MDDS Articulator Volume 16 Issue 5

ARTICULATOR SUMMER MDDS

Connections for Metro Denver’s Dental Profession

Summer 2012 Volume 16, Issue 5

EDITION

HOT TOPICS - ACCESS TO CARE

- WHAT'S HAPPENING IN TODAY'S DENTAL MARKETPLACE? Reflections: Access to Care Shuffle 6 Access to Care- Your Role and Mine 8 What's Happening In Today's Dental Marketplace? 12 Diagnosis and Management of Obstructive Sleep Apnea (OSA) 16 Invest in Your First Impression 20 Financial Management - Rules of Thumb

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SAVE THE DATE & SIGN UP EARLY

Nov. 16-17, 2012 8:00am - 4:00pm

Metropolitan Denver Dental Society 3690 S. Yosemite St. Denver, CO 80237

Metro Denver Dental Society & Dr. Barry Glassman Present:

“Dr. Glassman is a great speaker.

I left his lecture able to incorporate sleep medicine into my practice and provide a fantastic service for my patients. I highly recommend taking his course.”

- Dr. Mitch Friedman

Comprehensive Dental Sleep Medicine and Oral Appliance Therapy

Through this course you will learn – This unique exciting two day advanced course in dental sleep medicine will review the basic concepts of sleep medicine and proceed in-depth into critical areas required to fully and confidently implement dental sleep medicine into a dental practice: 1. How to identify potential patients in your practice and increase referral base

Barry Glassman, DMD, is a Diplomate of the Academy of Dental Sleep Medicine and is Board Certified in Dental Sleep Medicine. We are very fortunate, once again, to have him join us and take our dentists one step further into oral sleep medicine and appliances!

2. Managing all potential muscle, joint, and occlusal untoward effects of oral appliance therapy 3. A Step-by-Step guide to appliance therapy and the use of home studies in guiding titration and in outcome measurement 4. Case presentations of more complex cases and an opportunity to bring your cases to present and/or discuss 5. Bruxism as a movement disorder of sleep and the relationship between pain and sleep as well as bruxism’s role in dental health 6. A comprehensive literature review No prerequisite required to take this class

Register today at mddsdentist.com or call (303) 488-9700

ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

Volume 16, Issue 5

MDDS Articulator Editor Carrie Seabury, DDS

Director of Marketing and Communications Jason Mauterer Creative Manager & Managing Editor Chris Nelson Communications Committee Anil Idiculla, DMD, Chair Michael Diorio, DDS Karen Franz, DDS Kelly Freeman, DDS Brandon Hall, DDS Kyle Klepacki, DDS Jeremy Kott, DDS Maria Juliana DiPasquale, DMD Nicholas Poulos, DDS Maureen Roach, DMD MDDS Executive Committee President D. Diane Fuller, DDS President-Elect Mitchell N. Friedman, DDS Treasurer Larry Weddle, DMD Secretary Ian Paisley, DDS

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Inside This Issue:

A Letter from the President .............4

Event Calendar .............................18

Access to Care Shuffle ....................6

Invest in Your First Impression........20

Access to Care, Your Role and Mine ..8

Non-Profit News ...........................22

Member Matters ...........................10

Education ......................................25

What's Happening in Today's

Rules of Thumb .............................26

Marketplace? ...............................12 Clearing up myths surrounding sales/use Annual Meeting Wrap-up .............14

taxes for dentists located in Colorado ..26

Diagnosis and Management of

MDDS Spotlight.............................28

Obstructive Sleep Apnea (OSA) ....16

Executive Director Elizabeth Price, MBA, CDE, CAE Printing Dilley Printing The Articulator is published bi-monthly by the Metropolitan Denver Dental Society and distributed to MDDS members as a direct benefit of membership.

Editorial Policy All statements of opinion and of supposed fact are published under the authority of the authors, including editorials, letters and book reviews.

They are not to be accepted as the views and/or opinions of the MDDS. The Articulator encourages letters to the editor, but reserves the right to edit and publish under the discretion of the editor.

Advertising Policy MDDS reserves the right, in its sole discretion, to accept or reject advertising in its publications for any reasons including, but not limited to, materials which are offensive, defamatory or contrary to the best interests of MDDS. Advertiser represents and warrants the advertising is original; it does not infringe the copyright, trademark, service mark or proprietary rights of any other person; it does not invade the privacy rights of any person; and it is free from any libel, libelous or defamatory material. Advertiser agrees to indemnify and hold MDDS harmless from and against any breach of this warranty as well as any damages, expenses or costs (including attorney’s fees) arising from any claims of third parties.

Inquiries may be addressed to: Metropolitan Denver Dental Society 3690 S. Yosemite St., Suite 200 Denver, CO 80237-1827 Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com ©2011 Metropolitan Denver Dental Society

Member Publication

Summer 2012

Classifieds.....................................30

Get To Know Your MDDS Staff

Chris Nelson- Creative Manager, MDDS Managing Editor For this issue we would like to introduce you to Chris Nelson. Chris, or CT, joined MDDS in December of 2010 to take the position of Creative Manager – just in time for a trial-by-fire lesson in putting on the Rocky Mountain Dental Convention. CT is originally from Nebraska and moved to Denver in 2002. He is a true Cornhusker, having received a BA in Graphic Design/Art History from the University of Nebraska Lincoln.

First and foremost, CT is an incredibly talented artist. His genre is New Contemporary Painting, and he currently has collections in the United States, Southeast Asia, Europe, Turkey and the Middle East. In 2007, he held a solo exhibition in Kuwait City, Kuwait, and he currently has a solo showing this summer at the Knew Conscience Gallery here in Denver.

CT is the life-blood of the look and feel of MDDS and the RMDC. Since he designs all of

our marketing materials, he is able to maintain consistency in our look and message across the board. CT also played a key role in the complete rebranding of the 2012 Rocky Mountain Dental Convention, a campaign that went on to win the prestigious Gold Key Award from the Business Marketing Association of Colorado (for more about this MDDS achievement, check out Bragging Rights on page 28). This was the first time this award had been bestowed upon an association in its first year of submission.

Besides being a talented artist, CT says he likes kittens and collects vintage screwdrivers. He enjoys long walks in haunted sewer systems and one day intends to be able to predict ant trails using advanced mathematical equations. Did we mention his unique sense of humor? He’s a great fit in our light-hearted team and Board.

MDDS is incredibly proud of CT and delighted he is part of our family and the newest managing editor of the Articulator. As we move into the future, and embrace the “new” that is ahead of us, CT is sure to help us continue to be the asset we strive to be for the dentists of metro Denver.

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A LETTER FROM OUR PRESIDENT A Letter From the President

By D. Diane Fuller, DDS

I

n taking on the responsibilities of the presidency of the Metro Denver Dental Society, there are two aspects of my new leadership position that stretch me out of my comfort zone. The presidency requires that I be not only a master of ceremonies, but also a master of the pen. Building my courage up to give my speech for the MDDS Annual Meeting took many rehearsals and re-writes.

It also required tapping into the strength and humility I developed during my dental school days when I was one of only a handful of female students surviving in a male dominated field. So, I’m finally over the trauma of my speech for our meeting at the Brown Palace (the sun has come out, the birds are singing, life is good) and now I face my next challenge: the Reflections of the MDDS President.

I actually started out as Journalism major.

I even had a scholarship. Someone thought I was OK at it. My high school English teacher (unbeknownst to me) was still reading my essay on “My Most Embarrassing Moment” to her classes fifteen years later (my cousin happened to be in her class). And no, I’m not going to share it, even though to this day it still stands as my most embarrassing moment. I don't know if she kept reading it because it was well written or because it was so hilarious.

So putting pen to paper, (literally I don’t do computer – well, a little) a few thoughts about our society come to mind. I had the privilege to attend the CDA Component Society Leadership Workshop. I thought I would be bored, but it was dynamic, exciting, informative and helpful. I hope CDA does it every year. Over and over when we were sharing about encouraging and increasing membership, the theme of the one to one

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contact couldn’t be emphasized enough.

One lady dentist from a smaller component society (she was hilarious) said she literally went door to door inviting dentists personally.

She said one of her tactics was to give them responsibility for whatever event it was and used the example of asking them to “bring the chips” for a picnic event. When finally everyone stopped laughing, she said “really, giving them a responsibility makes it harder for them not to show up” (guilt them if you will).

The 2012-13 MDDS Executive Committee: Dr. Larry Weddle, Treasurer, Dr. Diane Fuller, President, Dr. Mitchell Friedman, President-elect, and Dr. Ian Paisley, Secretary

When we broke into discussion groups, there was a very quiet person to my right. At the very end of the workshop, it occurred to me to put some of the input into action. I tend to be an introvert and don’t really do well talking to someone I don’t know. But I turned to him and asked where he practiced. It turns out he was a third year dental student and a very nice person. He then asked me what my leadership position was for MDDS…”yeah, so much for fame”.

Really, this one to one contact cannot be emphasized enough. I’ll bet every one of you can remember the dentist who brought you into membership and hopefully a more satisfying professional experience. I hope each of you will make a mental note and commitment to go over and talk to that lonely dentist who just doesn’t know anyone yet, at a meeting, or to walk down the hall and

invite that neighbor dentist to a continuing ed lecture or lunch. Let’s all get out of our comfort zones and just DO IT. There are a lot of really nice colleagues out there whom we just don’t know yet.

The other thing the workshop made me realize was how lucky we, as MDDS, are to have all the resources we do. The variety and proximity of fellow dentists enriches our professional experience immensely. We are also blessed to have the continuity with and information of our state association. CDA is invaluable in keeping us apprised on many fronts, but especially the state and national political scene, one to which we all need to pay attention.

But very seriously, I am so honored to be MDDS President this year. I will do my utmost to promote and perhaps even better our society. It is my fervent hope that our new continuing ed center will accomplish just that.

I am blessed to have the most energetic and accomplished staff I have ever witnessed at MDDS; and the most intelligent, dynamic and thoughtful Executive Board and Directors. I am honored to follow Dr. Chuck Danna in taking on the presidency of the Metro Denver Dental Society. Dr. Danna has been one of the most thoughtful and kind leaders of MDDS that I have ever known. His gentle sense of humor has gotten us through many difficult situations as a Board . He will be sorely missed.

I’m just glad that his skills and knowledge will continue to be utilized in other areas of MDDS. I hope all you, our fellow colleagues, will join us in promoting a very good year for our society and our profession.

“OH! And one more thing – don’t forget the chips!”

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MDDS NIGHT at the Colorado Rockies vs. the Miami Marlins

Saturday, August 18, 2012 Catered BBQ starts at 4:30pm Game begins at 6:10pm

Bring your Friends and Family to watch the Colorado Rockies beat the Miami Marlins!

Hosted by:

$50 dollars per person REGISTER ONLINE at mddsdentist.com. If you have any questions contact Debra Arneson, Associate Director of Convention & Events, at darneson@mddsdentist.com or call (303) 488-9700.

Battista Design Group, P.C. Photos featuring the office of George F. Beilby, DDS

REFLECTIONS Access to Care Shuffle

By Carrie Seabury, DDS

T

here are epic moments throughout history that define our society. For my fellow generation X’ers there are three critical events that shaped every one of us. The first event was the 1989 first regular episode of The Simpsons ever aired on TV. Can you even fathom what kind of a person you would have become if this series had never graced our TV sets with its wit, charm and quotable moments? Another event that changed our X’ers forever is the epic disaster of the Cabbage Patch Kid Christmas shortage in 1983. Did you cry yourself to sleep on your wee little pillow when you were told that Santa was fresh out of your dream doll? How about the most influential event in our lives? Do you remember where you were when you viewed the historical moment that changed our lives forever? Of course, I am referring to the 1985 Chicago Bears Superbowl Shuffle. When it aired on TV, there was a total absence of cheap network tricks designed to draw us in.

No one was suspended on a zip line, careening into the crowd, there were no rings of fire, dangerous animals with large teeth, and no wardrobe malfunctions. The 1985 Bears were simply a group of guys shuffling on down, doin' it for you.

The Superbowl Shuffle is an enigma to me. Ever since that fateful day in 1985 I find myself thinking

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of it fortnightly. Why was it so successful? Why do we all remember being stuck to our TV screens watching the most horrifyingly wonderful performance of our generation’s history unfold? Why does my neighbor still know every single lyric 26 years later? I think the most rivoting, mind-blowing thing about the Superbowl Shuffle was that for the most part, these NFL players had absolutely no business getting in front of a mic. They couldn’t dance,

“If you care to take a moment and contemplate the true meaning behind the Shuffle, it may actually bring a tear to your eye.” they couldn’t rap, and to be brutally honest, their Shufflin’ skillz would make LMFAO throw up in their mouths a little. **Disclaimer**All of the above harsh judgments do not apply to William Perry. Duh. My theory of why the Shuffle was so successful is that it was so unexpected. We had never seen anything like it. When you really look at the lyrics, it is a tremendously humble group of men stating why they are so passionate about their profession.

These gentlemen came together as a unified group to tell the world why they will be victorious. If you care to take a moment and contemplate the true meaning behind the Shuffle,

it may actually bring a tear to your eye. I am familiar with the rule that there is no crying in football so I warn you, you should only endeavor to do this whilst holding a pint of Ben & Jerry’s Chunky Monkey with Steel Magnolias playing in the background so you can blame your tears on Shelby’s untimely death.

Colorado’s access to care problem is begging for a similar approach. Just like the Chicago Bears did, we need to do something completely different than what has been attempted before. I cringe a little when I hear about the potential solution for a mid-level provider. I feel like we have been down this road twice before to no avail. Sadly, inventing the independent hygienist and the expanded duties dental assistant has not helped to even come close to controlling the most rampant, chronic disease that our state faces.

In fact, we seem to be losing ground.

Just like the Bears players, each of our MDDS dentists brings a different talent to the field. There are thousands of Colorado dentists quietly doing what is right to help our Coloradoans gain access to care.

For centuries, dentists have taken partial or no payment for services rendered. Dentists have traded their expertise for farm livestock, jams, and items they will never use in order to help their patients gain dental care while maintaining their dignity. We don’t brag about these gifts. We don’t want any public

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acknowledgement of our generosity – we give these oral health gifts every day because we feel it is our duty. We are a bunch of tender-hearted, giving people. We do what we

“It may be time to get a little loud.” can everyday to help our Coloradoans achieve high levels of oral health. These days, however, our quiet, humble approach does not seem like it is enough. It may be time to get a little loud.

I am not suggesting we develop a new and improved Superbowl Dental Shuffle to take to the media. (Although it has been over two decades and I’m hoping someone fills that void soon.) There is no need to embarrass ourselves with cheesy rap lyrics and attempts at being cool. We aren’t by nature very cool (unless you’re Dr. Diorio, the baddest rapping dentist in the biz and the exception to that stereotype) but we sure are nice. We need to find a way to spread our nice throughout the state and let people know all the nice things we do for our

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patients.

The Superbowl Shuffle reminds us of the things we are forgetting to do while battling our access to care state issues. We are forgetting to present ourselves as a unified front. We are forgetting to dig into our talent pool and expand the use of people already trained and licensed to deliver high quality oral care. We are forgetting the effectiveness of creative, out-of-the-box solutions that capture the attention of our providers, our patients, and our state legislators. The Superbowl Shuffle can teach us so much. All we need to do is stop and listen.

Each one of us has a duty as a practitioner in this beautiful state to step outside of our cottage industry dental practice and become part of the state’s solution. There are so many wonderful ideas on how to participate and so many ideas we haven’t thought of yet. Now is a critical time to put some thought into how you can help.

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ACCESS TO CARE

YOUR ROLE AND MINE

By Kyle Klepacki, DDS

W

hen I was asked to write an article on access to care my first thought was, “Hummm...I am still just getting settled in here. I am not sure that I am the most appropriate person to ask.” I have a decent grasp of what prevents kids from getting care on a national level and I treated almost 100% medicaid recipient children while in Milwaukee, but as for the issues facing the Denver metro…good question! My second thought was, “I have been in Denver for almost two years now. I need to get more involved! This is just the right way to get the ball rolling.” After feeling guilty for a few minutes, I realized that I do more than I originally gave myself credit for. While the offices I practice at

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do not bill Medicaid, the owning doctors and I are involved in some creative programs that provide free care for kids in need.

As it turns out, there seem to be many MDDS dentists who are breaking the mold when it comes to giving back. Here is some inspiration for anyone who wants to help.

IT CAN BE SIMPLE! That being said, hold on to your pocket protectors, let’s start with research. I know…by default, research is not simple but… let’s make it simple. In this case, there are so many articles addressing the access to care issues that I was completely overwhelmed when I started looking for any article that even Articulator

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FEATURED STORY remotely addressed the issue in a general manner. For example, the AAPD manual lists literally hundreds of research references in more than half a dozen “Oral Health Policies” each of which focuses on a specific topic related to access to care. When broken down, all point to what I consider two main areas of deficiency.

1. Dentists across the nation site low reimbursement rates and broken appointments as major concerns with accepting Medicaid.

2. Whether it is lack of motivation, education, location, time, or transportation, patients and parents of patients with the greatest need for care often don’t seek that care in an appropriate manner.

Obviously, the solutions to these problems on a national level are not simple and Denver is not exempt from the same issues that plague most metropolitan areas, but making a difference does not need to be difficult. If you want to help keep it simple, get creative, and keep in mind that no one expects you to correct the entire problem! If you help out even a small number of people, it means a lot to each of them and especially to their parents (if they are kids). Here are some examples of how local dentists are using their creativity to serve the underprivileged just as much as they are using their clinical skills.

Dr. Kevin Theroux paired up free comprehensive dental care with community service through his Smiles for a Lifetime (S4L) Foundation chapter. The idea is simple. The children of S4L receive dental care from a group of local private practice

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dentists (including orthodontic care from Dr. Theroux) and in return they are required to create and complete a self-directed 40 hour community service project as part of the S4L “pay-it-forward” program. I have had the privilege of working with a handful of these children and I can wholeheartedly say that each of them is motivated, polite, and respectful.

Not into spending hours upon hours to establish a non-profit organization?

Try something more straight forward.

Sweetpea Children’s Dentistry, the pediatric practice of Dr. Beth Nielsen,

“If you help out even a small number of people, it means a lot to each of them and especially to their parents (if they are kids).” provides free care for the children of the families at the Denver Seminary.

Again, the idea is simple. Dr. Nielsen recognized a group of kids who were not adequately provided for (Denver Seminary families often face financial difficulties and language barriers), so she decided to help.

Where do your talents lie? How can you help?

Money always helps…and I am not talking about a personal cash donation. Many dentists may not have the time or knowledge to organize a significant fundraising event, however, most all of us either know someone or have someone on staff who does. The first annual “Friday Night Bites,” was hosted this winter by Dr. Anil Idiculla who utilized his staff, multiple Denver businesses, and many of his local

dentist friends to raise money that benefited the Colorado Orthodontic Foundation, which provides affordable orthodontic treatment and education to as many financially challenged children and families as possible.

Not only did it make for an enjoyable evening, but it also the raised over $15,000!

If you want to know just how easy it can be to get started, here you go.

It took me exactly two e-mails to become a specialty provider for KIND (Kids In Need of Dentistry). Now I am on their list of pediatric dentists who will take on pediatric cases that are not ideal for their clinics. In addition to KIND, there are multiple programs in Colorado such as Colorado Mission of Mercy and Give Kids a Smile that make participation easy.

They hold events throughout the year that require little more then a one day commitment and in most cases getting started takes little effort.

Most of us are aware of the previously mentioned “mainstream” organizations, but if you are looking for something a little more unique, the MDDS website lists multiple other ways to get involved. In addition, it provides patients with info on clinics and organizations that work with various forms of insurance/state aid.

Although the access to care issues facing our community and the rest of the nation will never be completely resolved, each of us has a role to play in improving the lives of the less fortunate. Simple ideas that help out even a small number of patients do make an impact. If you play to your strengths and keep it simple, giving back should be enjoyable.

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MEMBER MATTERS MDDS High Tea @ The Brown Palace– April 28, 2012 The first MDDS Bi-annual Women’s Mixer held at the historic Brown Palace featured High Tea and a tower of girl power! With over 60 attendees, women dentists from all over Denver came together for some much-needed networking and camaraderie. This event was supported by a grant from the ADA Membership Program for Growth and sponsored by COPIC.

Drs. Sonya Villarreal, Dinorah Moya Riley and Olinga Hargreaves enjoying their time at the High Tea.

MDDS President Dr. Diane Fuller and Executive Director Elizabeth Price are just a few of our ladies in leadership at MDDS.

MDDS Crawfish Boil – May 12, 2012

The first Annual MDDS Crawfish Boil held at the 12 Mile House Picnic Area of the Cherry Creek State Park was a delicious event! There was music by Tony Trahan and the BlueKrewe, dancing, games, smores, and of course, a slew of Cajun vittles. This event was supported by a grant from the ADA Membership Program for Growth and sponsored by Henry Schein Dental.

Mrs. Katherine Scheidt, Mrs. Tonya Danna and Dr. Diane Fuller digging in to some crawfish.

Tony Trahan and the BlueKrewe rockin’ some Zydeco music.

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Bayou Bob’s catered the party and everything was amazing.

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New Members - Welcome!

Dr. Nathan Barton Dr. Semiramida Condoianis Dr. Alison W. Hoover Dr. Matthew A. Johanson

Dr. James R. Lessig Dr. Alex R. Roberts Dr. Joseph E. Taylor

MDDS New Member Networking Event – June 14, 2012

2012 }

Mrs. Shelly Fava, Dr. Jennifer Berwick, Dr. Scott Maloney, Dr. Kenneth Burson and Dr. Chad Boustany enjoying happy hour and some networking at The Pioneer.

CDA 125th Annual Session

MDDS packed the House this year with 62 delegates! We would like to thank everyone for their time and hard work.

only three lectureS left:

august 23 BioHorizons

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Avoiding and managing complications of implant therapy

october 11 Astra Tech

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Parameters for integration of aesthetics and function in implant dentistry

november 15 Zimmer Dental

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dr. Bach le, oral and Maxillofacial Surgeon Burbank, California dr. Sergio rubinstein, Prosthodontist Chicago, Illinois

Interdisciplinary implant dentistry: current concepts and techniques in aesthetics and immediacy dr. John P. davliakos, Prosthodontist Annapolis, Maryland

Location: MDDS Building, 3690 S. Yosemite Street Denver, Colorado 80237

Time: 5:30 PM to 8:30 PM /// Complimentary light dinner at 5:30 PM. Lecture begins promptly at 6:00 PM. /// CE credits are available. Fees for 2012 are waived due to corporate sponsorship.

Please Note: Capacity is limited. If interested in attending, please call 720.488.7677 to reserve your place.

aldo leopardi, BdS, ddS, MS Prosthodontist /// P. 720.488.7677 /// f. 720.488.7717 The House of Delegates opened with and address from ADA President Dr. Bill Calnon.

Scan thiS code for the full Schedule or viSit: www.knowledgefactoryco.com/disc-schedule-2012

Taking a leisurely boat ride out to the Island where the Friday night festivities occurred.

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WHAT'S HAPPENING IN TODAY'S DENTAL MARKETPLACE?

By Larry Chatterley & Randon Jensen

D

uring the past year or so, we have received many phone calls-almost weekly—from dentists asking how things are going in the dental marketplace. Most are really looking for some point of comparison to determine how they are doing in relation to their contemporaries. Consequently, we thought to share some of our perceptions of the current dental related practice, business and economic environment, based on conversations we are having with many dentists every day who are practicing in this particular market. Please keep in mind this is only our perception. It may not directly reflect the status of things in your particular area, nor what you are experiencing personally at present. Moreover, we have not taken a scientific approach to this data, nor have we conducted any formal surveys. With that in mind, we have set forth our perceived “score” of the strength and/or favorability of certain market elements (relative to the most common questions we are asked) on a scale of 1 to 5, with five being strong and/or favorable and 1 being weak or unfavorable. Three, then, represents the average, or what has been most common historically.

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Question: How often do associate positions with private practices (i.e., practice not owned by large groups or corporations) come available? Score 1.5 Most private practices have an insufficient patient load and production schedule to keep two dentists busy. Since most private practitioners only have enough to keep themselves busy, they are not in a position to hire an associate. Consequently, for those dentists looking for work, finding an associate position is becoming much more challenging. Notwithstanding, the foregoing does not hold true for most rural areas.

Question: How does new patient flow currently compare to the past? Score 2 Most general dentists we talk to are booked out one to two weeks, at best, operatively; although hygiene schedules seem to still be booking out longer and scores higher at around 2.5 to 3.0.

Question: How many associate buy-in and buy-out opportunities are currently available as compared to, say, 10 years ago? Score 1.0. During the 1980’s and 90’s associate buy-in and buy-out opportunities were much more prevalent than they are now. This is

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MARKETPLACE due, in part, to a more competitive market overall, reduced patient load and lower new patient flow. (See also the question regarding associate positions, above).

Question: Is the number of sellers ready to retire and exit their practices the same as it was, say, five years ago? Score 2.0. Dental school enrollment has increased over the past five years, and many sellers are waiting to sell and retire because the value of their retirement savings having diminished in recent years to a point where they feel they cannot afford to exit practice as soon as they might have otherwise hoped to.

Question: Are banks lending money for practice acquisitions and start-up’s? Score 2.5. Banks are still lending money for practice acquisitions and start-up’s; however, the underwriting criteria for these types of loans have tightened up. Even though some banks will lend to new graduates, most require at least one to two years of postgraduate experience. In addition, lenders are looking for borrowers with little to no credit card debit, modest savings in the bank and, of course, a good credit score (FICO score of at least 700 or better).

Despite financing being harder to come by, interest rates on these loans have never been lower. In some instances the rates are as lows as 5 percent. As such, it may be wise to look into refinancing any practice related debt you may have if you are paying interest at a rate higher than 6.0 percent, APR. Question: How prevalent has participation in PPO and other discount insurance programs become? Score 1.5 (This score can be construed either way. Given that prevailing sentiment that PPO insurance participation is less favorable, the lower score is applied.)

Twenty years ago very few practices participated as contracted providers for PPO type insurance plans. Today, a majority of practices are contracted as in-network providers with at least one or more of these types of programs. Many dentist who have not historically participated in these plans feel compelled to do so now in order to remain competitive, retain their previously out-of-network patients and attract new patients. Again, practices in rural areas prove to be an exception. Due primarily to low competition and a lower percentage of the local population with PPO dental insurance coverage, there is little or no PPO participation by dentists in small towns.

Question: How is the economy affecting the market? Score 2.

According to a recent article published in JADA (May, 2012 edition), companies that offer dental insurance have been shifting more of that cost to their employees by either reducing the coverage benefits

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or increasing the portion of the premium amount to be paid by the employee. The article goes on to indicate that there has been a steady decrease in the utilization of dental care by the American public since 2005, which means fewer people are choosing to see the dentist regularly or at all. The combination of decreasing dental insurance benefits, lower personal income and reduced dental services utilization is and has been resulting in lower net revenues to the average general dentist as compared to pre-recession levels.

It appears consumers who are still choosing to seek dental care are either staying in network with PPO insurance providers, are seeking out practices that accept their insurance or just are spending less on dental care altogether.

Question: Are office lease rates higher or lower than they were five years ago? Score 4.5. Rent rates have been steadily decreasing over the past four years. Vacancies in professional office space are high in some areas, which is driving the cost of space down generally.

Consequently, if your office lease is up for renewal soon, look into the going market rate for comparable office space in your area and compare that to the rate you are paying currently. If the prevailing rate is lower, use that as leverage to negotiate lower rent for yourself.

Question: What’s it like to start a practice from scratch in this market? How successful have practice start-ups been compared to practice acquisitions lately? Score 3. It appears that most start ups are holding their own, meaning they are surviving and doing well, at least here in Colorado. However, location is critical to the success of a start up, not to mention the quintessential need to make a strong connection with patients. Any dentist with strong people skills and good clinical skills can do well.

So, what is happening in the local dental marketplace? In short, a lot is happening. The economy is having an impact on the dental marketplace in many different ways. As you can see, some of it is good and some of it is less than good. Regardless of the economy, the marketplace or other conditions on the environment, any dentist can survive and even thrive by taking control of his or her own destiny, starting with his/her own attitude and focusing attention on the proper care and concern for patients. We hope you are in that category.

Mr. Larry Chatterley is a consultant with CTC Associates, Dental Practice Transition Consultants. He can be reached at (303) 795-8800 or at larry@ctc-associates.com.

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The silent auction and wine tasting in full swing

MDDS Treasurer Dr. Larry Weddle

115

th

Annual

Meeting,

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Dr. Paul Glick receiving the Outgoing Board Member Award from Dr. Charles Danna

Silent Auction & Society Dinner

Dr. Diane Fuller and daughter, Mrs. Stephanie Riddell

Dr. Scott Maloney receiving the Outgoing Board Member Award from Dr. Charles Danna

T

he MDDS 115th Annual Meeting, Silent Auction and Society Dinner was held on May 17, 2012 at the historic Brown Palace. Not only was it a beautiful event, but over $5,400 was raised for the Metro Denver Dental Foundation. We would like to extend a warm “Thank you� to all of our attendees, sponsors and silent auction donors. We look forward to seeing you next year at Wings Over the Rockies.

2012 MDDS Honus Maximus award winner Dr. George Gatseos

Drs. Thomas Pixley and Dr. Sheldon Newman

MDDS Executive Director Mrs. Elizabeth Price

Mr. Jason Mauterer, recipient of the MDDS Exemplary Staff Award, and Mrs. Shelly Fava

Mrs. Elizabeth Price, Dr. Larry Weddle and Dr. Carolyn Seabury

Dr. Garza, Dr. Levin, Mrs. & Dr. Poulos, Dr. Idiculla and Dr. Roach

Dr. Jennifer Garza receiving the MDDF Award of Excellence from Dr. Patrick Prentergast

Dr. Ian Paisley receiving the Outgoing Committee Chair Award from Dr. Charles Danna

Dr. Karen Foster receiving the Volunteer of the Year Award from Dr. Charles Danna

Dr. Anil Idiculla receiving the Chairman of the Year Award from Dr. Charles Danna

Dr. Brian Gurinsky receiving the Outgoing Committee Chair Award from Dr. Charles Danna

ADA 2nd Vice President Dr. Kenneth Versman swearing in the 2012-13 MDDS Board of Directors

2012-13 MDDS Board of Directors MDDS President Dr. Diane Fuller

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DIAGNOSIS AND MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA (OSA)

By M. Juliana DiPasquale, DMD

O

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SA (Obstructive Sleep Apnea) is characterized by closure of the pharyngeal space during sleep causing airflow obstruction, which results in hypoxia and hypercapnia leading to arousal from sleep. Sites of airway obstruction include the retropalatal region and the retro-glossal region. OSA affects roughly 2-4% of North American adult population and has serious clinical, social and economic consequences (1).

the consequences of OSA are not only getting inappropriate rest and feeling tired, but there are serious medical outcomes that result. In contrast to OSA, Upper Airway Resistance Syndrome (UARS) is consistent with loud snoring, frequent arousal from sleep, but without apnea and oxygen desaturation. Although most snorers have some level of OSA, about 1/3 suffer from UARS (2). Factors directly related to increase in airway obstruction and increased OSA severity are: weight gain, alcohol consumption at bed time, muscle relaxants and sedatives and supine posture during sleep (3).

In normal sleep patterns, a person experiences a decrease in muscle tone (leading to airway collapse), respiratory drive, title volume, minute ventilation, lung volume, oxygen saturation and an overall decrease in cardiac function. This is consistent with a 10-20% decrease in metabolic activity (2). OSA leads to an increase in intrathoracic pressures due to obstructed breathing, and decreased oxygenation due to lack of proper ventilation. In turn, this leads to increased systemic and pulmonary pressures, and cardiac dysrhythmias. Over time, there is increased load on the heart with decreased cardiac output and consequent heart failure. Therefore,

Common symptoms reported by patients suffering from OSA include: daytime sleepiness; insomnia; decreased cognitive function; sexual dysfunction; morning headaches; loud snoring. These symptoms can lead to poor performance in the work place, accidents and alterations in personality (2); therefore symptoms of OSA have a great impact on all aspects of life.

In most OSA cases, there is rarely a single site of airway obstruction.

Instead, OSA is typically caused by a combination of areas of obstruction. Many surgical interventions only address one area of obstruction leading to decreased successful outcomes.

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FEATURED STORY Diagnosis: Diagnostic evaluation of the OSA patient includes: Nasopharyngoscopy (evaluates area of airway collapse), cephalometric analysis (evaluates airway size, and maxillary and mandible positioning), and polysomnography. Polysomnography reveals the Respiratory Disturbance Index (RDI). This is calculated by adding the number of apneas and hypopneas divided by total hours of sleep. RDI of 5- 15 is considered mild, 15-30 moderate and greater than 30 is severe. An RDI greater than 20 is associated with increased mortality (2). Successful treatment of OSA is considered an RDI of less than 20 and a 50% reduction of pre-treatment RDI. Non-surgical Management: CPAP (Continuous Positive Airway Pressure) or BiPAP (bi-level positive airway pressure) is the first line of treatment for OSA. It maintains positive upper airway pressure to prevent collapse during inhalation and exhalations. It is very successful treatment if compliance is high. Unfortunately, most patients are unable to maintain adequate compliance using CPAP due to discomfort and inconvenience. Complications associated with CPAP include dry mouth,

conjuctivits, pressure sores, skin irritation, nasal congestion and bleeding, bloating, and rarely lung collapse.

Weight Loss: BMI has a direct correlation to OSA severity and proper weight control impacts the success of other modes of treatment. Therefore weight loss is a crucial part of management of OSA and UARS.

Be sure to attend MDDS's CE course "Comprehensive Dental Sleep Medicine and Oral Appliance Therapy" November 16-17, 2012.

Visit mddsdentist.com for more information.

Oral Appliances: There are many FDA approved appliances made to treat obstructive sleep apnea. Although different appliances focus on different modalities to alleviate symptoms and signs of OSA, all have the common goal of increasing posterior airway space. Oral appliances are indicated for mild and moderate OSA and in patients who cannot tolerate CPAP (3).

Different appliance types include:

1. Mandibular jaw repositioning: The majority of oral appliances focus on moving the lower jaw downward and forward. Most appliances open the vertical by about 5mm and lock the maxilla and mandible into place. Some designs allow for lateral movement of the mandible and some do not. The amount of mandibular protrusion can be titrated and its success measured with polysomnography (3).

These devices can result in TMJ symptoms and changes in occlusion.

2. Tongue repositioning: Some OSA appliances focus on keeping the tongue against the roof of the mouth so it cannot slip posteriorly. This is accomplished by barriers, flanges, pins, posts and/or vacuum assistance.

3. Dilating Internal Nares: A few appliances increase the potential of air flow into the nose by stretching the nasolabial tissue. This is done with an acrylic or silicone flange that reaches under the upper lip.

4. Soft palate repositioner: This appliance attempts to lift the soft palate with a posterior acrylic extension. Some Continued on page 19

This patient underwent Maxillo-Mandibular Advancement surgery (1cm advancement). Before and after panoramic radiographs showing significant improvement in posterior airway space. (Photographs printed with permission from Dr. Luis Vega, Assistant Professor; Medical Director, TMJ program; Assistant Program director, Oral and Maxillofacial Surgery, University of Florida, Jacksonville).

mddsdentist.com

This is the same patient from the previous photographs. Before and after facial profile pictures demonstrating usual facial changes associated with Maxillo-Mandibular advancement surgery.

(Photographs printed with permission from Dr. Luis Vega, Assistant Professor; Medical Director, TMJ program; Assistant Program director, Oral and Maxillofacial Surgery, University of Florida, Jacksonville).

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EVENT CALENDAR AUGUST 2012 August 9

Metro Denver Dental Society: New Member Event Downtown Location TBD 6:00pm - 8:00pm (dates and locations are subject to change) For more info go to: mddsdentist.com

August 16

Kids in Need of Dentistry Expressions of KINDness History Colorado Center 1200 Broadway Denver, CO 80203 kindsmiles.org

August 18

MDDS Night with the Rockies Coors Field 2001 Blake Street Denver, Colorado 80205 Dinner at 4:30pm and Game at 6:10pm (303) 488-9700 For more info go to: mddsdentist.com

October 25

Metro Denver Dental Society: New Member Event Location TBD (dates and locations are subject to change) For more info go to: mddsdentist.com

October 18

Metro Denver Dental Society: CPR & AED Training, a Two-Year Certificate Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00pm - 9:00pm (303) 488-9700 For more info go to: mddsdentist.com

NOVEMBER 2012 November 3

Metro Denver Dental Society: CPR & AED Training, a Two-Year Certificate Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00pm - 9:00pm (303) 488-9700 For more info go to: mddsdentist.com

Metro Denver Dental Society: Behavior Management Strategies in Pediatric Dentistry with Special Consideration of Medical Immobilization - Dr. Ulrich Klein Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 Time 8:00am-3:00pm (303) 488-9700 For more info go to: mddsdentist.com

SEPTEMBER 2012

November 16 & 17

August 21

September 14

Metro Denver Dental Society: Negotiating Office Leases and Purchases Capitalizing on the Current Market Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 9:00am - 12:00pm For more info go to: mddsdentist.com

September 19

Metro Denver Dental Society: CPR & AED Training, a Two-Year Certificate Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00pm - 9:00pm (303) 488-9700 For more info go to: mddsdentist.com

OCTOBER 2012 October date TBD

D.I.S.C - Avoiding and managing complications of implant therapy Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St.,

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Denver, CO 80237 6:00pm - 9:00pm (720) 488-7677 For more info go to: knowledgefactoryco com/2012/05/disc-schedule-2012/

Metro Denver Dental Society: Comprehensive Dental Sleep Medicine and Oral Appliance Therapy - Dr. Barry Glassman Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 Time 8:00am-4:00pm (303) 488-9700 For more info go to: mddsdentist.com

November 22

Metro Denver Dental Society: Women Dentist Event Location TBD (dates and locations are subject to change) For more info go to: mddsdentist.com

DECEMBER 2012 December date TBD - 2 day course

Metro Denver Dental Society: Nitrous Oxide/Oxygen Administration Training Dr. Jerome Greene Location TBD Time TBD (303) 488-9700 For more info go to: mddsdentist.com

JANUARY 2013 January 24-26

Metro Denver Dental Society: 2013 Rocky Mountain Dental Convention Colorado Convention Center (303) 488-9700 For more info go to: rmdconline.com

FEBUARY 2013 Febuary 22

Metro Denver Dental Society: Basic Radiation Basic Radiation Education for Unlicensed Dental Personnel Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 Time 8:00pm-12:00pm (303) 488-9700 For more info go to: mddsdentist.com

MARCH 2013 March 8

Metro Denver Dental Society: Endo Mini Residency Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 Time TBD (303) 488-9700 For more info go to: mddsdentist.com

APRIL 2013 April 19 & 20

Metro Denver Dental Society: Botox and Dermal Fillers Training: Course I American Academy of Dacial Estetics Dr. Louis Malcmacher Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 Time 8:30am-5:00pm (303) 488-9700 For more info go to: mddsdentist.com

MAY 2013 May 16

MDDS 116th Annual Meeting Wings Over the Rockies 7711 E Academy Blvd # 1 Denver, CO 80237 Time TBD (303) 488-9700 For more info go to: mddsdentist.com

(dates and locations are subject to change)

Continued from page 17 other complications such as velopharyngeal incompetency and increased risk of paresthesia. Despite potential for poor aesthetic outcome and potential surgical complications, patient satisfaction is extremely high as many patients are be able to stop CPAP use.

Intra-operative photograph showing 1cm advancement of the mandible. The patient is placed into intermaxillary fixation with surgical splint until rigid fixation is applied. Next step in surgery (showed by the next picture) is maxillary advancement and internal fixation. The maxilla is fixated with pre-bent plates for 1cm advancement. (Photographs printed with permission from Dr. Luis Vega, Assistant Professor; Medical Director, TMJ program; Assistant Program director, Oral and Maxillofacial Surgery, University of Florida, Jacksonville).

appliances are adjustable during followup visits so that lateral movement and vertical opening can be fine tuned. Certain appliances address the need for mouth breathing and others do not. Edentulous patients and patients with TMD have additional issues that can be addressed by select appliances. Despite lower success rate as compared to CPAP, oral appliances have a higher patient acceptance rate due to being less cumbersome, lower cost, not making noise and being more acceptable to bed partners (3).

Surgical Management: The most common reason to pursue surgical intervention for treatment of OSA is the possibility of eliminating the need for C-PAP use during sleep. (4) Surgical interventions include: 1. Correction of a significantly deviated nasal septum: OSA is never a result of nasal obstruction alone. Although this may be a necessary adjunct surgical procedure, it is not considered appropriate treatment on its own.

2. UPPP (uvulopalatopharyngoplasty): It includes the removal of tonsils and palatal tissue to shorten the soft palate in attempts to decrease post-palatal obstruction. Success rate for UPPP is less than 50% and its associated morbidity makes this procedure less than ideal for curative management of OSA. A mddsdentist.com

modification of this procedure is the Laser Assisted Palatoplasty, which is supposed to be simple and less painful as compared to traditional UPPP, but it may require repeated treatments to obtain similar results (which often are less than ideal).

3. Tongue base reduction: This surgical intervention has a high morbidity rate due to significant post-surgical swelling and discomfort. It also only addresses one site of airway obstruction with resulting low success rate.

4. Maxillomandibular Advancement (MMA): MMA is the single most successful surgical intervention to treat OSA and most often cure the disease. This surgical procedure is similar in execution to traditional orthognathic surgery. In contrast to orthognathic surgery, in MMA orthodontics is rarely used and the maxilla and mandible are advanced as much as possible (usually 1cm) to result in forward movement of the palatal soft tissue as well and the anterior belly of the digastric, mylohyoid, genioglossus, and geniohyoid.

This causes forward movement of the soft palate and base of the tongue resulting in better tongue support and reduction in airway obstruction (4). MMA is 90% successful (2). Genioplasty for further anterior pull of the digastric, geniohyoid and genioglossus can also be performed in conjunction with MMA. Significant maxillary and mandibular advancement can lead to potential poor aesthetic and

5. Tracheostomy: 100% successful because it bypasses all sites of pharyngeal obstruction, although the stigma of having a tracheostomy and its associated care makes this surgical intervention not desirable. It is often a last resort or a temporary measure until the disease is successfully treated by other interventions.

The success of any surgical treatment depends upon the number of obstructive sites, severity of disease (RDI) and patient’s BMI (3).

Conclusion: Management of OSA should occur through a multi-disciplinary approach with input from the general dentist, the oral surgeon, otolaryngologist, sleep medicine specialist, primary care physician, weight management and the dental laboratory. No single treatment option applies to every patient, and trial and error until success is achieved is inevitable. A combination of interventions is usually necessary and patient compliance is of uttermost importance. There are many options available to the patient, and thorough informed consent is a necessity.

REFERENCES: 1. Horner RL. “Pathophysiology of Obstructive Sleep Apnea.” J Cardiopulm Rehabil Prev. 2008 Spe-Oct;28(5):289-98 2. Waite, PD. “Obstructive Sleep Apnea: A review of the pathophysiology and surgical management.” Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Apr; 85 (4):352-61.

3. Fleisher KE, Krieger AC. “Current trends in the treatment of obstructive sleep apnea.” J Oral Maxillofac Surg. 2007 Oct;65(10):2056-68.

4. Goodday R. “Diagnosis, treatment planning and surgical correction of obstructive sleep apnea.”

J Oral Maxillofac Surg. 2009 Oct;67(10):2183-96.

To register for the MDDS CE course "Comprehensive Dental Sleep Medicine and Oral Appliance Therapy" visit mddsdentist.com.

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LIFESTYLE

Invest in Your First Impression

By Milena Joy

Y

ou have spent endless hours and thousands of dollars researching the best equipment, hiring the most competent people and developing the most efficient and effective processes. You have a formal marketing plan that is diligently executed each month. Yet, when a patient walks into your office there is an absolute disconnect. They do not know that they are walking into an office of the most qualified, organized and successful team of dental professionals. You have failed to invest in your first impression.

55% of a first impression is based on how one looks and only 7% is based on what they say (Albert Mehrabian, Professor Emeritus of Psychology, UCLA). This means a practice cannot simply give first class service; they need to exude it. It means going beyond a kind smile and having each person in your office look and feel like a sharp professional.

Clothing, shoes, accessories, hair and makeup are the key components of a first impression. Evaluate each one of these and determine what you need to do to make sure your image aligns with your patients’ expectations.

Clothing Your office is not a runway, nor is it a gym. Clothing is the most obvious and visible indicator we use to make a ten second snap judgment about a person’s character, experiences and qualifications. Consider: Styles. Smooth fabrics are perceived as more professional and powerful, while textured fabrics like corduroy are less professional. Keep in mind that less professional is not necessarily unprofessional.

As the doctor you may want to land on the high side of professional, while your front end staff requires a more approachable look that is in the center of the spectrum.

Colors. Deep, dark colors like black, navy and grey are the most sophisticated, stable and powerful colors you can wear. Light pastel colors and white are seen as fresh, young and less experienced.

Condition. Wearing clothes that show signs of wear and tear or clothes that are noticeably too big

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or tight can make you appear oblivious and careless.

Relevance. When you wear clothes that are outdated, your ideas are viewed as outdated. This does not mean you should wear current trends head to toe. Ideally 90% of what you wear is classic, the other 10% is trendy. Classic styles are timeless and appealing to most, but having one piece such as a tie, shirt or accessory that is on trend will keep the look current.

really just makes good business sense for women.

According to a study in the American Economic Review, women who wear makeup earn on average 30% more than those who do not. Consider: Style. Contrary to popular belief, short hair for women is not necessarily the most manageable.

Long hair can be easily pulled back into a sleek ponytail, while short hair can require more time to style. Men’s hair is best short and any facial hair should be finely trimmed. Less is more with makeup. Makeup should look natural and flawless.

The goal is to enhance your features without masking your face.

Color. Unnatural colors in your hair or makeup are seen as juvenile. Most everyone looks best in the hair color they were born with. Makeup color should also be natural looking so as to attract, not distract.

Shoes & Accessories They say that the best way to know how a man or woman values his own worth is by the quality of his shoes. Likewise, accessories are the finishing touch of any outfit and signify attention to detail. Consider: Style. Shoes and accessories can make an otherwise conservative outfit sexy or make a simple outfit smart. Skinny, high heals will send a different message than sturdy heal. Men’s shoes should be polished and soles should not be visibly worn looking. A watch is a sophisticated accessory that can be a distinguishing status symbol for both men and women.

Scale. Clunky shoes and big jewelry pieces add visual volume and are distracting. Shoes should have clean, contouring lines and all accessories should be proportionate to the individual wearing them.

Color. While a punch of color can add interest, loud colors like red in big doses may be interpreted as aggressive and intimidating. Instead, use color as a visual accent with a tie or scarf.

Hair & Makeup You wear your hair every day, so keeping it groomed and healthy is just basic hygiene. While the choice to wear or not wear makeup may seem personal, it

Condition. Whether you are prone to dry or oily hair, it is important to take steps to regulate the condition. Similarly, makeup should not be caked on nor leave an oily film. It is smart to have a professional prescribe you products for both hair and makeup that will keep each in balance.

Investing in your image is not a luxury; it is a necessity. You have spent far too much time and money on your business to have your first impression stand in the way. Creating a dress code may sound like an archaic idea, but it is the best way to literally make it black and white for you and your employees. In that policy you will want to acknowledge clothing, shoes, accessories, hair and makeup to ensure the entire office projects an image that is a firm representation of your professional standards.

Milena Joy is a corporate and personal image consultant, speaker and author based in Denver, CO. She earned her image certification at the Image Resource Center of New York. She is the founder of Milena Distinctive Image Consulting where she helps individuals look effortlessly stylish every day and businesses enhance their professional presence. milenaconsulting.com

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Stability · Strength · Service Did you realize we offer: • Malpractice Coverage Administrator of the Dentists Professional Liability Trust • Workers Compensation - Low Rates • Business owners Package - tailored to your needs • Medical Insurance Personal and Group

www.dentalliability.com

Berkley Risk Services of Colorado 2000 S Colorado Blvd, Annex Building, Suite 410 Denver, CO 80222

MARK YOUR CALENDAR fOR SEPTEMbER 14TH!

• Disability - True own occupation • Business Disability • Business Insurance • Life Insurance • ERISA Bonds • Employment Practices Liability Coverage • Group Disability • Long Term Care • Home and Auto

Phone: (303) 357-2600 Fax: (866) 699-1559 Toll Free: (877) 502-0100

Catastrophes don’t make courtesy calls.

Injuries, illness, weather disasters, accidents… these things don’t make courtesy calls before knocking on your door. When they show up and interrupt your practice, all you need to know is that you’re covered. Period.

Dr. Scott Whitney hosts the MOLARS Dental Golf Championship Hit the links for the 7th Annual MOLARS Dental Golf Championship at The Ridge at Castle Pines North on Sept.14th and support the Smile Again Program® while you play one of Colorado’s most beautiful courses.

REGISTER BY AUG.12th!!

For information Call Amy R. Boymel 303-957-3272 Or email aboymel@mddf.org

“I’ll be there next Tuesday, between 10:00 a.m and noon...”

• Property & casualty insurance – workers compensation – business owners package – employment practices liability • Individual and group – disability – health – life

www.copicfsg.com • 720-858-6280/800-421-1834

NON-PROFIT NEWS MDDF Shred Event – a Record Breaker!

By Amy Boymel, MDDF Executive Director

U

nder bright, sunny skies, the first Saturday in June provided the perfect setting for MDDF’s annual Shred Event. Cars, trucks and mini-vans filled with boxes paraded through the MDDS/CDA parking lot; there was even a Rodeo Clown in one Unloading boxes of records to be shredded. car! The 2012 Shred Event not only destroyed more than 650 boxes of old records, it set a new record – raising more than $14,000 to help support MDDF programs!

And it couldn’t have happened without you – MDDS members!

Volunteers came out in full force to lend a hand. MDDF board members Dr. Pat Prendergast, Dr. Nelle Barr, Dr. Nicole Furuta, Ms. Judy Holmes and immediate past board President Dr. Michael Poulos were joined by MDDS board members Dr. Karen Foster and Dr. Sheldon Newman; former MDDS board Presidents Dr. Charles Danna and Dr. Paul Bottone; volunteer Dr. Carl Boymel; and dental student Mr. Jason Reiss.

Additional help was provided by Ms. Korinna Milam.

This event would not be possible without the generous support of our two sponsors, Cornerstone Records Management and BVB General Contractors. The Cornerstone Crew – Bill, Craig & Matt – had Shredding trucks humming and ready to go early in the morning. BVB’s Carter Mann provided goodies including bagels, coffee, and refreshing cold drinks enjoyed by everyone. MDDF is truly grateful to have such wonderful partners.

If you missed the Shred Event this year, there’s always next year! But if you need help clearing out the clutter sooner, please consider contacting Cornerstone Records Management at 303-307-9890. Be sure to mention that you’re an MDDS member for special “members only” discount rates.

To everyone who supported the 2012 Shred Event – whether you posted your Legal Notice through MDDF, brought your boxes to the event, or volunteered your time – THANK YOU! Have a question? Please contact Amy Boymel at aboymel@mddf.org or 303-957-3272.

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By By Ms. Nancy Hansen Colorado Dental Manager’s Association provides a continuing education forum for Office Managers to learn from top dental professionals in the Metro area and each other. Our quarterly meetings are sponsored by area dental professionals and annual $150 dues.

Would your office have benefited from?

Nate Reynolds of Dental Trust: Risk Management in your office.

Amy Kirsch of Kirsch Practice Management: Know your office numbers.

Judy Holmes, Atty of Law: Pitfalls of hiring and firing. Is it Good business management to hire an associate as Contract Labor?

Kim McGuire of Fortune Management: 3 strategies to boost your bottom line.

Amy DeBisschop, Federal labor regulator: Compliance with Fair labors Standard Act. Caron Notarmuzi State Sales tax trainer: Sales tax requirements for Colorado Dental Practices.

Rita Zamora: Social Media in the Dental Practice Nova Consulting: Personalities Clashing…Discovering the Causes and Managing the Effects.

CDMA is beneficial for your Office Manager to learn how to be proactive by listening to speakers that specialize in the daily issues that every office faces. Each of our members finds the meetings to be both educational and motivating. To learn more about Colorado Dental Manager’s Association please contact our secretary, Leigh Olson at 720-233-0574 or email her at Leigh.Olson@comcast.net. Please visit our website at www.mycdma.org.

Social Media Tip! Google Plus Pages

by Rita Zamora

Is your practice on Google Plus yet? Google Plus Business Pages are similar to Facebook Pages—although said to be more valuable from potential search vs. social benefit at this time. Note when you establish a Google Page, it is ideal to have one unified log-in to access all Google products, including: Google Places, Google Plus personal profile, Google Plus Page, etc. Having one log-in will allow you to easily utilize, monitor, and manage all of your important Google products from one convenient location.

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MDDS WOULD LIKE TO ENCOURAGE ITS MEMBERS to volunteer for this

year’s Fall 9Health Fair. Volunteering to do oral health screenings is easier than ever with the new 9Health Fair website, and crucial to so many of the area’s underserved. To volunteer, go to 9healthfair.org and hover over “Volunteer” in the blue box to the left of the page. Choose “Sign Up to Volunteer” from the menu. At the bottom of the Volunteer Sign-up form is the option labeled “I am volunteering as a part of a group” – choose yes and enter “MDDS” as the group name. It takes about five minutes to sign up, and can affect the lives of so many. We hope to see you there!

Kids In Need of Dentistry (KIND) is excited to celebrate 100 years of KINDness and saving children’s smiles into the next century.

Our year long celebration will culminate with a Gala: Kids In Need of Dentistry’s Expressions of KINDness. Not only will we celebrate with the people most supportive of our organization, we will recognize the journey and progress of an organization dedicated to bridging the gap for families struggling to provide quality dental care and education for their children.

This premier event will take place on Saturday, September, 29, 2012, 6 p.m., at the newly opened, History Colorado Center, located at 1200 Broadway, Denver, CO. Sponsorships are still available for this event. For more information regarding sponsorships and ticket sales, please call Julie Collett, 303-733-3710, ext. 11 and check our website, www.kindsmiles.org.

WATCH DENTAL LINE 9 ON CHANNEL 9

Tuesday Sept. 18, 2012 4:00pm Thursday Sept. 20, 2012 6:00am

EDUCATION Congratulations to the University of Colorado Anschutz Medical Campus graduating dental class of 2012!

Dr. Paul Andrews

Dr. Russell Ash

Dr. Shaharyar Ashraf

Dr. Andrew Bagley

Dr. Gregory Bauer

Dr. Jason Beddes

Dr. Chad Bergan

Dr. Jonathan Bishop

Dr. Karina Bogdasarova

Dr. Tyler Borg

Dr. Courtney Bourret

Dr. Nathaniel Cejka

Dr. Lindsey Dundas

Dr. Frank Emmert

Dr. Lynn Fee

Dr. Benjamin Gardner

Dr. Cody Garrison

Dr. Adam Gentry

Dr. Charanjit Gill

Dr. Melanie Hageman

Dr. Rocky Horton

Dr. Michael A. Johnson Dr. Michael S. Johnson

Dr. Patrick Kelly

Dr. Anjuli Kramer

Dr. Somi Lim

Dr. Jacob Mackey

Dr. Jessica Milburn

Dr. Christopher Mohr Dr. Christopher Nakamura

Dr. Anil Nutakki

Dr. Kenneth Ostrov

Dr. Mark Palmer

Dr. Curtis Pino

Dr. Jeffery Poulson

Dr. Kristina Rabatin

Dr. Rebecca Ress

Dr. Diana Rubino

Dr. Steven Savage

Dr. Allison Schmidt

Dr. Michael Schuiling

Dr. Justin Smutz

Dr. Ashley Spooner

Dr. Paige Sthen

Dr. John Thousand IV

Dr. Eric Wilson

Dr. Carla Janda

Dr. Thomas Pixley, Immediate Past President of CDA

Dr. Denise Kassebaum, Dean

Drs. Bauer, Borg and Nutakki presenting the student’s awards to teachers

Not pictured: Dr. Brandon Campbell, Dr. Mellissa Gilman, Dr. Michael Gross, Dr. Patrick Hannaway, Dr. Matthew Hockin

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FINANCIAL MANAGEMENT

Rules of Thumb

By Edward Leone Jr. DMD, MBA, CFP, RFC

M

ost of us consider basic rules of thumb when making

decisions on complex and important issues. If you are

a dentist considering a sale of your private practice, you may be setting your sale price at 20-60% of annual revenue plus equipment and inventory value as a general rule of thumb. Maybe your patients follow the rule of thumb to have a dental prophylaxis twice a year. Homebuyers are often cautioned against purchasing a home priced higher than 2.5 times their annual gross income. However, all of these rules of thumb neglect to account for individually specific circumstances. Dental practices can be very unique. Dental hygiene and preventive needs vary greatly from patient to patient. The ability to purchase a home is also derived from an individual’s asset base and their varying requirements for shelter.

It is common for individuals to base retirement planning strategies on rules of thumb represented in advertisements, websites and do it yourself print materials. For example, we frequently hear that we should save 10% to 15% of income towards retirement.

In my financial planning experience, this strategy, when followed consistently, generally creates prudent spending patterns and adequately prepares an individual for a comfortable retirement. The rule of 72 states that dividing your investment return into 72 gives the number of years it will take to double your initial investment value. We often hear that an individual in retirement should target replacing only 80% of their preretirement income. This is appealing based on the fact that work related expenses and savings for retirement may no longer be necessary during those retirement years so income needs might be reduced. However, savings based on an 80% replacement formula may not provide the support necessary to cover all retirement lifestyle expenses depending on future personal goals, unknown expenses and long-term inflation consequences.

There is also the rule for targeting 20 times current income to create a suitable retirement portfolio. Once again this formula may not consider the effects of inflation on purchasing power and other factors such as increasing longevity trends, for example. Some may argue that you need to purchase life insurance in an amount equal to 6 to 10 times your income. This guide may not account for accumulated assets over time, changing family dynamics and estate planning needs. Life insurance needs will most likely change over the course of your lifetime. Another common rule of thumb for constructing a prudent portfolio asset allocation is to subtract your age from 110. The result is the equity allocation of the portfolio and the remainder is the fixed income allocation of the portfolio. This formula may not address an individual’s risk tolerance along with the threat of inflation on the functionality of the portfolio. Finally, a somewhat controversial rule targets a 4% or less withdrawal rate during the distribution of retirement portfolio assets to prevent the depletion of assets before death. In my experience, this guide does adequately consider individual longevity projections.

In most cases the accuracy or the pitfalls of these rules of thumb can be discovered when engaging in a comprehensive financial plan that considers the following unique aspects: 1. Personal goals Many people desire to have vacation homes, be involved in recreational and travel activities, or legacy goals, all which must be considered in life and retirement planning.

2. Financial resources Earnings potential and accumulation of assets must be weighed against debt obligations and lifestyle expenses. It is optimal for a retiree’s balance sheet to reflect no more than 30% exposure to liabilities and debt obligations.

3. Timing of retirement The amount of time available for the accumulation of retirement assets is an essential element of financial planning.

4. Expected longevity Mortality tables generally work well for insurance companies since they engage in the rule of large numbers and can estimate an individual’s potential life termination event based on averages.

For personal retirement planning, it is crucial to consider family longevity history and individual’s life expectancy.

5. Estate planning issues This can be complicated depending on the size of an estate and both federal and state law. A will is a basic estate planning tool, but trusts and other will substitutes may be a necessary part of a financial plan.

6. Risk management issues It is important that life, disability, casualty and liability risks are mitigated with appropriate insurance products without incurring great expenses or sacrificing liquidity.

7. Tax issues Monitoring income tax, capital gains tax and estate tax exposures while working and in retirement are key elements of an efficient financial plan.

8. Risk tolerance An individual’s investment risk tolerance is one of the primary factors for portfolio asset allocation and the expected rate of return. This tolerance must also consider the long-term impact of inflation and its erosion of purchasing power.

A financial plan that is professionally organized and regularly updated is a very effective approach to the dynamic challenges of life and the customized assessment of valid rules of thumb.

Sources: “Public Awareness of Retirement Planning Rules of Thumb” by Robert Mayer PHD, Cathleen Zick PHD, Journal of Personal Finance, Volume 10 2011 Dr. Leone is a past President of the Metropolitan Denver Dental Society and a past President of the Colorado Dental Association. He is currently serving the dental profession as the Treasurer of the American Dental Association. Dr. Leone is also an Associate with GHP Investment Advisors Inc. (GHPIA) in Denver, Colorado. For more information about GHPIA, go to www.ghpia.com

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Articulator

Summer 2012

Clearing up myths surrounding sales/use taxes for dentists located in Colorado

By Caron Notarmuzi

M

any myths surround the topic of sales and use taxes in Colorado. There is no exception for those who purchase/ sell tangible personal property (TPP) in the medical/dental fields. One of the most common myths among medical doctors and dentists is that they don’t sell anything that requires the collection of sales taxes. This may or may not be true. Another myth among all Colorado business owners is that the seller/vendor is always held liable for the collection of sales taxes and this may not be the case. Have you ever wondered whether you should collect sales taxes on supplies given to your patients? Do you know what use tax is and when it might be due? In addition to the myths surrounding this complex topic, there are also many questions.

The unanswered questions are those that can be costly to businesses when they find out they are not in compliance.

In Colorado, when TPP is sold to the end user, which is someone who has no intention of reselling what was purchased, sales tax is due. In the medical/dental field, doctors are considered the end user if they are purchasing tangible property they give away to their patients. For example, if a dentist purchases toothbrushes to give to his/her patients, the vendor of those toothbrushes should collect sales tax on those purchases from the dentist. In many cases, the vendor will not collect any sales taxes or will not collect enough taxes from the purchaser for various reasons. One reason sales tax may not be collected at the time of purchase could be because the dentist used a sales tax license when making the purchase, which is an indication he/she is not going to be the end user. If you purchase toothbrushes with your sales tax license and no sales tax was paid to the vendor, once you give away those brushes, you must report the wholesale amount of those brushes on line 10 of your sales tax return, form DR 0100, “Retail Sales Tax Return.” On the other hand, if you purchase toothbrushes, and those toothbrushes do not go into inventory and no sales tax was collected by the vendor, use tax would be owed to the jurisdictions that have a use tax. For example, the state has a use tax of 2.9%. Therefore, if you didn’t pay 2.9% sales tax to a vendor for the brushes, you would owe 2.9% use tax on that purchase and need to remit it on form DR 0252, “Consumer Use Tax Return.”

Dentists and doctors should be colleting sales taxes from their patients when they sell tangible property to those patients in addition to providing services. For example, if a patient sees a dentist for a cleaning and exam and in addition to those services, the dentist sells a whitening kit to the patient, sales tax should be collected on the whitening kit. Ultimately, licensed vendors are held liable for

mddsdentist.com

collecting sales taxes.

Although, vendors may not always be required to collect Colorado sales taxes. If that’s the case, the purchaser is liable for paying use taxes as previously indicated.

However, sales tax is not due when there is a sales/use tax exemption on the tangible personal property. For example, when a dental laboratory purchases items that become constituent parts of a prosthetic device to be resold to a dentist, the purchases are exempt from sales and use tax. Purchases of supplies and materials that do not become constituent parts of a prosthetic device are taxable. Sales of prosthetic devices to a dentist are exempt from sales or use tax.

Prosthetic devices are replacements for lost or missing natural parts, or are the addition of devices through prosthetic dentistry to aid the dental bodily functions. Prosthetic dentistry consists of the use of inlays, crowns, replacement of lost teeth, bands, brackets, and other band attachments, wires, intraoral and/or extraoral traction devices, and retaining or holding appliances and other devices which aid in the dental bodily functions. Gold and silver used for fillings are also exempt. General business equipment and supplies are taxable as are all hand instruments; dental equipment and furnishings; supplies used for patient diagnostic records; and other items used for patient care. Dental laboratories must obtain a sales tax license and must collect and remit sales tax on taxable sales.

Home-rule cities in Colorado collect their own taxes and follow their own codes. If your business is located in a home-rule city, you are advised to contact the city directly to discuss rules on sales/purchases as they may not be the same as the rules applicable to the state and state-collected local jurisdictions. Contact information for home-rule cities is located in the Department of Revenue publication, DR 1002, “Sales/Use Tax Rates” or by going to the Department of Local Affairs Web site, under Active Colorado Municipalities.

For additional information on this topic, attend a “live” class offered monthly at various locations across Colorado. All classes are free of charge. A complete list of classes can be found at www.TaxSeminars. state.co.us. In addition to the live classes, many classes are offered online. Online classes can be viewed in PDF format and/or can be taken online where CPE credit can be obtained. If you have general questions or you are having problems with your sales tax account, contact the Department of Revenue Tax Information Call Center at (303) 238-7378.

Articulator

Summer 2012

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MDDS SPOTLIGHT Bragging Rights

By Carrie Seabury, DDS, MDDS Editor & Board Member

W

e are incredibly luckyto have a talented, hardworking staff running the MDDS show. Our staff members never stop improving themselves and work incredibly well together. They are truly the reason for all of MDDS’s recent success and growth. This team has embraced the importance of the mission of MDDS and they all work hard to see our society succeed. Here are a few highlights of recent staff accomplishments: Two staff members are pursuing or have already received their CMP certification. (Certified Meeting Professional ). MDDS sponsors our staff members in pursuing this important accomplishment (the society pays the fees involved and gives staffers the time to do it). The CMP program recognizes individuals who have achieved the industry's highest standard of professionalism.

The Convention Industry Council website states “Through the CMP program, individuals who are employed in meeting management pursue continuing education, increase their industry involvement, and gain industry-wide recognition.

The requirements for certification are based on professional experience and a written examination. Over 14,000 individuals in 36 countries

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and territories have earned the CMP designation since its inception in 1985.”

visual. We’re honoring the creativity that gets real world results – the work that works.”

By completing her CMP, Debra Arneson has shown commitment to our society’s success. Shelly Fava is about to receive her CMP as well. We are grateful for their efforts that reach above and beyond expectations. It is extremely rare to have two CMP staff members in an organization of our size.

Jason Mauterer was the Marketing Director on the campaign that won the BMA Gold Key Award, and Chris Nelson was the designer.

Together with the rest of the staff, they created an incredible RMDC marketing campaign that drew in record breaking numbers for attendance, sponsorship, and booth vendors. Chris also recently held his first major gallery show in Denver at Knew Conscious Gallery. His visual talents add an unparalleled polish to MDDS.

Rocky Mountain Dental Convention

20 CONNECT 12 RMDC ▶ DENVER,CO

MDDS was recently honored with the Business Marketing Association Gold Key Award. This award is given to the Colorado marketing team that can blend style and substance together and produces results.

According to Colorado’s BMA website, “Unlike any other marketing awards show, the Colorado BMA Gold Key Award doesn’t just look at the clever headline or the shocking

Our Executive Director, Elizabeth Price, hand-picked many of our current staff members and created an elite, cohesive team truly capable of anything. She also found the time to earn her CAE (Certified Association Executive).

Never before has MDDS enjoyed so much success and recognition. Our society truly benefits from all the hard work and dedication our staff members invested. We are humbled by the successes achieved by our MDDS staff and look forward to many more years of growth and accomplishments.

Articulator

Summer 2012

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I am looking for a Hy-GENIUS! If you have a team mentality, and believer your role is more than just cleaning teeth – then you may be the one I am seeking. I have a small practice in Lakewood, CO. with a huge focus on personalized, health oriented care for my patients. Certification in anesthesia, laser, nitrous. Flexible thinking & very good people skills are key!

Aurora, Colo. Professional dental office space consisting of 1003 sq. ft. available for lease. Some existing dental equipment, currently in suite, may also be available to purchase making for an affordable, smooth and quick practice start up. Suite is partitioned, plumbed, and wired for three dental operatories. Ideal location with great traffic visibility and easy access. Call Dr. Trompeter at: 303-688-3838, (C: 720-2441523) or e-mail at trompeternotes@msn.com

PRACTICES FOR SALE! ASSOCIATE BUY-OUTS AND BUY-INS! New Listings Available for 2012! Metro Denver!

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For more information on current practice opportunities, including an overview of each practice, please visit our website www.ctcassociates.com or call Larry Chatterley and Susannah Hazelrigg with CTC Associates at (303)795-8800.

Pediatric Dental Practice: South Denver, 3 ops, grossing $239,000. For more information, please visit www.ctc-associates. com or call Larry Chatterley and Susannah Hazelrigg at (303)795-8800.

Hire me to SELL your practice! Choose a Broker You Can Trust! I get results! Ask your friends! I find the BEST Buyers and make you proud of your decision! Direct Sales! Associate to Partnerships! Associate Buy-outs! 17 Years Experience in Dental Practice Transitions! Susan Spear, Practice Transition Specialist / Licensed Broker SAS Transitions, Inc. SAS Dental Practice Brokers 303.973.2147 susan@sastransitions.com

Need Help BUYING a Practice? Help with Appraisals, Reports, Financing and More! I provide expert advice on how to Purchase Your Practice, Negotiate on your behalf, and help you successfully become the New Owner! Why go it alone? Fair fees without risk! Susan Spear, Practice Transition Specialist / Licensed Broker SAS Transitions, Inc. SAS Dental Practice Brokers 303.973.2147 susan@sastransitions.com Start-up/Practice Management: For more information on doing a scratch start-up or assistance with managing your practice, call Marie Chatterley at (720)219-4766 or email marie@ctc-associates.com.

For Sale: MiniCam Plus Intraoral Camera with white cart and Sharp monitor. $350 works perfectly and looks like new. Please call 303-617-5212. Aurora, CO Micro-Etcher (Danville) needed. Used, good condition. Kids In Need of Dentistry, 303-733-3710 ext. 17

Associate Positions: Current associate opportunities available are in Lakewood and Edwards. Other associate opportunities may be listed on our website www.ctc-associates. com. To apply, email your resume and cover letter to info@ctc-associates.com. Please specify which location you are applying for and when you are available to start.

BEST CARD IS PROUD TO BE THE CREDIT CARD PROCESSOR OF THE METROPOLITAN DENVER DENTAL SOCIETY AND THOUSANDS OF DENTISTS WHO SAVE AN AVERAGE 23%/YEAR

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Buyer Representation: If you would like more information on buying a practice or associating before a buy-in or buy-out, call Larry Chatterley and Susannah Hazelrigg CTC Associates at (303)795-8800 or email info@ctc-associates.com.

Transition Services: For more information on how to sell your practice or bring in an associate, please contact Larry Chatterley and Susannah Hazelrigg with CTC Associates at (303)795-8800 or visit our website for practice transition information and current practice opportunities www. ctc-associates.com.

Advertise with US! Market your business to the Metro Denver dental profession!

For more details visit mddsdentist.com or contact Jason Mauterer at jmauterer@mddsdentist.com or call 303.488.9700 x3270 Download the ad kit at this address mddsdentist.com/articulator/advertising.asp

Colin Carr

“C

hristian Gile and Carr Healthcare Realty are truly peak performers. They are thorough, patient, professional, and a pleasure to work with. If you are looking to relocate your practice or start one from scratch, I would highly recommend them!”

David Bennett, DDS

President

303.817.6654 colin@carrhr.com

Christian Gile Principal Denver Metro

303.960.4072 christian@carrhr.com

At Carr Healthcare Realty…

We provide experienced representation and skilled negotiating for dentists’ office space needs.

Whether you are purchasing, relocating, opening a new office, or renewing your existing lease, we can help you receive favorable terms and concessions.

Every transaction is unique and provides substantial opportunities on which to capitalize. The slightest difference in the terms negotiated in a lease or purchase can impact your practice by hundreds of thousands of dollars. With this much at stake, expert representation and skilled negotiating are essential to receive the most favorable terms.

Roger Hernandez Colorado Springs Southern Colorado

719.339.9007 roger@carrhr.com

Kevin Schutz

Boulder • Northern Colorado Western Slope • Wyoming 970.690.5869 kevin@carrhr.com

If your lease is expiring in the next 12 – 18 months, allow us to show you how we can help you capitalize on your next lease or purchase.

Lease Negotiations • Office Relocations • Lease Renewals • Purchases