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1.888.4.SHATKIN or register online at www.shatkinfirst.com Shatkin FIRST is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by the AGD for Fellowship/Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (April/18/2018) to (April/18/2019). Provider ID# (217959)

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CONTENTS PRESIDENT'S MESSAGE 4 OFFICIAL PUBLICATION OF THE UTAH DENTAL ASSOCIATION

CONTRIBUTING WRITERS A Dentist’s Guide to the Law ADA News Dr. Ken Baldwin Dr. David W. Chambers Dr. Gregory Gatrell Dr Barry Howell ISDA News Paula Meehl, CMA, CPA Dr. Matthew Messina Eric S Richmond, ESQ Dr Michael Smuin Dr. Mark R. Taylor Dr Keith Valachi

COVER PHOTO Cherry blossoms at Utah State Capitol Matt Morgan for Utah Office of Tourism

PUBLISHER: Mills Publishing, Inc. PRESIDENT Dan Miller OFFICE ADMINISTRATOR Cynthia Bell Snow GRAPHIC DESIGNERS Ken Magleby Patrick Witmer

ART DIRECTOR Jackie Medina

ADVERTISING REPRESENTATIVES Paula Bell Paul Nicholas

The Utah Dental Association holds itself wholly free from responsibility for the opinions, theories or criticisms herein expressed, except as otherwise declared by formal resolution adopted by the association. The UDA reserves the right to decline, withdraw or edit copy at its discretion. UDA Action is published bi-monthly. Annual subscriptions rates are complimentary to all UDA members as a direct benefit of membership. Non-members $30. Utah Dental Association, 801-261-5315 1568 500 W Ste. 102, Woods Cross, Utah 84010 uda@uda.org. UDA Action is published by Mills Publishing, Inc. 801-467-9419; 772 East 3300 South, Suite 200, Salt Lake City, Utah 84106. Inquiries concerning advertising should be directed to Mills Publishing, Inc. Copyright 2022.

Dental Practice Challenges

ASSOCIATION 5

We Need You

9 ADA Urges Congress to Include Dentists in Decision-Making Bodies Leveraging Best COVID-19 Practices For Future Pandemics 11

ADA Urges HRSA to Prioritize Dental Workforce Shortages, Oral Health Disparities

PRACTICE 6 What are the Antitrust Laws and What Do They Mean

to Me as A Dentist?

Can I Consult With Other Dentists When Setting My Fees?

Are We Happy Yet?

Pat Yourself on the Back Good Doctor

Interpreters for Hearing Impaired Patients

Ethics Should Fit the Scope of Practice

16 U.S. Dentists Still Prescribe Opioids Despite Effective Alternatives 16

Time to Celebrate

When Will it End?

OKU Dental Honor Society Letter

Dental Sleep Matters

Readiness, the Key to Success

Maintaining Mental Health in Stressful Times

PRESIDENT'S MESSAGE DENTAL PRACTICE CHALLENGES “4 out of 5 dentists recommend chewing Trident gum after every meal” has long been a slogan of Trident sugar free gum. How many times have you been asked this in your practice? I have personally had a few patients ask this over the years. Here is another one. 9 out of 10 dentists recommend Sensodyne and Pronamel as the brand for acid wear. We hear these advertising slogans all the time, but do we really back these products as advertised? Fortunately, no one on Capitol Hill asks what percentage of dentists back some of our proposed legislation. If we were looking at what percentage of dentists in our state are members of the dental association, I would be embarrassed to tell them that fewer than 60% of dentists in some areas of our state are members. I think that Trident and Sensodyne advertisers would need to come up with a different message if only 6 out of 10 dentists recommend their product. Times have changed when it comes to the percentage of the population who are members of an association. What is it that makes our membership less important? Why don’t we as dentists in Utah feel like we need to be a part of an association? In our state we have some of the lowest membership rates in the nation while also having some of the lowest dues. The Utah Dental Association works hard to provide one of the best state dental conventions in the nation. We offer many opportunities for continuing education at a reasonable rate. Some complain that we don’t offer enough variety. We are not trying to compete with the customized CE that you can find

Academy of LDS Dentists

at locations around the country. I’m glad I don’t have to pay top dollar for a CE course on opioid prescribing or go to an American Medical Association CE provider and take 10 hours of CE on the topic. We also have one of the strongest state level legislative efforts. We have made many positive legislative changes for both dentists and patients and we are one of the leaders nationally on state legislation that effects dentistry. Currently Draper City Council is reviewing whether it will continue public fluoridation. Historically the Utah Dental Association has supported public fluoridation. I hope the member and nonmember dentists in Draper are willing to speak up for the importance of public fluoridation. There have been many challenges to the practice of dentistry over the years and most have gone un-noticed. Recently there have been changes to our state dental license and a postponed requirement for E-Prescribing but we saw an attempt to add dental to an already underfunded Medicare part B. There are constant challenges we face. Mid-Level Providers and Independent hygiene practice are just a few… The list goes on and on. Never has there been a time that it is more important to be a member of the association. We need to spread the word to our neighbors about the importance of the association. I look forward to seeing each of you at our Annual Utah Dental Association Convention. Dr. Gregory Gatrell UDA President

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March / April 2022

ASSOCIATION WE NEED YOU! A few years back it was decided that the UDA board members would make a regular contribution to the UDA Action, with the President writing in each issue. Writing these articles has been a challenge for me I do not enjoy writing, in fact as an undergrad I dropped a few classes because they required too much writing. So with any luck this will be my last article because my term as a UDA officer has come to an end. I have thoroughly enjoyed my tenure as a UDA officer. It has required many hours of study, travel, time away from the office and in some instances becoming involved in issues that I had no particular interest. In all of that however the lessons learned and the friendships gained have been far beyond my expectations. I appreciate all who sacrifice and serve in an effort to build our profession and maintain a quality professional organization. I recall my first exposure to the ADA. As most of the preinternet dentists will recall the ADA had publications which could be found at the library. These publications were vital in the predental student phase. They were used to help understand the pre-requisites required by each school, they also help in determining which schools to apply to. I remember seeing the address to the ADA, 211 East Chicago Ave Chicago, IL. Fast forward 30+ years and I am standing in Chicago looking up at 211 East Chicago Ave, it was a nostalgic moment. This entity that I have looked to for information all of these years through publications and the internet and now I am in person interacting with employees, state and national leaders. These individuals are interested in me, my state association and the patients of my practice. Through these and many other experiences I have come to realize the ADA is not about the 211 East Chicago Ave. it is not a small group of individuals calling all of the shots. It is about the work that goes on within the organization and the members it serves.

practices and the pressures of running a business pressing down on us. The out flow of cash is increasing and the in flow is becoming harder to obtain. I have no doubt that without the ADA the logistics of running a dental practice would be much more difficult and complex. We would be spending far more than the cost of our dues to tackle the issues on our own. The fact of the matter is we would be trying to join forces with each other, forming an association, to battle these issues because we all realize there is strength in numbers. Thankfully we do not need to form an association that happened in 1859 and that association has been driving dentistry forward for 160 years. The work of the ADA is not perfect, the work of the UDA is not perfect, the profession is not perfect-we still have a lot of work to do. We need to be united and work together to continue the advancement of our profession. This work will happen more efficiently and effectively as we join forces and work together. What are the benefits of belonging to the ADA? Our last publication of the Action was completely devoted to sharing member benefits. If you are not convinced the ADA has value to you as a dental professional, I challenge you to spend a few minutes on the ADA website and discover for yourself the benefits available. The larger question is how can I help advance my profession to benefit me and future dental professionals? Answer, get involved in your local dental society, attend their functions and activities. Look for ways to help on the state level. Share your concerns and ideas with local and state leaders. Keep your membership current by renewing your membership in a timely manner and encourage other to do the same. Donate to UDPAC to assist the association in advocacy efforts. I guess the other way you could advance the profession is to form your own association, good luck with that. Bottom line is we need you, thanks for being a member of the UDA/ADA. Dr Michael Smuin UDA Past President

As dental professionals we need the ADA, we need it from the predental moments on through retirement. The ADA needs us as members, it is unable to function without the support and input of state associations and the volunteers up and down the chain of command. It needs the revenue generated from dues obtained from us as members. As state leaders one of our major concerns is membership. We are aware that membership dues are significant, we pay them too, but the more you become involved in the ADA the more value you see in what happens across the nation. I understand how tunnel vision concerning the work of the ADA can occur. It is very easy to become wrapped up in our

UDA Action

Join Us At the 2022 UDA Convention March 31 – April 1, 2022 Salt Palace Convention Center Register at www.uda.org

PRACTICE WHAT ARE THE ANTITRUST LAWS AND WHAT DO THEY MEAN TO ME AS A DENTIST? The antitrust laws are a series of laws that protect the public by promoting competition, including assuring that business entities complete independently. Congress passed the Sherman Act, the first antitrust law, in 1890. The Sherman Act addresses the practices of companies possessing substantial market power, sometimes amounting to monopolies that restrict competition and drive smaller competitors out of the marketplace. The Sherman Act, which prevents the improper acquisition or use of monopoly power, also prohibits join action (“contracts, combinations or conspiracies”) by competitors in restraint of trade. It is this latter prohibition which has the greatest application to health care providers and professional organizations. Other antitrust laws were enacted later to address particular anticompetitive practices. In 1914, Congress passed the Federal Trade Commission Act, which bans unfair methods of competition and unfair or deceptive acts or practice, and the Clayton Act, which prohibits such mergers and acquisitions that substantially lessen competition or tend to create a monopoly. The Clayton Act was amended in 1936 by the Robinson-Patman Act to ban discriminatory pricing and again in 1976 by the HartScott-Rodino Antitrust Improvements Act to require advance government notice from companies that are planning large mergers and acquisitions. The states also have antitrust laws which are based on these federal laws.

For dentists, the main concern is that the antitrust laws prohibit certain joint actions by competitors that unreasonably restrain trade or harm competition, such as: • Price fixing, including express or tacit agreement relating to prices and fees • Agreements to allocate markets or customers • Agreements not to compete, except for certain legitimate purposes • Boycotts, or joint refusals to deal, directed against third parties, or agreements to exclude competitors or potential competitors from the marketplace • Joint efforts to influence rates or charges, as in the case of insurers The antitrust laws are enforced by the U.S. Department of Justice, the Federal Trade Commission (FTC) and the state attorneys general. Private parties, including competing dentists and insures, who are injured in their business or property, can also bring legal actions to seek recourse for their injuries. Violations of the antitrust laws can result in severe sanction and penalties, including treble damages for the harmed caused (three times the actual damages,) injunctive relief and consent judgment/ decrees, penalties of up to #1 million per violation for individuals and up to $100 million for corporations, and imprisonment for up to 10 years. None of the final costs are likely to be covered by an individual’s malpractice or business insurance.

YOU BELIEVE IN PROVIDING SERVICE AND EXPERTISE. SO DO WE. Your patients rely on your expertise to evaluate and make recommendations for good oral health. Your local independent insurance agent can do the same for you when it comes to suggesting the right combination of coverage to protect the practice you’ve worked hard to build. Find an independent agent representing The Cincinnati Insurance Company by visiting cinfin.com or by calling Mike Terrell, 800-769-0548.

March / April 2022

PRACTICE CAN I CONSULT WITH OTHER DENTISTS WHEN SETTING MY FEES? As a general rule, discussion among independent dentists about the fees they will charge can lead to allegations of a violation of the antitrust laws, especially where those discussions are followed by the adoption of identical pricing. Dentists are viewed as competitors in the marketplace, and agreements between competitors to fix prices is presumptively illegal. Moreover, price fixing is regarded as a “per se” violation, meaning that liability is automatic, with no consideration of any justifications or offsetting circumstances.

not subject to the antitrust laws, but the parameters for such networks are strictly defined.

To avoid creating significant legal risk – both criminal and potentially expensive civil liability exposure – sole practitioners should always set their fees independently, based on what they perceive to be the value of their services and what they believe the market will bear. Dentists in partnerships or joint or group practices, however, are regarded as participants in a single entity for antitrust purposes, and their collaboration is legitimate. Similarly, properly structured networks of dentists that share financial risks may be viewed on balance as pro-competitive and thus, within that network,

A Dentist’s Guide to the Law

Related References and Resources Federal Trade Commission (FTC). 200. 2000. Antitrust Guidelines for Collaborations among Competitors. www.ftc.gov/sites/default/files/attachments/press-releases/ ftc-doj-issue-antitrust-guidelines-collaborations-amongcompetitors/ftcdojguidelines.pdf.

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PRACTICE ARE WE HAPPY YET? Sometimes we are given an opportunity to consider our lives from the perspective of where we have been, where we are now, and where we hope to be. I think it is fair to say that all of us want to be happy in all the stages of our lives. As we consider our lives there is an easy analogy related to the seasons of the year. In Utah of course we experience all four seasons to one degree or another. The spring time of our lives is frequently equated to the years from 0 to 25; the summer of our lives from 25 to 45; the fall of our lives from 45 to 65; and the winter time of our lives from 65 until we have the big dirt nap. I hate to admit it, but I’m well into the fall time of my life. The overall question is “Am I Happy”? We spend much of our lives pursuing this nebulous but real goal of attaining happiness. When we are children our parents will generally do everything they can to ensure that we are cared for, protected, and given opportunities that in their estimation will bring happiness. As we grow up we seek independence and autonomy which give us opportunities to grow and learn on our own. As we leave our childhood and begin to enter into the summer of our lives most of us quite naturally and quite normally look forward to pursuing goals that we believe will bring us happiness. This may be related to family goals, IE I want to marry and have a family; or to educational goals such as completing undergraduate university studies or completing our dental school studies or postgraduate studies; starting a business or seeking stable longterm employment to provide for our families and ourselves. As we move into the fall time of our lives we find that our responsibilities do not decrease but in fact increase. We seek to provide stability and happiness opportunities for not only our children and those around us but find that frequently we are caring for aged parents, ensuring financial stability that will increase the likelihood of aging with dignity and autonomy, crossing things off our bucket list that we always wanted to do, but find that time is now running short. Psychologists and researchers have identified three separate areas that are crucial to being happy in life. The first area is that of having, cherishing, and nurturing close relationships. These tend to be family relationships but include relationships with neighbors and friends. While it is looking hopeful that the pandemic may soon become an endemic problem, and allow an increase in social relationships, it has had a significant toll, particularly on the young people in our society. Socializing with others is a fundamental human need 8

and many studies have noted that making connections, which is an essential part of learning and growing as an individual, have been greatly decreased by the closure of educational institutions and will no doubt have an effect on young individuals ability to make lasting relationships with others in the future. Social media has been helpful in this area but cannot compensate for in-person contact that we as human beings require to survive. Many people can experience symptoms of mental illness as a result of forced isolation that came about from restrictions placed during the pandemic to prevent and/or control the spread of covid. How this will play out in the future remains to be seen. The overall problem is that having close relationships is one of the fundamental aspects of being happy. The second fundamental aspect of being happy is having a purpose in life. This is frequently related to a job that we love, but may encompass other things as well. What the job is is not important. The important part is that we love doing it and that it provides a way to contribute to society. Having a job that one hates is a common finding in unhappy people. The third fundamental of happiness is being able to help others. Studies have shown that those that serve other people, even if Incorporated in a job or something that has monetary returns, contributes to overall happiness for those that serve. What are some minor things that we can do to improve our happiness level? First of all we need to make the determination to be happy in the moment. We all went to dental school and not very many of us would consider that to be the happiest time of our lives, however, I remember speaking to a prominent otolaryngologist prior to attending dental school and he told my wife and me that the time at school would probably be one of the happiest times of our lives. He was of course speaking from the position of looking back upon it knowing of the increase in responsibilities and obligations that would come afterwards. He was right. Secondly we need to live out of ourselves. Service to others provides a great increase in our happiness level. We are in a unique position as dentists to be able to provide great services to our patients, our employees, our family, and our community. Our happiness level also increases significantly as we express gratitude. Many studies have been done that support keeping ‘an attitude of gratitude” and writing in a “gratitude journal” at least once a week will increase our happiness. We should write down what we are grateful for. This helps us to focus on the good in our lives and not be focused on the bad. March / April 2022

While social media has allowed us to remain in greater contact with those around us during the pandemic it has also been responsible for increasing significant problems when we compare our “average life” to the “fantastic life” that is obviously occurring with everyone else that is posting on social media. Expressing gratitude in our lives and keeping a gratitude journal keeps envy and other negative feelings at bay and anchors us in reality. So the question now is “are we happy yet”? Are we continuing to look to the future before we allow ourselves to be happy? Are we going to be happy only when we have finished our training? Are we going to be happy only when our debts are paid? Are we going to be happy only when all of our children are perfect? Are we going to be happy only when our marriage is perfect?

Are we going to be happy only when we are retired? Are we going to be happy only when we feel we have compensated for a past mistake? If we are waiting for the “only whens” the time will never come. We need to decide in our lives now to be happy now and realize that it can be obtained in the here and now regardless of our circumstances. We are in the best profession in the world. Service, gratitude, satisfaction in a job well done, providing for others and ourselves are all inherent in dentistry. We can all be happy in the here and now! Dr. Ken Baldwin ADA Delegate

ASSOCIATION ADA URGES CONGRESS TO INCLUDE DENTISTS IN DECISION-MAKING BODIES LEVERAGING BEST COVID-19 PRACTICES FOR FUTURE PANDEMICS Washington — The American Dental Association is urging lawmakers to include dentists in any decision-making bodies on pandemic preparedness when developing legislation that aims to leverage best practices from the COVID-19 pandemic to enhance the nation’s response to future public health emergencies. In a Feb. 4 letter to the leadership of the Senate Committee on Health, Education, Labor and Pensions, ADA President Cesar R. Sabates, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., said the ADA was pleased to comment on the discussion draft of the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act, or PREVENT Pandemics Act. “The most glaring oversight in the federal response to COVID-19 — and one we hope you will correct in this bill — is the extent to which dentistry had to fight to be recognized as a viable resource in expanding the nation’s medical surge capacity,” Drs. Sabates and Cohlmia wrote. “We therefore ask that dentists be identified by name — alongside physicians — as essential members of any planning and decision-making bodies.” The ADA shared examples of how dentists weren’t considered early in the pandemic such as when federal officials granted temporary nationwide authority for pharmacists to order and administer FDA-approved COVID-19 tests. The ADA advocated for dentists to be granted the same authority and at least 24 states and the District of Columbia did so, but the Department of Health and Human Services never followed suit. “We do not believe [HHS] intended to exclude any qualified providers from being able to administer these tests,” Drs.

Sabates and Cohlmia wrote. “It is simply our experience that being at the table early on — and being there in a codified way — can prevent these missed opportunities from happening.” The letter also said the ADA is grateful that the PREP Act was eventually amended to authorize dentists to administer the COVID-19 vaccines nationwide. Additionally, the ADA was pleased with the Centers for Disease Control and Prevention’s recommendation that dental personnel be placed in Tier 1 of the critical workers who were given immediate access to the initially limited supply of the COVID-19 vaccine. “Unfortunately, we are not convinced either action would have been obvious without our advocacy,” Drs. Sabates and Cohlmia wrote. “The Pandemic and All-Hazards Preparedness Act and the Federal Emergency Management Agency’s National Response Framework both recognize dentistry as a vital medical countermeasure. Having dentistry at the planning table early on — and being there in a codified way —will help ensure this vital national resource will not be overlooked. We hope that will be reflected in the final bill,” the letter concluded. The ADA also offered suggestions on other sections of the draft bill, including those on access to mental health services, emergency department referral, the social determinants of health and more. Follow all the ADA’s advocacy efforts at ADA.org/advocacy. ADA News February 9, 2022

UDA Action

PRACTICE PAT YOURSELF ON THE BACK GOOD DOCTOR A number of years ago I built a small greenhouse in my yard to help extend the exceedingly short summers we experience living in Marion, Utah. The small community of Marion sits at 6,500 feet, nestled against the base of the beautiful Uintah Mountains. Cultivating a vegetable garden in that harsh climate can be quite challenging. Nevertheless, my wife, Mary Jane, has learned the secrets of high altitude gardening very well. This greenhouse is not heated. But, it does have a small fan that keeps the two outer layers of greenhouse plastic separated from one another, giving the vegetables inside a little more protection from the cold. This small fan runs 24/7. It runs when it is twenty-five below zero in the dead of winter. It runs when the sun is beating down on it in the middle of our short summers. When I purchased the kit for this greenhouse, I remember thinking to myself, “That fan is going to take a lot of abuse. I should purchase a second, back-up fan, for when the original one stops working.” That was seven years ago. The original fan is still running. In my opinion, that is remarkable durability. Now that I have heaped praise upon my little greenhouse fan, it will probably stop working tomorrow. That’s life isn’t it… Anything that holds up well, especially in harsh conditions, we consider to be remarkably successful. My little greenhouse fan operates in a pretty harsh environment. Nevertheless, this environment is nothing like the cavity we refer to as the human mouth. Now, that is harsh! Our restorations are called upon to soldier up, and perform like my little greenhouse fan. On top of that, they must look good as well. We bond into place the toughest, most esthetically pleasing, and biocompatible materials we can find. Then immediately, the assault begins. First, it starts with acidic beverages, then acidic, hot beverages, followed by acidic, cold beverages. These daytime, acid baths are followed by the nighttime orgies of streptococcus mutans bacteria, and their friends, spewing their caustic excrement throughout the mouth, especially at the margins of our carefully placed restorations. This daily bath of corrosive chemistry is often accompanied by nightly beatings, as the patient clenches, grinds and gnashes their teeth together for hours on end. With some patients, these daily attack rituals can also be augmented by fingernail biting, fishing line biting, thread biting, and/or the biting, and cutting of almost anything imaginable, when either a knife or a pair of scissors is not handy. On top of all this, there are the more commonplace duties, the meals, the snacking, the chewing of year-old beef jerky, or worse, the stale Big Hunk candy bar, and the countless crisp apples and carrots that are torn apart without regard to

the tremendous shear forces generated against our restorations. Wow! Our restorations put my little greenhouse fan to shame. Thanks to some great material scientists, and chemists, we have outstanding materials with which to perform our craft. But, that is just the beginning. The rest is up to us. If our application of these restorative materials is inappropriate, or if there are flaws in our technique, the failure rate goes up. Any way you slice it, there is a lot that goes into the delivery of excellent dental care for our patients. The term doctor is appropriate and should not be taken lightly. It is our responsibility to assimilate all of the pertinent information, starting with the patient’s temperament, circumstances and objectives. What are we trying to accomplish together? Are we looking primarily for strength, beauty, or both? Does the patient have abusive oral habits that could negatively affect outcomes? Where is this patient on the homecare spectrum? These are just some of the questions that must be answered in order to provide our patients with the best possible restorative outcomes. Once you have decided upon the most appropriate restorative application for a given situation, then you employ your very best restorative protocol. That is no small task either. Many of the materials we work with are very technique sensitive. Furthermore, you are not working on some inanimate object, laying lifeless on the workbench. No, everything you do is attached to a live body, complete with feelings, emotion, and painful nerve endings extending to every square millimeter of everything you come in contact with during treatment. You must wade through saliva, gorp, and hyperactive tongues, making every effort to maintain the necessary dry field to accommodate our finicky restorative materials that do not like moisture until they are firmly attached at their intended location. And, once the restoration is in place, you then do your best to be the consummate educator, and the eternal teacher, by continually reinforcing the importance of good home care, and regular exams. Yes, there is a lot that goes into the delivery of excellent dental care for our patients. Doctor, you and your team do an excellent job! Give yourself a pat on the back. Nothing lasts forever. Even the little fan in my greenhouse is going to fail someday. And, so will some of your restorations. That doesn’t make you a bad dentist. You are a good dentist, doing your best in a harsh environment, and often under difficult circumstances. Even our best work sometimes fails. Learn from it. Embrace it, and quit blaming yourself. Failing restorations do not make you a failure! Every effort you make to do a little better, and be a little better at what we do as dentists, improves the life of another human being. Now, isn’t that wonderful! Dr. Mark R. Taylor UDA Treasurer March / April 2022

ADA URGES HRSA TO PRIORITIZE DENTAL WORKFORCE SHORTAGES, ORAL HEALTH DISPARITIES Washington — The American Dental Association is asking the Health Resources and Services Administration to prioritize several issues, including addressing dental workforce shortages and oral health disparities. In a Feb. 15 letter to Carole Johnson, the new HRSA administrator, ADA President Cesar R. Sabates, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., welcomed her back to the agency in her new role as administrator, and said the Association looks forward to working with HRSA on the following issues: • Addressing dental workforce shortages through Title VII oral health training grants. • Expanding efforts to increase the dental workforce in underserved communities through the Teaching Health Center Graduate Medical Education program. • Continuing to fund the National Health Service Corps Scholarship Program, including the National Students to Service Loan Repayment Program. • Expediting Provider Relief Fund reconsideration applications. • Improving public and medical provider education about oral health to meet the HHS Healthy People target for utilization of the oral health care system. • Addressing oral health disparities to achieve optimal oral health for all people. • Continuing to prioritize integration of oral health and primary care practice. • Reforming health professional shortage area scoring. • Addressing parity between dental case management and medical case management. • Training Medicaid auditors to ensure that dental program integrity is fair and efficient without jeopardizing access to care. • Ensuring loan repayment equity for early career-dentists in federally qualified health centers with added clarity on eligible health professional shortage area scores. • Giving loan repayment to dentists collaborating with addiction specialists. • Supporting medical-dental collaboration projects. • Promoting the value of community water fluoridation. • Addressing maternal and child dental needs such as sealants and access to care for pregnant women. The letter concluded by urging HRSA to install a chief dental officer to oversee these efforts. Follow all the ADA’s advocacy efforts at ADA.org/advocacy. ADA News February 17, 2022 UDA Action

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PRACTICE INTERPRETERS FOR HEARING IMPAIRED PATIENTS The Americans with Disabilities Act (ADA) classifies dental offices as places of public accommodation. Accordingly, offices must make “reasonable modifications” to their practices, polices and procedures in order to accommodate disabled patients. This act covers all types of disabilities, but in this article I want to discuss one of the most common patients that will enter a dental office that are covered by the act. The most common situation encountered by dental offices occurs with hearing, vison, or speech impaired patients. The ADA requires dental offices to supply “appropriate auxiliary aids and services where necessary to ensure effective communication” with disabled patients. “Effective communication” methods are not described in the ADA, and depending on the circumstances surrounding each individual patient, effective communication could range from the use of written materials, audio/visual aids and/or the exchange of notes to the use of qualified interpreters,. There

are factors dentists should consider when determining which methods are best applied in a specific situation. It is also important to understand that if the patient makes a change in the way that they are able to receive the effected communication the dental office will need to accept that change. Past practice of communication between the patient and the dental office is informative of what my work for the patient. However, if the patient decides that the form of communication is no longer working, the office will need to find a solution to make a reasonable accommodation. The nature of the communication that will take place should be at the forefront of any determination on auxiliary aids. Lengthy conversation that deal with complex issues, such as a discussion of symptoms and the presentation of a diagnosis and treatment plan, may point toward the use of an interpreter. On the other hand, written materials or the exchange of notes may suffice when interacting with patients during routine hygiene visits or when dealing with billing and insurance issues.

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Dentists should also consider patients’ communication skills and knowledge when making a determination on auxiliary aids. For instance, a patient who is able to read lips may not require the same types of aids as others. Patient’s specific requests for interpreters and the availability of qualified interpreters are other factors that should be considered. If a patient is specifically requesting an interpreter, that request should be seen as a reasonable accommodation. However, if the patient is specifying the specific interpreter or specific interpreting firm, the dental office is not bound to any specific interpreter. The reasonable accommodation in this case is not the specific interpreter the patient is asking for, instead it is an interpreter who has the qualifications and can do the job. Involving the patient in the decision on auxiliary aids is critical. Ultimately, dental offices want to establish a method of communication that allows the dentist and patient to effectively exchange information about the patient’s oral health status and treatment plan. Patients must be able to ask questions to the dentist and understand instructions provided by the dentist. Once again it is important to continue the communication with the patient and make any necessary

changes based upon the understanding of the patient. In many cases, effective communication may only be accomplished through the use of an interpreter. In these instances, the dental office will be required to obtain and pay for the interpreter’s services. The cost of providing the interpreter service cannot be passed along to the patient or payer as a surcharge. The important thing to remember when dealing with a patient is covered by the ADA is that the law is put in place to ensure that people with disabilities are treated on the same level as their peers who do not have a disability. Therefore, each dental office should do what they can to ensure that the patient with a disability is treated equally. As stated many times in this article making a responsible for a disabled patient is the correct thing to do in a treatment setting. By making that accommodation the dental office is abiding by the ADA and ensuring that the dentist is providing oral health care at the highest ethical standard. Eric S Richmond, ESQ

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PRACTICE ETHICS SHOULD FIT THE SCOPE OF PRACTICE Which of the following is a definition and which is a characterization? • Humans have dignity, individual and collective rights and may not be harmed. • Humans are featherless bipeds (Aristotle). The first is more attractive: It says nice things about humans. It also characterizes seagulls, religious and fraternal organizations, the redwoods and the U. S. Constitution. But the function of definitions is to sort things into examples and nonexamples. Aristotle’s rule would pretty accurately get all the humans in one pile and all the nonhumans in another. Dentistry is evolving, and recently there has been interest in defining oral health or even health generally to accommodate these changes. Consider the following: • World Health Organization (WHO) definition: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. • American Dental Association (ADA) definition: Oral health is a functional, structural, aesthetic, physiologic and psychosocial state of well-being and is essential to an individual’s general health and quality of life. • FDI World Dental Federation definition: Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex. There is a bit of circularity in the WHO definition since one of the dictionary definitions of “well-being” is “a state of health.” The second part just says that other definitions are incomplete. The ADA “definition” is also circular, but positive in the set of characterizations that are enumerated: “Functional, structural and aesthetic” features are traditional criteria for judging the work of dentists. But it is not traditional to hold dentists responsible for psychosocial thriving. Dentists would not have their licenses disciplined for failure to do so in a “complete” fashion. The FDI definition is a little stronger. It lists a set of operations relative to the oral complex that “healthy” individuals are capable of without undesirable limitations. The trouble here is that health is defined by a standard of disease. It is the old question of whether the patient has a temperature. Yes, everyone does, but is it too low to be consistent with life or so high that it represents a threat? In a way, these “definitions” are telling us where to look and when to feel satisfied but not whether we have found what we are looking for. 14

It is as clear as can be that dentistry has succeeded and beyond anything that could have been imagined even a few years ago. Master clinicians of 100, 50 and perhaps even fewer years ago lacked the know-how, technology and delivery systems to accomplish what is now expected of the average recent graduate. Americans expect that long-lasting, painless, beautiful smiles can be had by those who want them. At the same time, school districts across the country are forgoing hundreds of thousands of dollars annually in lost per capita attendance reimbursement because children are absent with oral pain. Rural America is being left behind by the consolidation of dental business and its technology boom that depends on a concentration of paying customers. Dental visits are up slightly for the young and the old, but down for the majority of the population. Dentists are the least trusted of the health professionals while at the same time dentistry is regarded as one of the top “jobs.” The progress of dentistry depends to some extent on how dentistry is defined. We are tangled in confusions over means and ends, individuals and communities, opportunities and obligations and the assumption that what is legally and economically justified is also ethical. Many of the exciting recent developments in dentistry, especially those of a highly technical and interdisciplinary nature, serve real needs, but for a small segment of the population. Sometimes the prospect of mastering a new technology skews treatment patterns. The greatest concern among dentists and patients alike now is overtreatment: Technically acceptable treatment that is not needed. Both dentistry (the means) and oral health (the outcome) must be ethically sound. Questionable procedures justified by good intentions fail the test of ethics. So does wanting to be a technique star at the expense of patients’ health broadly speaking. The WHO, ADA and FDI definitions are open on the question of whether oral health is an individual or a general good. Would a community with a basically adequate level of dental functioning be healthier than one with a few “show-off” mouths and many in oral distress? There is much to be said on both sides of this issue. We can hardly fault patients who want the best for themselves or criticize dentists for responding more readily to those who are willing to pay for the best. There are large cohorts of individuals who place low value on oral health, are demanding and difficult to treat (if they even show for a scheduled appointment) and detract from the capacity to serve others. Governments and insurance exist for the very purpose of balancing individual and group needs. Professional organizations have the double responsibility of representing the well-being of members and assuring the public that the profession (in the collective sense) is responding to the needs of the public (in the March / April 2022

collective sense). The ethical challenge comes in claiming to be addressing community needs by only responding to individual needs. There is ample evidence in the technology literature that periods of rapid change coincide with and contribute to periods of increasing disparities in income and health. The category-creating feature of definitions advances claims about who is entitled to do what. As statements about scope of practice, they define markets. Expanding the scope of dentistry has both positive and negative features. Claims on larger markets will lead inevitably to conflicts with other professions and with payers. Scope implies responsibility. Using CBCT images is a market builder. It also represents a liability because the visual area available for review, and thus for which a practitioner is responsible for acting knowledgeably on, is increased. Failure to diagnose, especially relatively lowpaying areas of periodontal disease and oral cancer, is one of the leading reasons for malpractice suits and actions against dentists’ licenses. This is case selectivity. Broadening the scope of practice means increasing the level of training. The tension between expanding the market and expanding the training necessary can be gauged by comparing

the profession’s budget for lobbying and indemnity programs with its support of education. The ethical issue associated with itching to enlarge scope at the higher end is that in order to be financially sustainable, resources will have to go to fewer patients paying higher fees for more advanced (or different) needs. This is entirely a legal or economic consideration, except in cases where a profession attempts to prevent others from servicing needs that are unattractive to the profession. Then it is an ethical issue Some tentative definitions … • Oral health: Optimal attainable function and appearance and prevention and repair of diseases and damage to the orofacial complex, including conditions that interact with it. • Dentistry: The profession that accepts responsibility for oral health outcomes as its essential and primary reason for existing. • Dental market: Range of activities dentists have an economic and legal right to perform. David W. Chambers, EdM, MBA, PhD,

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PRACTICE U.S. DENTISTS STILL PRESCRIBE OPIOIDS DESPITE EFFECTIVE ALTERNATIVES A survey of dentists in the U.S. revealed that an overwhelming majority of those who responded believe nonsteroidal anti-inflammatory drug (NSAID)-acetaminophen combinations are as effective or more effective in managing dental pain as opioids; however, almost half say they still prescribe opioids. The results of the survey, conducted by PharmedOut with undergraduate students at the Georgetown University School of Nursing and Health Studies, were published in the Journal of the American Dental Association. Previous studies found that dentists comprise 15.8% of opioid prescribers and prescribe 8.6% of opioid medications in the U.S. Dentists are the highest prescribers of opioids to patients aged 18 and younger. “We know that the first exposure to opioids for many people occurs in their teens and early 20s following common dental procedures like third molar extractions,” said Nkechi Nwokorie, who conducted the work as an undergraduate at Georgetown. “This is a particularly vulnerable population for misuse.” The Georgetown researchers received 291 survey responses and analyzed 269 completed surveys. Although 84% of respondents reported believing that NSAID-acetaminophen combinations are equally as effective or more effective than opioids, 43% of respondents also reported regularly prescribing opioid medications. “This underscores the need for more education about the harms of opioids and the need for national guidelines to align clinical practice with current evidence,” said Adriane FughBerman, MD, a professor in the departments of pharmacology and physiology and family medicine at the Georgetown University Medical Center. Learn more about this study in the Journal of the American Dental Association (2021); doi. org/10.1016/j.adaj.2021.07.018.

PRACTICE TIME TO CELEBRATE It was time for spring cleaning and I was in the basement, dusting off some wine bottles that I have been storing. I don’t have a big collection or a large wine cellar by any means, but there are wines that I have been storing for a while now. I got to reflecting on the labels and how I had picked up some of them. For me, the real value of wine is in the story, not so much the taste of an individual bottle. I don’t have a discriminating enough palate to really know the subtle differences. We have been to Napa Valley twice over the last 30 years and I treasure the memories of visiting certain vineyards with friends and learning about wine through the tastings. Wine has always been more about the experience than the specific taste. Cleaning the bottles got me thinking about why I was saving the wine. At what time in the future will there be a better time to drink it? Now, it seems, is perfect to find a reason to drink good wine. It’s high time to celebrate. We have been starved of the chance to get together with friends and enjoy their company. There is nothing better than meeting with people and simply talking. The Dalai Lama said, “When you speak, you repeat what you know. When you listen, you learn something new.” That’s excellent advice. We certainly need to broaden our horizons and share experiences with others. There is a limit to how close that we can get on Zoom. The relationships we build through human touch and interaction so often center around food and drink. Since the dawn of recorded history, people have bonded around the cooking fire, telling stories of deeds great and small. It’s time to return to that. Driving back from visiting family in North Carolina last month, I was struck by the number of those green highway exit signs that call attention to the “Scenic Overlook Ahead.” I just wanted to pull off and see what everyone was so excited about! Sadly, I didn’t make the time because we needed to drive the 730 miles from Wilmington back to Columbus all on Sunday. I should make time on the trip to savor the experience rather than watch the mountains fly by at 70 miles an hour. I guess, we have been led to believe that we need to have a reason to celebrate. I’m coming to the conclusion that it’s up to me to create the events to celebrate. If they aren’t just waiting there for me, then it’s OK to find something and just call over friends to make a big deal out of it. Someone had to be the first person to say “Wow, that’s a pretty view! Maybe we should put up a road sign and invite other people to see it too!” If we’re going to stop and smell the roses, someone had to plant the roses tin the first place. I’m going to commit to finding reasons to dink the good wine, metaphorically and physically. To stop and look at the view. Breaking up the journey to celebrate is worthwhile and a completely normal, human thing to do. We have lost a year with friends and family. Now is the time to get that back. I’m going to open an excellent bottle and savor the experience with friends, creating new stories and the memories that go with them. Anyone interest? Matthew Messina, DDS ODA Today

March / April 2022

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VOLUNTEER LINE: 385-246-9215 VOLUNTEER DONATEDDENTAL.ORG WWW.DONATEDDENTAL.ORG WE INVITE YOU TO CONTINUE DR. MONTGOMERY'S LEGACY

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Subject: Division of Occupational and Professional Licensing (DOPL)Lifts Temporary Suspension of “Live” Continuing Education (CE) Requirements

Salt Lake Donated Dental

To Whom It May Concern:

Services in to

The Division of Occupational and Professional Licensing is lifinng the temporary waiver of “live” CE requirements that allowed licensees to meet theirprovide CE requirements online or virtually,to quality access but will accept online/virtual CE a “live’ CE until December 31, 2021. DOPL has determined it is safe to return to “live” or in-person CE opportunities after referring to dental comprehensive the collaborative work of state and local public health experts, the Governor’s Office, the hospital industry, business leaders, and important guidance from legislative leadership found on care for community#s coronavirus.utah.gov. Effective May 15, 2021, Governor Spencer Cox has endedour Utah’s declared emergency regarding COVID-19 and lifted statewide mask mandates. In additional, transmission rates continue to decline as more eligible Utahns, receive theirmost COVID-19vulnerable. vaccinations. Today, The Division understands that in-person seminars, conferences, classes,etc. take time to plan and schedule. These factors make it difficult for CE providers to offervolunteer “live” CE within the next 6 dentists and months. To allow CE providers time to arrange “live” CE again, DOPL will continue to accept virtual or online CE T through December 31, 2021. Beginning January 1, 2022, licensees will need hygienists still to pursue “live” CE options to meet renewal requirements if they are required by statute or administrative rule. For example, those whose licenses expire May 31, 2022, maby submit both online/virtual CE and in-person CE to meet the CE requirements as long as the online/virtual CE make a difference was obtained prior to December 31, 2021

like you

Thank you for your cooperation. If you have any questions regarding “live” and online/virtual CE Requirements, call (801) 530-6628.

Volunteer dentists and hygienists can fulfill 15% of their CE re,uirements with hours spent volunteering at SLDDS. Receive 1 hour of CE credit (for a maximum of 4.5 per year) for every 4 hours volunteered.

PRACTICE WHEN WILL IT END? If your patients are anything like mine, at some time during the day, the topic of COVID-19 is going to come up. How it has affected their children or elderly parents, their jobs, school or almost every aspect of their lives. Granted, things are much better now than they were this time last year, and certainly better than the early days of the pandemic. But what would it take to return to a pre-pandemic life? In the early days of the outbreak, the Centers for Disease Control advocated for a national goal of achieving herdimmunity, the farmyard phrase that postulated if up to 85% of the population were vaccinated, the virus would run out of hosts and fall into the background of the seasonal flu. Unfortunately, the virus didn’t get the message and it mutated, and the population has been slow to achieve the necessary vaccination level (less than 60% of adult Americans are fully vaccinated). Dr Jefferson Jones, a medical officer on the CDC’s COVID-19 Epidemiology Task Force has also stated, “Thinking that we’ll be able to achieve some kind of threshold were there’ll be no more transmissions of infections may not be possible.”

So where does this leave us? In an article published in JAMA, the authors addressed the possible scenarios of how the pandemic could play out. ERADICATION – a global reduction of the disease to zero. To accomplish this both the vaccine and the derived immunity would have to be long lasting or repeatedly boosted to prevent secondary transmission against all manner of present or future variants. This would require a world-wide effort over an unknown timeline. ELIMINATION – the regional, rather than global reduction of the disease prevalence to zero, A more realistic approach until vaccines and boosters are available globally. Elimination would require strict border management to ensure incoming individuals are SARS CoV2 free, and full compliance of the population within the borders. CONFLAGRATION – a steady state of moderate level of SARS-CoV2

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Where large segments of the population are under-vaccinated or without exposure immunity, the virus is capable reproduction and mutations. Breakthrough cases continue and outbreaks are more widespread. With limited and/or less effective vaccines available to many areas of the world, outbreaks on a wider scale can be expected. COHABITATION – where most outbreaks would slow down significantly, but some may persist at either low levels of in the form of sporadic outbreaks. Here in the United States, cohabitation may be the best case and most realistic scenario for the near future. Vaccinations and boosters are modified to provide high levels of immunity as new variants arise. Breakthrough cases or localized outbreaks may occur, but at a lower level of either occurrence or severity. Over

time, global immunity due to exposure or vaccination becomes commonplace and variant symptoms become less severe. This was the pattern of the N1H1 Influenza A virus that caused the 1918 Spanish Influenza global pandemic. This same virus is still with us today. The world has worked hard to mitigate or eliminate diseases before. Smallpox was responsible for 10% of all deaths in the 20th century until a global campaign led to its eradication. Ultimately, where the COVID-19 pandemic ends is up to how we manage it from the local level to the world at large. Dr Barry Howell Illinois Dental News

OMICRON KAPPA UPSILON DENTAL HONOR SOCIETY BETTA KAPPA CHAPTER University of Utah School of Dentistry

Notice to all Utah members of the OKU dental honor society:

The University of Utah now has a chapter that might be closer to home for you! We would love to have you participate with us as we meet annually to honor new inductees. Moving your membership to Betta Kappa chapter is easy and allows you to more conveniently be a part of OKU activities. Local chapter dues for 2022 are as follows:

2022 Annual Betta Kappa Chapter Dues: $30 May 5th Induction Dinner at Wakara Way Marriott, per person cost: $40

Please join ususfor Cinco de de Mayo! Mayo! Please join foraadelicious deliciousSouthwest SouthwestDinner DinnerBuffet Buffetin inhonor honorof of the the date, date, Cinco

You can also help sponsor an inductee for an additional: $40

Whether or not you can join us this year for dinner, $30 is all it takes to become a part of our chapter. Please contact any member of the Betta Kappa Executive Board if you would like to discuss making this change: Dr. Bryan Trump 801-598-8469

Dr. Mark Taylor 801-455-9989

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Dr. Gary Lowder 801-213-3506 19

PRACTICE DENTAL SLEEP MATTERS How fortunate we are to be dentists in the modern era, with technological advancements that allow us to optimally restore dentitions with highly esthetic and functional restorations. Perhaps of even greater significance is the emergence of the understanding of the intricate oral systemic health connection, solidifying our roles as “physicians of the oral cavity” instead of merely being “molar mechanics.” This is already evident with our clinical screening for hypertension and management of periodontal disease, with connections to multiple medical conditions. One still relatively untapped role for our profession is helping to manage the ongoing healthcare crisis of obstructive sleep apnea (OSA), with oral appliance therapy (OAT). Sleep apnea has become a unifying diagnosis in medicine, as it can affect virtually all the systems of the body. The most common (and effective) treatment for OSA is PAP (positive airway pressure), which currently account for approximately 95% of treatment cases vs approximately with OAT. The American Academy of Sleep Medicine (AASM) estimates that OSA affects approximately 30 million adults (or approximately 26% of the adult population) with greater than 80% undiagnosed and

untreated – a number that’s remained static for the last 20 years – with untold impacts on personal health and an estimated $150 billion annual economic burden in the U.S. alone. A dental practice with 1,000 adult patients may then have approximately 260 potential OSA patients x 80% = 208+ undiagnosed OSA cases! The true “low hanging fruits” are among the 20% who are diagnosed but may be PAP non-compliant, now ripe to be managed with OAT as second-line therapy. The ongoing COVID-19 crises provides an additional opportunity in that the AASM recommends patients with upper respiratory infections should not use PAP machine, which suggests they should also have an oral appliance to be used when necessary, to provide continuous therapy. There is a compelling opportunity for our profession to expand our role in this critical arena, especially since dentists occupy a unique gatekeeper position. Many people visit the dentist more frequently than their physician. Enter the ADA: In 2017, guidelines were released (http:// www.ada.org/en/member-center/leadership-goverance/ councils-commissions-and-committee/dentistry-role-in-sleeprelated-breathing-disorders) that advise dentists to screen all patients for OSA and refer those at risk to our sleep medicine

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PRACTICE READINESS, THE KEY TO SUCCESS colleagues for formal diagnosis. While this is currently only a recommendation, it may one day be the standard of care for dental practices, just as screening for oral cancer has become. While the upper airway is clearly an area within our scope of practice, it remains merely a dark and mysterious hole for many of us, lurking just behind our primary area of focus – the dentition – just a slippery crown or rubber dam clamp away. I feel it is imperative that the population focuses not only on those “little hard white things” but also encompasses the airway, and the enigmatic TMJs so commonly affected by sleep-related problems. Barriers exist to dentists more actively managing OSA; lack of adequate education, difficulty developing effective screening and referral protocols, sleep physician resistance to OAT and clinical challenges of managing OAT side effects and treating patients with a sometimes less effective therapy vs PAP. At the same time, the emerging DSM field is changing rapidly, due to CPAP dissatisfied patients becoming more aware of the benefits of OAT, and more sleep medical providers beginning to accept OAT as a viable treatment. New technology such as MATRx Plus that helps predict OAT response and target therapeutic mandibular position may also help pave the way for greater dentist participation in managing OSA, by allowing us to focus on cases with the highest likelihood of success. I’ve heard frequently that the “golden days” of dentistry are behind us. But to appropriate a famous quote from Mark Twain, “The reports of our death are greatly exaggerated.” Emerging opportunities to meld our dental skills with management of associated medical problems will continue to have a profound effect on our profession and, ultimately, on our patients’ health and well-being.

“The keys to personal and practice readiness lie in planning. Each facet of planning is equally critical to being in a commanding and confident position when the time comes to sell your practice.” If seems like just yesterday that you graduated from dental school, excited to begin your journey of improving the lives of our patients. You’ve dedicated your life to your profession, and provided a wonderful “work home” for you staff, and now it is time to transition to retirement. Before you pull the trigger on your practice transition, consider your “readiness.” Evaluate your emotional, financial, and practice readiness. Your readiness in all aspects plays a considerable role in your ability to land the right buyer and feel confident in your decision. Emotional Readiness – Most of us have personally served our clients or patients for our entire career have invested a significant amount of personal capital in our work. We’ve immersed ourselves in a single focus. Other than family, it likely has been your primary purpose in life. Eliminating that purpose is a major life event that needs to be carefully planned well in advance in terms of redirection of our focus and energies. Making a change like selling your practice without having a new focus can have significant negative consequences. Personal financial readiness is critical to your ability to retire. Unfortunately, studies have shown that fewer than 10% of dentists reach the point of financial independence despite having an above-average income throughout their careers. Numerous reasons for this are beyond the scope of this article but result from a lack of proper planning. We strongly recommend that dentists engage an independent financial planner before they start making major life decisions that may misdirect their cash flow. If you have not worked with a financial planner, now is the time to engage one to build a formal financial planning model. Your planner will help you assess you anticipated cash requirements and income throughout your remaining life expectancy. The plan will also help identify the amount needed from the practice sale to round out your investment portfolio to meet your needs in retirement. Practice readiness is key to your practice being attractive to potential buyers. Top practices have well-defined staff roles and responsibilities, effective and documented systems and process and up-to-date infrastructure. These practices generate consistency high financial results and thus are more attractive and valuable to potential buyers. We’ve found that an average practice on autopilot usually needs about five years of improvements to get “tuned-up” to the point of being a top practice. The keys to personal and practice readiness lie in planning. Each facet of planning is equally critical to being in a commanding and confident position when the time comes to sell your practice. Paula Meehl, CMA, CPA

Dr Keith Valachi

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PRACTICE MAINTAINING MENTAL HEALTH IN STRESSFUL TIMES EATING HEALTHY Food is not only fuel for our bodies but fuel for our minds. Good eating habits can be difficult to maintain during busy, stressful, or depressing times. Like many of us under these circumstances you may find yourself under eating, reaching for the quick, unhealthy fixes, self-soothing by overeating, or a combination of all of the above. Don’t delay in taking the steps needed to practicing healthier eating habits, they can make a world of difference!

Photo: Image licensed by Ingram Image

We hear is almost every day, almost everywhere we turn. . . it has been a rough year. Before we become numb to the repeated reminder of the kick in the teeth this year has been, let’s take time to acknowledge what may be less obvious. Mental health. This can be an uncomfortable, tricky topic to navigate. Do we even realize when it is affecting us? Are we honoring each mechanism of ourselves that is tied to mental health? A large amount of research suggests that suicide was afflicted the dental profession more than any other. The ADA hope to change this statistic but the only way to start is with YOU. So, hold on, strain in, and through one hand in the air because added onto this statistic is a worldwide pandemic, economic uncertainty, one heck of a stressful election season, and a current state of civil unrest. It is ok to accept that all of this is at war with your mental health. The key is to take action! Although some of the following may seem simple, perhaps repetitive and no doubt things you already know; we encourage you to take the time to read through and really evaluate how you are addressing these key factors of good mental health in your everyday life. EXERCISE Where you do fit physical activity into your schedule and how important is it to you? Has your exercise routine been disrupted? If so, now is the time to figure out how to get I back on track. Even if you start with small, subtle adjustments you can see big changes. For most healthy adults 150 to 300 minutes per week, (roughly 30 to 43 minutes per day is suggested. That’s just one episode of your favorite show, you’ve got this! Stretching is essential. Practicing dentistry can require putting one’s body in uncomfortable positions and performing repetitive hand motions daily. This can be hard on your musculoskeletal system leading to painful and even sometimes permanent damage. 22

SLEEP Do you have a daily sleep routine? If so, has it been disrupted lately? Maintaining a routine around sleep is said to be one of the best ways to achieve the optimal sleep you need. Symptoms of sleep deprivation include an inability to concentrate, drowsiness, mood swings, lowered immunity, and a decrease in productivity. During sleep the brain compartmentalizes then stores important information from the day, helping us to reset and eventually store more information the next day. So, you can see how a disruption in this pattern can be detrimental to you and your dental practice. STRESS MANAGEMENT Stress. Even saying the word can be stressful! It can creep in on us and present itself in ways that are commonly overlooked. Not all stress is bad, some stress is said to be essential in creating a good well-being, the key is in balancing. It you are experiencing the following symptoms, it may be a sign that your balance has shifted, and that stress is weighing down. Are you experiencing the following symptoms, it may be a sign that your balance has shifted, and that stress is weighing down. Are you experiencing a continuous sense of unease or being unsettled, inability to sleep or sleep properly, repeated or prolonged illness, shortened temper, forgetfulness, loss of energy or a desire to over-eat? If so, refer to the web page for ways to help with mindfulness and balancing stress. It is important to remember that maintaining good mental health can be work, sometimes hard work. It is also important to remember that improving one’s mental health is just as rewarding a goal to work for and achieve as any other. Lifting those proverbial weight can leave us with some awesome muscles to flex. The time to start and/or continue on that journey in now. Yes, right this moment. Don’t set it aside for tomorrow or next week or when you “have time.” Your work is important, your time is important, your patients, staff, families, and friends are all important but none of that is more important than your well-being. Take the end of this article as a start. ISDA News

March / April 2022

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