operatory. NW GEORGIA #8193 PRICE REDUCED!!! Gross collections $1.04 Million; 4 days; 5 operatories; 1,800 sq. ft. office space. NW GEORGIA #8455 Gross Collections $1.06 Million; 4 days; 5 operatories; 2450 sq. ft. office space. SOUTHEASTERN GEORGIA #8172 Gross collections $752,638; 4 days; 5 operatories; 1,732 sq. ft. office space. PAULDING COUNTY #3001 Gross collections $643,500; 4 days 5 operatories; 2,000 sq. ft. office space. CAR-

ROLLTON #8736 Owner recently passed away. Sales price is $568,000. AUGUSTA #8747 Gross collections $1.22 Million; 6 days; 7 operatories; 5000 sq. ft. office space. LAKE LANIER #8734 Gross Collections $385,377; 4 days; 3 operatories; 1 plumbed but not equipped; 1800 sq. ft. office space. For information, call Dr. Earl Douglas, (770) 664-1982 or email Earl@adssouth.com. MCDONOUGH, GA. If you are looking for a strong hygiene department, this opportunity has it! The seller is currently referring out almost everything and hygiene department produces 50%! This is a great bread-n-butter practice that has amazing potential to grow. The practice is currently only open 3 days per week and is on track to produce over $400K. There is plenty of room to grow with 7 ops. Seller is distracted with other projects. Call Southeast Transitions at (678) 482-7305 or email michelle@southeasttransitions.com or visit www.southeasttransitions.com for more details on this and other opportunities.


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MANY GREAT OPPORTUNITIES NOW AVAILABLE: Peachtree City Area: gross $750K; South of Atlanta: gross $1M; Lake Hartwell Area: gross $600K; Gainesville: gross $1M; Decatur: gross $520K; Lithia Springs: Space w/ equipment. Call Southeast Transitions at (678) 482-7305 or email michelle@southeasttransitions.com or visit www.southeasttransitions.com for more details on this and other opportunities. Available: ALPHARETTA: Beautiful, new, 4 ops, satellite 2 days/week. ATLANTA: Partnership. $2.4 million FFS practice. 9 operatories. DULUTH: Merger. GWINNETT: Grossing $823,000, 8 operatories. JASPER: Grossing $350,000. JOHNS CREEK: FFS Merger. NORCROSS: Grossing $580,000, 4 operatories. SNELLVILLE: Merger into beautiful new facility. Contact Richane Swedenburg, New South Dental Transitions: (770) 630-0436, Check new listings, www.newsouthdental.com; info@newsouthdental.com.

GDA ACTION SEPTEMBER 2010

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breaking the mold Affinity for Extreme Skiing Pulls Dr. Tom Jagor to Jackson Hole, Wyoming There is skiing. Then there is the “steep and deep” skiing that Atlanta dentist Dr. Tom Jagor indulges in when he visits Jackson Hole, Wyoming. “There is definitely an element of danger to steep and deep skiing, which involves skiing on black and double black terrain and going off-course,” said Dr. Jagor. “The first time I participated in the camp offered by the Jackson Hole Mountain Resort, I was maneuvering around this huge rock when the instructor cautioned me that ‘this is definitely a must-not fall situation. You will be hurt if you fall.’ That will make you pay attention like not much else.”

Dr. Jagor taking a break during a ski excursion.

Double black diamond ski slopes are steep, typically more than the 40 percent grade of the average black diamond ski slope. This means that the slope is at an angle of at least 25 degrees above horizontal. The trails are often hazardous, narrow, and crowded with trees and rocks. Because of their steep terrain, many double black diamond trails are not groomed, leaving snow to pile up in deep drifts and moguls. “The camp matches three or four skiers with a single instructor,” said Dr. Jagor. “Your group heads out to ski early in the morning, so you get to make ‘first tracks’ on a trail. Because you are going

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into more hazardous areas, you must take more equipment with you than on a typical ski run, including a radio transmitter, a shovel, and even body probes to assist in case of a search situation. But the attraction of skiing where no one else can go is intense. It is just so beautiful in these untouched areas. I had skied at Jackson Hole for 10 years before trying a camp, and I saw parts of the mountains I’d never seen before.” The challenges offered by the steep and deep camp drew Dr. Jagor in while he was on an otherwise standard ski trip. “I likened signing up for the camp to signing up for the Academy of General Dentistry Master’s Class,” he said. “Signing up for something that requires a lot of dedication and concentration pushes you to do things you would not normally do. I wanted an experience with the camp that would push me to be a better skier. Before attending a steep and deep camp, Dr. Jagor said that he would ski black runs if he had to, but he did not enjoy the experience. “Now,” he said, “I’ll ski anything that you throw at me. Skiing on groomed runs is boring to me now. I’m not afraid to ski through woods or extreme terrain, because I know how to do it!” Although the skiing was tough and the days were long, the steep and deep camp experience did hand Dr. Jagor some light moments. “The instructors film you as you ski,” said Dr. Jagor. “We would view the films in the evenings while the instructors offered tips on improving our body positioning. But the instructors also filmed some pretty hilarious falls. No one was hurt during these falls, but they were spectacular. One poor lady tumbled I know 500 yards. They edited the films and set them to music for a film at the end-of-the-camp party.” A casual skier at North Carolina resorts while in high school in Atlanta, Dr. Jagor became a devoted skier while attending dental school at Loyola University in Chicago. “We would drive up to Wisconsin at night and ski regularly,” he said. “Now, my

Skiers participating in a “steep and deep” skiing camp at Jackson Hole Mountain Resort enjoy a magnificent off-course mountain view.

“Steep and deep” skiers like Dr. Jagor tackle trails that are often hazardous, narrow, and crowded with trees and rocks. Because of their steep terrain, these trails are not groomed, leaving snow to pile up in deep drifts and moguls.

whole family skis, although I’m the only one who has been through steep and deep camps. And I have to credit Dr. Tom Skafidas and Dr. Mollie Winston for introducing me to Jackson Hole to start with.” Dr. Jagor hopes to participate in another camp again. “The teamwork, the awareness of your surroundings, the ability to improve your skills—who would not enjoy that kind of trip?” he said.


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Inside This Issue • GDA Honors Dentists Who Make a Difference • President Harrington Sets Goals, Outlines Challenges for Year

DATED MATERIAL PLEASE DELIVER AS SOON AS POSSIBLE

ACTION

Suite 200, Building 17, 7000 Peachtree Dunwoody Road Atlanta, Georgia 30328-1655 www.gadental.org

GDA Action  

GDA Action is the Journal of the Georgia Dental Association

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