Articulator, Volume 20, Issue 2

ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

WE BUILT THE MWDI….SO WHAT’S NEXT?? pg.10

Winter 2015 Volume 20, Issue 2

Short Term Orthodontics - Ethical Dilemma 7 Important Considerations When Forming Dental Partnerships 8 HIPAA Violations On The Rise: Are You Breaking the Law? 12 LOST IN SPACE How to Get Predictable Results From Your Laboratory 20

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ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

Volume 20, Issue 2

MDDS Articulator Editor Brandon Hall, DDS Associate Editor Jeremy Kott, DDS

Creative Manager & Managing Editor CT Nelson Director of Marketing & Communications Cara Stan MDDS Executive Committee President Ian Paisley, DDS President-Elect Sheldon Newman, DDS

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Winter 2015

Inside This Issue:

President's Letter .............................4

Freedom Day 2015 ........................14

Member Matters ..............................5

You Can Change Lives! .................16

Be Remarkable ................................6

Member Spotlight ..............................18

Short Term Orthodontics

LOST IN SPACE How to Get Predictable

- Ethical Dilemma ............................7

Results From Your Laboratory ........ 20

Secretary Brian Gurinsky, DDS

Important Considerations When Forming

Case of Intracranial Abscess Suspected

Executive Director Elizabeth Price, MBA, CDE, CAE

Dental Partnerships ...............................8

Treasurer Nicholas Chiovitti, DDS

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.

Well… We Built the Mwdi….So What’s

Secondary to Periodontal Infection and Odontogenic Infection .......................24

Next??........................................... 10

Event Calander ............................. 26

HIPAA Violations On The Rise: Are You

Classifieds..................................... 31

Breaking the Law? .......................... 12

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 925 Lincoln Street, Unit B Denver, CO 80203 Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com ©2011 Metropolitan Denver Dental Society

Member Publication

MESSAGE TO OUR READERS:

CALL FOR ARTICLES – SUBMIT YOURS TODAY!

T

he Articulator belongs to you, our readers. Share your indepth subject knowledge, events and accomplishments with the Metro Denver dental community. By submitting articles, photos, happenings, etc. to us for consideration, article submissions are open to members and vendors in the dental community.

Please submit your articles, photos, etc. to CT Nelson, Managing Editor, at creative@mddsdentist.com.

3

PRESIDENT'S LETTER

THE RIGHT STUFF

By Ian Paisley, DDS

I

find that I don’t have a lot of time to read these days. Between a busy practice, a family (including an 11-month-old) and serving as President of the Society, free time has become scarce. However, I did make a point of reading a book over my summer vacation back in northwest Montana. As the trip approached, I didn’t have a book I was eager to read until I was leafing through my dental school’s quarterly journal.

There it mentioned a new book, “Quest for Excellence, The Arthur A. Dugoni Story,” and I knew this was the one.

move his family of seven to the state of Washington and pursue an advanced degree in orthodontics. All the while, he made a priority of contributing to the profession of dentistry as a dental school faculty member and a leader in organized dentistry.

His accomplishments are too many to list but they did include serving as President of the California Dental Association and the American Dental Association.

What I remember most, though, were the quarterly meetings at the dental school where he invited student leaders to meet for dinner with department chairs. At the meeting he would As dentists we can all think back to allow the students to present a person in our past that served as a our concerns to the faculty. mentor. Someone who provided such a Then, he would ask the faculty great example of what we hoped to be in how they felt they could address the future, that we still remember them these concerns. The results well to this day. For me that person were amazing. Knowing that we was Dr. Arthur Dugoni, the Dean of were being listened to, students the University of the Pacific School of asked for reasonable changes Dentistry while I was a student. In fact, and the faculty knew that he was dean for nearly 30 years and Dean Dugoni expected them now the school bears his name.

Dr. Arthur Dugoni to take our requests seriously.

His facilitation of this type of I first became interested in organized communication was just one dentistry while attending a career fair manifestation of his unique leadership ability. during my undergraduate years at Northwestern University. Later, my “older brother” in the dental class ahead encouraged me to While I could never hope to accomplish all the feats that Dean pursue an ASDA leadership position. But it was Dean Dugoni who Dugoni achieved, I am inspired to strive for my personal best in showed me how much could be accomplished for our profession by my practice, my profession and my personal life. A particular quote an individual who had the dedication, desire and perseverance to struck me, “Our intention is not to bury our hearts and souls in the make a difference. I knew I was in for a treat when his book arrived practice of dentistry so that we exclude all else, but rather to live, as on my desk. well as make a living. For the achievement of a career is not an end, but a means. One may succeed as a dentist but fail as a person.” I As I made my way through the chapters I learned of a man who would like to take this opportunity to encourage all MDDS members was the son of hard-working but fairly poor Italian immigrants in to follow Dr. Dugoni’s example and take your lives to the next level.

San Francisco. This is a man who was gifted with a great intellect Whether it is getting involved in organized dentistry, volunteer but over the years developed an unbelievable work ethic and ability dentistry, a charity organization or something else, go out and make to communicate with others at many levels. I marveled as he a difference! discussed the decision to leave pediatric practice at the age of 35,

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Articulator

Winter 2015

MEMBER MATTERS MDDS Board of Directors Induction 7-29-15

New Members, Welcome!

Dr. Gregory Bauer Dr. Raktim Bir Dr. Daniel Crawford Dr. Mario DeNicola Dr. Chelsea Freiberg Dr. Dharti Gandhi Dr. Jay Heim Dr. Bahman Horouzinia Dr. Julie LeBlanc

The 2015 – 2016 Board of Directors take their oath of office.

MDDS President Dr. Ian Paisley honors outgoing President Dr. Larry Weddle

MDDS New Member Event @ Amato's Ale House 8-27-15

Dr. Jerod Leff Dr. Greg McGlone Dr. Jayme Michalson Dr. Craig Owens Dr. Derek Owens Dr. Devin Rentz Dr. Chelsea Shellhart Dr. Anuj Suri Dr. Daniel Thousand Dr. Ashley Tucker

New MDDS members chat over hor d’oeuvres and cocktails.

Attendees enjoyed happy hour snacks

It was a packed house at the August New Member Welcome Event

Dr. Arthur Yagudayev and Pacific Dental sponsors

Dr. Robert Denny and Dr. Paul Quiram

CU Lunch and Learn 9-16-15

CU dental students receive feedback on how MDDS can help them succeed after dental school

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Drs. Carrie Mauterer and Kenny Burson share their post grad experiences

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Winter 2015

5

REFLECTIONS

BE REMARKABLE

By Brandon Hall, DDS, Editor

A

s we come to the close of 2015, there’s always

Surprise them with lunch or dinner. Buy them a spa day or have a “movie

some self-reflection that happens this time of

night and margaritas” outing. Don’t stress over exactly what it is you do but it

year. We look back at the passing time and think

needs to be from the heart. Don’t forget about your support system.

about the what-ifs, the regrets, the should’ves

and the could’ves. Yet, there are times we did something special.

I’ve also found hand written notes to patients is a great way to connect with

Many of the

them and show your compassion.

memories are touching,

Your assistants and hygienists are

and some we choose to bury forever. For

finding out about their summers,

some it’s about family or friends.

weddings,

For

babies,

new

dogs,

others it’s about professional decisions.

whatever. Use that in your note.

You certainly can’t change the past but you

Maybe a patient had someone close

can definitely change the future. There’s a

pass away. Send them a quick note.

little time left in 2015 so I challenge you to

Heck, put a gift card in there. It

be remarkable in how you live your life and

shows your patient you’re different.

what you do at the office.

Without great patients, you don’t have a great dental practice.

I spent a long weekend in Las Vegas for Sirona’s CEREC 30th Anniversary

3)

celebration. Wow, what a show! Sirona

you woke up in the morning and

certainly knows how to have a party. But

rather than dreading going into

they also knows what it means to stand out

the office, you went in with positive

among the crowd. There were several take-

energy?

home lessons I brought back (aside from

morning workout or just spending

lack of sleep and a hangover):

10 minutes and finding things to be

1)

Be disruptive. Thirty years ago,

chairside milling it was just so out there.

Lots of “experts” said it would never work.

It would never match lab quality dental restorations. However, it was a ripple in the

"Without great patients, you don’t have a great dental practice."

Change your state.

What if

Perhaps that means a

thankful for. Maybe it’s meditation.

Setting the tone for your day is so important. Tony Robbins spoke at CEREC 30 and talked a lot about “changing your state.”

So many

outcomes in business relationships

dental world that would create a tidal wave. And look now. CAD/CAM is hot

have to do with your emotional and physiological state. While his energy

and creating beautifully fitting and gorgeously esthetic chairside restorations

is seemingly other-wordly, he encouraged us dentists to think about how we

in single visit dentistry. The technology is insane! It’s what patients want and

portray ourselves to our teams and patients.

are willing to pay for.

Things like fear and apprehension are often a function of our physiology.

While for you, it may not be CAD/CAM or even a dental technology of any

Making a radical change in our bodies can give you more courage and less

kind. Perhaps it’s something that makes you stick out. Is it a friend who

anxiety. Make it a habit to push your body physically. Go on a hard run or

you’ve wanted to reach out to but haven’t yet. Maybe it’s that marathon that

bike up that steep hill and suffer. You’ll find that when your change your

haven’t signed up for yet. Stop going with the crowd and doing whatever

body, you change your mind. And when you change your mind, you respond

everyone else is doing. Do something crazy and stand out. Be the ripple in

differently to things that normally would’ve caused you to cower and run.

someone’s life that creates change.

Have one ritual for yourself that will better you physically. Do it every day for a month. I promise you’ll feel better. It’ll change your state. And you’ll

2) Show people you care. When was the last time you did something simple

be able to be more remarkable to your family, your friends, your team and

such as thanked your staff at the end of a work day. I wouldn’t be where I’m

your patients.

at without my team. I don’t take that for granted, and you shouldn’t either.

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Articulator

Winter 2015

CLINICAL SHORT TERM ORTHODONTICS - ETHICAL DILEMMA

By Brandon Martin, DDS, MS Ethical Dilemma: You have a patient that loves to smile, but has been hiding behind overlapping central incisors for years. You suggested short-term orthodontics (approximately six months of treatment) to improve the alignment of the maxillary anterior teeth. The patient was thrilled by the option, but tells you she saw an orthodontist last year that said she really needs 2 years

Choice “C” is the best option. The ADA Code of Ethics calls for Patient Autonomy - the dentist has the duty to “treat the patient according to the patient’s desires, within the bounds of accepted treatment” while giving due consideration to “the patient’s needs, desires, and abilities.” Additionally, the Code of Ethics requires Nonmaleficence – we have the duty to refrain from harming our patients. We are tasked with “keeping knowledge and skills current” and to “seek consultation whenever the welfare of patients will be safeguarded or advanced by utilizing those who have special skills, knowledge, and experience.”

What should you do?

A.) Call the orthodontist who did the last consultation and ask the doctor if it will be okay if you proceed with anterior alignment only.

Doctor-patient communication is the key to a successful and mutually beneficial relationship. As part of our informed consent process we should review the proposed treatment, reasonable alternatives and explain risks and benefits.

After adequately reviewing treatment options, the patient should be involved in the treatment decision. The dentist should encourage patients to seek the best treatment option that will minimize harm and maximize benefit. To minimize harm, the dentist should carefully evaluate which option is best for the particular case, and refer if they feel others may be more skilled or experienced.

To maximize benefit, the dentist should educate patients and make them part of the treatment process. To best serve our patients it is important to keep our knowledge and skills current, to effectively communicate the risks and benefits of different treatment options, and help promote our patient’s welfare by making informed treatment decisions.

of treatment.

B.) Explain that orthodontists tend to be very idealistic and want everything to be perfect even if the patient doesn’t want everything to be perfect. As the patient, you have the right to decide what you want to do with your teeth. Remind them that their bite has been that way for 40 years, and there won’t be any problems with leaving it that way for another 40 years.

C.) Let the patient know there are many treatment options available including comprehensive orthodontics with full bite correction, limited orthodontics focusing on limited treatment goals or “instant orthodontics” utilizing restorative dentistry. Review the benefits and risks of each treatment option in detail. Refer to other professionals as needed if any alternatives are outside of your training or comfort level. After the patient has made a treatment decision, be respectful and supportive.

D.) Tell the patient to go get another consultation that can act as the “tie-breaker."

About Dr. Brandon Martin Dr. Martin received his DDS at the University of California in San Francisco and his orthodontic specialty certificate from the University of Maryland. He is a partner in a private orthodontic practice with multiple locations in California.

7

PRACTICE MANAGEMENT

IMPORTANT CONSIDERATIONS WHEN FORMING DENTAL PARTNERSHIPS

By Jesse Morris, AIF®, CFS®, PPC - Associate Financial Advisor, Summit Wealth Group

P

artnership - An equal or proportional ownership of a business. This typically means an equal ownership of the hard assets and may include intangible assets such as goodwill or profits.

Dental practices, or any practice/business for that matter, goes through transition. Often these transitions involve bringing on new partners, looking at all of the details in the business, and a variety of different emotions. As advisors and planners by nature, we know that considering the possible partnership from every angle is a very wise idea. We’ve pulled together some important angles to consider when considering a dental partnership opportunity.

bring a third-party into the partnership agreement process to help you think through all of the angles.

Thoughts and questions to consider: 1) What personality traits, strengths, experience do each of us bring to the partnership?

2) What goals does each have for their career? For the partnership?

3) What percentage ownership is the current owner willing to sell?

"Fifty percent of partnerships discussed fail to ever form. Of those that form, only fifty precent survive. "

Planning out a successful partnership is extremely important because fifty percent of partnerships discussed fail to ever form.

Of those that form, only fifty precent survive. Failed partnerships are often due to poor planning, differing expectations and not formalizing an agreement in writing. With this knowledge and our experience, we have seen successful partnerships form from clear preliminary communication, careful planning and written agreements.

Dental practices face specific challenges in partnership agreements.

A true legal partnership includes a very important characteristic for a dental practice, which states all partners, to the full extent of their personal assets, are responsible for the acts of any of the partners Before any partnership agreements are put in place, there are a number of important questions to consider and think through. Then, when the different parties are ready, it is wise to bring a trusted consultant and lawyer to help walk you through the process. It is essential to

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4) What assets are included in the sale?

Important Aspects to a Partnership Agreement: Stock Ownership

The partnership itself is an involved arrangement, but it has some clear pieces. Most partnerships will involve the purchase of stock. It is imperative that the value paid for the stock should not be the full amount paid for the practice. Stocks also must be paid with “after-tax” dollars. Furthermore, the purchase price is generally split between a small amount for the stock and the balance to be paid as deferred compensation to the seller. The justification for this type of approach requires precise wording in the “Stockholder Agreement” to pass IRS scrutiny. Also, the most important inclusions in the arrangement are the warranties and hold-harmless provisions. Concurrent with the sale of stock, each doctor will get a new employment agreement. As equal or almost equal owners these agreements will be almost identical. A comprehensive look at the partnership of stocks is vital to success.

Assets Acquired Once the basics of the stocks are defined, the partnership agreement needs to take assets into consideration. One of the keys is to clearly

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Winter 2015

define what are considered to be assets of the partnership. Becoming a partner typically means ownership of all assets to run the practice.

However, the valuation relative to the goodwill aspect is typically tied to the individual production of each owner. Initially, the new dentist is buying access to the existing client base. This means they are to receive equal opportunity to see recall patients, present treatment needed and provide the required services. Also, they are buying the right to see an equal number of new patients. Both of these aspects are referred to as “sharing” and should be thoroughly discussed between both parties.

Splitting the Income Once a partnership is set up, income may look different for both parties.

A discussion needs to be had on how the practice net income (income after expense) remains for the owners. You’ll want to talk about how both expenses and profits will be split. Expenses may be split by production, but for the most part, rent and other facility related expenses are almost always split equally. Supplies, depending on the practice, could also be split based on production. Profit splits are typically based on production, but profits are split by ownership. In some general dentistry and perio specialties, the hygiene revenue could be split based on production ratios or who conducted the exam.

Agreements Ultimately the agreement needs to cover the “buy-in price,” which is based off a proposed purchase price. This can be established when an associate first comes on or at a later date. Then, a Letter of Intent (LOI) needs to be established. A LOI spells out the preliminary terms of a buy-in/ buy-out situation. Typically, it is a letter that is not binding, but includes important matters discussed and is written down. The LOI, while not binding, is essential to form the framework for a successful partnership as it anticipates possible scenarios in writing.

Below Are Key Parts To A Letter Of Intent: 1) Goals -“Employee Agreement”- detailing compensation, benefits, responsibilities, hours of employment, and probably a non-compete provision.

2) “Non-compete Agreement”- a contract limiting a party from competing with a business after termination of employment or completion of a business sale.

d. How the doctors will be compensated e. How patients, expenses, and profits will be split f. How future Buy-ins/Buy-outs will be handled g. What happens in the event of death or disability h. Conflict resolution i. Management duties j. Cross-purchase life and disability insurance 6) “Stock Purchase Agreement”- terms of the sale. The agreement is fairly straight-forward, boilerplate-type content, with a lot of legal terminology Whether you are considering a partnership right now, or know that you may someday, it is important to consider the questions and topics you should pay attention to in a dental partnership. Asking good questions and getting sound counsel can set you up with peace of mind in a dental practice transition.

About Jesse Morris Jesse Morris has specialized insights into the dental industry, providing comprehensive financial services to our dental clients, their teams, and their practices. Jesse leads the Lone Tree office at Summit as an Associate Financial Advisor and Branch Manager of Summit Accounting Solutions.

Jesse combines a wealth of knowledge in business planning, finance, retirement plans, and financial planning to provide expert insights to both our financial planning clients and accounting clients.

Jesse has over eight years of experience in the financial services industry with a degree in Finance from the University of Colorado. Jesse holds the FINRA Series 6, 7, 63 and 65 securities registrations through Commonwealth Financial Network and Colorado Life and Health insurance licenses. He holds the Accredited Investment Fiduciary® (AIF®) designation, which represents a thorough knowledge of and ability to apply fiduciary practices.

He also holds the Certified Fund Specialist® (CFS®) designation and the Professional Plan Consultant (PPC) designation.

3) Worst Case Scenarios - The documents should provide worst-case scenarios, such as split partnership and a means to amicably separate the partnership.

4) “Stock Restriction Agreement”- defines who can own an interest in the partnership.

figure 2

5) Detailed Instructions: The letter of intent should spell out details for all of the following items:

figure 2

a. How the purchase price will be allocated b. How the purchase price will be paid c. How the partnership will be run

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Articulator

Winter 2015

9

MDDS NEWS

WELL… WE BUILT THE MWDI...SO WHAT’S NEXT??

By Elizabeth Price MBA, CAE, CDE, MDDS Executive Director

T

10

he RMDC is running smoothly – attendance is higher than ever. The Mountain West Dental Institute (MWDI) is consistently full of courses and used by members and professionals from all over the continent. We are paying off our bills and have a great staff; membership numbers are on the rise; and there are many new events to keep our members active in their community…so what’s next? This year marked the third and final year of the Metro Denver Dental Society Board of Director’s Applied Strategic Plan (let’s just call it the ASP for short).

What is an ASP and how does it concern the average member? An ASP basically outlines the answer to the question, “What’s next?”

fact, which is very statistically relevant. THANK YOU! The MDDS Board of Directors, along with a group of key members (the brain trust), staff and a professional facilitator (the cat herder) took that survey data, distilled it down, then met for two days and created a plan for what the Society will be doing for its members over the next three years. The “cat herder” then refined that plan data into our formal 2015-2018 ASP. The four objectives from that ASP have been assigned to various committees who are now working on ideas and ways in which to accomplish those goals.

Remember the survey that was mailed and emailed to you a few months ago? Just say yes. Some of you actually responded – 18% in

2. Create and implement an improved sales and marketing campaign targeted at recruiting recent graduates and International Student

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The ASP objectives are as follows: 1. Build the MWDI brand through a general awareness campaign.

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Winter 2015

Program graduates from the University of Colorado School of Dental Medicine along with other key schools.

3. Create a new, enhanced and modernized RMDC Expo Hall experience.

4. Increase community outreach through awareness and involvement in local functions and political activities.

Objective 1 The MWDI is consistently filled with MDDS courses and programs put on by other groups. However, we can always do more to keep this valuable community resource fully utilized 5-7 days a week. Our committees have begun researching the

"Do you have issues finding assistants with advanced or specialty training?" feasibility of creating a workforce training program for advanced and specialty assistants. The main goal of this program would be to keep our members supplied with assistants who have advanced training while furthering the MWDI education brand. Do you have issues finding assistants with advanced or specialty training?

Do you want to help solve this problem? If you said YES, we ask that you please respond to the e-survey (coming soon!) regarding this topic. If you said NO, we still ask for your feedback. We don’t want to waste time and resources on something our members do not support. This data will help us form what programs to offer for your staffing needs. An investigation will also be done into the feasibility and desire for an MWDI fellowship for members who have completed a certain amount of CE at MWDI. In addition, we will research the interest in an annual University Professor Technology Summit.

Objective 2 This one is pretty basic: attract and retain brand new dentists in our Society as members. Our membership numbers are at a record high, so why is this an objective? Unfortunately, our market share is down. Denver is growing by leaps and bounds so we need to be more proactive about recruiting and retaining our new dentists and showing them the value of organized dentistry. You will see MDDS doing more active recruitment at our local dental school, with an additional focus on the International Program Students.

These students are the future of organized dentistry. As members, we encourage you to attend our New Member Welcome Events and our other various social events. We invite third and fourth year dental students to these in hopes they will become active participants in our dental community early on in their career.

Objective 3 I am super excited about this objective and I know our RMDC attendees will be as well! MDDS will be taking some time and money to revamp our Expo Hall at the RMDC. We plan to add

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more technology, networking and education areas to create an enhanced, modernized experience for attendees and exhibitors. The RMDC committees will be asking for input from exhibitors to help form the new plan for the Expo Hall. By 2018, the hall will be a buzzing mecca of dental technologies and a “can’t miss” for attendees.

Objective 4 Get out in the community. If you do, you will see MDDS. In fact, why not join us! You will see us participating in several new community events and we will need volunteers. Keep an eye out for opportunities to join us at events such as fun runs, Denver St. Patrick’s Day Parade, health fairs and the like. MDDS is the oral health authority committed to its members and the community of the Rocky Mountain Region (sound familiar – that is our vision statement!) and we are spreading the word to make this vision a reality.

If any of these objectives look like something you would be interested in helping us achieve, give us a call. We are always looking for committed committee members and volunteers. No time to commit – that’s ok! Your dues help support this work on your behalf. Try to make it to an event once in a while though, send us an article or announcement to print in The Articulator, attend the RMDC and reconnect with your dental community. YOU are what’s next at MDDS!

DOES YOUR PERSONAL DISABILITY POLICY: • Cover you in your “own occupation” even if you choose to work in another after a disability?

• Separately cover your student loan payments?

• Cover you fully for “mental/nervous” claims?

• Protect your retirement plan contributions?

Be sure to know. Find out how yours compares.

For Dentists and Specialists, the best value is the strongest policy.

Contact David Richards, Disability Income Specialist for the dental profession since 1993 at 303.714.5875 and visit the website

www.ddsdi.com Articulator

Winter 2015

11

TRIPARTITE NEWS

HIPAA VIOLATIONS ON THE RISE: ARE YOU BREAKING THE LAW?

By Crysia Gabneski, Strategic Communication Specialist for the Colorado Dental Association

P

rotecting your patients’ health information is of the utmost importance when it comes to sustaining a successful practice. But in an ever-evolving digital age, with many ways to communicate with your patients, are you as a provider doing everything you need to legally to comply with the Health Information Portability and Accountability Act (HIPAA)? Protecting your patients means you’re protecting your practice.

And now, with electronic messaging becoming the norm, it’s more important than ever.

The federal government continues to tighten its enforcement of HIPAA laws, leaving practices like yours at major risk if you and your staff aren’t in compliance.

The penalties for violations are staggering: One incident could put a practice out of business. Ask yourself, Can I 1 because afford to pay $50,000 or even up toFigure $1.5 million an email with private patient health information got into the wrong hands? Not many practice owners can, nor do they want to. In extreme cases, these violations can be considered criminal acts and can lead to prosecution by the Department of Justice, complete with stints behind bars for up to 10 years. So how do you protect your patients and your practice from electronic messaging-related HIPAA violations?

Know What to Look For Evaluate your current communication method, among your staff members and also between your practice and its patients and other providers. Many electronic messaging systems on the market today are secure, but they might not meet the standard of HIPAA compliance. If you or your staff members email data, lab reports, x-rays and other private information relating to your patients, to each other or to other dentists, make sure your messaging system is HIPAA-compliant.

Remember, “secure” doesn’t always mean “HIPAAcompliant.”

Even if you think you’re doing everything right, double check. Three of the most common email servers— Outlook 365, Yahoo Mail and Gmail—though secure, are missing several features that are necessary to be considered HIPAA-compliant.

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There are five specific HIPAA requirements related to email.

1. Access Controls: A covered entity is required to implement technical policies and procedures that limits access to systems containing protected health information only to personnel with sufficient access rights (164.312 (a)), including having: a. A unique user identification b. An emergency access procedure c. An automatic logoff process d. An encryption and decryption process

"The Colorado Dental Association endorses iMedicor, Figure 1 a national provider for secure, HIPAA-compliant messaging through a proprietary product called the iCore Exchange."

2. Audit Controls: A covered entity is required to implement software that records and examines activity in systems that contain or use protected health information (164.312(b)).

3. Integrity: A covered entity is required to develop and implement policies and procedures to protect protected health information from altercation or destruction (164.312©). This includes having a method to authenticate protected health information.

4. Person or Entity Authentication: A covered entity has to implement procedures to verify a person or entity accessing protected health information is the one to whom the protected health information belongs (164.32(d)).

5. Transmission Security: A covered entity is required to implement technical measures to guard against unauthorized access to protected health information that is transmitted over an electronic communication network (164.312(e)). This includes integrity controls and encryption.

Aside from ensuring your chosen electronic messaging system has these features, it’s also crucial that your system have what’s called “direct” data exchange protocol. This is the federal standard for secure messaging, and it allows you and your staff members to send HIPAA-compliant, encrypted email messages to people outside your network via the Internet. Direct data-exchange protocol uses a two-step verification system, checking for two unique identifiers such as a Social Security number and an ADA number. Direct protocol is a feature that gives a sender confidence that an email recipient truly is the intended recipient.

Choosing the Right System for Your Practice So where do you start your search for the right electronic messaging system for your practice? The Colorado Dental Association endorses iMedicor, a national provider for secure, HIPAA-compliant messaging through a proprietary product called the iCore Exchange. The iCore Exchange product allows dentists, patients and other healthcare providers to communicate, collaborate and exchange records, x-rays and other protected health information, with the assurance they are in full compliance with all current federal HIPAA laws.

The iCore Exchange acts as a messaging hub allowing multiple email providers (secure and non-secure) to be managed and accessed through an easy-to-navigate dashboard. The iCore Exchange integrates seamlessly with most electronic health record, imaging and messaging systems. And it’s a cloud-based product, which eliminates the need to purchase additional hardware and pay high IT costs, and it can be accessed at any time from any location with an Internet connection.

The bottom line is unless a practice is using an email system that is HIPAA-compliant, its providers are at risk of incurring violations and receiving penalties, fines or jail time. Make sure you’re in compliance. Your practice and your patients’ privacy depend on it.

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Winter 2015

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NON PROFIT NEWS

FREEDOM DAY 2015

Appletree Dental

Belmar Park Dental

O

n September 10, 2015, dentists across Colorado and the rest of the country donated time and resources to provide veterans, active military personnel and their immediate families free dental care.

Although this is the first year MDDS was involved, Freedom Day USA began three years ago to say thank you to our nation’s heroes. This event takes places on the 2nd Thursday of September every year and we encourage you to get involved! To learn more about Freedom Day USA and how to help visit freedomdayusa.org.

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Winter 2015

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15

NON PROFIT NEWS

YOU CAN CHANGE LIVES!

T

hrough Dental Lifeline Network, the Colorado Donated Dental Services (DDS) program, offers comprehensive dental treatment to people with disabilities or who are age 65 or older, or medically fragile and cannot afford care.

At age 52, Terry was residing in an assisted living facility, due to developmental disabilities resulting from a remote anoxic brain injury. He also has end stage renal disease and receives dialysis treatments at a facility three times per week, but is not eligible for a kidney transplant. Adding to Terry’s health ailments, he had no upper teeth, only nine lower teeth and no access to dental care.

Dr. Eric Van Zytveld, a 25-year Denver DDS volunteer and Dental Lifeline Network Colorado board member, came to Terry’s rescue by referring him to Colorado DDS. Dr. Van Zytveld, a general dentist, donated two extractions, four restorations and full upper and partial lower dentures.

“Terry is the nicest person you’d ever want to meet. He needed a clean bill of health so he could undergo surgery.

We taught him how to take better care of his mouth.

Getting his teeth back made a huge difference in the way Terry felt about himself and his oral health. The reason I’ve volunteered for DDS for so long is because the patients are so appreciative.”

– Dr. Eric Van Zytveld

16

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Dr. Van Zytveld also has a message for dentists who are thinking about volunteering for DDS: “The satisfaction you get from being able to help other people is beyond compare. My entire staff feels so much better about their ability to impact someone’s life and they really get involved when they see the huge need these people have.”

assistance from specialists and laboratories, and serves as the liaison between your staff and the patient.

Volunteering is easy - Your staff will love the experience!

• Patients are prescreened.

• Review the patient profile in advance and choose to see or decline any patient.

• Determine your own treatment plan.

• See patients in your office on your schedule.

• Never pay lab costs.

• No extra paperwork for your staff.

Volunteers say they never expected how much their staff appreciates the DDS experience.

Staff members celebrate the success of patients and value the teamwork they provide with their dentists.

Terry (left) with Denver Donated Dental Services (DDS) volunteer Dr. Eric Van Zytveld

Medically fragile patients often need dental care to qualify for lifesaving or life-sustaining treatments such as chemotherapy, joint replacement, cardiac surgery and organ transplants. For those who qualify for Medicare, that program may cover their medical treatments, but Medicare does not cover dental treatment. Although some dental procedures are covered through Medicaid, many individuals who cannot afford dental care they desperately need are not eligible for the Medicaid program.

For more information about volunteering, contact Denver DDS Coordinator Kevin McGrellis at (303) 534-3931 or kmcgrellis@ DentalLifeline.org, or visit DentalLifeline.org/ colorado.

About Dental Lifeline and DDS Donated Dental Services (DDS) is the flagship program of Dental Lifeline Network, a national nonprofit organization and a charitable affiliate of the American Dental Association.

Now 30 years old, the DDS program was founded in Colorado where it has provided more than $27 million to 11,600 patients.

Nationally, DDS has provided $300 million in donated care to more than 107,000 patients in 50 states and Washington D.C.

Volunteer Now! In the metro Denver area, 209 dentists volunteer for DDS, but more volunteers are always needed. Nearly 100 people are on waiting lists. You can treat one patient per year or as many as you choose.

A DDS coordinator ensures that patients arrive on time for appointments, arranges for

Articulator

Winter 2015

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Winter 2015

17

MEMBERSHIP SPOTLIGHT Current MDDS members were asked why they are a member of the tripartite and here's what they shared with us.

SIZE DOES MATTER

RHETT MURRY, DDS

D

r. Murray's father, a physician, was a member of the American Medical Association. When Dr. Murray was a young dentist, the AMA dissolved their tripartite structure and no longer required national, state and local societies to be joined together. He watched the AMA weaken terribly from that change and it impacted his desire to be involved in his professional tripartite association. "To me, the tripartite is where you get the strength. You get the good ideas from the local components, and then it rises to the top and gets the power to put it through the state and national levels."

"I really believe in the tripartite working well together to make things happen and once you separate that, then our power in Washington goes away. Congressmen are more likely to be persuaded by an organization with 165,000 members than smaller groups with 20,000 members." Membership size matters and having one united voice gives power to make things happen!

SUPPORTING HIM EVERY STEP OF THE WAY DAVID KLEKAMP, DDS

D

r. David Klekamp, a general dentist in Denver, still remembers getting his ADA membership card in the mail 30+ years ago - it had white-out on it. That card prompted him to get involved at the local level and despite its condition, he has remained a member because of the support he's received from the tripartite every step of the way. "The dental society offers me something all the time and has taught and given me so much."

Dr. Klekamp feels that dentists are confronted by a lot of different issues whether it's staffing, amalgam separators or business competition. Being a member of organized dentistry offers a support group and an opportunity to network with colleagues who are an invaluable source of information, encouragement and collaboration. This has led to both friendships and better business practices. "The dental society supports you, you have people you can run to with questions or that can help out others." There is no doubt that Dr. Klekamp plans on remaining an involved member because organized dentistry has "stimulated me to do better for my patients and my patients are better served because I'm a Society member."

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Winter 2015

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Winter 2015

19

CLINICAL

LOST IN SPACE

How to Get Predictable Results From Your Laboratory By “Diamond” Dave Andrus, CDT Dentistry by Justin Smutz, DDS

T

here are two primary reasons crown and bridge

as the great times.

cases fail in the esthetic zone: 1) under qualified dental technicians and

The second point deals with how your ceramist knows how to make

2) insufficient information provided to the

restorations in the esthetic zone? It is an everyday occurrence for dental

laboratory from the dentist.

laboratories to receive anterior crown and bridge cases that don’t have sufficient guide lines or information to allow them to fabricate final

Regarding the first point, over the last 20 years there have been significant

restorations with predictably great results (Figure 1). Dentistry gives us

changes in the dental industry. Periodic economic down turns, veteran

generic criteria to follow when fabricating restorations in the esthetic zone

technicians retiring or their labs going out of business, proliferation of

but they are at best only starting points. There is no way for a technician

insurance driven pricing, off shore laboratories and in-office milling

to know where the lip line is from the information they get from a stone

systems have been primary players in the loss of experienced technicians

model or how long the incisal edge should be on an anterior bridge without

and the closure of significant numbers of smaller labs. The fix for this

pre-operative models. Even when old restorations are being replaced, the

dilemma, believe it or not, is in your hands as dentists. If you aren’t

information gleaned from pre-op models which show wear patterns, wear

currently working with a ceramist or laboratory you are delighted with, find one and stick with them so they will be there for you in the long run. These labs are the labs owned and operated

“Don’t copy the old restorations.”

restorations give the technician a great head start on what should be done on the new restorations so you don’t have to make the same adjustments

by veteran ceramists and technicians who not only know how to create

on the new restorations. If you are concerned a technician will try to copy

great anterior restorations but fabricate great posterior restorations that

old restorations if a pre-op model is sent, this can be taken care of by five

look and fit like the human body grew them. The fees you’ll pay will be a

words on the prescription that read, “Don’t copy the old restorations.” Pre-

little higher, the success rate will be much higher and your stress level will

operative impressions and good photos are vitally important information

be much lower. These are the labs where the person you talk to is the same

for esthetic cases from a single unit case to full mouth cases!

person making your restorations. These are the technicians you can call or text when you have a patient in the chair to get quick, accurate answers to your questions when you need it. These are the technicians you can partner with to help grow your practice because patients are happy with the long lasting “pretty teeth” you have provided them. These are the technicians with enough experience that you are comfortable having them chair-side when your patient’s case is complex enough that it takes more than one dental professional to come up with the best solution. The dentist-laboratory relationship is much like a marriage; chose one that you’ll be glad to have standing beside you through the rough times as well

20

facets, past occlusal adjustments made on the old

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The intent of this article is to offer a proven step-by-step sequence to follow for predictably great esthetic and functional results the first time around.

• Get your technician involved in the case early! Before any teeth are prepped or any old restorations are removed or altered, send upper and lower full arch PVS impressions (that can be poured repeatedly) to your lab with occlusal bite registrations so models can be made and your technician can evaluate the case. (Figure 2) When taking these impressions, it is important to use light body at the gingival to get the best detail replication possible of the sulcus and embrasure areas (see the “instant make over”

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Winter 2015

bullet below for the reason). The information sent with the impressions should include: the patient’s esthetic expectations, the number of restorations agreed upon by the patient, the material choices you are considering, any patient specific requirement i.e. current/future splint therapy, future restorations planned for after the esthetic work is completed, root canal treated teeth or discolored teeth when considering all ceramic restorations, etc.

Figure 1: How long should the incisal edges be for this bridge? This is the dilemma technicians are faced with every day.

Figure 2: Pre-op models.

Figure 3: Diagnostic wax-up with blue wax.

Figure 4: Putty Matrix made from the diagnostic wax up that can be used for an instant make-over mock up and provisional crowns.

Figure 5: Instant make-over overlay.

Figure 6: Patient presentation models made from the putty matrix.

• Send counting photos. Take a series of close up, rapid succession still photos (be sure your strobe batteries are fresh) that show only the patient’s mouth while the patient slowly counts from 50 to 60 by ones. Have your camera ready, tell the patient to start counting and take pictures as rapidly as your camera will allow them to be taken.

This series of pictures will show the technician the relationship of the incisal edge of the patient’s upper teeth to the lower lip and where the upper lip naturally falls while the patient is speaking.

• Send Emma pictures. Have the patient say Emma, Emma, Emma (three times) and relax their lips in the open position. Repeat this until you have captured a photo of the natural lip position when the patient’s lips are relaxed but slightly open. (Figure 7) • Send retracted cheeks photos of the patient’s teeth occluded.

Using cheek retractors with the patient’s teeth occluded, take a series of six photos that only show the patient’s upper and lower gingiva and upper and lower teeth from the following positions: 1) Right Side Profile i.e. 90 degrees from straight on; 2) Oblique Left i.e. 45 degree angle from straight on; 3) Straight on in front of the patient, perpendicular to the labial surface of the upper teeth to show labial contour and texture; 4) Straight on in front with the camera slightly above the aforementioned angle i.e. with the camera positioned slightly

(Continued on pg. 22)

toward the forehead to show translucency of the anterior teeth; 5) Oblique Left;

Figure 7: Final provisionals made in 15 minutes from lab provided putty matrix.

6) Right Profile.

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21

(Continued from pg. 21)

• Send open bite, retracted cheeks photos. With the patients cheeks retracted, take a series of six photos as mentioned above but with the

•Tooth-by-tooth reduction guide. We provide our clients with a detailed,

patient’s teeth opened slightly so the upper and lower incisal edges are

written, tooth-by-tooth reduction guide that includes any adjustments

visible in the photo.

to the opposing teeth, crown lengthening or subsequent details that

• Send good shade photos. See “Diamond” Dave’s article “50 SHADES

should be addressed at the preparation appointment.

OF GRAY, How to get shades right the first time” in the Fall 2015

• Bite registrations are taken on the prepared teeth. If necessary, face-

Volume 20. Issue 1 of the ARTICULATOR pages 20-22. This was the last

bow records should also be taken at this time and sent to the laboratory.

ARTICULATOR magazine you received with the tenth birthday cake on the cover. It is also available on line.

• Provisional putty matrix. The same putty matrix mentioned above, or one that includes any changes, is provided to be used to fabricate the

• Diagnostic wax ups provided by the lab (Figure 3). Our diagnostic wax

provisional restorations at the final preparation appointment. Dr. Justin

ups are done with blue wax and are not for patient presentation. They

Smutz reported the time required to do the final provisionals on the

are done on models with as little reduction made to the original model

eight unit case in this article was “15 minutes, for everything; occlusal

as possible which provides us with a guide for the amount of reduction

adjustments, and flash clean up”. (Figure 7) NOTE: this is only possible

necessary when the teeth are prepared. With this “blue wax up”, for example, it is easy to see the distal sides of #8 and #9 will require more reduction than the mesial sides which will allow the mesial widening of the laterals and the slight distal narrowing of the centrals to compensate for the width gain of the centrals due to closing the mesial diastema

"This technique can be used as a sales aid allowing the patient to instantly see what their new smile can look like."

between the centrals.

if the initial diagnostic impressions capture great gingival and interproximal detail (as described in the first bullet point above) to achieve a snug seal of the putty matrix to the gingiva.

• Deliver the final restorations. Production of the final restorations in the laboratory is predictable because the details have been worked out ahead of time which makes delivery of the final

restorations predictable as well. At the time this article was submitted

• Instant make-over. (Figure 4) We provide the dentist with a putty

for publication, the case shown in the photos was still in provisional

matrix made from our diagnostic blue wax up which serves four

crowns, however, Dr. Smutz delivered another eight unit cosmetic case

functions.

(which was shown in “Diamond” Daves article “50 SHADES OF GRAY,

1) The dentist or assistant can extrude a small amount of temporary material into the matrix, insert it into the patient’s mouth before any preparation has been done, wait for it to set, and then remove the putty matrix. The patient can instantly see the proposed end result and even dictate small changes.

2) This technique can be used as a sales aid allowing the patient to instantly see what their new smile can look like (Figure 5).

3) We have occasionally had dentists let patients wear the instant makeover for a couple days to see if incisal lengths are satisfactory, get input

How to get shades right the first time” in the Fall 2015 Volume 20. Issue 1 of the ARTICULATOR pages 20-22) similar to this case and reported the final delivery took 2 hours 20 minutes.

About the Author Dave Andrus has owned and operated Diamond Dental Studio in Byers, Colorado for 29 years. He has been a technician for 37 years and can be reached at andruscompanies@netecin.net or (303) 822-6666.

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from family members and make final decisions on going forward with the procedure. If the detail replication, especially at the gingival sulcus and interproximal areas is very good in the initial PVS impression for the study models (as mentioned in “get your technician involved in the case early” bullet) the clean-up is minimal. If any changes are made to the overlay, an impression should be taken and sent to the laboratory so the technician can replicate them. The instant make-over overlay can then be easily removed by an assistant.

4) We create the patient presentation model from the matrix in white stone. (Figure 6)

22

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Winter 2015

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Winter 2015

23

CLINICAL CASE OF INTRACRANIAL ABSCESS SUSPECTED SECONDARY TO PERIODONTAL INFECTION AND ODONTOGENIC INFECTION

By Robert Reti, DDS, Michael B. Barbick, DMD., MD. & Michael Noble, DDS

I

NTRODUCTION Odontogenic infections are the oldest disease processes that are treated by the oral and maxillofacial surgeon. Concerning is the general poor understanding of the severity these infections can attain. A deep spreading infection can quickly compromise the nearby airway, limit oral intake to the point of severe dehydration or malnutrition, spread to the mediastinum and occasionally seed to the central nervous system. In the following case report, we describe a case of a right occipital brain abscess of dental origin.

CASE REPORT A 40-year-old male reported to an outside emergency department with complaint of two weeks of headaches that had progressively worsened, even more so for the prior 3 days. On the date of admission, he became lethargic and a cranial CT and an MRI was completed that was consistent for a brain abscess and intraventricular rupture. That patient was transferred to our hospital with direct admission to the neurosurgery service. His past medical history was significant for Hepatitis B and colon polyps. He had no allergies. Current smoking history, social alcohol use and history of recreational drugs abuse.

Upon arrival he became non-focal, but obtunded and agitated. His white blood cell count (WBC) was non-elevated and had an increased temperature, but without fever. Review of the CT scan revealed a 3 x 3 cm right parieto-occipital ring enhancing lesion with intraventricular extension consistent with a brain abscess with intraventricular rupture (Figure 1). The patient was taken emergently to the operating room for a right frontal bur hole with insertion of a right frontal external ventricular drainage catheter and a right parieto-occipital craniotomy with evacuation of brain abscess with ultrasound guidance (Figure 2).

Intraoperative report notes approximately 10ml of gross purulence was drained.

The patient remained intubated and recovered in the Neurosurgical Intensive Care Unit. The infectious disease team was consulted and the patient was placed on a regiment of vancomycin, ertapenem and getamycin. A transesophageal echo cardiogram was completed to evaluate for a possible cardiogenic source of infectious vegetation. The results showed a normal ejection fraction at 60% no thrombi, normal valvular function and structure and no evidence of vegetations.

The microbiological cultures returned as Streptococcus viridians.

Suspicion for dental source of infection was questioned and an Oral and Maxillofacial surgery consult was requested. Head and neck exam revealed no appreciable swelling, erythema or subcutaneous crepitus. Ability to palate the inferior border of the mandible bilateral.

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Winter 2015

Cardiovasvular exam was negative for rubs, gallops or murmurs.

He was negative for Hamon’s sign. The limited exam revealed multiple periodontally compromised teeth with 2+ mobility. There were multiple areas with sulcular purulence appreciated. No floor of the mouth elevation or lateral pharyngeal bulging. A CT of the facial bones with contrast revealed a developing right sublingual abscess with generalized severe periodontitis and multiple teeth with periodontal ligament spaces widening (Figure 3 and 4). After a prolonged discussion with his next of kin, his mother, it was decided the patient was best treated with full mouth extractions to remove his compromised teeth and suspected source of infection.

The patient was extubated the following day and remained on Unsayn with the infectious disease closely monitoring the patient. The cerbral spinal fluid protein count slowly began to trend downwards and returned to clear from amber and cloudy.

The patient was discharged to a rehabilitation approximately four weeks from date of admission without functional deficits and on a prolonged course of antibiotics.

DISCUSSION Brain abscesses are rare, but serious, life-threatening conditions associated with high morbidity and mortality1,2. Brain abscess, occurs at a rate of one per 100,000 population4. The brain is remarkably resistant to infection due to the rich vascular supply and the impermeable blood brain barrier. Once intracranial, bacteria may produce a severe inflammatory response due to the absence of lymphatics, lack of subarachnoid space capillaries, and the presence of Virchow-Robin spaces4. The most common source of microbial infection remains direct or indirect cranial infection arising from the paranasal sinuses, middle ear and teeth.

Inoculation occurs by direct extension of a contiguous suppurative infection or anachoresis. twenty-five % of intracranial abscess are termed “cryptic abscess” as the source of inoculation is never discovered3.

The most typical presentation is a dull aching headache without localization found in 75% with diagnosis of brain abscess2,4. Rupture into the ventricular space is often fatal and presents as sudden worsening of a preexisting headache accompanied by new onset of meningismus. Focal neurological findings may on not be present depending on the location and depth of the infection. Mental status changes and focal neurologic deficits can aid in localization of the abscess2,4. Aphasia and visual field disturbances may suggest temporal lobe involvement4. Drowsiness, motor speech disorder, hemiparesis and grand mal seizures may be involvement of the frontal lobe. While Ataxia may result from a cerebellar abscess, dysphagia and facial weakness are seen commonly seen with brainstem involvement. Fever is found in less than 50% of cases and should therefore not exclude a possible diagnosis. Patient will commonly have a non elevated WBC and normal erythrocyte sedimentation rate. Blood cultures are typically found to show no growth.

Diagnosis of a brain abscess of dental origin is historically one of exclusion. In order to fault an intracranial abscess to be caused by

mddsdentist.com

dental origin Ewald et al. describe three criteria that need to be fulfilled3. The first is that no other source of infection can be found.

The second is identification of the offending microorganism to be of oral floor. The third clinical and or radiographical signs of an acute or chronic dental or “paradental” infection. All which were met in this case. Microbiological cultures of brain abscess are frequently polymicrobrial, although the literature reports S. viridians as the single organism in brain abscesses reported to dental infection5.

Surgical intervention is normally delayed until a mature capsule forms around the infection as reports in the literature suggest twice the mortality rate in treatment of acute abscesses4. Antibiotic treatment maybe the only treatment modality required in cases of multiple abscesses, anatomically inaccessible, critically ill or a single abscess less than 2 cm3,5. There is a propensity toward treatment via aspiration, although excision seems to be associated with more rapid resolution, decreased dosing time for antibiotic therapy, and a shorter hospital stay. Stereotactic techniques such as ultrasound or CT guided surgery have greatly improved the precision of aspiration5.

CONCLUSION Dental infections although the majorities are benign disease processes can have dire consequence and should be treated in a quick and aggressive manner. A fast spreading infection can quickly become an airway issue due to the nearby anatomy but also may extend to structures beyond the “paradental” region. It should always be kept in the back of our minds when treating these patients of what can happen so we are always prepared.

About Dr. Robert Reti , Dr. Michael Barbick and Dr. Michael Noble Dr. Robert Reti Graduated from the University of Detroit Mercy School of Dental Medicine in 2009. He went on to complete his General Surgery Internship and Oral and Maxillofacial Surgery training at Tufts Medical Center in Boston in 2013. After completing his residency, Dr. Reti was selected for an advanced fellowship in Oral & Maxillofacial Surgery at Mercy Hospital in St. Louis where he trained with some of the city’s most respected facial cosmetic, maxillofacial and occuloplastic surgeons. He currently practices at Southwest Oral Surgery in St. Louis.

Dr. Michael Barbick is an attending Oral and Maxillofacial Surgeon at Mercy Hospital and is part of the Oral Facial Surgery and Implant Center group.

Dr. Michael Noble is at Chairman and Fellowship Director of Oral and Maxillofacial Surgeon at Mercy Hospital in St. Louis.

1. Hibberd C and Nguyen T. (2012) Brain Abscess Secondary to a Dental Infection in an 11-Year-Old Child: Case Report. J Can Dent Assoc 2012;78:c49 2. Mathisen G. and Johnson P. (1997) Brain Abscess. Clinical Infectious Diseases 25:763–81 3.Ewald C . Kuhn S and Kalff R. (2006) Pyogenic Infections of the Central Nervous System Secondary to Dental Infections—A Report of Six Cases. Neurosurg Rev 29: 163–167 4.Lazow S., Izzo S. and Vazquez D. (2011) Do Dental Infections Really Cause Central Nervous System Infections? Oral Maxillofacial Surg Clin N Am 23 569–578.

5. Brook I.(19920 Aerobic and anaerobic bacteriology of Intracranial Abscesses. Pediatr Neurol 8:210–4.

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Be sure to check out the RMDC HANDS-ON COURSES being held at the:

MOUNTAIN WEST DENTAL INSTITUTE!

Visit MDDSdentist.com for a full schedule of other upcoming courses at the MWDI! • 140-seat Auditorium (can be divided in two) • Banquet Hall • 20-seat Executive Board Room • Hands-on Learning Lab Benches for 40 participants • Large Wet Lab • Four (4) Educational Operatories including one (1) equipped for surgery • 2D/3D Digital Imaging Suite • Planmeca PlanScan™ (mill & scanner) • Equipped to capture and stream live video • MDDS members receive a 15% discount • Multi-day & multi-room discounts • A/V always included • No catering restrictions • Free Wi-Fi • Two (2) free parking structures Metro Denver Dental Society | 925 Lincoln Street, Unit B Denver, CO 80203 | (303) 488-9700

MWDI.ORG

EVENT CALENDAR OCTOBER 2015

DECEMBER 2015

October 30 Earn a Full Day of CE Credits with JADA Live for Under $100 Double Tree Denver Tech Center in Greenwood Village 7801 E. Orchard Rd, Greenwood Village, CO 80111 8:00am-5:00pm

December 5 MDDS EventNitrous Oxide/Oxygen Administration Training Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00 am-5:00pm

NOVEMBER 2015

December 12 Women Dentist Event The Westin DIA 8300 Pena Blvd.

Denver, CO 80249

Novemver 5-10 ADA 2015 – America's Dental Meeting Walter E. Washingten Convention Center Washington D.C. All Day November 6-7 Botulinum Toxin & Dermal Fillers Level I & Frontline TMJ & Orofacial Pain Level I – American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 Nov 6th 8:00 am-5:00pm Nov 7th 8:00 am-12:00pm (303) 488-9700 November 13 Hands-on: Lasers for Hygienists – Dr. Robert Convissar Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:30 am-4:30pm (303) 488-9700

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mddsdentist.com

JANUARY 2016 January 21-23 2016 Rocky Mountain Dental Convention Colorado Convention Center 700 14th Street Denver, CO 80202 Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700

FEBRUARY 2016 February 26 Basic Radiation for the Unlicensed Dental Personnel – Dr. Brad Potter Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00 am-12:00pm (303) 488-9700

February 26-27 Hands-on: Recognition and Management of Medical Emergencies: Participate in an Advanced Clinical Simulation – Dr. Jeff Young Children's Hospital Colorado 13123 E 16th Avenue Aurora, CO 80045 Feb 26th 9:00pm-4:00pm Feb 27th 9:00pm-4:00pm (303) 488-9700 February 27 Colorado Society of Oral & Maxillofacial Surgeons Winter Meeting Children's Hospital Colorado Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:30 am-3:30pm (303) 488-9700

APRIL 2016 April 8-9 Botulinum Toxin & Dermal Fillers Levels I & II & Frontline TMJ & Orofacial Pain Level I Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 April 8 8:30am-4:30pm April 9 8:30am-4:30pm (303) 488-9700

MAY 2016 May 21 Behavior Guidance Emphasizing Immobilization/Protective Stabilization Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00pm-3:00pm (303) 488-9700

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Winter 2015

Need CE?

The Colorado Dental Association, Metro Denver Dental Society and Colorado component societies are excited to offer a new opportunity to help members fulfill continuing education!

In a partnership with JADA Live, the publishers of The Journal of the American Dental Association, we will present an exciting day of CE (6.5 hours) for a very minimal fee! $125 for ADA/CDA Members and $165 for non-members.

This Survey Style Course Includes: • Carries Detection: Digital Age Solutions to Ancient Problems • Adhesive Dentistry: A Guide to Clinical Success • Entering the Digital 3D Ecosystem, the Utopian Dental Experience • More to be announced soon!

You will receive 6.5 units of continuing education credit upon successful completion of this course.

American Dental Association is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Register at www.JADALive.org/denver 28

mddsdentist.com

Mark your Calendar!

October 30, 2015 8:00 a.m. - 5:30 p.m.

DoubleTree Denver Tech Center 7801 E. Orchard Dr. Greenwood Village, CO 80111

Have questions?

Contact the CDA at 303-996-2842 or jeanne@cdaonline.org Articulator

Winter 2015

TRIPARTITE NEWS

FLUORIDATION TO CONTINUE IN DENVER, OTHER MUNICIPALITIES

By Michelle Manchir, Senior Editor at American Dental Association

C

ommunity water fluoridation will continue in three more municipalities after their respective leadership boards voted on the issue in August. Here is a summary of the votes:

All four present members of the Denver Board of Water Commissioners on Aug. 26 voted to continue supplying optimally fluoridated water to the system’s 1.3 million customers in Denver and surrounding suburbs, according to Denver Water.

“If Denver Water were to cease supplementing fluoride, customers would still receive fluoridated drinking water, but the levels would vary significantly, creating an imbalance throughout our service area,” said Denver Water Commissioner Penfield Tate in a news release.

“Community water fluoridation provides dental health benefits across all socioeconomic communities in a predictable and uniform manner.”

The decision followed an information session in July.

Board and staff reviewed and researched the latest science and recommendations of national, state and local public health agencies and medical professionals, according to a news release.

Dr. Mark Crabtree, a former chair of ADA Council on Access, Prevention and Interprofessional Relations, oversees a nonprofit dental clinic in Martinsville and informed council members about fluoridation facts before the vote. Dr. Crabtree told the ADA News after the vote it’s important that those in the dental community help citizens understand the safety and benefits of fluoridating water. “If we’re not there to provide the information and advocate for the safety and health of the community, who will?” he said.

“If Denver Water were to cease supplementing fluoride, customers would still receive fluoridated drinking water, but the levels would vary significantly, creating an imbalance throughout our service area.”

The resolution the board adopted Aug. 26 stated: “Nothing has been presented to the Board or learned in our research that would justify ignoring the advice of these public health agencies and medical and community organizations, or deviating from the thoroughly researched and documented recommendation of the U.S. Public Health Service.”

Denver Water has been regulating the fluoride in the water system since 1953.

Colorado Dental Association members, including past president Dr. Brett Kessler, provided supportive comments and testimony to commissioners. CDA Associate Executive Director Molly Pereira lauded the commissioners’ decision.

“They made a decision based on their study of fact and science,” she said. “They didn’t allow themselves to be swayed by emotional arguments. They took the time to make sure they were protecting the safety of the public. We can’t ask for anything more than that.”

mddsdentist.com

In other news, the city council in Martinsville, Virginia, on Aug. 25 voted 3-2 against a motion to cease the addition of fluoride to its water supply. Council member Gene Teague, who voted for fluoride, said the research and evidence convinced him. “Not one of those major medical organizations has come out and said fluoride... is unsafe for the community,” Mr. Teague said during the meeting, which can be viewed on the city’s website.

Finally, city commissioners in Eustis, Florida, voted unanimously Aug. 20 to maintain community water fluoridation in the community, according to the Florida Dental Association. Members of the FDA gave a presentation and were present at the meeting.

These victories come after Austin city officials voted to defeat a challenge to the city’s fluoridation program on Aug. 19.

About the Author Michelle Manchir is Senior Editor at American Dental Association, prior to that she was a writer at the Chicago Tribune. Over the years she has covered a wide range of topics, including the Illinois legislature, local government, crime and schools. She started her career at the Palladium-Item in Richmond, Ind. Ms. Manchir has a master’s degree in public affairs reporting from the University of Illinois at Springfield.

'Manchir M. Fluoridation to continue in Denver, other municipalities.' Posted online August 31, 2015 at http://www.ada.org/en/publications/ada-news/2015archive/august/fluoridation-to-continue-in-denver. Copyright © 2015 American Dental Association. All rights reserved. Reprinted with permission.

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Winter 2015

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CLASSIFIEDS Items for Sale Ortho Shell For Sale: Price $150K, Furniture, Fixtures, Equip, 5 Ops - brand new - built Sept 2014. 2,256 square feet. Desirable Lowry neighborhood. ADS Precise Consultants, 888-9092545, adsprecise.com, frontdesk@adsprecise.com.

Job Board: Oral Surgeon in Castle Rock: With patient convenience in mind, we like to offer multi-specialties in one location. (Private Practice)

PERIO Practice – Tucson, AZ - Annual Revenues $611K, Practice Price $140K, Bldg also for sale - bldg price $140K, Dr. Retiring. ADS Precise Consultants, 800-307-2537, frontdesk@ adsprecise.com, www.adsprecise.com.

Perio Associateship leading to buy-out, Colorado Springs, CO. ADS Precise Consultants, 888909-2545, frontdesk@adsprecise.com, www.adsprecise.com.

GP: So Wyoming (WY 1434) Annual Revenues $805K, 6 ops, 3800 sq ft. ADS Precise Consultants, 888-909-2545.

Real Estate:

GP: North Denver (CO 1136) Ann Revs $1.3M, 8 ops, 2800 sf bldg 1, 4700 sf bldg 2. ADS Precise Consultants, 888-909-2545.

Oral Surgery/Dental Office-Lakewood: Former Oral Surgery office with upgrades. Spacious waiting area with beautiful curved reception desk, four operatories, lab, after-surgery recovery area. Contact Kay Hoppal, Broker, Hamilton Properties Corp., 303-340-3529 or email kayhoppal@hamiltonproperties.com.

GP: Montrose, Price $270K Annual Revenues $650K, 3 ops + 1 possible, 3 staff, 4 days per week, doctor retiring. Bldg for sale 800 sf, 6000 sf lot(CO 1432)ADS Precise Consultants, 800307-2537, frontdesk@adsprecise.com, www.adsprecise.com.

General Practice: Aurora, CO (CO 1527) Annual Revenues $500K, 3 ops, 3 days per week, Dr. Retiring. ADS Precise Consultants, frontdesk@adsprecise.com, www.adsprecise.com, 888-9092545.

General Practice for Sale - Denver Metro, CO (CO 1522) Annual Revenues $209K, Price 113K, 2 ops, 868 square feet, Dr. retiring. ADS Precise Consultants, frontdesk@adsprecise.com, www. adsprecise.com. 855-461-0101.

General Practice for Sale: Vail Valley, CO (CO 1516). Annual Revenues $396K, 6 Ops. ADS Precise Consultants, 888-909-2545, www. adsprecise.com.

General Practice: Maui, HI - Annual Revenues: $636K, 3 Ops, 782 square feet, 4 staff, 4 days/ week. ADS Precise Consultants, 888-909-2545, www.adsprecise.com, frontdesk@adsprecise. com.

GP: Northern WY (WY 1236) Annual Revs $759K, 5 ops, dr. retiring.

GP: Eastern Plains, Sale Price $349,000,Annual Revenues $624K,1,000 sq ft, 3 ops fully equipped,2 staff, Mon-Th 8:30a-5p, Fri 8a-12p (no patients), space available to expand (CO 1327) GP: for sale in Arvada, Colo. (CO 1123). Annual revenue $135,000, three ops, 950 square feet.

ADS Precise Consultants, 800-307-2537, frontdesk@adsprecise.com, www.adsprecise.com.

GP: in South Central Mountains (CO 1326): Price: $30K, annual revenues $95K, adjusted net income $65K, net income after loan payments $56K, 1 op, 2-2.5 days/wk, dr. moving out of state. Price $30,000. ADS Precise Consultants, 800-307-2537, frontdesk@adsprecise.com, www. adsprecise.com.

Visit mddsdentist.com/classifieds to place an ad.

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Winter 2015

31

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