Issuu

After years of paying premiums…

Why is it So Hard to Collect On My Disability Policy? No matter where you are in the disability claims process, our firm is here to help. Please visit our website, www.disabilitycounsel.net, to view our dentist resource page. Derek R. Funk, Esq. Direct: 480.685.3638 dfunk@cobelaw.com

If you would like to speak with an attorney about your disability claim, please feel free to call or e-mail Mr. Funk directly.

CONTENTS

OFFICIAL PUBLICATION OF THE UTAH DENTAL ASSOCIATION

CONTRIBUTING WRITERS Dr Greg Gatrell Dr Drew Jones Dr Ken Baldwin Dr Brent Larson Dr Robert Buchholz Dr Becky Warnken Dr Steven Parkin CDA Dr Denise Habjan Richard Wilde Kimber Solana

COVER PHOTO Angel Arch and Molar Rock, Canyonlands NP Image Credit: © Tom Till / Visit Utah

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 2021.

PRESIDENT'S MESSAGE Enjoying the Sunrise

ASSOCIATION 6 The UDA Would Like to Welcome our Newly Elected

Officers to the UDA Board

The Utah Dental Association Would Like to Recognize the Recipients of the 2021 Distinguished Service Awards

2021-2022 UDA Board of Directors

Keep Your Contact Info Up to Date

How to Love Dentistry

ADA Names Dr Raymond A. Cohlmia as New Executive Director

EDITORIAL 5 Excellence

PRACTICE

Factors Affecting Job Satisfaction

What's in your Glove Compartment?

How Should I Evaluate a Contract with an Insurance Plan

Trust Your Instincts

Biological Imbalance Linked to Periodontitis, Kidney Disease

What is Appropriate Speech in the Dental Office?

Omega-3 Molecules Regenerate Periodontal Tissue

Periodontitis Increases Risk of Heart Attacks

Ergonomics

LETTER

COMMUNITY

Help With the Dental Needs of the Less Fortunate

I am Right Where I Choose to be

PRESIDENT'S MESSAGE

ENJOYING THE SUNRISE I enjoy watching the sun rise. Each morning in the spring I look forward to how much brighter it is, or I look for the change of position against the landscape. I suppose I enjoy watching the sun rise because it also reminds me of some of my other favorite things in life like fishing, hiking or floating down a river. I remember fishing on the river with my dad on multiple occasions and moving towards the sun unobstructed morning rays so they could thaw me out. The fishing was generally better before the sun’s rays hit the water, but they brought so much comfort. It seems like more people talk about the sun set than the sun rise. I suppose it is because it generally takes more effort to be in a position to watch the sun rise. There are and have been many challenges to the profession of dentistry over the years and the last year was no exception. We faced challenges that I had not seen before nor that I expected to see. It makes me wonder what the next year will bring. Hopefully, we will be able to enjoy a peaceful, productive year(s) before the next great challenge arises. Many problems dentists in the state face are generally not new, though they have changed in presentation. These problems

are often not effectively tackled by any one individual, but by a team effort. There are some who do not see the Utah Dental Association as solving their individual problems, but the Association is here to support the overall profession of dentistry for both dentists and patients and the overall need and mission of the Utah Dental Association has remained unchanged. Years ago, the Utah Dental Association played a larger social role in many dentists lives than it currently does. I have watched this decline over the years, and I have not been able to pinpoint what has driven the loss of interest. I suppose we are just busier in our own lives. As I traveled the state to the various CQI meetings last year I could not help but notice how many of us enjoy the company of our colleagues and that we frequently have a hard time leaving for the evening. Sometimes it takes some effort to appreciate what we have and what our association with each other is really worth. As the dark days of the COVID-19 pandemic are slowly fading I hope we look forward to the rising future dentistry holds and to the friendships we have and will develop as colleagues, dentists and as an association. Dr Greg Gatrell UDA President

Your patients rely on your expertise to evaluate and make recommendations to keep them healthy. 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.

SPEND YOUR TIME EXAMINING YOUR CLIENT’S TEETH, NOT YOUR COVERAGE.

Find an independent agent representing The Cincinnati Insurance Company by visiting cinfin.com or by calling Mike Terrell, 800-769-0548.

May / June 2021

EDITOR'S MESSAGE

EXCELLENCE This has been a hard year for my family. COVID has affected my ability to work as a dentist. I am at high risk for COVID— old age, heart issues, and border line diabetic, but at least I am not obese. My 14- and 16-year-old sons were out of school from March 2020 until January 2021. Salt Lake School District was online only. I am proud to report that I did much better in 7th and 8th grade this year then when I took them about 50 years ago. My oldest son will complete his biomedical engineering degree from the University of Utah this spring. He came to America at the age of four. He spoke no English (I adopted him). Through hard work, he graduated from West High School with 60 college credits from his AP tests and IB, International Baccalaureate, degree. He was awarded The Presidential Scholarship and will graduate with a 3.8 GPA. His counselor said that he had an 80% chance of being accepted to medical school. This week he was notified that he had not been accepted to medical school at the University of Utah. It is unexplainable to me how he could not be admitted but being an Asian male is not the right demographic fit for today’s top tier universities and competitive graduate programs. (For those interested in this topic, I recommend Kenny Xu’s An Inconvenient Minority). Naturally, it was heartbreaking for him. Yesterday my wife came home and told me her contract would not be renewed next year as a 5th grade teacher. Apparently, students had complained to their parents and the parents had complained to the principal that she gave too much homework and graded too hard. I told her that it is only the 5th grade and that if she would just give the kids all A’s and no homework that she would have no problems at school and the parents would love her. Unfortunately, she believes that students should work and learn, even if they are in 5th grade. Her students outperformed the other 5th grade classes at her school on the state exams but that is not as important to the principal as having happy students.

accept. I will always come down on the side of excellence. I do not care what the race, religion, gender, ethnicity, or other demographic characteristics are, but of course, the government and others do. I would like to know about someone’s background and where they came from because that may tell you how hard they work and what obstacles they had to overcome, but that is not dependent on race, religion, ethnicity, or gender. At CQI this year it was proudly announced by the University of Utah Dental School that this year they had a class of 26 women and 24 men. This was the first class where they had more women than men students. If the fifty best applicants are women then admit all women and if the fifty best applicants are men, then admit all men. Unlike some medical professions (OB-GYN for instance), the profession of dentistry does not lend itself to one gender or the other. (For your information in 2018 there were more women dental students than men dental students and in about 10 years they are projecting that there will be more female dentists than male dentists). How do we demand excellence from students once they have been admitted to dental school? Demand they complete so many procedures to graduate. Each student needs to complete so many dentures, so many composite restorations, so many units of crown and bridge, so many root canals and so on. No one will ever convince me that todays “competency” system is better than the old days of demanding a student perform a certain number of procedures to graduate. You only get better through practice. Why do you think Joe Ingles is shooting a career high in three pointers this year? It is because he took the time off from COVID and spent it shooting 3s all day—at least that is what he told DJ & PK on 1280 The Zone. Today’s students want to work hard and do well but sometimes the system may work against them.

So, you can see this has not been the best year of my life. But did I learn anything from it? One thing I learned from the experience of my son and my wife is that I am not so sure where our country is headed. There seems to be an idea that excellence does not matter anymore. If excellence interferes with “social justice” or happiness of the students, then it is not important.

How do dentists develop and maintain excellence once they graduate and are licensed? You cannot get enough CE. Todays online learning makes it easier than ever to get information. Study clubs are helpful. Use the resources of the UDA and ADA. Get out and talk to other dentists or visit their offices. Learning never ends. Today’s dentistry encompasses so many areas that I have given up learning how to do everything. There are certain areas of dentistry I enjoy and other areas I prefer to stay away from. Do the things you enjoy. We are in a frustrating business because not everything will always turn out to be “excellent”, but we try our best and remember that Joe Ingles hits only about 50% of this three-point shots. Imagine what he would be shooting if he hadn’t practiced so much.

I hope excellence is something that our profession never turns away from. It starts when schools decide which students to

Dr Drew Jones UDA Action Editor

UDA Action

ASSOCIATION THE UDA WOULD LIKE TO WELCOME OUR NEWLY ELECTED OFFICERS TO THE UDA BOARD Dr Len Aste is the newly elected Secretary of the UDA Board. Dr Aste is originally from Bountiful, Utah, but has lived and practiced in Manti for 25 years. He graduated from Creighton University in Nebraska, following graduation he joined the United States Public Health Service and was assigned to the Federal Bureau of Prisons where he worked in several different penitentiaries around the county. Following this service, Dr Aste found his practice in Manti in the UDA-Action Classified Section.

Utah State Dental Advisory Board. Dr Aste also serves as a floor examiner for the WREB exam and a member of CITA. In 2001 he started G3 Foundation, this is a humanitarian organization that has taken over 2,000 dental students to the Dominican Republic to provide free dental care to the poor and dispossessed. Dr Aste has been married to his wife Ellen for 37 years and has four children, one daughter and three sons. His daughter, Whitney followed him into dentistry. He has two grandchildren and hope to have a few more eventually.

He served two terms as President of the Central Utah Dental District and recently completed an eight year tenure on the

Dr Scott Theurer has been re-elected to the role of ADA Delegate. Dr. Theurer grew up in North Logan and graduated from Sky View High School. He graduated from Utah State University with a degree in Biology and then attended Washington University School of Dental Medicine. Dr Theurer acquired a practice in Logan, recently his son joined his practice as an associate.

HOSPITAL QUALITY ANESTHESIA IN THE COMFORT OF YOUR OFFICE

Able to induce anesthesia for complex treatment plans or procedures.

Image licensed by IngramImage

Utah’s leader in in-office Dental Anesthesia

He has been involved in the leadership of the Utah Dental Association, serving as the UDA President in 2012-13 and as an ADA Delegate from 2016-2021. He previously served on the ADA Council on Dental Practice from 2014-2018. Dr Theurer started the Bear River Head Start Fluoride Varnish and Oral screening Program in 2002. He initiated this program providing this critical service for 250+ children in 11 different centers across 2 counties. This project continues 3 times every year. Dr Theurer and his wife Teresa have one daughter and three sons, two married to dentists, one a dentist, and the last not planning to be a dentist nor married to one. They are proud grandparents to 15 wonderful grandchildren.

To schedule an appointment, or for additional information call

801-631-1312

May / June 2021

ASSOCIATION THE UTAH DENTAL ASSOCIATION WOULD LIKE TO RECOGNIZE THE RECIPIENTS OF THE 2021 DISTINGUISHED SERVICE AWARDS.

WE APPRECIATE THEIR CONTRIBUTIONS TO DENTISTRY IN UTAH Dr Mark Cowley Dr Mark V Cowley was raised in Brigham City and attended Weber State University where he completed his prerequisites for dental school. He attended dental school at the University of Washington in Seattle, graduating in 1983. Dr Cowley has been in private practice in South Ogden for 38 years. He has been involved in organized dentistry for many years, serving as the President of the Weber District Dental Society, President of the Utah Dental Association and as an ADA Delegate from 2012-2020. Dr Cowley has also been on the PIE Advisory Board for over 32 years. Dr Cowley likes to keep busy with various activities and hobbies. Some of these include as youth leader in the Boy Scouts of America and multiple areas of church service. He is a private pilot and enjoys restoring old cars. Dr Cowley resides in North Ogden with his wife Betty, they have three daughters, and one son, who are all married and has five grandkids, ages 6 to 18.

Meet. Play. Learn. Oct. 11–13, 2021 With electric events, dynamic speakers, hot-offthe-press content, non-stop inspiration, and a community that is amazing, the ADA is proud to present a reimagined annual meeting that is sure to make you smile. Registration opens on June 23! SmileCon will be held in Las Vegas at the Mandalay Bay Resort and Casino.

What’s your practice worth?

Dr Joel Janis Dr. Joel Janis earned a BA degree in Zoology in 1957 from UCLA and graduated from the University of the Pacific School of Dentistry with a DDS in 1961. After practicing general dentistry for 35 years in the San Francisco Bay area Dr Janis spent 10 years on the faculty at University of the Pacific School of Dentistry followed by 6 years at Roseman University Dental School. He is currently an associate professor at the University of Utah School of Dentistry. Dr Janis enjoys 10 mile bicycle rides along the foothills of Mapleton where he lives and having fun working with awesome dental students. He also has used his dental skills to train dental faculty in advanced operative and cosmetic dentistry techniques in Mongolia during a humanitarian service mission for the Church of Jesus Christ of Latter day Saints 2002. Since 1968

Dr Janis has been married for 62 years to the same person. Has seven children, 30 grandchildren and 20 great children with more on the way.

UDA Action

Receive a free market value analysis today. www.AFTCO.net | 800.232.3826

ASSOCIATION 2021-2022 UDA BOARD OF DIRECTORS

Greg W Gatrell DDS UDA President

Kay B Christensen DDS UDA President elect

Rodney J Thornell DMD ADA Delegate 2018-2022

J Jerald Boseman DDS Convention Coordinator

Mark R Taylor DDS UDA Treasurer

Brent A Larson DDS ADA Delegate 2019-2023

Glenn A Zeh DDS UDPAC Chairman

Len R Aste DDS UDA Secretary

Ken J Baldwin DDS ADA Delegate 2020-2024

Val L Radmall DDS Executive Director

Mike C Smuin DDS UDA Past president

Scott L Theurer DMD ADA Delegate 2021-2025

Dotty S Tanner Assistant Director

Becky S Waters RDH Assistant Director

ASSOCIATION KEEP YOUR CONTACT INFO UP TO DATE Here is a tip – keep your contact information, such as office address, home address, phone number, and email address – current by letting the UDA know any time there is a change. It is important, the UDA needs to be able to contact you to inform you of breaking news or other information. For example, several members recently reported they were not receiving UDA Updates with important information. The reason? The email address the UDA had on file had not been updated. 8

If you are not receiving emails from the UDA, it is likely that you do not have a current, active email address on file with the association. With the increase in e-communication, it’s critical that the UDA has an active email address in which to reach you. Maximize your membership – to contact the UDA to make an address change, email change, etc. email uda@uda.org.

May / June 2021

Join Us for a Day of LIVE CE!!! For Dentists & Hygienists September 24, 2021 Salt Palace Convention Center 8:00 AM – 5:00 PM Rachel Wall, RDH, BS - Elevating Your Hygiene Service Bethany Valachi, PT, DPT, MS – Solving Work Related Pain in Dentistry Cory Glenn, DDS – Digital Dentistry in Practice Jason Chandler, DMD, MS – Sedation & Anesthesia Review Adam McCormick, DDS FACS - Med Emergencies & Provisional Implants Patrick Hall, DMD, MS – Bone Grafts & Neuromodulators Over 30 Vendors will be onsite. Lunch Included

Registration will be available June 2021.

UDA Action

PRACTICE FACTORS AFFECTING JOB SATISFACTION When I was a college student shadowing Dr. “K” I had the opportunity to speak with him about dentistry in general and what facets and challenges he enjoyed. He loved providing wonderful care for his patients and he loved dentistry in general. To him it was an opportunity to serve family and friends and have a good living all at the same time. He also enjoyed being his own boss. One conversation has stayed with me and that is regarding some of the things which he did not enjoy in dentistry. It basically came down to some of the business side of dentistry. He didn’t complain about the accounting, the taxes, the accounts receivable, or the bad debt owed to the practice and how to deal with it. Nor did he talk about the purchasing, the rent, the mortgage payment, or how to deal with the office layout and the flow of patients. The thing that he did mention is that of dealing with employees and proper labor relations. I have now put in more than 20 years of private practice and have learned why he didn’t complain much of the other things of running the business. We hire accountants. We can delegate ordering supplies, paying the rent or mortgage, and paying the utilities. What we cannot delegate is dealing with employees and “labor relations.” In the typical private practice, we are in fact the boss. Of course, there are companies that have come to our rescue in many ways by taking over the business side of the practice. This includes employing people to work for them so they handle the payroll and taxes. However, this does not relieve the potential problems of dealing with employees. I can honestly say that I’ve enjoyed almost every employee that has worked for me, but I can also honestly say that some are better than others. I have learned, however, that happy employees almost always translate to a happier work environment. This translates to more satisfaction not only on the part of the employees and dentist, but also leads to greater patient satisfaction. Many studies have been done on what constitutes employee happiness. Most of the studies have several things in common. We automatically think that wages are the most important thing for employee happiness and retention and yet that does not rank first in any of the studies that I reviewed. The top 10 things that employees value are: 1. Appreciation, respect and praise for their work. They want to feel recognized, which is something we all want. We want patients to leave appreciating what we have been able to do for them and feeling happy about the work that we’ve been able to provide. Our employees are exactly the same way. The studies suggest that if we are not misers in praising an employee for a job well done then that employee is happier, more productive, and it makes a happier work environment for everyone. 2. Good relationships with colleagues and fellow employees. 10

In my office when I’m looking to hire a new employee, I look at the basic skill requirement that will be necessary, previous experience, basic integrity, honesty, availability, hours they want to work etc., but I primarily interview potential employees with the idea of them being able to get along with other employees in the office. Nothing is more disruptive than interoffice disputes and bad feelings towards fellow employees. I frequently remind my employees that we are all human, that we all have faults, and that we all need to try to help each other and not be critical of each other in destructive ways. 3. A good work life balance. Dentists put in long hours, not only in our training and continuing education, but in running the business and in providing patient care. Our employees are dedicated but perhaps less interested in putting in long hours because they are not owners in the business. In my office, I have zero full-time employees. All of my employees are part-time, and they enjoy being able to have a better work life balance. Of course, there are employees in many of our dental offices that require or want to work full-time, but we need to be aware that they enjoy some time off just as much as we do. 4. Good relationships with superiors. In the dental office this means maintaining a good relationship with the office manager and with the doctor. The doctor also needs to respect the office managers opinions and support him or her in their sometimes difficult job of refereeing. 5. Financial stability of the practice or business for whom they work. As the old saying goes “all the rats leave a sinking ship” and the same is true with our practices. We need to maintain a viable practice where our employees are relatively assured that they can realistically expect a paycheck for the time that they put in. 6. Learning and career development. Some employees desire to have only a well-defined and outlined list of responsibilities, but many desire to expand their opportunities to learn and to serve the practice in an expanded way. This includes out of the office education opportunities such as the annual UDA meeting, in office continuing education such as CPR, and cross training between the front office and back-office responsibilities. Most of my front office employees are capable of assisting surgically as well as dealing with front office responsibilities such as scheduling, insurance questions, collecting payments, and the other myriad demands of the office. 7. Job security. This has some cross reference to point 5, that of financial stability of the practice, but also the feeling that as they contribute to building the practice that they have a measure of job security. This allows employees to move forward in their personal lives. Most of our offices have a trial period for new employees where they can learn to be comfortable with the requirements of employment, but also where the employer has the opportunity to May / June 2021

determine if the employee is a good fit in that office. Job security is associated with those who are not on a trial basis.

employees. They are generally very proud to a part of the dental team and work with “their doctor.”

8. An attractive salary or hourly wage. The old adage that you “get what you pay for” applies here as well. We need to consider keeping our salaries and hourly wages competitive in order to maintain our employee base. Sadly, I have learned that it is almost always more costly to train a new employee than it is to provide an appropriate raise when it is earned.

I have learned more from my failures than my successes including as an employer. We all know how quickly employees can be lost because of moving, changing family situations, better employment that generally includes improved benefits, or health concerns of the employee or loved ones. However, I have been blessed with the best employees that I’ve ever had. In my practice I have tended to hire more mature, more experienced, and older individuals with one exception. I have had the blessing of hiring many of students to work for me while they are attending school. To say they are motivated is an understatement. This has helped keep our office “young” as well as providing an opportunity to mentor these individuals. Many of these wonderful bright students have gone on to become respected dentists, dental specialists, physicians, nurses, and physician assistants. We can all be Dr. “K” to the rising generation of health care providers. You never know what conversations they will remember years later that will help them, their employees, and patients in the future.

9. Interesting job content. This certainly relates to point 6 above, but we have to remember that just as we can become fatigued with repetitive basic restorative procedures, our employees can become equally tired if they only do the “boring stuff ” in the office. Electronic records have reduced the need for “filing charts” but there is still plenty of seemingly small boring matters that need to be delt with. 10. Company values. What more can be said here? Dentistry provides tremendous service to our individual patients and their families and to our community at large. Health care providers in general really did go into the profession for the opportunity to provide a valuable service to our patients and community, and not to just earn a living. We don’t have to go looking for something other then what we do as far as company values are concerned. I don’t think we realize how significant that is to our

Dr. Ken J. Baldwin ADA Delegate

MCNA Insurance Company is pleased to administer benefits for the Utah Medicaid Dental Program. MCNA is a provider-centered organization committed to helping dentists serve Medicaid and CHIP enrollees. We provide dentists with leading-edge technology and superb customer service support to reduce missed appointments and encourage patients to seek timely dental care. For more information, visit us online at: www.mcnaUT.net

UDA Action

ASSOCIATION HOW TO LOVE DENTISTRY We are living in a changing world. Sometimes it is hard to know what is good, better or best- even in our professional lives. When I was just starting in dentistry, over 40 years ago, I was told not to plan on my home or my practice as part of my retirement savings (I will always be grateful for that advise). For many today home and practice may be major parts of retirement planning. When I began practicing, advertising was strongly frowned upon. Now every practice management plan has some advertising element. Insurance companies paid your claims with few concerns about fees or documentation. Wow has that changed. Many offices now even have their own dental benefit plan. Dental Services/Support Organizations (DSOs) have become common practice models. Dental implants have gone from being a very questionable procedure, almost a hiss and a by word, to a predictable mainstream procedure. Radiographs required a dipping tank or if you were high tech, an automatic developer. Now we are getting single PAs, panorex and 3 dimensional images instantly. We are constantly incorporating new restorative materials and techniques. The meticulous gold foil that I proudly did on my dental boards no longer exists. The peg board system which allowed one receptionist to handle the front office, including filing all insurance claims, for two dentists, has been replaced by computer systems that require 2-3 front desk personnel plus an IT person, to handle that same aspect of a similar practice. We have new specialties in Dental Anesthesiology, Oral Medicine, and Orofacial Pain. I could go on. Wow – lots of changes. Some of these changes have made our lives better and some have added to our stresses. Questions on how to run an ethical, successful and happy practice are getting more complicated. One aspect of our practice that has stayed constant and made practicing dentistry so enjoyable is the opportunity to serve our patients and the Doctor/Patient relationship. I am grateful to our Dental Association for formulating our CODE OF ETHICS, which has protected that relationship and given us a guide that we need in this world of “business ethics” where whatever we do is OK if it makes money and doesn’t technically break the law. The ADA Code of Ethics by which we are all bound, not only gives us a guide, but helps us define what it is to be a “Professional”. Someone who enjoys immense trust but is also held to a higher personal standard. Someone who also makes his/her community and profession better.

The ADA Code of Ethics, which can be found on the ADA website is made up of five guiding principles: 1. PATIENT AUTONOMY - patients are involved in decisions and can self-govern. 2. NONMALEFIECENCE – do no harm, in treatment, referring or not, and use of auxiliaries 3. BENEFICENCE - do good, for your patients and community 4. JUSTICE - be fair in all dealings, patient treatment, billing, obligatory criticism of others 5. VERACITY – always be truthful in procedures and dates, billing, treatment options etc. Winston Churchill once said, “We make a living by what we get, we make a life by what we give”. In an article in Harvard Business Review entitled How Will You Measure Your Life, Clayton Christensen, a distinguished professor at the Harvard Business School states “remember the importance of humility” and “choose the right yardstick”. He concludes that the metric that will ultimately count in how we will be remembered is not by the dollars made but by the lives we touched. We are in a unique position to impact many lives. As dentists, our position of trust is something we should cherish and work to be worthy of. After 40 plus years of practice, I have concluded that if I put my patients needs first, in all decisions, I will have an ethical practice, my outcomes will be better, and I will love going to work each day. Soon I will be challenged with how to transition into retirement. Can I put my patients first? Will they be taken care of in the best way? If it’s all about money, I will have missed the boat. Despite its challenges, we in dentistry, are a lucky group in a wonderful profession. I am surrounded by amazing, wonderful, great dentists. Enjoy the ride, take care of your patients and community, keep up the good work and continue to make the world a better place. Dr Brent A Larson ADA Delegate

LIKE US ON FACEBOOK! Utah Dental Association

May / June 2021

PRACTICE WHAT’S IN YOUR GLOVE COMPARTMENT? Almost a quarter century ago, while attending a “Dental Emergencies” CE program, the speaker went somewhat “off topic.” The Doctor/Lecturer stepped back from the podium and challenged his dentist audience … to be something other than just clinicians and openly wondered if we considered ourselves a “total health practitioner.” It wasn’t a trick question, but many of us were cautious in answering! He then piggybacked a second question which was: Would any of us have a problem putting a “pocket mask” in our car’s glove compartment? His point was – are we, as total health practitioners, willing to – if needed – use (pocket mask) it in an emergency situation, outside our work environment? Today … my pocket mask is still lying in my car’s glove compartment awaiting that first moment of need. And as I write this op-ed, I still hope it will never see the light of day. In that same time frame our country’s citizens were unconsciously being exposed to a health care crisis like no other – including our current COVID-19 pandemic – and we’re still suffering from its consequences, today. I don’t believe many general dentists have been directly INFLUENCED during the crisis, but I can’t say the same for some of our profession’s specialty group members. The crisis took root in the late ‘90s and bore fruit by the turn of the millennium. What I’m referencing is the marketing of Purdue Pharma’s time release pain medication -OXYCONTIN. From 1995 up until October 21, 2020 – estimates are – 250,000500,000 citizens or more, have died from drug overdoses, with OxyContin being the most abuse drug of choice. Let that sink in for a few seconds. That’s anywhere from TWO and a HALF to FIVE full capacity, fan filled football games. The reason I’m using the above October date is because that’s when Purdue Pharma’s family-owned business finally settled for EIGHT BILLION DOLLARS+ with the federal government. The company pleaded guilty to fraudulently marketing the painkiller that may be responsible for addicting thousands of Americans, resulting in opioid overdoses. State and local lawsuits are not affected by this settlement and will continue to be heard in courts in future years.

In metropolitan Cincinnati, my first memories of Purdue Pharma’s influence on our profession occurred far too frequently, started in the late ‘90s. I began noticing that some of my teen patients were developing an affinity for a specific dental specialist. On several occasions, when referring my teen patients for specialist treatment, the teen(s) would ask to be referred to a SPECIFIC SPECIALIST. Once a referral pattern was established, I began confronting the teen(s) and asked why they specifically were requesting to be referred to Dr “X”. Each time the same specialist was identified. It became apparent that the community had a “Doctor Feel Good” practicing with in it. I couldn’t help but wonder how many elaborate Purdue Pharma dinners or trips to warm climates were logged by dentists, in order to change the prescribing habits of “XYZ” specialist. I sincerely doubt that each of you can state that you haven’t known someone that has been affected by an overdose of some type of opioid derived drug. So… like that aforementioned “Dental Emergencies” CE speaker, I want to challenge each of you to step away from just wearing the mantle of DDS/DMD and become a “Total health practitioner” … by placing a two pack of “Narcan Nasal Spray” in your car’s glove compartment. And if you’re like me, up until this year quite a few of you had no idea that a regular “Joe” can walk into any pharmacy and buy a two-pack box of Naloxone HCL-4mg nasal spray for about $85.00. NO PRESCRIPTION IS NEEDED!!! There are a couple “warnings” that come with the two pack of Narcan: 1. Keep out of sunlight. 2. Store at room temperature (no higher than 77F) and do not freeze! The likelihood of running into a situation with an overdose victim is no doubt much more likely than having to use a pocket mask. Then again the situation might be such that both the mask and the Narcan two pack are necessary!!! Don’t be hesitant to be a “Doctor-Doctor!!!” (Narcan Nasal Spray is distributed by ADAPT PHARMA, INC. AND HAS BEEN ON PHARACY SHELVES SINCE 2016.) Robert Buchholz, DDS ODA Today

UDA Action

PRACTICE HOW SHOULD I EVALUATE A CONTRACT WITH AN INSURANCE PLAN Before signing any agreement, including a contract with an insurance plan, do your homework to be sure the proposed agreement makes business sense to you, make sure you understand all of the provisions, and consult with your attorney as necessary. Remember that a decision as to whether to enter into an agreement is an individual business decision, based on your practice preferences and needs. Start with the practice and financial considerations. If you join a PPO to fill empty chair time, do you stand to profit? If you run the numbers and believe you will lose money on each PPO or HMO patient, don’t expect to make it up on volume. The ADA has an array of resources to help you assess whether and how to participate in a particular plan. Start with the practice resources first. The ADA’s informational legal resources can help you get a feel for the legalities involved. As a rule of thumb, there is no need to get a lawyer’s advice on the legal aspects of the transaction if a deal does not make business sense to you in the first place. Perhaps the best-known ADA practice resource is the Contract Analysis Service. This service analyzes provider contracts before they are signed, including contracts from managed care companies, and informs members in clear language about the provisions of the contracts so they can make informed decisions about the implications of participation. The service is available free to members through their state societies. It is not a substitute for legal advice but can be of great help to you and your attorney when considering legal issues in plan participation. The ADA also offers a resource called, “What Every Dentist Should Know before Signing a Dental Provider Contract,” which has additional information on provider contracts (see Related References and Resources). This document addresses the following. • Stop, read, and consider before you sign • Term and termination • Modification clause • What documents make up the contract? Obtain and carefully review all attachments, exhibits, appendices, and undisclosed documents before signing the contract • Plans included under the contract • Coverage determinations • Liability: never sign a contract with a hold harmless clause without first consulting your personal attorney and your professional liability insurance carrier about the legal and financial implications of the clause • Referrals: you have an obligation to your patients to make sure that treatment is not compromised, regardless of any restrictions in the contract • Utilization review: will the utilization review process influence or control the way in which you practice dentistry or compromise your professional judgment? 14

• • • • • • • • • • •

Peer review Grievance system Arbitration Insurance: confirm exactly what your obligations are so you will know if you need to purchase additional insurance or change carriers. Compensation Most favored nation clause: will you be required to give XYZ Company the benefit of any “better price” that you give another dental benefit organization? Noncompetition clause Assignment/delegation Liquidated damages: consult with counsel about liquidated damages provision Entire understanding: if it isn’t in the contract, it probably is not enforceable. Governing law

The “What Every Dentist Should Know before Signing a Dental Provider Contract” document is intended as a supplement to the tailored, informational analyses of contracts offered by the ADA Contract Analysis Service. While none of these resources constitute legal advice, we hope they are of great help to you and your attorney. Remember, the decision regarding whether or not to enter into an insurance plan agreement is up to you, the individual dentist. Related References and Resources •American Dental Association (ADA) .2020. Dental Insurance Contract Concerns. https://success.ADA.org/en/dental-benefits/third-party-contract-issues. •ADA. 2020. What Every Dentist Should Know Before Signing a Dental Provider Contract. https://www.ADA.org/en/member-center/member-benefits/ legal-resources/contract-analysis-service A Dentist’s Guide to the Law, 246 Things Every Dentist Should Know. Fourth Edition. American Dental Association, Pages 140-141.

Text to: 1. 2.

801 -261 -5315

I nc l ud e y o ur Fi rs t a nd La s t N a m e Yo ur i nt e re s t s t o ge t i nv o l v e d : a) b) c) d) e)

House of Delegates - Governance UDA Action Committee- Publications UDPAC Committee – Legislation I know my legislators – Name them & connection I’d be willing to be a Collaborative Dentist

May / June 2021

PRACTICE TRUST YOUR INSTINCTS Occasionally, patients remind us why we matter in ways bigger than we can imagine. I don’t have to tell anyone that 2020 was a challenging year as a dentist and practice owner. We all know that. In the middle of the summer, when COVID-19 cancellations were still very much a challenge in our practices and shortly after the World Health Organization had released a statement saying that routine dental care should be postponed, was one such time. During this period, I saw a 69-year-old female patient for a routine hygiene exam. I begin each exam by palpating for lymphadenopathy. Immediately, my gut told me something wasn’t right when I discovered her right sublingual lymph node was firm, ridged and markedly abnormal from the left side. The patient had a history of cancer years before. I didn’t want to panic the patient, but I didn’t want her to take this lightly or ignore it either. I finished my exam and then sat her up. I showed her the lymph node and had her palpate it herself. We discussed her history and I stressed that this needed further evaluation. I wrote down exactly what description she needed to give her primary care physician (PCP) of the lymph node when she called to make an appointment. She stated that it hadn’t been more than six months since she had seen her PCP, and that nothing had come back abnormal at their last regular appointment. I assured her that we would just rather be safe than sorry, and she agreed. She called her PCP immediately upon leaving my office.

The physician assistant students I teach at the University of Tampa always ask how you know something is abnormal, or when you should insist something has a further evaluation. My answer is always the same; if you aren’t sure, insist they return in two weeks. If the abnormal spot or lymph node hasn’t changed, then you know it is worth further investigation. However, sometimes you just know something isn’t right and you can usually help the patient realize the same and guide them to further care. Trust your instincts. This is the one time when a patient will be truly grateful your instincts were wrong if it is nothing, and even more grateful you followed them if you are correct. It is my daily mission to stress to my patients and my peers the importance of our role as essential health care providers. Even in our day-to-day routine, what seems like a mundane exam can save lives. We can change lives with a smile, and we can save lives with a routine exam. As oral health care providers, we are essential and should not be undervalued. You matter to your patients, I pray you will never forget it! Dr Becky Warnken Today’s FDA

Two weeks later, my office received a call from this patient. She told Sandy at my front desk, “I don’t want to bother Dr. Becky, she is busy. But I need you to thank her for me. I need you to thank her for catching my cancer. I am entering Moffitt now for a workup and I don’t have a lot of time either, but please just tell her thank you.” She started crying, Sandy started cry. When Sandy told me, I started crying. I was devastated that my patient was facing a cancer diagnosis. I was simultaneously so thrilled that she had come in for her routine exam and that I hadn’t ignored my instincts. She’s undergoing treatment and at our last update her prognosis was good.

Create more accurate restorations with a faster turnaround time by going digital. Call to find out how to get a FIVE CROWN CREDIT! Full Contour Zirconia ✓ Quality Zirconia – Katana ✓ Fast turnaround – as little as three days in lab ✓ Special UDA intro offer Guided Implant Surgery ✓ Package includes: consultation, surgical guide, custom abutment and restoration ✓ Easy all-in-one price Custom Abutment and Crown ✓ Authentic custom abutments ✓ Full contour zirconia restoration included ✓ Easy all-in-one price

801.967.0592

UDA Action

digitalcontourlab.com

LETTER I AM RIGHT WHERE I CHOOSE TO BE Every now and then it is good to sit down and have a frank conversation with yourself. In a recent discussion with what I hope was my better self, I came to realize that I am exactly where I have chosen to be. That may not seem like much of a revelation, but truly, I am where I am professionally, socially, spiritually, and physically, because of the choices I have made over the years. Recently I was asked to join a PPO by a long-time patient. He was retiring and losing his company provided dental benefits and was purchasing insurance on his own. In this case, I told him I would look into it. I did. I first checked out the fee schedule of course. The fees were about 30% lower than my regular fees. The contract was the usual one-sided mass of hyperbole and confusion. The kind of lofty sounding piece of rhetorical legal work that withers all of us. The mental pain of wading through all of that evokes a temptation just to sign and move on, but I read the agreement to the end. The second to the last paragraph, almost incidental to the rest of the mouse trap, was a short paragraph that stopped me in my tracks. Here is what it said: “8.22 Lease of Provider Network and Claims Re-Pricing. (unidentified Insurance company) shall be permitted to lease or rent its provider network to third parties and affiliated entities and shall be permitted to enter into claims re-pricing agreements with third parties without the Practice’s consent. “ Excuse me? What was that? I called the insurance company and asked “Provider Contracting” to clarify the section and received an evasive explanation that left me grateful my father taught me to read, and re-read very carefully, anything I sign. Please correct me if I am wrong, but that little paragraph gives them the right to grant access to my contracted services (at their substantially reduced fee schedule) to any insurance company they choose without letting me know about it. Suddenly, I “take” insurance from companies I know nothing about. I

presume in this lease agreement with third parties, the lessee, pays some monetary compensation to the lessor for network access. What a wonderful revenue stream to the lessor! What a wonderful safety net of cost controls for insurers looking into an almost certain future of runaway inflation! One might say… “Well, I will get more patients and I don’t have to worry about signing up with each insurance company individually. Someone has done that for me … Hooray! It is so simple.” But being the devil’s advocate, I wonder if leasing their lower compensation network might at some point (say economic pressure) be offered to other insurers who now compensate me at a reasonable rate. Making their/my “accepted” fees the same across all insurance processors. Sounds a little like price fixing. Didn’t we just celebrate in January the passage of congressional legislation that put an end to insurance price fixing? As I recall The Competitive Health Insurance Reform Act (H.R. 1418) passed the House of Representatives and the Senate in 2020 and was signed into law on Jan. 13, 2021. Health insurers are now subject to the same laws as other businesses (dentistry included) that prohibit unfair practices such as price fixing, price gouging, collusion, and market allocations. Did we celebrate the many years of ADA legal and lobbying efforts too soon? Maybe we all should sit down and have a frank conversation with ourselves. Perhaps then we will realize that we don’t have a right to sit in our dental gatherings and complain about reimbursement rates in Utah. The only path to real change is not just to talk about it year after year (although I admit that a good gripe session may have some value). “Affirmation of suffering” may make us feel better in the moment knowing we are not alone, but the only way our situation in Utah will change is when we all start choosing differently. I am right where I have chosen to be… and so are you. Steven D Parkin DDS

May / June 2021

PRACTICE BIOLOGICAL IMBALANCE LINKED TO PERIODONTITIS, KIDNEY DISEASE An imbalance of the body’s oxygen-producing free radicals and its antioxidant cells could be the reason why periodontitis and chronic kidney disease affect each other, according to a new study led by the University of Birmingham and published in the Journal of Clinical Periodontology. In this study, over 700 patients with chronic kidney disease were examined using detailed oral and full-body examinations including blood samples. The aim was to test the hypothesis that periodontal inflammation and kidney function affect each other and to establish the underlying mechanism that may facilitate this. Results showed that just a 10% increase in gum inflammation reduces kidney function by 3%. In this group of patients, a 3% worsening in kidney function would translate to an increase in the risk of kidney failure over a five-year period from 32% to 34%. Results also showed that a 10% reduction in kidney function increases periodontal inflammation by 25%. In contrast to current beliefs that inflammation is the link between periodontitis and other systemic diseases, researchers

found for the first time that in this group of patients, the effect was caused by a biological process called “oxidative stress,” which is an imbalance between reactive oxygen species and the body’s antioxidant capacity that damages tissues on a cellular level. “This is the first paper to quantify the casual effect of periodontitis on kidney function and vice-versa as well as the first to elucidate the pathways involved,” said lead author Praveen Sharma, PhD, BDS, from the Periodontal Research Group at the University of Birmingham’s School of Dentistry. “It showed that even a modest reduction in gum inflammation can benefit renal function. “We hope that this research paves the way for further studies to see if improvements in kidney function following periodontal care translate to longer, healthier life for patients with chronic kidney disease.” Learn more about this study in the Journal of Clinical Periodontology (2020) CDA March 2021

We have practice in selling your practice. We have all of the experience, tools, and resources necessary to help you transition your practice into the right hands. With our help, you can avoid common pitfalls. We provide expertise on appraisals, practice sales, mergers, partnerships, and everything you might need for a fulfilling practice transition.

801.298.4242 | ctc-associates.com Randon Jensen | Larry Chatterley

UDA Action

PRACTICE WHAT IS APPROPRIATE SPEECH IN THE DENTAL OFFICE? Dentistry is an interactive and personal process. There is much more involved than just providing the actual services of dentistry. The teeth and mouth are attached to a living human being. Fortunately, none of us are robots.

It is important to consider others’ potential perspectives by the way we speak and act. We need help running our offices smoothly. Guidance is needed to help reduce the stress that we are experiencing in our dental offices.

Clinical treatment of patients is just one aspect of dentistry. We also have families of patients, staff, venders, etc., with whom we interact daily.

How do we respond to pointed questions about our political views? How do we respond to questions that seem controversial and offensive? This does not apply to just politics, but just about all other topics as well.

Communication is key. We communicate through words, mannerisms and actions. As health care providers, we strive to be caring, kind, compassionate and good listeners. We treat others as we want to be treated. Many would say to be successful you should treat all patients like family. We want those in our practice to feel comfortable and welcomed. Patients want to return to our practices for more than just the actual dental treatment. It’s the connections that we maintain with our patients and staff that keep patients coming back. From the first moment someone comes into the office and you ask them, “How are you doing today?” you do not know what response or questions you will get. But with that, how do we respond with the “charged” atmosphere that we seem to be in today? Everything, it seems, can be offensive to some and not others. How do we navigate this climate? Wikipedia defines “freedom of speech” as a principle that supports the freedom of an individual or a community to articulate their opinions and ideas without fear of retaliation, censorship, or legal sanction. “Political correctness” is a term used to describe language, policies or measures that are intended to avoid offense or disadvantage to members of particular groups in society. What can we use to guide us through this daily obstacle course?

These are difficult questions; we run practices that treat patients and have staff to support as well. It is not realistic to expect to just treat likeminded people. Nor would we want to. And we can all agree on some topics and not others. Is it OK to disagree? Should we say so or not? So, “free speech” and “political correctness “in the dental office — how do we navigate this and maintain a healthy practice and our own personal sanity? As dentists, we do our best to practice dentistry, but it is more than that as we interact with other human beings all day long. Answers are not easy. It would be nice if we could truly appreciate the diversity and embrace with compassion and kindness the differences of opinion that we all have. During these times, we can look to the ADA Code of Ethics’ principles of tolerance and integrity for guidance. Tolerance can be interpreted to expand beyond culture and ethical diversity and challenges dentists to simply recognize that “differences exist.” Integrity “requires the dentist to behave with honor and decency” and means the dentist recognizes when words or actions conflict with one’s values. If you value mutual respect and good communication with your patients and staff, you will consider a compatible response. What we can do is strive to truly do the best that we can as dentists and be mindful of others as ethically as we can. Denise Habjan, DDS CDA, April 2021

May / June 2021

PRACTICE OMEGA-3 MOLECULES REGENERATE PERIODONTAL TISSUE A recent study conducted by São Paulo’s Dental School (FOUSP) in Brazil and the Forsyth Institute shows that maresin and resolvin, produced by the body from omega-3 fatty acids, can help repair tissue damaged by periodontal disease by stimulating periodontal ligament stem cells. The periodontal ligament is one of the structures lost in severe cases of the disease. The study was published in the journal Frontiers in Immunology. Forsyth and FO-USP have long studied the mechanisms that lead to a resolution of inflammation in the periodontium. One of the focuses for the partnership is what is called pro-resolving lipid mediators, such as maresin and resolvin. “These molecules come into play in the second stage of the inflammatory process, referred to nowadays as the resolution stage, but some people apparently don’t produce enough of them, while in other cases their functions appear to be altered in

some way,” said doctorate student Emmanuel Albuquerque de Souza of FO-USP. Stimulating the release of these mediators could be a way to improve the success rate of so-called regenerative therapy. “The study shows for the first time that these two mediators enhance stem cell regenerative capacity even in the presence of inflammation,” said Marinella Holzhausen Caldeira, PhD, a professor in FO-USP’s Department of Periodontics and Souza’s thesis advisor in Brazil. Based on previous research demonstrating the action of maresin and resolvin in periodontal regeneration, researchers created two in vitro environments for stem cells, one representing inflamed tissue full of pro-inflammatory cytokines and the other simulating the inflammation resolution stage. They found that Continued on next page

UDA Action

COMMUNITY HELP WITH THE DENTAL NEEDS OF THE LESS FORTUNATE Wasatch Homeless Health Care, Inc., began in 1988 in a small office in the old Westinghouse Warehouse building on 210 S Rio Grande Street in Salt Lake City. In the early 90’s Wasatch Homeless Health purchased the building on the corner of 400 West and 400 South, and the Fourth Street Clinic was born. In 2014, a four-chair dental clinic opened at the Fourth Street Clinic. As dental professionals we understand the importance of proper dental care and its importance on the health of the whole body. Homelessness causes a challenge to receiving proper dental care and the Fourth Street Clinic in Salt Lake is working to alleviate some of those challenges. Please consider donating to the Fourth Street Clinic to help with their efforts. We know that homelessness hurts, but we also know that access to quality health care helps. We also know that the collective impact of the small, monthly gifts is tremendous as we work to provide health and dental care to Utah’s most vulnerable. A $25 donation to the Fourth Street

Omega-3 Molecules (Continued from previous page) pro-inflammation reduced stem cell activity, while the presence of maresin and resolvin increased their capacity to proliferate, migrate and rapidly acquire the functions of cells in the lost tissue. “When these stem cells are stimulated, they can acquire properties similar to those of periodontal cementoblasts, fibroblasts and osteoblasts,” Dr. Caldeira said. The finding shows the importance of creating a favorable environment for stem cells to function properly. The next step is understanding how to use maresin and resolvin therapeutically. One possibility could be to use their precursor, omega-3, via supplementation. “Recent clinical studies have shown 20

Clinic can provide vital services and supplies. Go to https://fourthstreetclinic.org/utahdental

that supplementation can have a highly positive effect when combined with basic periodontal therapy, which involves removal of the biofilm that accumulates in the tissue,” Dr. Caldeira said. The benefits are seen mainly in patients with diabetes or metabolic syndrome, which point to an altered inflammatory profile. Another possibility could be to treat stem cells with maresin and resolvin before using them in regenerative therapy to make the treatment more effective. Read more of this study in Frontiers of Immunology (2020) CDA March 2021

May / June 2021

PRACTICE PERIODONTITIS INCREASES RISK OF HEART ATTACKS People with periodontitis are at higher risk of experiencing major cardiovascular events, according to new research from the Forsyth Institute and Harvard University scientists and colleagues. In a longitudinal study published recently in the Journal of Periodontology, Dr. Thomas Van Dyke, DDS, PhD, senior member of staff at Forsyth, Ahmed Tawakol, MD, of Massachusetts General Hospital, and their collaborators showed that inflammation associated with active gum disease was predictive of arterial inflammation, which can cause heart attacks, strokes and other dangerous manifestations of cardiovascular disease. While growing evidence has suggested a link between periodontal disease and cardiovascular disease, the independence of this association and the pathway remained unclear. Hence, the research team tested the hypotheses that inflammation of the periodontium predicts future cardiovascular disease independently of shared disease risk factors and that the mechanism linking the two diseases involves heightened arterial inflammation. For the study, researchers performed positron emission tomography (PET) and computer tomography (CT) scans on 304 individuals to view and quantify inflammation in the arteries and gums of each patient. In follow-up studies approximately four years later, 13 of those individuals developed major adverse cardiovascular events. A presence of periodontal inflammation was shown to be predictive of cardiovascular events, even after researchers controlled for all other risk factors, such as smoking, high blood pressure, obesity and diabetes.

Importantly, researchers found that bone loss from prior periodontal disease was not associated with cardiovascular events. Patients who did not have actively inflamed gums had a lower risk of cardiovascular disease, even if those individuals had a prior history of periodontal disease as evidenced by periodontal bone loss in their CT scans. “This is very definitely related to people who have currently active inflammatory disease,” said Dr. Van Dyke, who is also the vice president of clinical and translational research at Forsyth. Researchers hypothesize that local periodontal inflammation activates and mobilizes cells signaling through bone marrow, which triggers the inflammation of arteries, leading to adverse cardiac events. While the study sample size is relatively small, Dr. Van Dyke said the observation is significant and should be studied in a much larger population. And for people with active periodontitis, seeking treatment could potentially prevent a dangerous cardiac event. “If you’re in the age zone for cardiovascular disease or have known cardiovascular disease, ignoring your periodontal disease can actually be dangerous and may increase your risk for a heart attack,” Dr. Van Dyke said. Learn more about this study in the Journal of Periodontology CDA April 2021

UDA Action

PRACTICE ERGONOMICS staff who haven’t been trained how to utilize the headrest so they just leave it in the same spot for every patient and procedure. With the patient positioned properly, the occlusal plane of the upper arch should be 20 to 25 degrees beyond the vertical. A properly positioned headrest or cushion will allow you to do this and should be adjusted immediately after the patient is seated. A double articulating headrest should be brought up and forward to support the base of the patient’s skull and keep them in a relaxed, open position, with only small adjustments to be made after reclining depend on patient feedback or the region you will be treating. Patients will tolerate a fairly high level of reclining without complaint when properly supported.

Photo: Image licensed by Ingram Image

Do you sometimes feel like you’ve been through the wringer at the end of the day and wonder whether you are a dentist or a contortionist? Studies show that nearly two-thirds of dentists who retire early are forced to do so because of musculoskeletal disorders and work-related pain. Having pain at the end of the day isn’t “just part of the job.” Just as you treat a patient who is in pain, properly identifying the source of the issue is a critical step in providing a solution. As an equipment specialist and technician visiting dental offices for the past 25 years, I have found that most ergonomic issues can be addressed by focusing on three equipment-related factors: 1. Patient positioning. 2. Operator and assistant positioning and seating. 3. Dental delivery system configuration and location. Patient Positioning Studies show that any procedure that requires a forward head posture of more than 20 degrees will contribute significantly to neck and shoulder pain issues. Practitioner feedback on proper posture usually focuses on their inability to see properly or patient comfort, but with correct equipment and training, both issues are easily addressed. Vertically adjustable, flip-up loupes with a declination angle of about 55 degrees addresses the head posture issue and allow you to sit in a neutral, vertical position. But even the right loupes won’t be effective unless you properly position the patient. Dental chairs are equipped with a variety of headrest styles, but the most versatile is the double articulating headrest. Too often we see dental chairs equipped with a fixed or flat style headrest that doesn’t allow for proper patient positioning, or dentists and

Operator and assistant positioning and seating. Dental stools are a specialty piece of equipment and should be customized and fitted specially for your body type. The evolution in dental seating now includes all manner of body supports options, molded and adjustable seat cushions, and gender-specific saddle type models fit specifically to your preferences and body type. A properly fitted stool will enhance breathing, circulation, spinal position and put your body into a stable and comforting position and enhance patient access. Always try before you buy, preferably with an in-office demo that you can use for several patients. Dental delivery style and positioning. Of the three focus areas we’ve discussed, this is the most open to user preference. Dental treatment spaces have seen a significant shift to 12 o’clock rear delivery, four-handed style equipped space, which when properly utilized is very effective at minimizing fatigue, twisting motions and provides versatility for left or right-handed operators. Side or over the patient delivery systems, however, are ideal for the operator who prefers to switch instruments or handpiece usage frequently and keep everything out in front of their body. There isn’t a right or wrong answer here, but you should go through a proper interview process about your preference and learn the trade-offs before selecting an equipment style and location. A delivery system in the wrong location will have a very negative effect on your posture and daily fatigue. We also commonly address light and noise issues in the treatment space. Improper light color and balance from all sources can contribute greatly to eyestrain and fatigue and ambient noise from equipment and handpieces is a frequent source of distraction and can significantly affect hearing loss. Richard Wilde WDAJ

May / June 2021

ASSOCIATION ADA NAMES DR RAYMOND A. COHLMIA AS NEW EXECUTIVE DIRECTOR The ADA announced May 12 that it named Raymond A. Cohlmia, D.D.S., dean of the University of Oklahoma College of Dentistry and a former ADA Board of Trustees member, as its executive director, effective Nov. 15. Dr. Cohlmia, of Oklahoma City, Oklahoma, will begin onboarding for his new position on Oct. 1. The announcement comes after a robust search process that began when the current executive director announced she would retire in 2021. “The American Dental Association is excited to welcome Dr. Cohlmia as its new executive director,” states ADA president Daniel J. Klemmedson, D.D.S., M.D. “In addition to a breadth of experience in dental practice and education, his many years of service in organized dentistry made him a standout candidate.” Dr. Klemmedson added that Dr. Cohlmia is widely respected in the dental community for his thoughtfulness, dedication and service-oriented approach to leadership.

and the American Dental Political Action Committee. Dr. Cohlmia has also represented his district as a delegate to the ADA’s House of Delegates — the governing body that develops ADA policies. “Throughout my career, I have had the privilege of working with the ADA in multiple roles,” Dr. Cohlmia said. “That, combined with my time spent in private practice and as an educator, will benefit me greatly in this new position. I am excited about the opportunities ahead with the American Dental Association, and I look forward to working together with its many members to advance both the organization and the profession.” Dr. Cohlmia earned his dental degree in 1988 from the OU College of Dentistry. He currently resides in northwest Oklahoma City with his wife, Sherry, and has three children. Kimber Solana ADA News

“With these qualities, as well as his proven background, he is well-suited to help the ADA drive dentistry forward and into the future,” Dr. Klemmedson said. Dr. Cohlmia’s experience includes joining the University of Oklahoma College of Dentistry faculty in 2009, serving in a variety of leadership positions. In 2011, he was named director of comprehensive care, and he served as assistant dean for patient care from 2013 until he was appointed dean in 2015. Prior to joining the University of Oklahoma, Dr. Cohlmia ran a private dental practice for 26 years. “I am humbled and honored to be selected as the next executive director of the American Dental Association,” said Dr. Cohlmia. “I have always believed that organized dentistry plays an integral role in the advancement of the profession, and to me, there is no better organization to advocate for oral health than the American Dental Association.” An active leader in the dental community at the local, state and national levels, Dr. Cohlmia served on the ADA Board of Trustees from 2015-19 and as president of the Oklahoma Dental Association in 2001 and his local dental society in 1997. He has led the ADA New Dentist Committee and Council on Membership, serving as chair in 1999 and 2007, respectively. Additional ADA appointments over the years include the Council on Annual Sessions, the Council on Dental Benefits, UDA Action

PROBLEM SOLVED Pacific Office Automation makes office printing and IT easy Document management, IT services, printers & multifunction products, and more for your digital success.

Pacific Office Automation 1325 West 2200 South, Ste B Salt Lake City, UT 84119 801-990-4001 pacificoffice.com