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ACTION

THE JOURNAL OF THE GEORGIA DENTAL ASSOCIATION

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OCTOBER 2008

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VOLUME 28, NUMBER 10 • OCTOBER 2008

ACTION 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

2008-2009 Georgia Dental Association Officers Mark S. Ritz, DDS, President Kent H. Percy, DDS, President Elect John F. Harrington Jr., DDS, Vice President James B. Hall III, DDS, MS, Secretary/Treasurer Jonathan S. Dubin, DMD, Editor

GDA/GDIS/GDHC Executive Office Staff Members Martha S. Phillips, Executive Director Lisa Chandler, Director of Member Services Nelda H. Greene, MBA, Associate Executive Director Delaine Hall, Director of Communications Skip Jones, Director of Operations (PDRS) Barbara Kaul, Property and Casualty Accounts Manager Courtney Layfield, Director of Administrative Services Victoria LeMaire, Medical Accounts Manager Melana Kopman McClatchey, General Counsel Denis Mucha, Director of Operations (GDIS) George Stewart, Operations Manager (PDRS) Phyllis Willich, Administrative Assistant Pamela K. Yungk, Director of Membership & Finance 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. © Copyright 2008 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.

on the cover Comprehensive overhaul of the health care system has emerged as a major issue during this election year. Presidential candidates are proposing reforms, polls show voters favoring universal healthcare, and the American Dental Association is taking a stance on dentistry’s inclusion in any universal coverage with a resolution to be debated at October’s House of Delegates. Read about GDA members’ reactions to the ADA’s proposal, and universal healthcare in particular, starting on page 16.

other features

sections

10

GDA Offers Host of Membership Benefits

4

Parting Shots

14

GDA Seeks Nominations for Key Positions

5

Editorial

6

President’s Commentary

9

Down in the Mouth

11

News and Views

33

Event Calendar

34

Classifieds

26

GDA Remembers Dr. Michael Rainwater with Award of Merit

29

Alliance Hosts Low Country Boil for MCG Dental Students

30

Dentists Required to Implement Indentity Theft Prevention Program

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Academy of General Dentistry . . . . . . . . . . . . .34 Anderson and Associates . . . . . . . . . . . . . . . .35 Center for TMJ Therapy . . . . . . . . . . . . . . . . . .12 DOCS Education . . . . . . . . . . . . . . . . . . . . . . . . .2 The Dentists Insurance Company . . . . . . . . . .39 The Doctor’s Safety Net . . . . . . . . . . . . . . . . . .14 Entaire Global Companies . . . . . . . . . . . . . . . . .8

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

GDA Dental Recovery Network . . . . . . . . . . . .15 GDA Membership Recruitment Drive . . . . . . .13 Georgia Association of Orthodontists . . . . . . .13 Georgia Dental Insurance Services . . . . . . . . .40 Great Expressions Dental Centers . . . . . . . . . .27 Henry Schein Practice Transitions . . . . . . . . . .38 Hungeling & Sons PC . . . . . . . . . . . . . . . . . . . .15 John Hancock—Long Term Care . . . . . . . . . . .17

Law Office of Stuart J. Oberman . . . . . . . . . . .37 New South Dental Transitions . . . . . . . . . . . . .23 Paragon Dental Practice Transitions . . . . . . . .20 Professional Debt Recovery Services . . . . . . .17 Professional Practice Management . . . . . . . . .32 The Snyder Group . . . . . . . . . . . . . . . . . . . . . . .22 Southeast Transitions . . . . . . . . . . . . . . . . . . . .36 Youvan Dental Laboratory . . . . . . . . . . . . . . . .28

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editorial perspective We ARE the Solution

Jonathan S. Dubin, DMD

See page 6 for detailed information on submitting your charitable case and photo for the “150 Faces” campaign, as well a patient release form. The form is also available at www.gadental.org. Dentists should submit their cases and photos (members are welcome to submit information on more than one patient) by October 1, 2008. If you have any questions regarding this campaign or the case and photo you plan to submit, call Delaine Hall at (800) 432-4357 or (404) 636-7553 or email her at hall@gadental.org.

As the American Dental Association House of Delegates opens in San Antonio, one of the resolutions up for debate and vote is whether to keep funding a trial program for a form of mid-level provider. I have to ask why funding mid-level providers is even up for debate. It makes me question what we (we are the ADA) are all about. As I understand it, ADA dentists stand for the best oral health care for our patients as well as what is best for our member dentists. Of what benefit can standing up for a twotiered oral health care system be? We should not support something out of fear—fear of government mandating a mid-level provider. To be fair after all, it has occurred in native Alaskan land and more recently in Minnesota. Those may be our failures, but I suggest that to capitulate is neither noble nor is it likely to be the answer to keeping the wolves at bay. Third party control of a health care system has proven to be fraught with problems. One has only to look at medicine as physicians struggle with third party control over which party knows the best care for the patient. What good are mid-level providers? Will such providers alleviate the access issue? Will they reduce the cost of care? Or just reduce the quality of care? The goal of those who support mid-level providers is to secure treatment for low income persons, and individuals in underserved areas. Again, I ask how will deploying mid-level providers reduce cost? More than likely such a deployment will reduce quality. The problems that exist in the patients in these areas (patients anywhere for that matter) such as complicated treatment needs and complex medical histories, would probably overwhelm a less educated and less skilled provider. The mid-level provider masquerades behind the access to care mask and resonates throughout political forums. Universal healthcare is forecast to be coming and branded as the access to care white knight. How? Is the government going to throw enough money out there to pay for the care? Do they have enough money? And if they do, they already have enough providers. They are called dentists. And if they don’t have the money, will

they mandate for lesser quality? How can lesser quality care solve an oral health care problem? There is a public belief that there are not enough dentists and that is why there are underserved areas and populations. In reality, there is a mal-distribution problem. Dentists, in general, do not gravitate to smaller towns or rural areas. Most dentists also do not participate in Medicaid. That program’s low reimbursement rates make it unprofitable to treat patients, in addition to all the confusing paperwork, and a tendency by some patients enrolled in the program to miss and or break appointments. Creating new types of midlevel providers does not solve any of these problems. I fail to understand how throwing money into a new type of provider makes any sense. Correct the current system and dentists will support that system. The Academy of General Dentistry published a white paper which just makes too much sense. The paper outlines the reasons for such access problems, and proposes a reasonable approach to attracting dentists to underserved areas. It points out the flaws in having lesser-educated and lesser-trained providers. Our Fifth District Trustee to the ADA Board of Trustees Dr. Marie Schweinebraten recently urged her fellow trustees to support the AGD and its white paper since the publication promotes a clear message that dentistry is a viable health care model that works, and promotes a pragmatic approach to the future of care. Instead of trying to create a two-tiered system doomed to failure, we need to focus on the distribution of dentists and preventative problems. I am dumbfounded and incensed that the ADA board voted down our trustee’s resolution 14-3. The answer lies in education, and properly placed expenditures. Read the AGD white paper and then tell any ADA delegates that you know what you think.

GDA ACTION OCTOBER 2008

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president’s commentary GDA Tackles Issues through Newly Appointed Task Forces

Mark S. Ritz, DDS

In an effort to address key areas of interest and concern to the dental profession, I recently created five task forces that address a variety of issues ranging from pediatric dental care to an exploration of redistricting of the GDA. All have finite charges with the expectation of recommendations from the task forces within the coming year. Representation on the task forces is broad-based focusing on not only district representation, but also specific areas of expertise and experience within organized dentistry depending on the issue being researched. The five newly appointed task forces are as follows: Task Force to Explore Redistricting, Leadership Implementation Task Force, Task Force to Serve as Liaison to Fisher Foundation, Task Force on Pediatric Dental Care, and Task Force on Oral Health in Institutional Settings. I am excited about the possibilities and recommendations that these five task forces will generate. We are extremely fortunate in Georgia to have such knowledgeable and dedicated volunteers. I appreciate everyone’s willingness to serve the profession. The charges to the five task forces follow. If you have ideas or comments or wish to provide input, please consider contacting the chairman. You may also contact the appropriate GDA executive office staff person for additional information. Staff emails are listed below.

TASK FORCE TO EXPLORE REDISTRICTING Chair: Dr. Bob O’Donnell (N) Members: Drs. Kara Moore (C), Jim Reynierson (E), Roy McDonald (N), Celeste Coggin (NW), Tom Broderick (SE), Chris Hasty (SW), and Eddie Paris (W) Officer Liaison: President Elect Dr. Kent Percy Staff Support Nelda Greene (greene@gadental.org)

Background: 2007-08 GDA President Dr. Donna Thomas Moses appointed a Leadership Task Force with a charge to research and discuss ways to encourage and develop leadership in the GDA. That task force proposed five recommendations, one of which is to explore redistricting the seven GDA districts. The current district configuration has been in place since 1946. The re-organization into the current seven districts was approved at the May 1946 GDA annual convention. The re-organization committee emphasized that the purpose of re-organization was to “achieve a better functioning of the district societies, a closer relation of the membership, and a general strengthening and expansion of the scope of activities of the Georgia Dental Association.” In 1988, then-President Dr. Bruce Buchanan convened a task force to investigate and recommend a new geographic distribution of the districts which was later dissolved without making any specific recommendations. Charge: 1) Provide a historical report on the current makeup of the GDA districts and include a history of the number of members within each district. Provide the district’s percentage of membership of the GDA. 2) Develop a White Paper that presents both the positive reasons for reconfiguring the GDA districts and reasons for making no change. 3) Meet with the district officers to present this historical data and the White Paper, encourage discussion, and solicit input. The purpose of the meeting is to provide the leadership of each district with enough background information for the officers to consider an open evaluation of the current composition of the districts and to provide the task force with an official response to the following questions:

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• Do you think the makeup of your district allows you to offer all volunteers who are interested the opportunity to participate in committees and leadership roles?

TASK FORCE TO SERVE AS LIAISON TO FISHER FOUNDATION

• Do you have difficulty in recruiting volunteers to take committee jobs or leadership positions?

Members: Dr. Julie Ann Routhier (SE) and others to be determined

Chair: Dr. Jimmy Talbot (NW)

Officer Liaison: President Dr. Mark Ritz • Is your district willing to look at a proposal for redistricting with the caveat that the proposal will be put before each district independently for each district to accept or decline? If there is no consensus, the proposal will not be taken to the House of Delegates for its consideration. Developing a proposal for redistricting will be an arduous process. Therefore, it is extremely important that the task force believes that a majority of the districts have bought into the idea before moving on to the development stage.

LEADERSHIP IMPLEMENTATION TASK FORCE Chair: Dr. Mike Loden (C) Members: Drs. Ched Smaha (C), Brian Hall (E), Matt Mazzawi (N), Marvin Winter (N), Kelly Rawlins (NW), Wilkie Stadeker (NW), Russ Clemmons (SE), Mike McCartney (SW), and Mark Lawrence (W) Officer Liaison: Vice President Dr. Jay Harrington Staff Support: Nelda Greene (greene@gadental.org) Background: This task force was assigned four of the five recommendations from the 2008 Leadership Task Force as outlined above. Charge: Implement the recommendations listed below from the 2008 Leadership Task Force and undertake any of the recommendations the task force can appropriately accomplish. It is expected that the task force will do everything possible to implement the recommendations, but if the task force believes that a standing committee can better accomplish the tasks, they may recommend that option to the GDA president. The task force should take these initial four recommendations as a minimum—it is appropriate for the task force to amplify any of these recommendations or to put forward other ideas that would be in harmony with the recommendations listed below. 1) Send a welcoming survey to newly licensed dentists that would serve as a contact by the GDA but would also introduce the various committee opportunities available for involvement. 2) Develop a written Procedure Manual for districts to use that contains job responsibilities / descriptions. 3) Initiate open forums within the districts as well as the Board of Trustees to plan long range and to seek out those individuals who need an opportunity to serve. Have an evaluation process for those who serve in leadership positions. 4) Provide a local participation program, such as Toastmasters, that provides adequate training for those interested in conducting meetings or making presentations.

Staff Support: Delaine Hall (hall@gadental.org) Background: In 1984, the GDA, at the request of President Dr. Jay McCaslin V, appointed an ad hoc committee to study the possibility of creating a dental foundation for Georgia. The House of Delegates voted in 1985 to form the Georgia Dental Education Foundation, and provided initial funding of $50,000 to establish Foundation activities. The Foundation was awarded 501(c)(3) charitable status on August 20, 1985. The first slate of officers for the GDEF was President Dr. Russ Ragsdale (NW) and GDA district representatives Drs. D.T. Walton Jr. (C), Bill Wege (E), Bill Callahan (N), Leon Aronson (SE), Ed Gandy (SW), Leo Berard (W), and Emile Fisher (At Large). In 2005, the GDEF was renamed as the Emile T. Fisher Foundation for Dental Education in Georgia. The Foundation reached $1 million in funds in 2007 (after 20 years of fundraising efforts). The purpose of the Task Force is to ensure that the GDA works in harmony with the Foundation and maintains a close and supportive relationship. Charge: 1) Attend the Fisher Dental Education Foundation meetings. 2) Help the Foundation board identify dentists in GDA districts not currently represented on the board to be nominated. 3) Report activities of the Foundation to the GDA Board of Trustees at each board meeting. 4) Offer GDA input at Foundation meetings based on established policy in coordination with the GDA’s staff support. 5) Be cognizant of proposals to change established policy or organizational structure of the Foundation. Report these actions to the GDA President and to the Board of Trustees with recommendations for any necessary action. 6) Create an atmosphere of good will between the GDA and the Foundation. Look for ways to enhance that relationship.

TASK FORCE ON PEDIATRIC DENTAL CARE Chair: Dr. Byron Colley (SE) Members: Drs. Jim Hall (C), Carole Hanes (E), Liz Lense (N), David Bradberry (NW), Rhea Haugseth (NW), Ed Green (SW), Matt Adams (W), and Scott Niette (W) Officer Liaison: President Dr. Mark Ritz Staff Support: Courtney Layfield (layfield@gadental.org)

President’s Commentary Continued on page 28 GDA ACTION OCTOBER 2008

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Wayne S. Maris, DDS

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down in the mouth Join the GDA (Good Day Association)

Wayne S. Maris, DDS

We dentists are known for joining a variety of dental organizations. We begin with our local component. For me this is the Southwestern District Dental Society. We are small in numbers compared to other districts. We are large in geographical coverage. Our district stretches from Waycross to Donalsonville. That is 160 miles. There are a lot of peanuts, cotton, and tobacco in between. Our membership joins us up with the Georgia Dental Association and the American Dental Association. For those who are in urban areas there are a variety of study clubs and local societies. It is tough for us small town rural dentists to do that. We huddle up in groups in the lecture hall lobby at our local meetings to discuss everything from dental politics to clinical dentistry. In addition there is the Academy of General Dentistry that is a worthy organization dedicated to continuing education. Each specialty group also has an organization to join. There are a number of invitational organizations. The Pierre Fauchard Academy was the first invitational organization I joined. The American and International Colleges are also worthy organizations that work for the betterment of dentistry. Here in Georgia we have the Georgia Academy of Dental Practice which is invitational too. It encourages spousal involvement. The yearly meeting offers continuing education of interest to both dentist and spouse. It moves its yearly meeting around. This year it was in Williamsburg, Virginia. I am a member of seven formal dental organizations. This makes for a big “ouch” at dues paying time. It is simply our dues for enjoying such a great profession. The opportunities are endless to attend meetings. For those of us who participate in the governance of these organizations it gives the opportunity to make friends more closely than simply attending the general meetings and continuing education. Going to the general meetings keeps us abreast of what is happening in our profession. A common thread

weaves its way through all the organizations. It is all in the best interest of the patient. There are many informal organizations we are all members of from time to time. Until I retired from extractions I was a member of the Broken Root Tip Society. My right thumb has osteoarthritis which makes routine extractions painful for me. I never did many extractions even living in a rural area. Operative dentistry is somewhat of a problem but not enough to send me to the thumb doctor. Four days of operative is about all I can do. Then there is the American Association of Separated Root Canal Files. That doesn’t happen often but a few times is bad enough. One endodontist told me if you don’t separate a file every now and then you don’t do root canals. Then there is the Society of the Broken Fresh Amalgam. “Gee doc, that feels a little high. Let me grind it down a little.” One large group is the Broken Porcelain Association. A dentist must break the porcelain on a bridge or crown on cementation to become a member. The largest of all the informal organizations is the Universal Association of Broken Appointments. Every time I do endodontics I threaten to form the “Fumble With the Rubber Dam Society.” Some dentists use the rubber dam for routine operative. Maybe that extra practice would help. Better yet leave the rubber dam placement to the expanded duty assistant. Some practice management gurus advocate this. Dentistry has its minor annoyances. How we respond can make or break a day. In practice for 37 years my response is to make light of them. Psychologists admonish people to not become upset over something you have no control over. How about another informal group—I Am Determined to Have a Good Day Association.

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Wanted: New Members to Enjoy GDA Membership Benefits Dr. Karyn Stockwell Chair, GDA Recruitment and Retention Committee

This issue of Action is being mailed to all dentists in the state, not just members, as an invitation to join the American Dental Association, Georgia Dental Association, and GDA district. Members are invited to share the application inserted in this journal with non-members and encourage them to join. (You can also print an application from the GDA Web site www.gadental.org). The GDA has sweetened the deal this year by sponsoring a membership recruitment prize. Between October 1, 2008, and January 31, 2009, each time a GDA member refers a non-member dentist to the GDA and that dentist officially joins the Association, both the referring dentist and new member will be entered into a contest to win a three-night stay at The Grove Park Inn in Asheville, North Carolina, during the 2009 GDA Annual Meeting. (See the ad on page 13 for more details on this campaign.) Our Association offers a number of opportunities and benefits to new and established dentists. Here is just a partial listing of the wealth of benefits that the GDA provides; see the GDA Web site for a membership flyer with even more benefits you can share with non-members. Legislative Advocacy—The GDA monitors hundreds of bills during each Georgia legislative session and actively opposes legislation that may adversely affect your patients and practice. Members receive periodic updates on advocacy activities during each legislative session via the GDA email newsletter, and a wrap-up after the session in the GDA journal Action. LAW Day Program / Contact Dentist Activities—These programs promote interaction between members and legislators and encourage members to advocate on behalf of their profession. GDA Action / Web Site—The monthly journal GDA Action and Web site www.gadental.org provide up-to-date information on the profession and association.

Public Relations Central—The GDA fosters a positive image about dentistry in the media, and responds to media crisis situations in an informed and effective manner on behalf of the profession. Survey Center—The GDA routinely surveys members to determine what dentists want and expect from their association. In addition, the GDA surveys pro-bono services provided by member dentists and uses this information as a public relations tool with the public and the media. Regulatory Agencies Liaison—The GDA provides members with information on OSHA, waste materials and waste water, x-ray certification, and NPI and HIPAA issues, among others. The GDA also regularly monitors the activities of state and federal regulatory agencies, including the Georgia Board of Dentistry, and provides updates to the membership. Third Party Payer Advocacy—The GDA provides members with valuable information on dealing with insurance companies and helping patients confused by insurance matters. Medicaid / PeachCare Advocacy—GDA staff members provide assistance with issues many providers in these programs face and advocate with state agencies on behalf of providers and patients. Georgia Dental Insurance Services / Professional Debt Recovery Services— These GDA subsidiaries provide members with outstanding products and services and access to highly qualified, professional staff members who work hard on your behalf. Endorsed Services—The GDA endorses a wide array of vendors from the wealth management firm UBS to dental uniform supplier Lands’ End who offer quality products and services usually along with special member pricing.

Annual Meeting—The GDA holds an annual session in a resort location that provides members with the opportunity to enjoy top-notch CE and meet with their colleagues and friends in a relaxed setting. The 2009 meeting is July 30 through August 2 at the Grove Park Inn in Asheville, NC. Dental Recovery Network—This GDA program provides staff and colleague support for members, or their family or staff members, who have chemical dependency, depression, or other well being issues. Peer Review—The GDA Peer Review Committee seeks to resolve treatmentoriented conflicts between patients and dentists. Student / New Dentist Relations—The GDA provides support to the Medical College of Georgia School of Dentistry in many areas, and supports keeping the quality of applicants at a high level so that GDA members have associates and potential buyers for their practices. The GDA also provides beginning practice support for newly licensed dentists. Patient Referrals—The GDA has a sophisticated data management software program that allows the executive office to track and make referrals to member dentists. Your Extra Staff—The GDA staff serves as your resource on any issue arising in your office and strives to help you or your staff members find answers or resolve issues. I encourage you again to share an application and list of benefits with a non-member. Thank you for helping to recruit new members for the GDA and for helping all dentists learn about the value of joining the GDA.

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members in the news Tourial Named Northern District Dentist of the Year The Northern District Dental Society named Sidney R. Tourial, DDS, as the Michael T. Rainwater Dentist of the Year honoree on September 20 at the district’s annual Gala for Smiles. The Gala, which raises funds for area charitable dental clinics, was held at the Georgia Aquarium. “Sidney is one of those unique individuals that enters our lives and makes a significant impact on how we think, work, and respond to challenges,” said NDDS Past President Dr. Bob O’Donnell. “He approaches everything he does with passion and commitment, always willing to do his share of the work, step outside the box when necessary, and never shy away from obstacles. He is a leader, a creative thinker, and a protector of our profession.” Dr. Tourial, a native of Atlanta, received his BA degree from Emory University and his Master’s in Anatomy from MCG. He received his dental degree from Emory School of Dentistry. He is a frequent lecturer and writer, having served as Editor of the Alpha Omega Atlantan and the Alpha Omegan (International Dental Journal). Dr. Tourial served as NDDS President in 2002-03 after 30 years of involvement in the district. At the GDA level, he recently completed service as Speaker of the House of Delegates. He is a GDA Honorable Fellow, and longtime delegate and alternate from the Northern District. He served as a GDA Alternate Delegate to the American Dental Association for 10 years. Dr. Tourial is a member of the Hinman Dental Society, the Pierre Fauchard Academy, and is a Fellow in the American College

(L to r): NDDS Past President Dr. Bob O’Donnell, Dr. Sidney Tourial, and NDDS President Dr. Chris Adkins.

of Dentists and the International College of Dentists. He has also served the Alpha Omega Dental Fraternity with distinction, first as President of the Emory Chapter, then President of the Atlanta Alumni Chapter, and as its International President in 1991. He is currently the Chairman of the AO Philanthropic Foundation.

Shop with GDA Endorsed Provider Lands’ End: A Better-Built Lab Coat Can Make All the Difference

New GDA endorsed provider Lands’ End offers special deals just for members!

Finding an exceptional lab coat at a great price is no easy process. Just ask Kim Ross, senior merchant at Lands’ End Business Outfitters. When her quest to find a style that met customers’ basic criteria failed, she enlisted the help of her design team. “My father was in the medical field so I had a pretty good idea where to start,” she says. “But to make sure, I talked to customers.” Kim Ross succeeded in building lab coats practically made to order. She used a durable cotton/polyester fabric that releases stains in the wash. She added pockets inside and out for optimum discretion. Side slits on lab coats make for easy pants pocket entry. She even made sure the women’s styles had princess seams. The result is added functionality. “When we add your monogram or logo, it really adds a custom look,” says Ross.

“The detailing is really nicely done,” says Debbie with Booth Orthodontics in Homer Glen, IL. She appreciates the hidden inside pockets and fit-for-her shape. “It’s nice to have a jacket that feels made for me.” Lands’ End is the only apparel company endorsed by ADA Member Advantage and the GDA, and provides personalized high-quality apparel for dentists and their staff. Find your next favorite Lab Coat or Consultation Jackets at Lands’ End online at www.ada.landsend.com. LAB COAT CLEARANCE! While supplies last, all Lab Coats and Consultation Jackets are on sale. All sizes just $9.99 (up to 75% off original prices). To order, call 800-990-5407 or shop www.ada.landsend.com.

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Members Seen in the News Craig Ajmo, DDS, a member of the GDA Northwestern District and 1981 graduate of the Emory University School of Dentistry, was a speaker at the summer International Association of Dental Research conference in Toronto, Canada. Dr. Ajmo attended on behalf of the Dental Practice Based Research Network, a consortium of participating practices and dental organizations committed to advancing knowledge of dental practice and ways to improve it. DPBRN’s major source of funding is the National Institute of Dental and Craniofacial Research, part of the U.S. National Institutes of Health. Dr. Ajmo presented the poster entitled “Assessment of primary caries lesion depths in dental PBRN practices.” Jonathan Dubin, DMD, a general dentist in Atlanta and Georgia Dental Association editor, had his August 2008 Action editorial “Make Mine Four Percent” reprinted in the ADA’s Dental Editor’s Digest. The publication is circulated monthly to all members of the American Association of Dental Editors, and those members are invited to reprint the Digest’s articles and editorials (usually only one or two editorials are selected each month).

tal education, including 550 hours dedicated to hands-on skills and techniques and more than 100 hours of service to the community. He is one of only three dentists in Georgia to have received this award. He is a 1979 graduate of the Emory University School of Dentistry. Timothy Kaigler, DMD, a general dentist in McDonough, and Michael Witcher, DDS, a general dentist in Gainesville, were named Masters of the Academy of General Dentistry in July 2008. To date, fewer than 1% of the AGD’s members have achieved Mastership. Dr. Kaigler is a 1980 graduate of the Medical College of Georgia School of Dentistry; Dr. Witcher is a 1982 graduate of the Emory University School of Dentistry. Michael Sebastian, DMD, an Atlanta orthodontist, and his office staff were recognized in the Sandy Springs Neighbor for soliciting donations for a Marine infantry reconnaissance unit deployed in Afghanistan.

One of the soldiers in the unit, Captain Frank Wilson, is a friend of Dr. Sebastian’s son and was deployed for his third rotation in that war-torn country in March 2008. The office sought donations for specific supplies requested by Capt. Wilson’s unit—one that spends long periods away from large military bases. Among the items requested were toothbrushes and fluoride toothpaste, sports magazines, movies (especially comedies), sunscreen / aftershave combination lotions, battery powered electric razors, eye drops, nasal saline solutions, vitamins, Chef Boyardee ravioli cans, and black socks. “We learned that often Marines have no water for laundry and wear socks for days before burning them with the garbage,” office employee Virginia Johnston told the newspaper. The office was able to send 30 boxes of supplies to the unit.

Drew Ferguson IV, DMD, a general dentist in West Point in Western District and 1992 graduate of the Medical College of Georgia School of Dentistry, also serves as the mayor of West Point. He and other Troup County leaders were profiled in an August 2008 Georgia Trend article that discussed the effects the planned opening of a Kia car manufacturing plant will have in the area. Dr. Ferguson’s father is the West Point Development Authority Chairman. “We are at the center of what will become the most important manufacturing center in Georgia,” Dr. Ferguson told the magazine. Kudos to this dentist member for helping to lead the way. Robert Finkel, DDS, a general dentist in Duluth, was recently granted the prestigious 2008 Lifelong Learning & Service Recognition award by the Academy of General Dentistry. The award is presented only to Masters of the AGD who complete more than 1,600 hours of continuing den-

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In Memoriam The GDA extends sympathy to the family and colleagues of the following individuals. For a full obituary on

these member dentists, visit www.gadental.org or call the GDA office.

Alvin M. Crews Jr., DDS, who died March 24, 2008, at the age of 80. Dr. Crews was a member of the GDA through the Northern District (Gainesville). The 1957 Emory University School of Dentistry graduate was a retired ADA Life Member.

accepted as a member approximately one year after the landmark case Bell v. Georgia Dental Association et al of February 1964. Dr. Goosby was also a GDA Honorable Fellow.

Charles Francis Goosby, DDS, who died September 2, 2008, at the age of 83. Dr. Goosby, a retired ADA Life Member, was a member of the GDA through the Northern District. The 1948 graduate of Meharry Medical College was the first African American dentist admitted as a member of the Georgia Dental Association. He was

Danny Ray Lee, DMD, who died September 15, 2008, at the age of 57. Dr. Lee, a general practitioner in Gray, was a GDA member through the Central District. The 1987 Medical College of Georgia School of Dentistry graduate is survived by two children, including GDA member Dr. Jason Lee of Augusta.

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Deadline for GDA Nominations is December 19

Dentists Encouraged to Express Interest in At-Large Delegation Positions The GDA Nominating Committee will meet on Saturday, January 10, 2009, at the GDA executive office to consider nominations for the following slate of offices. • GDA Vice President • GDA Secretary / Treasurer • GDA Board of Trustees (One Open Position) • ADA Delegation (Six Open Positions; Two of those At-Large) • Georgia Board of Dentistry (Three Open Positions) The Speaker of the House of Delegates is elected annually at the July House of Delegates. To handle this open position, President Dr. Mark Ritz will appoint a Nominating Committee to submit names for the position to the July 2009 House of Delegates. The Speaker shall be elected

for a one year term and may be reelected for a maximum of five consecutive terms. Dr. Kent Simmons was elected to the Speaker post at the July 2008 meeting, and he is eligible to be re-elected in July 2009. While districts are tasked with submitting official nominations for the majority of the open positions listed, GDA members should be aware that the two At-Large positions newly available on the ADA Delegation are open to all dentists, regardless of their GDA district affiliation. These slots on the Delegation were granted by the ADA due to the GDA’s increased membership numbers and subsequent right to have increased representation at the national level. A dentist who plans to pursue an At-Large position is asked give a courtesy contact to their district leaders to advise

them of his or her interest. Dentists may also speak to their districts if interested in any other positions. Please note that the deadline for districts and individual dentists to submit nomination information is December 19, 2008. That means that a candidate’s CV and any required supporting documentation (for instance, districts must submit an official letter from the district president or president elect attesting to district support of the candidate in addition to CVs) should be in the GDA executive office no later than the close of business that Friday.

GDA Board of Trustees The GDA Board of Trustees’ term of Dr. Richard Weinman, Trustee for the Northern District, expires in July 2009. The Northern District will forward a nomination for this

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position to the GDA—Dr. Weinman is eligible to be re-nominated.

Georgia Board of Dentistry The terms of district Board representatives Dr. Becky Carlon (Southwestern) and Dr. Barry Stacey (Northwestern) expire in March 2009. The term of Dr. Tom Godfrey (Northern) expires in August 2009. The districts so named will submit the appropriate nominations. The GDA House of Delegates will approve the nominations, and the GDA will send all names to the Governor for consideration.

ADA Delegation The terms of district Delegates Dr. Ty Ivey (Central), Dr. Tom Broderick (Southeastern), and Dr. Donna Thomas Moses (Northwestern), as well as district Alternate Delegate Dr. Carol Wolff (Northern) expire in January 2009. The districts so named will submit the appropriate nominations. Dr. Ivey is not eligible for re-nomination due to term limits, while the three other doctors are eligible to return to their Delegation slots. As mentioned above, the ADA awarded the GDA two new At-Large Delegation positions this year because of the GDA’s increased membership numbers. The new At-Large Delegate and At-Large Alternate Delegate will be elected at the January 2009 House of Delegates, and will serve until January 1, 2013 (a four-year term). Each delegate or alternate can serve a maximum of three consecutive four-year terms. Dentists in these positions will be required to attend the ADA Annual Session each year in addition to attending other state and regional meetings, participating in conference calls on ADA matters, and taking part in other meetings. The time commitment is significant. Any GDA member dentist in good standing may submit a CV to the GDA executive office by the December 19, 2008, deadline and notify the office of their intent to run for an At-Large position. Either the candidate or his or her proxy may speak on the candidate’s behalf at the January 2009 House of Delegates meeting, which will take place on Sunday, January 11, 2009, at the Westin Atlanta Perimeter North. After all candidates or proxies speak, voting will continue until one candidate receives a majority of the votes (only HOD members vote).

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Nominating Committee Members The Committee’s voting members are Central Drs. Lindsay Holliday and Roy Lehrman (observer Vice President Dr. Kara Moore); Eastern Drs. Erik Wells and Celia Dunn (observer Vice President Dr. Grant Loo); Northern Drs. Chris Adkins and Ben Jernigan (observer Vice President Dr. Jeff Kendrick); Northwestern Drs. Celeste Coggin and Bruce Camp (observer Vice President Dr. Terry O’Shea); Southeastern Drs. Ben Duval and Larry Schmitz (observer Vice President Dr. Mark Dusek); Southwestern Drs. Brent Depta and Chris Hasty (observer Vice President Dr. Jeff Singleton); Western Drs. Cathy Cook and Matt Adams (observer Vice President Dr. Jay Harris). State officer observers are President Elect Dr. Kent Percy and Vice President Dr. Jay Harrington. In addition to the two votes from each district, the GDA President has a vote. The total number of votes is 15. All voting is by secret ballot. Candidates or their designated representatives may address the Nominating Committee during its meeting on January 10, 2009. Each candidate will be limited to four minutes of speaking time.

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How Would Universal Healthcare Affect You?

GDA Leadership Tackles Tough Topic of Dentistry and Universal Health Coverage Universal healthcare, typically considered as a government mandated program of health care coverage, is a hot topic both in the presidential campaign and in organized dentistry. The American Dental Association will debate a resolution at its October House of Delegates that would define the organization’s role in future universal healthcare programs. This article looks at GDA leaders’ reactions to the resolution and to universal healthcare in general and thoughts from GDA leaders regarding universal healthcare’s impact on the future of dentistry. The article also includes sidebars containing critiques on the two presidential candidates’ health care reform plans, and the crisis facing dentistry under the British universal health program. The intention is to inform members how universal healthcare might impact their profession, and encourage them to voice their opinions to the GDA leadership.

Comprehensive overhaul of the health care system has emerged as a major issue during this election year. Presidential candidates Senator John McCain and Senator Barack Obama are backing plans they say would expand coverage options to the approximately 47 million individuals currently without health insurance. Senator Obama’s plan seeks to provide “affordable, accessible health care for all Americans” while Senator McCain’s health care call to action begins with the phrase “we can and must provide access to health care for every American.” Health care reform is an important topic to the electorate as well. A September

2008 Kaiser Family Foundation survey found that health care ranked third among issues voters want to hear candidates address, ranking only behind the economy and the Iraq war. [www.kff.org] What do voters want to hear? An October 2006 poll of 1,201 Americans sponsored by USA Today, ABC News, and the Kaiser Family Foundation gives us an idea. The survey revealed that 56 percent of Americans would prefer universal coverage to the current American health care system. (Notably, responses plummeted when the poll asked about tradeoffs. For instance, 76 percent opposed universal coverage if it meant that some currently covered treatments would no longer be covered, while 68 percent said they would oppose universal coverage if it led to limits on the choice of health care providers.) [www.usatoday.com] Dentistry has taken a fresh interest in the health care debate as well. Some 14 years after launching the slogan “Dentistry: Healthcare That Works” in response to reforms proposed by the Clinton administration’s Health Security Act (including one especially popular mandate for employers to provide health insurance coverage via Health Maintenance Organizations), the American Dental Association (ADA) made universal health care (UHC) a “mega topic” discussion prior to the opening session of the House of Delegates in September 2007. Delegates examined the potential impact of UHC on oral health care and discussed the complexities surrounding the subject. A poll taken after that ADA discussion showed that 81% of delegates were very or somewhat likely to believe that there will be some sort of universal healthcare coverage by 2012, and 54% were very or somewhat likely to believe that oral health would be included in that universal healthcare coverage. To top it off, 58% of delegates believed that universal healthcare would have a negative impact on dentistry. (In this context, universal healthcare was

defined as a government mandated program intended to ensure that all citizens / residents of a nation have access to most types of health care, through a variety of mechanisms, usually funded in part by that government.) [www.ada.org] The ADA took further action during the 2007 ADA House when attendees adopted Resolution 58H-2007. The resolution created the ADA Task Force on the Future of Health Care / Universal Coverage 2007-2008 (ADA Task Force) and directed the task force to develop goals and strategies to guide the ADA’s advocacy efforts as it relates to potential universal healthcare and report recommended actions to the 2008 ADA House. (See a list of Task Force members on page 18).

Many Board members are wary that if universal coverage was put in place that there would be an increased push to involve unsupervised mid-level providers in patient care under the guise of improving access to care and delivering care in a more cost efficient manner.

The task force has now created a resolution (see page 24) that the 2008 ADA House will debate and vote on this October. The resolution is backed by an 87-page report that gives the background for the resolution and outlines the debate. As the ADA frames the debate, this article will examine the reactions of GDA members to the ADA’s plan (as it existed in August

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2008), the ADA’s financial implications of including dentistry in a national health care scenario, and the ADA’s estimate of what happens to the dental workforce under universal coverage.

GDA Members React to the ADA Universal Healthcare Resolution and Supporting Documents The GDA Board of Trustees met via conference call in September 2008 to discuss the ADA task force’s resolution, background report, and two draft white papers, “Projected Costs of Including Dental Care in a National Health Care Program��� and “Dental Workforce Needs with and without Inclusion of Dental Care in Healthcare Reform.” Members did have four areas of minor concern, including beliefs that: Universal Health Coverage Continued on page 18

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• Certain definitions, including the one for access, could be stronger. • Patient behavior / education should have been emphasized to a greater extent. • Any universal healthcare scenario should focus on individuals with substantive need.

How the ADA Defines Access—Do You Agree? Appendix 2 to the informational report of the ADA Task Force is a glossary of health care reform terms. “Access to Care” is defined here as “The ability of an individual to obtain or make use of dental care, including the patient’s perceived need for care, cultural preferences, language, and other factors influencing their entry into the dental care system.” “I was somewhat surprised at this definition,” said GDA Vice President Dr. Jay Harrington. “I thought that the definition as put forward by the Academy of General Dentistry (AGD) in its ‘White Paper on Increasing Access to and Utilization of Oral Health Care Services’ was stronger.”

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The AGD paper defines “Access to Care” as “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.” There was a feeling among the GDA Board members that the AGD definition was more descriptive regarding the many different factors that influence access, including mal-distribution of dentists and personal responsibility. There was also a question among Board members as to why the ADA task force report did not define mid-level provider. Many Board members are wary that if universal coverage was put in place that there would be an increased push to involve unsupervised mid-level providers in patient care under the guise of improving access to care and delivering care in a more cost efficient manner. Board members mentioned that the AGD included the following definition in their access white paper: “Independent Mid-Level Provider—A dental auxiliary, working outside the dental team and without dentist supervision, who accepts the responsibility for patient diagnosis,

“Once a government program gets started…it’s not going back. …[t]he GDA Delegation was particularly concerned in 2007 about the crowding issue in relation to a 400% FPL, where individuals with private insurance would switch to expanded public funded coverage because it is perhaps cheaper or because employers drop their coverage. That is a threat.”

treatment and coordination of dental services with less education than what is currently required for a practicing dentist.” The Board noted the AGD paper in general for its strong stance against the deployment of any independent mid-level provider. The Board agreed that the introduction of such providers, as stated in the AGD white paper, had the potential to create a two-tiered system of delivery,

ADA Future of Health Care / Universal Coverage Task Force 2007-2008 • Dr. Charles Smith, Sixth District Trustee, Chairman • Board of Trustees members Dr. Donald Cadle Jr., Dr. William Calnon, Dr. Dennis Manning, Dr. Murray Sykes, and Dr. Ronald Tankersley • Dr. Frank Graham, vice-chair, Council on Dental Practice • Dr. Larry Dean Herwig, chair, Council on Communications • Dr. Stephen Jaworski, chair, Council on Dental Benefit Programs • Dr. Lindsey Robinson, chair, Council on Access, Prevention and Interprofessional Relations;

• Ex-officio members Dr. Mark Feldman and Dr. John Findley. • Staff support from Dr. Albert Guay, chief policy advisor; Dr. John Luther, senior vice president, Dental Practice / Professional Affairs; Mr. William Prentice, senior vice president, Government and Public Affairs; Mr. Thomas Conway, senior manager, Dental Terminology and Special Projects, Council on Dental Benefit Programs / Department of Dental Informatics. • Special assistance from Dr. Quinn Dufurrena, Hillenbrand Fellow; Dr. Lewis Lampiris, director, Council on Access, Prevention and Interprofessional Relations; and Ms. Beril Basman, managing vice president, Strategy Management.

• Dr. Keith Suchy, chair, Council on Government Affairs

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provide poorer quality care for poor and medically needy populations, and divert economic resources from oral health literacy, expansion of quality care, correction of mal-distribution, and commitment to prevention. Incidentally, the Board was dismayed over the fact that the ADA Board of Trustees voted 14-3 at its August meeting to defeat a resolution put forward by Fifth District Trustee Dr. Marie Schweinebraten to support the AGD and its access white paper. The Board was also concerned about the fact the ADA Task Force did not address mid-level providers in-depth especially because the ADA draft informational white paper “Dental Workforce Needs with and without Inclusion of Dental Care in Healthcare Reform” makes an alarming projection about the numbers of dentists needed under certain universal healthcare programs. The report states that (FPL stands for Federal Poverty Limit, which for 2008 is $10,400 for an individual, $14,000 for a family of two, $17,600 for a family of three, and $21,200 for a family of four in the contiguous 48 states; rates are higher in Alaska and Hawaii): “Extending coverage to children will, at most, increase the patient population by 0.66% using the 200% FPL and 0.25% using the 100% FPL limit. Adding low income, uncovered adults to the expansion increases the number of patients … by 4.29% using the 200% FPL limit and 1.71% using the 100% FPL limit. Extending coverage to individuals currently not covered under any dental plan, irrespective of income, would extend coverage to an additional 100.8 million individuals … this health reform plan would increase the number of patients by 20.92%.” The report concludes that there would be sufficient numbers of dentists in the workforce to care for children, and even low income adults with no insurance coverage, in a universal coverage program. However, if a universal coverage program sought to cover all individuals sans insurance, with its attendant 20.92% patient population increase, then there would not be enough dentists. Who then would be expected to provide care? The report uses the 100% and 200% FPL levels because many proposals to expand dental coverage to the uninsured range from 100% to 200% FPL. There

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Health watchdog highlights NHS dental care failures A July 31, 2008, article in The Guardian of England reported on a National Health Service survey that a fifth of people in England had been unable to get a dental checkup for the last two years. The Healthcare Commission found that more than a quarter (26%) of the people it surveyed did not see a dentist once every two years; in some areas, the figure rose to more than two-fifths (43%). More than eight in 10 (81%) of those who had not seen a dentist at all in the last two years had wanted to do so. The findings follow another 2008 survey that found one in four dentists plans to quit the NHS. The poll of 86 dentists, conducted for the Dental Practitioners’ Association (DPA), found many were dissatisfied with the dental contract introduced by the government two years ago. Almost all (95%) said access to NHS treatment had not improved since the reforms were introduced. More than four-fifths (85%) said the new contract, under which dentists are paid annually in return for a specified number of units of dental activity, was unworkable. More than a quarter (26%) said they did not intend to stay in the NHS after April 2009. The National Health Service system is the publicly funded health care system in England. The Service provides the majority of health care services in England. The Service is largely funded from general taxation. The government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health (Health Secretary). Most of the expenditure of The Department of Health (£98.6 billion in 2008-2009) is spent on the NHS.

was, however, a concern on the GDA Board of Trustees call about “FPL creep” should a universal program become enacted. Many dentists called to mind the eligibility expansions proposed by two Congressional bills introduced in 2007. The Children’s Health First Act (Dingell / Clinton, H.R. 1535 and S. 895) would have expanded eligibility in the State Children’s Health Insurance Program (SCHIP) to 400 percent of the FPL ($82,600 for a family of four) and create a “buy-in” option for non-eligible populations. The Children’s Health Insurance Program Reauthorization Act (Rockefeller / Snowe, S. 1224) would have expanded eligibility to

300% of the FPL. In addition, both bills would have allowed states to expand coverage to new populations, such as legal immigrants, pregnant women, and children of state employees. [www.heritage.org] “Once a government program gets started,” observed GDA President Elect Dr. Kent Percy on the Board of Trustees call, “It’s not going back. I know the GDA Delegation was particularly concerned in

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2007 about the crowding issue in relation to a 400% FPL, where individuals with private insurance would switch to expanded public funded coverage because it is perhaps cheaper or because employers drop their coverage. That is a threat.”

Dentistry Must Emphasize Patient Behavior / Education Numerous studies of Medicaid and SCHIP health programs have outlined the main reasons that dentists choose not to participate in the programs. Low reimbursement rates top the list, as Medicaid and SCHIP program rates generally do not cover the dentist’s actual cost of providing services. A second reason is the administrative complexity associated with being a government health care provider. Dentists are often frustrated by

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the complex claims processes, claim denials, payment times, and prior authorization requirements for routine services. Patient issues or conflicts in cultural behavior and expectations between dental providers and Medicaid patients are a third main reason. Dentists often believe that patients enrolled in government programs, and their parents and / or guardians, may be less informed about the importance of preventive dental care and proper hygiene and that, overall, oral health may be a low priority. Dentists find that patients in these programs are more likely than others to break appointments or not to keep appointments at all. Because fixed costs represent a significant portion of dentists’ fees, missed appointments are expensive for dentists. [www.ncsl.org] “I feel that the ADA documents certainly address patient education and oral health literacy, but the language could have been stronger,” said GDA Delegation to the ADA Chairman Dr. Richard Weinman. “The resolution does state that ‘improving oral health literacy makes patients better stewards of their own

health,’ but we need to hammer home that educational and oral health literacy efforts are important and affordable. Patient choices, including sometimes an unwillingness to seek available care, affect access to a great degree and that does not often receive the attention that it should.” Western District President Elect Dr. Matt Adams also chimed in about the value of education. “Preventive care could in the long term save the state and nation money. I will sometimes see a child with a toothache and find a lot of other work to be done besides. Some of the children who come in need hospitalization. If we could have seen this child beforehand, we could have treated them with less costly procedures and saved taxpayer money; educated the parents on proper home care; and made the procedure easier on the patient and the dentist.”

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Health Affairs Critiques the Candidates’ Health Care Plans In September 2008, this leading journal of health policy thought and research had opponents critique the health care reform plans of Senator John McCain and Senator Barack Obama. Excerpts from the critiques appear here. To read the full critique, visit www.healthaffairs.org.

Senator John McCain “Senator John McCain’s health plan would eliminate the current tax exclusion of employer payments for health coverage, replace the exclusion with a refundable tax credit for those who purchase coverage, and encourage Americans to move to a national market for non-group insurance. Middle-range estimates suggest that initially this change will have little impact on the number of uninsured people, although within five years this number will likely grow as the value of the tax credit falls relative to rising health care costs. Moving toward a relatively unregulated non-group market will tend to raise costs, reduce the generosity of benefits, and leave people with fewer consumer protections. “Senator McCain’s health plan has three central features: withdrawing the current tax exclusion of employer payments for employer-sponsored coverage (in other words, taxing premiums paid by employers), introducing a refundable individual health insurance tax credit, and deregulating non-group insurance by permitting the purchase of policies across state lines. “At its heart, the system he envisions is one in which many more—perhaps most—insured Americans would buy health insurance and health services in a national, relatively unregulated, competitive market, either on their own or as members of fluid, voluntary associations, such as churches or clubs. Because this would be a radical departure from the current system, its likely effects deserve close attention. “The Brookings Institution and Urban Institute’s Tax Policy Center estimate that the tax-related provisions in the McCain plan would cost about $1.3 trillion over ten years starting in 2009. In addition, the Guaranteed Access Plans, or high-risk pools, envisioned in the plan would cost about $70-$100 billion over this period. Current estimates of the costs of the plan have focused only on government costs, but the plan also would lead to shifts in spending within the private sector. The McCain plan would shift coverage toward the non-group market, lead to reductions in the comprehensiveness of coverage in that market through deregulation, and encourage employer-based coverage to become less generous as well. These changes would have the effect of shifting costs from insurance premiums toward out-of-pocket payments, and people with chronic or acute illnesses would likely incur much higher out-of-pocket health care costs than they do now. “We estimate that twenty million Americans—about one in every eight people with job-based coverage—would lose their current coverage as a result of the change in the tax treatment of coverage. Initially, this loss of job-based coverage would be offset by an increase in coverage in the non-group market (although not necessarily for the same individuals). Within five years, however, the net effect of the

plan is expected to be a net reduction in coverage relative to what would have been observed if the tax treatment of employer-sponsored coverage remains as it is now.”

Senator Barack Obama “The health reform plan put forth by Sen. Barack Obama focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses, and businesses experiencing catastrophic expenses. It greatly increases the federal regulation of private insurance but does not address the core economic incentives that drive health care spending. This omission along with the very substantial short-term savings claimed raise serious questions about its fiscal sustainability. Heavy regulation coupled with a fallback National Health Plan and a play-or-pay financing choice also raise questions about the future of the employer insurance market. “We focus on several key features of the Obama proposal: the new National Health Plan (NHP), the national Health Insurance Exchange, the reinsurance subsidy, the “play-or-pay” requirement on larger employers, and the mandate that children be insured. “The Obama . . . goal is to increase dramatically the number of newly covered people and bring costs under control. According to the campaign, the average family would save up to $2,500 a year as a result of new federal subsidies and proposals intended to slow the growth of health spending. Even then, the campaign says that federal outlays for health care would increase by $50-$65 billion annually when fully phased in. “Any major expansion of coverage will be costly, and the Obama promise of affordability would require new, large, and rapidly growing federal subsidies that are unlikely to be sustainable, fiscally or politically. The size of the new subsidies depends on what affordability means. Although the campaign has not defined the term, it is commonly thought of as a limit on the share of family income that goes to health care. Such “affordability” subsidies would be an ever-growing share of the federal budget if health spending continues its upward climb. Since the government would bear the full liability for all health costs exceeding the affordability standard, there would be a strong incentive to continue the behavior that has caused health spending to grow at alarming rates over the past decades. “In the likely event that other savings from health system efficiencies do not materialize quickly, Congress would face tough choices in meeting budgetary requirements. If Congress does as it has with Medicare, insurers and providers can expect to bear the brunt of the fiscal pressure, with reduced payments for services that fail to keep up with the rising costs of medical care, which ultimately will reduce patients’ access to care.”

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Many … voiced fears that low reimbursement rates in a universal coverage program would not only negatively impact current providers, but also that low rates mixed with the administrative difficulties and a patient population with low health care IQs would lead to general dentistry becoming less attractive as a profession, much as the primary practice of medicine seems to be falling out of favor with medical students for much the same reasons.

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Any Universal Healthcare Scenario Should Focus on Individuals with Substantive Need

GDA Members Appreciate ADA Observations on What Could Happen to Dentistry Under Universal Healthcare

The GDA call participants recognized that the ADA resolution and supporting documents were written in such a way to allow the ADA to have flexibility in a health care debate. Still, members had strong feelings about some of the wording regarding covered populations. “I am concerned that the ADA resolution discusses adult coverage the way it does,” said Dr. Weinman. “We must take care of the neediest, most vulnerable of our population— our children—first. To me, any discussion of adult coverage, such as in the statement ‘Limited government resources should allow for additional routine dental care coverage for all underserved populations as well as diagnostic and preventive for adults’ is like discussing building the second floor of a house before you finish the foundation.”

The participants on the GDA Board of Trustees call, although they touched on some areas of minor concern with the ADA’s efforts, were supportive of other efforts. For instance, Board members noted that the resolution clearly stated that dentist reimbursements matter. The resolution states that “Increased access to care for people covered by government-assisted dental programs depends on fair and adequate provider reimbursement rates. The vast majority of government programs are so seriously under-funded that dentists cannot recover the cost of materials used in providing care.” Many on the GDA Board of Trustees call voiced fears that low reimbursement rates in a universal coverage program would not only negatively impact current providers, but also that low rates mixed with the administrative difficulties and a patient population with

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low health care IQs would lead to general dentistry becoming less attractive as a profession, much as the primary practice of medicine seems to be falling out of favor with medical students for much the same reasons. For instance, according to an American Academy of Family Physicians survey, despite a continued demand for more primary care physicians, the total proportion of medical students moving into primary care specialties remains low. In 2007, of the total of 20,514 applicants who selected residencies through the National Resident Matching Program, only 3,008 moved into primary care programs. The physician workforce report and policy statement adopted by the AAFP Congress of Delegates in 2006 cited the need for nearly 40,000 more family physicians to meet the escalating health care needs of the American people. [www.aafp.org] An AAFP report on the resident matching program from 2005 states that the number of medical students entering family medicine residencies has declined 51.6 percent from 1997 to 2005. The article points out contributing factors such

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as declining primary care reimbursement rates, increasing student-loan debts, patient care and education factors, and the federal government’s decision to cut funding for training family physicians at the same time the need for these physicians has increased. One call participant was reminded of a 2007 article in the Wall Street Journal about the Massachusetts health care initiative. The initiative, passed in 2006, requires all individuals to have health coverage and all employers with more than 10 employees to contribute to employee health-care costs or pay a penalty. However, a 2007 study by the Massachusetts Medical Society points out that this state that is moving toward near-universal coverage faces a critical shortage of primary-care physicians. For those residents who can get an appointment with their primary-care doctor, the average wait was more than seven weeks, according to the medical society, a 57% leap from the 2006 survey. [www.wsj.com] “We need to take the facts and figures this ADA report provides and use them to illustrate that poor reimbursement rates

are not going to attract people to the profession and in fact will further the access problem,” said GDA Editor Dr. Jonathan Dubin. “It is clear—take Medicaid rates in Georgia. When we pushed the legislature to increase rates, the number of dentist providers went up. When the Care Management Organizations lowered rates, the number of providers went down. The data backs that up.”

Dentists Continue to Have Concerns About Becoming Involved in Universal Healthcare… …But given the numerous studies that link positive overall health outcomes with good oral health, that genie is likely to have left the bottle. “In other words,” GDA President Dr. Mark Ritz said, “How can you argue that dentistry is intrinsic to overall health while arguing that dentistry should not be a part of universal coverage?” The call’s participants agreed that was a difficult question to answer. Dr. Weinman said that one way to address the issue was to continue to highlight dentistry’s successes, outline what percentage of currently covered populations were receiving care, and stress all of the factors, including patient choice, that went into whether or not an individual accessed dental care. “We don’t need new layers of bureaucracy,” he said. “We need targeted plans to reach certain populations.” Dr. Dubin said that in his opinion, the less that dentistry is involved the better off dentistry will be. “The best option would be to limit involvement to Medicaid and SCHIP,” he said. “Look at medicine—we don’t want to go down that path.” Southwestern District President Elect Dr. Chris Hasty lamented that the force of response was being placed on dentistry. He mentioned his patients who are enrolled in government-funded programs seemed not to value appointments or the care he provides as much as his other patients. “Any program for me would

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need to push awareness of patient responsibility,” he said. Eastern District President Elect Dr. Celia Dunn echoed that feeling. “My concern is that the recipients of the excellent care which is given free or at low cost to the citizens of Georgia have no idea of what the actual cost is to provide the care,” she said. “They do not realize the continuing education commitments of the doctors, or the value of the treatment. I do not think the average Medicaid parent realizes that it costs a minimum of $110 to perform an exam, prophy, and x-rays and that is a conservative amount.”

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Everyone on the call agreed that one thing that dentistry should fear is involvement in the universal coverage program envisioned in the ADA draft informational white paper “Projected Costs of Including Dental Care in a National Health Care Program.” The ADA Task Force determined that the average Medicaid / State Children’s Health Insurance Program (SCHIP) percentage discount for 2008 is 48.6% of dentists’ reasonable and customary

charges, and thus based some projected costs on the premise that a universal coverage dental program would pay only 50% of dental fees. (However, since the report contains preliminary information, the paper may be revised as other information, such as responses from the April 2008 ADA Survey of Dental Prepayment Arrangements, are compiled.) The white paper also states that, while it is difficult to accurately measure changes

Projected Costs to Include Dental Care in National Health Care Program (at 50% Fees)

[these figures are rounded]

ADA Resolution 38 on Universal Healthcare Reform Resolved, that the following be adopted as the Association’s policy on health care reform and the inclusion of oral health care in any health care reform proposal:

IMPROVING ORAL HEALTH IN AMERICA • Oral Health is Essential for a Healthy America. • Dental Care is Essential to Overall Health. Americans cannot be healthy without it. • Health Care is a Shared Responsibility. No law, regulation or mandate will improve the oral health of the public unless policymakers, patients and dentists work together with a shared understanding of the importance of oral health and its relationships to overall health. • Prevention Pays. The key to improving and maintaining oral health is preventing oral disease. Community-based preventive initiatives, such as community water fluoridation and school-based screening and sealant programs are proven and cost-effective measures. These should be integral to oral health programs and policies, and will provide the greatest benefit to those at the highest risk of oral disease. • Improving Oral Health Literacy Makes Patients Better Stewards of Their Own Health. Patients, parents, pregnant women, care-givers and others need to understand the importance of good oral health, oral hygiene fundamentals, diet and nutritional guidelines, the need for regular dental care and, in many cases, how to navigate the system to get dental care. • Patients Need a Dental Home. All patients should have an ongoing relationship with a dentist with whom they can

collaboratively determine preventive and restorative treatment appropriate to their needs and resources.

ACCESS IS A KEY TO GOOD ORAL HEALTH • Improving Oral Health in America Requires a Strong Public Health Infrastructure to Overcome Obstacles to Care. The current dental public health infrastructure is insufficient to address the needs of disadvantaged groups. Efforts to improve access to dental care require investment in the nation’s public health infrastructure. The ADA recognizes that community-based disease prevention programs must be expanded and barriers to personal oral health care eliminated, if we are to meet the needs of the population. • Reimbursement Matters. Increased access to care for people covered by government assisted dental programs depends on fair and adequate provider reimbursement rates. The vast majority of government programs are so seriously under-funded that dentists cannot recover the cost of materials used in providing care. • Improving Access in Underserved Areas Requires ExtraMarket Incentives. Federal, state and local governments must develop financial incentives, such as student loan forgiveness, tax credits or other subsidies, to encourage dentists to locate their offices in areas that cannot otherwise support private dental practice. • Patients with the Greatest Need Must be First in Line for Care. Underfunded government programs fail to provide minimally adequate care to all they purport to cover. Funding should be prioritized so that those with the greatest need and those who will most benefit from care are first in line. For example, people needing emergency care and children

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in dental demand in a universal coverage program, increasing covered benefits and expanding the population that has access to covered benefits would boost demand for services as well as wait times at dental offices. Secretary / Treasurer Dr. Jim Hall summarized a feeling of dismay among the call participants by stating that, “at the reimbursement rates discussed in the papers I don’t see how dentistry could survive.” The white paper’s projected costs for including dentistry in a universal coverage program, in 2008 dollars, appear at left. The figures have been rounded, and do not take into consideration what percentage of the population might actually access dental care. Other dentists wondered who exactly universal healthcare would help. Western

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District Trustee Dr. Robert Carpenter asked, “How many individuals does the ADA feel would actually access universal healthcare if it was available?” he asked. “Legally, no hospital can turn away an emergency care patient. Indigent children and families can access care via Medicaid or PeachCare, although with Georgia’s economic situation, those programs could face deep cuts next year. Persons over age 65 can turn to Medicare. These are not perfect solutions, but they are options. There are people who just will not go, or don’t want to go to the dentist, or for that matter a physician, regardless of accessibility. “I feel that dentistry does a good job of taking care of the population that seeks our care,” Dr. Carpenter continued. “Individuals need to make a choice as to

needing diagnostic and preventive care should take precedence over other underserved groups. • Cost-Effective Allocation of Limited Government Funds is Essential. The relentless upward spiral of health care spending heightens the fierce competition among policy priorities for public dollars. With very limited government resources, children, pregnant women, the vulnerable elderly and individuals with special needs should receive diagnostic, preventive and emergency care. Adult emergency care should also be covered. Limited government resources should allow for additional routine dental care coverage for all underserved populations as well as diagnostic and preventive for adults. With sufficient funding, complex or comprehensive care should also be covered. • The Government Must Fund Public Health Benefit Programs Adequately. Programs such as Medicaid and the State’s Children Health Insurance Program (SCHIP) must ensure that vulnerable children and adults with inadequate resources have access to essential oral health care. Programs such as Medicaid must cover dental benefits for adults. Children in low-income families who are not eligible for Medicaid must have access to essential oral health care through SCHIP. Eligibility should reflect regional differences in the cost of living and purchasing power.

WE MUST BUILD ON CURRENT SUCCESSES • Open Markets Ensure Competition and Innovation. The dental private practice delivery system, which operates almost entirely separate from its medical counterpart, serves the vast majority of Americans well. While a fully-functional public health infrastructure is essential, efforts to broaden access to care for people who currently are underserved would be best accomplished by bringing more people into the private practice system.

their priorities. Government can’t dictate morality or responsibility.”

GDA Members Encouraged to Voice Opinions The ADA resolution and debate over its conclusions are only the first steps of an evolving process. The ADA, and GDA Board of Trustees, will continue to address this issue based on the vote at the ADA level and any policies implemented at the state level or under a new presidential administration. If you would like to voice your opinion, please call the GDA office at (800) 432-4357 or (404) 636-7553, send a fax to (404) 633-3943, or email hall@gadental.org.

• Private Dental Benefits Work. Benefits should be administered by independent companies, selected in the open market. Experience in other countries has shown that a single-payer system would stifle access, innovation and reduce the quality of patient care. • Universal Dental Coverage Mandates Will Not Solve the Access to Care Problem. Developing federal and state government programs that address not only funding but also non-economic barriers to care are necessary. The great majority of Americans already have access to dental care, and millions can afford care without having dental benefits. The government can use tax policy to encourage small employers and individuals to purchase dental benefit plans in the private sector or develop cooperative purchasing alliances for the segment of the population with privatelyfunded care. • Fostering the Next Generation of Dentists Must be a Priority. Having a sufficient number of dentists to provide care to all who require it depends upon a number of critical factors, including sufficient government support of dental higher education, overcoming current faculty shortages, providing affordable student loan programs, advanced public health training and ensuring the financial viability of dental practices. • Patients Must Receive Care from a Properly Educated and Trained Oral Health Workforce. The U.S. dental delivery system owes much of its success to the team model, which includes dental hygienists and assistants working under the supervision of a licensed dentist. While many underserved communities might benefit from the addition of specially trained, culturally-prepared dental support personnel, appropriate education, training, and dentist supervision is essential to ensure quality dental care.

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GDA Remembers Dr. Michael Rainwater with Award of Merit Michael T. Rainwater, DMD, who passed away in 2006, was honored posthumously during the 2008 Georgia Dental Association (GDA) Annual Meeting with the Award of Merit. This award, the highest the GDA can bestow, was accepted by his widow Susan, with his two daughters, parents, brother, sister-in-law, and niece looking on. Reprinted below are the comments offered by GDA members Nelson Conger, DMD, and Ty Ivey, DDS, as they presented the award to Dr. Rainwater’s family and remembered this admired GDA Past President.

Dr. Nelson Conger Today, for the first time in the history of the GDA, we give our highest honor—the Award of Merit—posthumously. We honor and remember today the life of Michael Thomas Rainwater.

Dr. Rainwater graduated from Mercer University with honors in 1974. He received his DMD degree from the Medical College of Georgia (MCG) in 1977 and set up private practice in Riverdale soon afterward. Mike quickly established himself as a leader in organized dentistry. He became an awardwinning editor of our journal, Action. He became the first MCG graduate to be elected a GDA officer when he became editor, eventually becoming president in 2001. Not only was he a leader in the GDA House of Delegates, but he became a respected leader at the ADA as well, serving seven years on the ADA Delegation, including as chairman. His reputation and respect at that level culminated in his election as the ADA Fifth District Trustee. Dr. Rainwater received two GDA Presidential commendations, the distinguished service award from the Northern District, which renamed the award in his

honor, and was recognized by MCG with its own distinguished alumni award. He left many lasting footprints upon the GDA organization including the restructuring of the Executive Committee into the Board of Trustees. These are the obligatory highlights of Mike’s professional career. But as impressive as they are—and I significantly condensed them—they do not do justice to the person and the dentist that Mike was. When I think of Mike Rainwater, I’m reminded of the lines from Shakespeare that Robert Kennedy used in his eulogy of the President: “And when he shall die, Take him and cut him out in little stars, And he will make the face of heaven so fine, That all the world will be in love with night, And pay not worship to the garish sun.” This verse is appropriate, because it often seemed that we all wanted some part of Mike. And,

The family of Award of Merit posthumous honoree Dr. Michael Rainwater poses with a portrait of the GDA Past President during the GDA Annual Meeting. The portrait will hang in the new dental school building at the Medical College of Georgia. Shown left to right standing are Medical College of Georgia Dental Dean Dr. Connie Drisko, Mrs. Susan Rainwater, Dr. Rainwater’s daughters Cason and Kathryn Rainwater, and Dr. Rainwater’s brother David with his wife Mary and his daughter Beth. Seated are Dr. Rainwater’s parents Neal and Louise Rainwater.

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Dr. Ty Ivey

Dr. Donna Thomas Moses (r) presents the Award of Merit to Mrs. Susan Rainwater.

incredibly, he was able to accommodate us all. Certainly, he was a devoted husband and father to his family. He was faithful to his church. He was dedicated and responsive to his patients. And he gave unselfishly and repeatedly to his profession and especially to the GDA. At virtually every level of our association, his voice was one that was always respected and listened to. One of Mike’s unique talents was that he could literally take a nap during meetings but still was eloquent when it was appropriate. You would see him with his eyes closed and assume that he was asleep, but then he would rise up and make a pertinent observation that the rest of us had missed. Mike had a talent for giving perhaps unwelcomed but necessary advice with a wit that made the message softer but still perfectly clear. I remember once I called Mike for his thoughts about a presentation that I was scheduled to make before an ADA committee that was not likely to be especially friendly to me. Mike thought for a moment and then in that wonderful, laconic manner of his said, “Well Nelson, just don’t expect them to strew palm leaves in your path because you will be greatly disappointed.” So Mike had me prepared for a hostile reception but in such a humorous way that it relaxed me and made my task easier. Mike Rainwater truly had the capacity and intellect to be all things to all people— husband, father, church leader, skilled dentist, professional icon, colleague, and friend. No one, living or deceased, is more deserving. No one has earned it more.

Nelson has told you what Mike did. I am going to attempt to tell you who he was at least to me. Mike grew up in Macon about 2 or 3 miles as the crow flies from where I grew up. We both went to the same high school and graduated from Mercer University, albeit nine years apart. He was a student of politics. He remembered that I was involved with Macon’s first fluoridation referendum in 1970 and he even had a campaign button from D.T. Walton’s ill fated run for Bibb County’s commission in 1968. He was a young Republican when there were no old Republicans. Mike was a collector. So, he not only took note of those types of events, he had something to commemorate them. Susan, heaven help you for all of those collections. I first saw Mike at a GDA meeting. You remembered Mike. He was the big guy with the two cute kids. And he was the one who was always there. Mike was a family man and we can be grateful that he considered dentistry a part of his family. He loved Susan, he loved his two girls, he loved his parents, he loved his brother, he loved his house at Big Canoe, he loved his job, and he loved the involvement that allowed him to show his love in one way or another. Mike agreed to become the editor of Action following two award winning editors, Bob Gilbert and Richard Smith. He quickly established himself as one who walked in no man’s shadow. When Mike wrote an editorial, he had the facts, he knew the issue, and he expressed eloquently the doctrine of the last bastion of dentistry in this country, the Fifth Trustee District. He dealt with the issues and he wrote without fear of criticism. After serving as editor, Mike was approached to go through the GDA chairs. You have heard all of the accolades, but what was building here was Mike’s already broad base of understanding of the issues facing the dental profession today. He and I talked often. It is a guy thing, but he gave me a nickname, so I returned the favor. His nickname was Luke. As in Skywalker. I told him that he was in training. Mike was different from most people. His strong suit was listening. He listened before he spoke and when he spoke, he not only spoke to the issue, but he had a solution. It was little wonder, that after he had been GDA president and chaired his ADA Council that he was overwhelmingly tapped to become the Trustee of the Fifth

District. As we left Philadelphia where he was installed as Trustee, I gave Mike a light saber for his collection (he was now a Jedi Knight). It is not always easy for Jedis. At the Board of Trustees level he was viewed as the Trustee of the Fifth, a defender of the traditional values that had served dentistry and its patients through the years. But after the first year, even those from the dark side were starting to notice our Jedi. Mike Rainwater was, as I have said, the defender of the faith at the national level. In December 2006, when Mike was taken from us, I said at that time something that I have said many times since. His death altered the course of dentistry in our country. For you who never really knew him, I wish you had, for no one that you know was poised to help you and your profession more than he was. For the family who helped mold him, we thank you for your input. For two young ladies who lost their father, let the memories of his example carry you throughout your life. And to Susan, we love you just as we loved him. He fought for what was right, for his beliefs, and for all of us.

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President’s Commentary Continued from page 7

Charge: The Task Force will research and recommend strategies to increase the number of dentists who establish dental homes for toddlers and pre-K populations. The Task Force will also develop strategies to encourage appropriate fluoride varnish services. Research should include: • Identification of barriers that prevent dentists from providing dental care for this age population;

• Explore the types of specific continuing education geared toward treating this population and create a list of courses. Determine if there is a need for additional courses and if so, is there a specific focus. The Task Force should utilize the following resources in developing recommendations: • Proposal to provide care to nursing home patients through an insurance product; • Interview dentists who are currently pursuing projects that would provide dental services to nursing home patients;

• Explore the types of specific continuing education geared towards treating this population and create a list of courses. Determine if there is a need for additional courses and if so, is there a specific focus;

• Reports produced by the GDA Task Force to Study the Oral Health Status of Patients in Institutional Settings;

• Review the report from the GDA Task Force on Fluoride Varnish;

• Compile a list of dentists who currently do an extensive amount of care for nursing home patients and follow with interviews as appropriate;

• Review the previous meetings with the Georgia Academy of Pediatric Physicians concerning a physician based fluoride varnish program;

• ADA Oral Longevity resources;

• Review the Head Start Program to determine the level of dental services provided in Georgia and if fluoride varnish is an active part of this program.

• CO-AGE information;

• North Carolina Nursing Home Oral Health Training Manual;

• Report presented to the GDA Board of Trustees from Georgia Dental Hygienists’ Association representatives.

TASK FORCE ON ORAL HEALTH IN INSTITUTIONAL SETTINGS Chair: Dr. Celia Dunn (E) Members: Drs. Richard Liipfert (C), Alfred Peters (C), George Coletti (N), Jonathan Dubin (N), Kevin Hendler (N), Steve Roser (N), Mark Shurett (N), Claude Daniel (NW), Terry O’Shea (NW), Felix Maher (SE), and Jeff King (W) Officer Liaison: President Dr. Mark Ritz Staff Support: Courtney Layfield (layfield@gadental.org) Charge: The Task Force will: • Research and recommend strategies to improve the oral health of patients in institutional settings; • Identify barriers that discourage dentists from providing services in-house to nursing home patients and develop strategies that will assist dentists in overcoming these barriers; • Identify risks associated with general supervision of dental care in institutional settings and recommend appropriate alternatives; • Determine the cost and feasibility of distributing a comprehensive manual (such as developed by the North Carolina Dental Association) to train nursing home staff on how to care for patients’ oral health needs;

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alliance Alliance Hosts Low Country Boil for MCG Dental Students Debbie Torbush, Alliance Student Spouse Liaison

Perfect weather, great friends, delicious food, beautiful setting, and young people—what else could one ask for when hosting a party? The Alliance of the Georgia Dental Association (AGDA) recently hosted a Low Country Boil for the married MCG dental students at the home of Dean Connie and Dr. Dick Drisko in Augusta, Georgia. We were so fortunate to have the local assistance of Jacquelyn Whetzel, president of the MCG Dental Student/ Spouse Alliance (DSSA) and Donna Strom, Dean Drisko’s Administrative Assistant to make this a special evening. Nine AGDA members including Sherry Kendrick (AGDA President), Mary Percy (AGDA Past President), Rose Marie Dougherty (AGDA Dental Health Education Co-chair), Dr. Janine BetheaFreihaut (AGDA Legislative Chair), Shari Carter (national Alliance Reference Committee Chair), Gigi Kudyba (national Alliance DHE Chair), Nancy Ferguson, Susan Rainwater, and I travelled to Augusta for the weekend. We enhanced the catered dinner with appetizers, desserts, beverages, and decorated tables at the Drisko’s home (Dick is the AGDA Eastern Component Representative). All of the married dental students were invited with the goal of increasing the DSSA membership. The Georgia Alliance paid the DSSA dues for the new members, four of whom are men, and hope to continue growing the membership throughout this year and beyond. We were also pleased to host Dr. Paul Kudyba, who was teaching at MCG that day, Drs. Carole and Phil Hanes, and Dr. Eladio DeLeon and his wife Dottie who is going to serve as my

(L to r): Rose Marie Dougherty, Dr. Janine Bethea-Freihaut, Susan Rainwater, Mary Percy, Gigi Kudyba, Dean Connie Drisko, Debbie Torbush, Dr. Dick Drisko, Sherry Kendrick, Shari Carter, Nancy Ferguson, and Student Alliance President Jacquelyn Whetzel.

MCG Student / Spouse Liaison co-chair. The night was perfect as we sat around the Drisko’s pool and watched the ducks swim in the lake under the beautiful full moon. Saturday morning, Jacquelyn hosted the Alliance group (both we AGDA members and the DSSA members and their children) at her home for a “Brunch and Learn.” We presented the Wanda Wondersmile Puppet Show and the Dipper Dan Program (smokeless tobacco model), and then gave them a set of each for their group. This group of student dental spouses was so excited and I know

they will continue to promote their spouse and dentistry wherever they should settle (of course we want them to remain in Georgia!). After meeting so many wonderful dental students and their spouses, we all agreed that MCG accepts only the best. So, if you have an opportunity to go to LAW Day with the MCG students, mentor one of the students, or hire one of them when they graduate, that will help to keep the best in the State of Georgia.

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Do You Provide Credit to Your Patients?

New Federal Rules Require Dentists to Develop Written Identity Theft Prevention Program Melana Kopman McClatchey, GDA General Counsel

The Georgia Dental Association (GDA) has become aware that the Federal Trade Commission (FTC) in concert with several other federal agencies has passed a set of Red Flag regulations. These regulations require financial institutions and creditors to develop and implement written identity theft prevention programs as part of the Fair and Accurate Credit Transactions (FACT) Act of 2003. The programs must be in place by November 1, 2008, and must provide for the identification, detection, and response to patterns, practices, or specific activities—known as “red flags”— that could indicate identity theft. To assist our members, the following is information that will answer your questions about this new rule.

Must Dentists Comply with the Red Flag Rules? All creditors who maintain accounts for their customers or patients are subject to the rules. This includes dentists who extend credit to or arrange credit for their patients. Guidance from the FTC explains that by deferring payment—for example, sending a bill or establishing a post-treatment payment plan—a health care provider is considered a creditor under the rules. Thus, a dentist, or any health care provider, who extends credit and maintains a covered account is supposed to have a written identity theft prevention program in place by November 1, 2008. Under the regulations, the word “creditor” is defined as “any entity that

regularly extends, renews, or continues credit; any entity that regularly arranges for the extension, renewal, or continuation of credit; or any assignee of an original creditor who is involved in the decision to extend, renew, or continue credit. However, accepting credit cards as a form of payment does not in and of itself make an entity a creditor.” Since the definition of creditor excludes providers who simply accept credit cards as a form of payment, such providers who do not engage in any other activity that would make them creditors probably do not fall under these regulations. According to a statement the FTC made to the American Dental Association (ADA) as reported in the October 9, 2008, ADA News, “[h]ealth care providers can be the

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first to spot the red flags that signal the risk of identity theft, including suspicious activity indicating that identity thieves may be using stolen information like names, Social Security numbers, insurance information, account numbers, and birth dates to open new accounts or get medical services.”

How Do Dentists Comply with the Red Flag Rules? Dentists must develop a written program that identifies and detects the relevant

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warning signs—or “red flags”—of identity theft. The rules provide 26 examples of suspicious activity that could be considered red flags (see sidebar). The 26 possible red flags fall into five categories—alerts, notifications, or warnings from a consumer reporting agency; suspicious documents; suspicious personally identifying information, such as a suspicious address; unusual use of—or suspicious activity relating to—a covered account; and notices from customers, victims of identity theft, law enforcement authorities, or other businesses about possible identity

theft in connection with covered accounts. The program must also describe how a dental practice would respond to detected red flags to prevent and / or lessen the impact of identity theft, and detail how a practice plans to stay up-to-date on identity theft trends and update their program.

Identity Theft Continued on page 32

The FTC’s List of 26 Possible “Red Flag” Indicators Six agencies were involved in drafting the red flag rules: the Treasury Department’s Office of Thrift Supervision, Office of Comptroller of the Currency, Federal Deposit Insurance Corporation, Federal Trade Commission, National Credit Union Administration, and the Federal Reserve System. The

agencies came up with the following guidelines as examples of red flags (as summarized by www.bankrate.com). These possible red flags are not to be used as a complete checklist by a dental practice, but rather as a starting point in program development.

1) A fraud alert included with a consumer report.

11) Lack of correlation between Social Security number range and date of birth.

2) Notice of a credit freeze in response to a request for a consumer report.

12) Personal identifying information associated with known fraud activity.

3) A consumer reporting agency providing a notice of address discrepancy.

13) Suspicious addresses supplied, such as a mail drop or prison, or phone numbers associated with pagers or answering service.

4) Unusual credit activity, such as an increased number of accounts or inquiries. 5) Documents provided for identification appearing altered or forged. 6) Photograph on ID inconsistent with appearance of customer. 7) Information on ID inconsistent with information provided by person opening account. 8) Information on ID, such as signature, inconsistent with information on file at financial institution. 9) Application appearing forged or altered or destroyed and reassembled. 10) Information on ID not matching any address in the consumer report, Social Security number has not been issued or appears on the Social Security Administration’s Death Master File, a file of information associated with Social Security numbers of those who are deceased.

14) Social Security number provided matching that submitted by another person opening an account or other customers. 15) An address or phone number matching that supplied by a large number of applicants. 16) The person opening the account unable to supply identifying information in response to notification that the application is incomplete. 17) Personal information inconsistent with information already on file at financial institution or creditor.

20) Most of available credit used for cash advances, jewelry or electronics, plus customer fails to make first payment. 21) Drastic change in payment patterns, use of available credit or spending patterns. 22) An account that has been inactive for a lengthy time suddenly exhibiting unusual activity. 23) Mail sent to customer repeatedly returned as undeliverable despite ongoing transactions on active account. 24) Financial institution or creditor notified that customer is not receiving paper account statements. 25) Financial institution or creditor notified of unauthorized charges or transactions on customer’s account. 26) Financial institution or creditor notified that it has opened a fraudulent account for a person engaged in identity theft.

18) Person opening account or customer unable to correctly answer challenge questions. 19) Shortly after change of address, creditor receiving request for additional users of account.

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Identity Theft Continued from page 31 Another section of the rules specifically requires persons who obtain reports from consumer reporting agencies to be alert for address discrepancies in those reports. The program must be managed by the “board of directors,” or, if there is no board, by appropriate management. For a dental practice this means an appropriate staff member. Included in the program should be a provision which requires this staff member to periodically report to the dentist on compliance with and the effectiveness of the policies and procedures in place.

What Does a Dental Practice Policy Need to Look Like? The rules provide affected organizations and individuals the opportunity to design and implement a program that is appropriate to their size and complexity, as well as the nature of their operations. Guidelines issued by the FTC and the other federal agencies (visit www.ftc.gov/opa/2007/10/redflag.shtm

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for more information) should be helpful in assisting covered entities in designing their programs. According to the ADA’s Chief Legal Counsel Tamra S. Kempf as reported in the October 9, 2008 ADA News, “[m]any dentists have longstanding relationships with their patients and their families. For those types of practices, a written program with policies and procedures may simply require a staff person to identify an existing patient by sight, obtain proper identification when a new or unrecognized patient comes to the practice, verify billing or other credit information in the patient’s file, and take action where discrepancies are noted. These steps should go a long way toward complying with the rules.”

What Are the Penalties For Failing to Comply with the Red Flag Regulations?

may commence a civil action to recover a civil penalty in a federal district court. Penalties imposed by the FTC for violations of FACTA may not exceed $2,500 per violation. The GDA will keep our members informed as more detailed compliance guidance on the Red Flag rules becomes available. Do you have questions? Visit the FTC Web site at ftc.gov/opa/2007/10/ redflag.shtm to read the government’s information. You may also contact the author at mcclatchey@gadental.org or email the FTC at redflags@ftc.gov.

Please be aware that this article is for informational purposes only and is not intended to provide legal advice. Dentists must consult with their private attorneys for such advice.

The FTC provides oversight for creditors subject to these regulations. In the event of a knowing violation, which constitutes a pattern or practice of violations, the FTC

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classified ads DENTAL RELATED SERVICES

How GDA members can place classified ads AD FORM: Submit all ads on a GDA Classified Advertisement Form. To obtain a form, call Lisa Chandler at (800) 432-4357 or (404) 636-7553, or email chandler@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).

X-RAY SAFETY CERTIFICATION: Dental assistants. This convenient six-hour Windows CD-ROM has certified hundreds of x-ray machine operators and complies with Georgia Law regarding x-raying patients. Send $139.99 per registrant with name(s) to: Dr. Rick Waters, 385 Pinewood Circle, Athens, GA 30606. For faster UPS delivery, securely order online at: www.acteva.com/go/laser.

EQUIPMENT FOR SALE / LEASE Equipment for Sale: Adec Chairs, Adec Cabinets, 12 O’Clock cabinets all in excellent condition. TLC Lighting Center with large track. Call (678) 474-9345. 12 O’Clock cabinets are designed to hold keyboard, computer and monitor. Email questions to xytek@bellsouth.net. For Sale: 2003 model Biolase, used infrequently, $4500. Also Kavo Diagnodent Classic, extra probes $400. Contact Steve at sdsdds17@bellsouth.net.

Entire Dental Office for Sale: Call before talking to dealer! Vast amount usable materials / supplies / even more items now catalogued— must see to believe! Dr Adec dental unit cart, Apollo by Midmark compressor (less than 1 years’ use), Thermafil / other endodontic supplies, Analytic Technologies / Kerr pulp testers, Whip-Mix articulator, Adec tub / tray system, 2 SS White Spacemaker x-ray units w / one control unit, High Impact Marketing-photo atlases of cosmetic / restorative dentistry along with Smile Gallery I, Dentsply / Rnn amalgamator, Patterson ultrasonic cleaner (brand new), Sharp Z70 copier, Royal 515 programmable typewriter, temporary crown kits, lateral file cabinets, disposables, instruments, reception room / office furniture. Bring assistant / front desk person to view items! Excellent condition. From upscale Atlanta practice. Serious inquiries only please! Call (678) 525-3878 or (770) 850-1802.

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.

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POSITIONS AVAILABLE Endodontist needed 1 - 1 1/2 days per week, Smyrna / Vinings area. Days negotiable. To discuss this position call Ginger at (770) 435-5450 or (770) 435-4240. After more than thirty-five years of service to the Gilmer County area, Dr. George M. Talbot Jr. is retiring. This creates an excellent opportunity for another dentist to join our practice. We are a high quality, fee for service multi-doctor practice, with a state of the art facility overlooking a mountain river and park. Associates wanting to buy into the practice are welcome. Please email CVs to talbotdental@ ellijay.com or fax to (706) 635-5879. Check out our web page at www.talbotdental.com or contact Jo Lynn Long, (706) 636-5878, for more information. Attention: Left handed dentists! Part-time associate needed to extend office hours. Evenings, Fridays, and Saturdays. Excellent clinical experience for the right practitioner. Long term buy out possible. Must have interest in implant surgery, conscious sedation, and oral rehabilitation. Atlanta, GA. (770) 432-8516. Experienced general dentist needed for full time position in the Buford area. Excellent location in fast growing area. Great opportunity. Call (770) 962-0515 or fax CV to (770) 962-1244.

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Associate Dentist position available for a family and cosmetic dental practice located in the metro Atlanta area. Large patient base, new-build out, state-of-the-art facility, exceptional support staff. This is your opportunity for career-high income. Please fax resumes to (770) 944-0343. Tired of associating w/no ownership potential? Don’t want a “start-up” in these uncertain economic conditions? We offer “buy-in” opportunities for GPs & specialists! Real income production from an existing practice w / 100% financing available! Email us @ recruitdds1@yahoo.com. Kool Smiles currently has opportunities available for FT general and pediatric dentists in Macon, Valdosta, Dalton, and Columbus. Our offices are brand new and equipped with state of the art technology such as digital x-rays and electronic dental records. Hands on training provided by pediatric dentists! Kool Smiles offers: $100-120K base compensation for new graduates (based on 32 or 40 hrs work week), experienced dentists’ salary is negotiable. Kool Smiles now offers a company matched wealth management program—earning you over $1 Million during the course of your career at Kool Smiles! We also offer bonus potential of up to $70K, health insurance, dental insurance, paid malpractice insurance, paid vacation, paid holidays, continuing education,

paid long term disability / short term disability, and much more! The ideal dentist will enjoy working with kids. For a fun and rewarding place to work, please visit our Web site at http://www.koolsmilespc.com/careers/dentists.html. For details regarding any specific geographic area of interest feel free to contact Shone DuRante at (770) 916-5043. Dentist Opportunities—Southern Crescent Personnel has a number of positions immediately available throughout the metro Atlanta area…full-time, part-time, Locum tenens…corporations and private practices. Call to discuss benefits and specifics of each opening. Great earning potential. Contact Susan Monroe at smonroe@scp-jobs.com or (770) 968-4602. Please visit us at www.scp-jobs.com. Atlanta, Augusta, & Suburbs—equity opportunities for purchase or associate leading to purchase. 100% financing, no out-of-pocket expense. Earn a nice income from day one. Contact Dr. Steve Katz of Paragon Dental Transitions at (706) 851-5465 or skatz@paragon.us.com.

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CLASSIFIEDS Continued from page 35 East Metro Atlanta—Associate Dentist. Established dynamic practice offers a unique opportunity for motivated professionals. No empty chairs…No insurance claim problems…With career high income potential. New graduates welcome…No debt and no initial practice setup. Contact Tina Titshaw at tina@myrockdale.com or call (678) 413-8130 or fax resume to (770) 760-1375.

POSITIONS WANTED / SEEKING EMPLOYMENT / WANT TO BUY Female dentist seeks associate position in Atlanta area. I have eleven years of experience and recently relocated from the northeast. I enjoy adult dentistry with emphasis on cosmetic and implant dentistry. Please contact Neda at (508) 380-0036 or email at Nedar97@yahoo.com. 2003 MCG Grad, 4 years’ private practice experience plus 1 year hospital residency seeks to own general practice in Atlanta. Not in Midtown, out of respect for mentor. Experience in restorative, endo, implant placement, thirds EXT, grafting, IV sedation, esthetics. Buy your practice? Locum / PT hire while starting my practice? Where do you fit into the puzzle? Charles Poole, DMD (404) 735-3233 or cwpooledmd@gmail.com.

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PRACTICES / SPACE / LOTS FOR SALE / LEASE / SHARE

Professional office located in a high profile area of Valdosta, GA. Designed for General Practice and Orthodontics. May be easily modified to satisfy requirements of any specialty. (229) 251-0099.

SANDERSVILLE, GEORGIA—PRACTICE FOR SALE. Free standing building with 4 fully equipped operatories. Beautiful, efficient T.H.E. design. Priced below Southeast Transitions appraisal. Owner financing available. Ideal start up practice or satellite / specialist opportunity. Walk into a well-established practice of 27 years in a nice family-oriented small town. Owner is retiring for other business interests. (478) 5521230 Day; (478) 552-2289 Evening.

Gainesville – Associate Buy-Out. This is an excellent opportunity to acquire a great practice. This practice has been in Gainesville for more than 20 years. 6 ops, on track to gross over $1M in 2008. There are plenty of patients for the incoming buyer. Real Estate also for sale. For more information, please call (678) 482-7305 or email pete@southeasttransitions.com.

Dental Practice / Office Condo, Jonesboro, GA. Southern Regional Hospital area. Attractive office space, 1100 sq. ft., 3 operatories plumbed / 2 equipped, large lab, and private office with shower. Pay yourself rent. Move right in. Buy practice or real estate only. Close to interstate and short walk to public transportation. Contact Dean Cox (678) 584-4477.

Buford – All FFS practice in high traffic area. This practice has collected an average of $500K for the last 3 years. The practice has 3 ops (2 equipped) and is 5 years young. If you are thinking of starting up in this area you should see this practice. For more information please call (678) 482-7305 or email pete@southeasttransitions.com.

Dental office for sale or lease. Located in Lake Park, GA., this 1500 sq. ft. office includes four fully equipped rooms, x-ray units, orthopanograph, furniture, fixtures, and more. Only five miles from the Florida line and one mile east of I-75, this area has enjoyed rapid economic growth. After 28 years in a thriving practice, present owner retired June 2008. Call (229) 244-3836 or (229) 269-5881.

Oral Surgery North Metro Atlanta. This practice collected $500K in 2007, all FFS. This 3 operatory facility is in a great location. The seller would like to work for the buyer to transition the staff and patients to the new owner. For more information please call (678) 482-7305 or email pete@southeasttransitions.com..

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PRACTICES FOR SALE—for more information, call Dr. Earl Douglas, ADS South, (770) 664-1982: ATLANTA #8557: Gross $770,141; 4 days 3 operatories; 1,131 sq. ft. office space. CARROLL COUNTY #8428: Gross $609,663; 4 days 4 operatories; 2,000 sq. ft. office space. Additional plumbed but unequipped operatory. DULUTH OFFICE SPACE & EQUIPMENT FOR SALE #8393: Five (open-bay) operatory office with a Planmeca pan/ceph. Equipment will include 4 chairs, 5 delivery units, 10 computers, and misc. office equipment. LILBURN #8516: Gross $1.07 Million; 5 days 8 operatories; 3,000 sq. ft. office space. RIVERDALE #8517: Gross $836,285; 4 days 8 operatories; 4,030 sq. ft. office space. Two additional plumbed but unequipped operatories. SOUTHEASTERN GEORGIA #8172: Gross $796,640; 4 days 5 operatories; 1,732 sq. ft. office space. ASSOCIATE POSITIONS AVAILABLE, contact Vikki Howard (910) 523-1949. Two operatory practice for sale in North Georgia Mountains. Office only 5 years old. Beautiful, booming town along main interstate in North Georgia. Only working two days a week and can handle more but don’t have time, need to sell. Call (706) 231-6584 or email northgeorgiadentist@gmail.com. LEASE: 2 Suites Available Immediately in beautifully landscaped professional building; Kennesaw, near KSU, just off I-75 and I-575. Oral Surgery Suite—1945 sq. ft., 3 surgical

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operatories, 1 exam / post-op room, recovery area. Orthodontic or Pediatric Dental Suite—1695 sq. ft. open bay area plumbed for 4 chairs, plus one private treatment room. Available for lease in April 2009: Endodontic Suite—1530 sq. ft. 4 treatment rooms. Well established Periodontist and General Dentist occupy adjoining offices. Contact Joyce @ (770) 424-9292. Dental building and equipment for sale as is by recently retired owner. Same location, 35 years, free standing brick, large lab (exodontia, dentures, partials, c/b), busy main road, corner lot. Approximately 6 blocks to Phoebe Putney Hospital and Palmyra Hospital. Good to like-new equipment. Asking $185,000 owner financing. Dr. Norm Bevan, 128 Westfield Rd., Leesburg, Ga. 31763 (229) 432-0448. Orthodontic, periodontic, oral surgery or endodontic space available in beautiful freestanding building in Smyrna / Vinings area. Already built out with some remaining equipment and furniture. Great opportunity for right person. Call Steve (770) 778-5764 or (770) 425-8805. Excellent opportunity for a general dentist or specialist to rent / buy 3000-6000 sq. ft. of space in a Class A building just off I-85 and Clairmont Road. Office building is located at a traffic light facing Century Center. Also 2000 sq. ft. of finished space available in Cartersville and Hiram. Call (678) 640-5466 or (770) 590-4884.

Many Great Opportunities Now Available. Roswell, Stone Mountain, Cumming, McDonough, Dalton, Tucker. Call Southeast Transitions at (678) 482-7305 or email pete@southeasttransitions.com or visit www.southeasttransitions.com for more information on these and other opportunities. Available: DULUTH: Grossing $345,000. Nice office, 4 operatories. DUNWOODY: Grossing $335,000. FFS; good location. DUNWOODY: Grossing $795,000. FFS practice 30 years. ROSWELL MERGER: FFS grossing $580,000. ROME: Grossing $600,000, 6 operatories, PPO. STONE MOUNTAIN: $1.18 million gross. Cash flow $400,000+. SOUTH ATLANTA: Grossing $1.3 million, 7 operatories. ASSOCIATESHIPS: Lake Oconee, LaGrange. Contact Richane Swedenburg, New South Dental Transitions: (770) 630-0436, www.newsouthdental.com, info@newsouthdental.com.

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Temporary Dentists Available for Fill In Work 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 Available on a Daily Basis: Can cover Hygiene and Emergencies ($65/hour) OR Hygiene, Emergencies, and Simple Restorative ($80/hour). Limited to locations within an hour’s drive from Atlanta. Sometimes available on the same day if called early enough. Licensed, Insured, and DEA Registered. Email atlanta_dentist@yahoo.com or call (770) 262-7898. Locum tenens: Filling the hole and bridging the gap. So you can be out, I will be in. I have a Georgia license, DEA number, and insurance. Benefit from 37 years of general practice experience. Call B. Reighard, DDS, at (404) 786-0229 or (912) 634-6304.

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Inside This Issue • GDA Invites Non-Member Dentists to Join; Enjoy Member Benefits

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

• New Federal Rules Require Dentists to Develop Written ID Theft Prevention Program DATED MATERIAL PLEASE DELIVER AS SOON AS POSSIBLE

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