March 2011 Nugget

March 2011

The line between medicine & dentistry blurs Inside:

New guidelines for total joint prophylaxis Blood pressure monitoring in a dental office PLUS: Are you utilizing social media to benefit your practice?

don’t miss these upcoming events! continuing education

member forum

March 4, 2011

March 18, 2011

5

RPDs — Still a Good Option in the Age of Implants

CE, Co

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Presented by: Alan Carr, DMD, MS Course Objectives: • Unique differences between RPDs and other prosthetic options • Why reports of periodontal disease in RPD wearers exist, and whether there is a true causal nature to the relationship • Key clinical/patient features that put patients at risk for dissatisfaction when provided with RPDs

Build Your Own Employee Handbook Presented by: Mari Bradford (CEA)

8:30am–1:30pm • 4 ceu (20%) SDDS Office

member forum March 8, 2011

March 24, 2011

Benign & Malignant Tumors of the Neck & Skin Presented by: Barbara Burrall, MD

Spou s Nigh e t!

%

Topics will include: Pri • Handbook benefits and risks inclu ce hand des • Policies Required by State bo and Federal Law on CD ok !

• Recommended Policies • What NOT to put in a Handbook

8:30am–1:30pm • 5 ceu (Core) Hyatt Regency Sacramento

general meeting

4

CE, 20

The Numbers of your practice: The good, the bad, avoiding the ugly Presented by: Chris Mann, CPA, CFP; John Urrutia, CPA; Neil Beeman, CPA (Mann, Urrutia, Nelson, CPAs)

Course Objectives: • Recognize normal variant cutaneous structures, a range of benign cutaneous tumors and a range of cutaneous malignant tumors, including melanoma and non-melanoma cancers • Perform a general head and neck skin cancer screening

Topics will include: • The best structure for your business • Red flags when someone else is “handling” your numbers • How your practice and your personal life work together • What your CPA should be doing • The right time for investing: expanding, building, partnering

6:00pm–9:00pm • 2 ceu, Core Sacramento Hilton — Arden West

6:30pm–8:30pm • No ceu Sacramento Hilton — Arden West

Table of Contents

THE NUGGET March 2011 Volume 57, Number 3

Features 7

Breaking Down the Barriers Tim Mickiewicz, DDS

8–9

Antibiotic Prophylaxis For Patients with Joint Replacements Kevin Keating, DDS, MS

10–11

Guidelines for Monitoring Blood Pressure of Dental Patients Kevin Keating, DDS, MS

12

Guidelines for Obtaining Medical Consultation for Patients Receiving Dental Treatment Art Curley, JD

Specials 9

Letter to the Editor (re: February 2011 Nugget) Kevin Keating, DDS, MS

Regulars 4 5 6 11 14 15 17–18 20 23 23 24–25 25 26 28 29 30 31 32

President’s Message From the Editor’s Desk Cathy’s Corner Link of the Month YOU: The Dentist… the Business Owner Foundation Update Being Social YOU: The Dentist… the Employer Committee Corner Committee Meeting Schedule Vendor Members Vendor Member Spotlights We’re Blowing Your Horn!

Advertiser Index Membership Update Event Highlights Classified Ads SDDS Calendar of Events

The Nugget is a four-time International College of Dentists Journalism Award Winner: Golden Pen (Honorable Mention, 2007) Article or series of articles of interest to the profession

Outstanding Cover (2007) Remarkable cover

Overall Newsletter (2007) Exceptional publication overall

Platinum Pencil (2010) Outstanding use of graphics

* featured on cover www.sdds.org

November March 2011 2007 | 3| 3

President’s Message Gatekeepers

By Wai M. Chan, DDS

As dentists, we are part of the healthcare team.

We are experts of the oral maxillofacial area of the body. Just like our medical colleagues, who are experts and specialists in their respective specialties, we do not know nor do we claim to know everything about the rest of the body. But we work together to provide good health for our patients.

and swallowing. It would also help to prevent further tooth decay on those patients.

More and more dental offices are taking blood pressure on adult patients as a screening for hypertension. We have screened patients for oral cancer during our initial and recall examinations. Dentists, dental hygienists and team members have talked with patients on oral hygiene, smoking cessation, diet and body mass index. Early intervention is important.

That is why we are doing screening and educating our patients. According to the Institute of Medicine, sleep disorders and sleep deprivation is an unmet public health problem. It is appropriate for us to screen for sleep disordered breathing. It may not be just snoring. Referring those patients who seem to have obstructive sleep apnea or sleep related breathing problems to their physician for sleep test; and then follow up with a phone call or fax to patient’s physician would ensure patients receive the proper care. Their health and their quality of life will improve with the proper diagnosis and treatment. This is team work.

Unless you practice pediatric dentistry, our patient population is getting older. With advances in modern medicine, patients are living longer. Some patients might come in with complicated health histories and a long list of medications they are taking. For these patients, in addition to checking our PDR or Epocrates, we may have to consult with their pharmacists and physicians. We also have patients in various age groups who come to see us after they have recent surgeries. We may have to work with our medical colleagues to find out if antibiotic coverage is needed.

Patients who are diabetic and developing acute periodontal problems may have a change in their diabetic condition. Patients on certain medications may develop dry mouth and dental cervical decay. They may need to have their medication modified. By talking with or faxing the information to their pharmacists and physicians, we would be able to provide better patient comfort in speaking, eating

consult with our dental colleagues on dental/ oral issues, we should also consult with our

We are the gatekeepers of our patients’ oral health, but we see more than the mouth and the face. medical colleagues on medical issues. The communications reaffirm that dental care is part of total health care and that dentists are part of the healthcare team.

We are the gatekeepers of our patients’ oral health, but we see more than the mouth and the face. For the health of our patients, let us collaborate with our medical colleagues in identifying the medical problems, and arriving at the best mode of patient care. 

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Our medical colleagues consult with each other to provide the best treatment for their patients. They started doing that during their medical school training and residencies.

Calling/consulting your colleagues is expected and is part of the process in affirming the diagnosis and best treatments. Just as we

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4 | The Nugget

Sacramento District Dental Society

From the Editor’s desk “The Times, They Be A-Changing” (again… & again… & again…)

One of our members cried out to the Dental Society last year for help regarding the everchanging prophylaxis guidelines for treating patients. His specific frustration was that, once again, the guidelines for prophylactic antibiotics had changed, this time for total joint replacement. As we “ol’ timers” know, whether the guidelines for prophylaxis are from the AHA, AMA, ADA or AAOS, there have been many changes to prophylaxis guidelines since their implementation 30 years ago. Many of us will recall the early days when Endocarditis Prophylaxis started two days prior to dental treatment and continued for the five days following treatment. That morphed to a loading dose on the day of treatment followed by two days of antibiotics. Based on further evidence on outcomes, the guidelines then became 3 gm pre-op, followed by 1.5 gms of Amoxicillin six hours later, and then moderated to the standard we have now been using for many years. The Total Joint Replacement Prophylaxis Guidelines for Dentistry for many years mirrored the Endocarditis Guidelines.

That is now not the case. The Total Joint Replacement Prophylaxis Guidelines are different and now include different antibiotic recommendations than the Endocarditis Guidelines. Therein lies the core issue that frustrated him: the guidelines have once again changed and what are we going to do about it? That leads us to this issue of the Nugget, dedicated to the topic of prophylaxis for dental treatment. One thing remains true, and that is nothing stays the same.

I think it is important for you to know that the SDDS Board of Directors met and discussed how to address this member’s concerns. During the discussion it became painfully obvious to the Board that only one in roughly three or four of the Board members knew that the American Association of Orthopedic Surgeons (AAOS) had published their guidelines almost two years ago and that these guidelines contradict AMA guidelines by recommending lifetime prophylactic antibiotics for dental treatment of patients with total joint prosthesis. The AMA guidelines requiring antibiotics for only two www.sdds.org

years following surgical total joint replacement are superseded by the AAOS guidelines, since the Orthopedists are the experts in this field of medicine. So if only a small percentage of very knowledgeable Board members were aware of this change to the Total Joint Replacement Guidelines, the Board had to assume that this was a reflection of a similar ratio in our members. This observation was certainly an unexpected but very valuable outcome of this member’s request for help. In all fairness to our members, these guidelines were not well publicized by AAOS nor ADA. The Board appointed a Prophylaxis Task Force to look into the guidelines for Prophylaxis and make recommendations to the Board for action. The Task Force was also charged to develop strategies for addressing the changes and the fact that the guidelines seem to be in conflict by being required, not required, altered, modified, etc.

The member had also insisted out of frustration that our Society to take the lead in developing a position paper on prophylactic antibiotics for all dentists that helps clear up the confusion and ends the constant changes. This too became a charge for the Task Force to consider.

The Prophylaxis Task Force met this past December to discuss options and strategies for dealing with this issue. The first issue addressed was: should SDDS take the lead in developing guidelines for total joint prophylaxis and other medical conditions requiring prophylaxis against transient bacteremias? The Task Force members recognize that bacteremias of oral origin do occur and some of those bacteremias occur directly as a result of dental treatment. Other oral sources of bacteremia can be home oral health care, lack of home oral health care and those bacteremias that occur during the act of eating. We also recognized that our Society has many members who may have the interest, but unfortunately lack the academic research credentials or do not have the medical specialty expertise to develop these guidelines.

Those best suited for developing guidelines are those in a University setting who have the clinical, research and medical specialization

By Kevin Keating, DDS, MS

Guest Editor

background to justify the rational for those guidelines. As such, we cannot issue a guideline for a medical condition without risking a regulatory legal charge of practicing medicine without a license.

The Task Force found out that the ADA and the American Association of Orthopedic Surgeons are now working together with a joint panel of experts to develop a consensus guideline to be published hopefully in 2012.

The next issue the Task Force discussed was making our members aware of these new guidelines. The recommendation to the Board of Directors was to use the Nugget and the SDDS Continuing Education Program to make our members aware of the changes. This Nugget issue is the first step in that process.

Recognizing that whether a practitioner decides whether or not to follow guidelines is not a problem, until it is a problem. When it does become a problem, it generally involves defending in court the decisions made during treatment. So we asked Art Curley to weigh in on this matter using his vast experience as a Malpractice Defense Attorney. Hopefully it is NOT when we have a legal problem that we become better educated about standard of care issues as they relate to prophylaxis.

Those of us on the Board of Directors and the Task Force wish to thank Dr. Tim Mickiewicz for his passionate cry of frustration which led to our collective efforts to make all our members aware of the current guidelines for Total Joint Replacement, and that in the near future there may come revisions when the joint ADA and AAOS guidelines are made public. I also want to personally thank Dr. Mickiewicz for his written contribution to this issue of the Nugget. As the Guest Editor, it is my hope that you find the articles both informative and stimulating. I firmly believe that the personal principles which guide me though a career where nothing stays the same, absolutely apply here. In closing, I would like to share them with you. The principles by which I live are firm and intractable. The first firm and intractable principal is: Be Flexible.  March 2011 | 5

Cathy’s Corner “A Concern”

Amador • El Dorado • Placer • Sacramento • Yolo

Leadership

By Cathy B. Levering

SDDS Executive Director

Several months ago a member called me (as many do!) with a concern. As always, I asked that he write it up in an email, send me some background material and I would present it to the Executive Committee, the Board and the appropriate committee for review and consideration.

LSS (“long story short”)… this “concern” is the topic of this issue of The Nugget.

Thank you, Dr. Tim Mickiewicz, for bringing it forth. Thanks to the Board of Directors for seeing the importance of this topic. And thanks to Dr. Kevin Keating for chairing the task force, the information gathering, presenting the information and recommendations and, finally, for writing most of the articles for this issue — a “guest editor” indeed!

Lest you think that your phone calls, your emails, your comments “from a messenger” go unheard, they don’t.

With an organization that is local and that has more than 1500 members, we hear from you often. I have been involved in the association business for 17 years and I can truly say that SDDS members are definitely vocal! We have eight phones lines and two fax lines that are always busy and a DSL and server that deliver nearly 700 emails each day — all for the benefit of members, their concerns and their questions regarding the running of their businesses and the concern for their patients as well as their colleagues.

A couple of weeks ago I a got a call from another “concerned” member. But this call was different. Very different. It seems that we have a member who has liver cancer and needs a donor — quickly. Donating a part of your liver, as I understand it, is not a difficult procedure — but an enormous gesture.

Obviously, this will be a lifesaving donation, if you are a match.

If you are interested, please contact me (confidentially, of course) and I can give you the details on how to be tested if you could possibly be a match. You need to be O positive and under the age of 55 to begin the process.

Like I said, members contact me all the time about their concerns and their issues. But this issue really will save a colleague’s life. Are you interested?  A Gala event to support the Foundation

A gala to benefit Sacramento District Dental Foundation

Sponsors needed!

Table & Corporate

EXECUTIVE COMMITTEE

Dan Haberman, DDS, MS Carl Hillendahl, DDS Jennifer Goss, DDS Kenneth Moore, DDS Craig Johnson, DDS Viren Patel, DDS Wallace Bellamy, DMD Brian Royse, DDS Kim Wallace, DDS

Board of Directors

Kevin Keating, DDS, MS Donald Rollofson, DMD CE: Jonathan Szymanowski, DMD, MMSc CPR: Margaret Delmore, MD, DDS Dental Health: Dean Ahmad, DDS Ethics: Volki Felahy, DDS Foundation: Robert Daby, DDS Leadership Development: Terrence Jones, DDS Legislative: Mike Payne, DDS, MSD / Gabrielle Rasi, DDS Membership: Lisa Laptalo, DDS Peer Review: Bryan Judd, DDS / Brett Peterson, DDS Dental Careers Workgroup: Robin Berrin, DDS Beverly Kodama, DDS Budget & Finance Advisory: Gary Ackerman, DDS Bylaws Advisory: Adrian Carrington, DDS Fluoridation Advisory: Kim Wallace, DDS Forensics Advisory: George Gould, DDS / Mark Porco, DDS Strategic Planning Advisory: Victor Hawkins, DDS/ Gary Ackerman, DDS Golf Tournament: Damon Szymanowski, DMD SacPAC: Donald Rollofson, DMD SDDF Gala Fundraiser: Wes Yee, DDS Smiles for Kids: Donald Rollofson, DMD

Trustees Committees Standing

Ad hoc Advisory Task Forces Workgroups

Special Events Other

Nugget Editorial Board

SDDS Staff

James Musser, DDS

Cathy Levering

Editor

Paul Binon, DDS, MSD Donna Galante, DMD Alexander Malick, DMD James McNerney, DMD Christy Rollofson, DDS Oladimeji Sorunke, BDS Ash Vasanthan, DDS, MS

Executive Director

Della Yee

Program Manager/ Executive Assistant

Melissa Orth

Publications Coordinator

Lisa Murphy

Member Liaison/ Peer Review Coordinator

Erin Castleberry

Member Liaison/ Smiles for Kids Coordinator

Editors Emeritus: William Parker, DMD, MS, PhD • Bevan Richardson, DDS

More info: (916) 446-1227

Saturday: October 1, 2011 6:30pm • Hyatt Regency Sacramento

6 | The Nugget

President — Wai Chan, DDS Immediate Past President — Terrence Jones, DDS President Elect — Victor Hawkins, DDS Treasurer — Gary Ackerman, DDS Secretary — Kelly Giannetti, DDS Editor — James Musser, DDS Executive Director — Cathy Levering

Advertising rates and information are sent upon request. Acceptance of advertising in the Nugget in no way constitutes approval or endorsement by Sacramento District Dental Society of products or services advertised. SDDS reserves the right to reject any advertisement.

The Nugget is an opinion and discussion magazine for SDDS membership.

Opinions expressed by authors are their own, and not necessarily those of SDDS or the Nugget Editorial Board. SDDS reserves the right to edit all contributions for clarity and length, as well as reject any material submitted.

The Nugget is published monthly (except bimonthly in June/July and Aug/Sept) by the SDDS, 915 28th Street, Sacramento, CA 95816 (916) 446-1211. Subscriptions are free to SDDS members, $50 per year for CDA/ADA members and $125 per year for nonmembers for postage and handling. Third class postage paid at Sacramento, CA.

Postmaster: Send address changes to SDDS, 915 28th Street, Sacramento, CA 95816.

Sacramento District Dental Society

© 2008 Sacramento District Dental Society

The Evolution of

Sacramento District Dental Society

Breaking Down

the Barriers

By Tim Mickiewicz, DDS

SDDS Member

What is it going to take? For too long dentists have lived in a self-imposed exile as the poor stepchild of medicine. Being isolationist by nature, most general dentists don’t enjoy the collegiality of large multi-specialist groups or hospital based practices. This perceived imbalance is perpetuated by our reluctance to contact physicians because of the “real doctor / just a dentistâ€? discomfort‌ because of some odd programming that we are not equals. It is time for you to toss that mentality out of the window. Now, more than ever, we need our medical colleagues to be true partners in health care. This Nugget issue is a testament that cooperation between us is not just a liability issue but a true example of the compassion, empathy and sincere care we provide. If you take off your loupes you will see the blurry line between medicine and dentistry. I enjoy a great relationship with the medical community. This did not happen overnight and a concentrated effort is made every day to raise my personal bar of understanding increasingly complex cases. The strategy employed is not a huge secret and I refuse to use the trite appeal for collaboration or thinking outside of the box.

Just think.

interferes with the efficacy of the birth control medication? Have you ever seen an ACE inhibitor induced angioedema, which can mimic a severe abcess or cellulitis? And of course you know never to mix the Ace inhibitor with an NSAID. The list is endless.

The point: read the history and be a bit of a snoop, discretely of course. If you have a question, call the physician and ask a few questions. The rules: do your homework first and don’t waste their time. Respect them to be abrupt (no insult; they are busy too).

need us. Increasingly, the process is becoming obvious. But you need to step outside of your comfort zone of complacency and realize that marginal integrity and the coefficient of thermal expansion are equally important to stress induced bruxism and degenerative joint disease secondary to estrogen imbalance.

Learn about an amazingly unrecognized acid reflux issue. Acid reflux may be why your crown failed and may continue to do so until you appreciate the treatment of patients, not just teeth.

Edward O. Wilson, humanist biologist of And since they gave me this forum to be a DNA fame wrote a fascinating tome in 1998 bit preachy‌ whatever happened to the old “Consilience: The Unity of Knowledge.â€? school professional courtesy? Be nice to those The basic premise is uniting science and the nurses and medical assistants, they are the gate humanities to explain natural phenomenon keepers to the physician and will open the door - heady stuff and a sure cure for insomnia. to having someone to bounce questions off of.

After four reads, I started to identify common Give them a break on the fees, they deserve themes that seem to transcend all cultures it. I have physicians shadow me for their and subcultures such as ours. The unification sleep medicine rotations. They are amazed at of all knowledge! You can’t possibly amass how seamless our practice is when we juggle all of the information out there, so people multiple chairs with staffs that seem to read universally have innate abilities to search our mind. They are sometimes a bit jealous of for answers, consult with elders, learn from our independence from the Medicare debacle, the mistakes of others and a commonality our patients who accept a wellness preventive of ethics. It’s basically a math and physics oriented practice‌ as a group we even earn problem. So how is consilience a strategy for more than the average primary care doc. We In our quest to do what is best for our improved communication? Think. Search are equals and compatriots in the battle to do patients, it is critical that we start with the for the why behind a patient’s problem. what is best for that person in front of us. I Birds Landing Hunting Preserve & Sporting Clays. Rio Vista, CA most fundamental tenet of medicine‌ a Then draw on your team to help you find don’t have all of the answers and have been good history. I am often privy to a patient’s appropriate answers. Check your ego and humbled many times. But I’m not afraid to $95 ask Donation Perquestion.

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Targeting Smiles

Sporting Clays Tournament. Saturday, May 22, 2010

2nd Annual Targeting Smiles

Registration Check-in 8 to 9:30 a.m.

www.sdds.org

March 2011 | 7

Antibiotic Prophylaxis for patients with joint replacements Yes, the protocol has changed again.

There are more than 1,000,000 total joint replacement surgeries performed annually in the United States, of which approximately seven percent are to replace failing prosthetic joints.1 Infections of total joint replacements usually result in failure and lead to the replacement of the prosthesis. Recognizing the

The health care professional who is planning treatment should do so in consultation with the patient’s surgeon on the need for prophylactic antibiotics. risks to prosthetic joints associated with blood born bacteremias, the American Association of Orthopaedic Surgeons (AAOS) and American Academy of Orthopaedic Surgeons have modified their recommendations for preoperative prophylactic antibiotics for medical and dental procedures.

In February of 2009, the American Association of Orthopaedic Surgeons (AAOS) presented their most current recommendations for antibiotic prophylaxis in patients with total joint replacements. The revised guidelines recommend that patients with total joint replacements should receive prophylactic antibiotics appropriate for the type of medical or dental procedure that is anticipated. The prophylactic antibiotics are given to minimize the hematogenous spread of bacteria to the prosthesis. The antibiotic recommended in these newer guidelines is specific for the common bacteria associated with the medical or dental procedure. Dermatologic procedures would focus on staphylococci and oral procedures would require antibiotics more appropriate for streptococci. Unlike the prior guidelines, wherein prophylaxis was recommended only for the two years 8 | The Nugget

following placement of the prosthetic joint, the current AAOS recommendation again recommends the need for preoperative antibiotic prophylaxis for the lifetime of the patient. As we know, the AMA guideline recommends prophylaxis for two years, but those most closely associated with joint failure the orthopedic surgeons, have published their recommendations which will supersede those of the AMA. In light of the American Heart Association’s reasoning behind modification of their recommendations for prophylactic antibiotics for those at risk for bacterial endocarditis, there appears to be controversy about the relative risks associated with dental treatment versus other sources of oral cavity induced bacteremias. Since there is controversy over the perceived and real risks of bacteremias originating in oral cavity, the ADA and the AAOS have appointed a joint task force of experts to develop an evidence-based position paper on antibiotic prophylaxis recommendations for dental treatment for those patients with total joint replacement. It is my understanding this joint position paper is anticipated to be completed in 2012. Until this joint position paper is developed and disseminated, it is strongly recommended that the premedication protocols of the American Academy of Orthopaedic Surgeons should be used for managing patients with total joint replacement.

The AAOS position paper also states that the health care professional who is planning

By Kevin Keating, DDS, MS

SDDS Member

treatment should do so in consultation with the patient’s surgeon on the need for prophylactic antibiotics and confirm if that surgeon has specific recommendations that are different than those of the guidelines.

This is also the recommendation of TDIC. It is TDIC’s recommendation to obtain written confirmation of the surgeon’s recommendations for prophylaxis. They suggest utilizing a faxable Medical Consultation form that can be returned to your office from the surgeon’s office confirming both the need for prophylaxis and the preferred prophylactic antibiotic regimen for that patient. Using a faxable Medical Consultation form to obtain a medical recommendation to utilize or not utilize prophylactic antibiotics is necessary for legal reasons. Art Curley, a prominent Malpractice Defense attorney and consultant for TDIC, states that not to do so would be ill advised, especially in the event an untoward outcome occurs3.

The following should be pointed out so that there is no confusion: The AAOS guideline states that patients with pins, plates and screws, or other orthopedic hardware that is not within a synovial joint are not at increased risk for hematogenous seeding by microorganisms.

At right is the table from the AAOS guidelines, listing those for whom they recommend prophylactic antibiotics. I also have reproduced their antibiotic regimen which is not the same as other prophylactic antibiotic regimens.

References: 1. Number of Patients, Number of Procedures, Average Patient Age, Average Length of Stay — National Hospital Discharge Survey 1998-2005. Data obtained from: U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics.

2. Information Statement: Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements, American Academy of Orthopaedic Surgeons: February 2009, Revised June 2010 3. Art Curley, Esq., The Dentists Insurance Company malpractice attorney consultant, Personal Communication. January 2011.

Sacramento District Dental Society

Table 1: Patients at Potential Increased Risk of Hematogenous Total Joint Infection2 • All patients with prosthetic joint replacement • Immunocompromised/ immunosuppressed patients • Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus erythematosus) • Drug-induced immunosuppression • Radiation-induced immunosuppression • Patients with co-morbidities (e.g.: diabetes, obesity, HIV, smoking) • Previous prosthetic joint infections • Malnourishment • Hemophilia • HIV infection • Insulin-dependent (Type 1) diabetes • Malignancy • Megaprostheses

AAOS Recommended Protocol for Dental Procedures likely to cause Bacteremias2 Cephalexin, Cephradine, Amoxicillin 2 grams PO 1 hour prior to treatment

Note: There is no alternative antibiotic suggested for those patients who are allergic to penicillin and cephalosporin antibiotics. Consequently, one must consult with the patient’s surgeon and obtain written confirmation as to what alternative antibiotic therapy should be utilized.

The faxable Medical Consultation form suggested by TDIC is a valuable tool for facilitating this consultation. The benefit of the fax form is it allows for direct communication in a timely fashion and does not require pulling the physician or you away from patient care. For those insured by TDIC, one can obtain this form on line at http://www.thedentists.com/risk_ management/recordkeeping/forms or by calling the TDIC advice line at 800.733.0634.  www.sdds.org

Letter to the editor RE: February 2011 Nugget — “Is This Dentist Real?”

Dear Dr. Acheson, I write for several reasons. First I wish to thank you and congratulate you for your well thought out Nugget issue on the access to care and the potential for change to come to the dental work force model. I absolutely agree with you that the current model for oral health care delivery is not broken. I am glad that you correctly pointed out that two well organized and financed Foundations have been the force behind the actions that have institued Dental Health Care Therapists in Alaska. They were also the motivating force behind workforce changes in other states as well. There are up to 20 states wherein work force models are being championed by outside forces for changing how dental care is delivered. With roughly 10,000,000 individuals in California who reportedly have barriers to dental care, we need to be ever vigilant. Forces outside organized dentistry will move to provide solutions for those ten million Californians who have the potential to change the work force model we currently enjoy.

I will use your discussion regarding AB2637 as a point to illustrate how others who have a vested interest in oral health care can effectively change our model without our participation in the actions by the legislature — specifically, the endodontic component of the RDAEF duties established by AB2637. The duty allowing a RDA with EF training to “fill’ canals was put into the legislation by an interested stakeholder group after the dentists essentially signed off on the intended legislation. Those few dentists involved in the legislation’s development, who noticed the change in the endodontic duty, assumed it something the endodontic community wanted. Only after the passage of the legislation did it become evident to the endodontic community and the broader dentist community that this had been “slipped” into the legislation. One motivation for making this a duty was the hope it would help with a barrier to care by allowing more endodontics to be done for those in need.

Fortunately, because of the risks associated with disesthesia, paresthesia and overextension into the sinuses, this duty has been changed in the regulations from filling root canals, to fitting gutta percha in preparation for condensation by the dentist. I know because I represented both the American Association of Endodontists and the California Association of Endodontists and worked with the Dental Board of California to change this duty.

We in the dental community need to be vigilant and we also have to be knowledgeable about the various potential models that may be proposed to change how dental care is delivered. We need to be knowledgeable because on the surface, a proposed solution for reducing barriers to care may look appealing to the legislature. Due to the demographics of ten million underserved Californians, we may or may not be able to dissuade the legislature from acting. And if change does come, we need be able to ensure that the dentist stays at the head of that model so the model change will have the potential to be effective.

Kevin Keating, DDS, MS SDDS Member

SDDS Membership Committee presents the

2011 New Member Dinner • April 6, 2011 6pm • Old Spaghetti Factory • Contact SDDS for more info (916.446.1227) March 2011 | 9

Guidelines for Monitoring Blood Pressure of Dental Patients Individuals with diagnosed or undiagnosed hypertension enter our dental offices daily as our patients. As a general rule, the patients we see with hypertension are well managed because they have previously been diagnosed and treated by their physicians.

Unfortunately, many individuals we see as patients have either not been diagnosed and treated as hypertensive or have experienced physiological changes wherein their current mediations are no longer managing their blood pressure adequately. Consequently, it is a great benefit for the patient and the dentist to routinely monitor blood pressure as part of a routine dental examination and treatment. It is beneficial for the patient who has undiagnosed or poorly managed hypertension to be made aware of their condition so that they can seek appropriate medical consultation and treatment. This practice can also be extremely beneficial for both the patient and the treating dentist for those patients whose blood pressure is so high that it would be imprudent to proceed with elective dental treatment until the blood pressure has been evaluated and managed by their physician.

In 2003, the current classification of blood pressure in adults was established and the recommendations for follow-up care were established.1 Hypertension was defined in that report as blood pressure in excess of

By Kevin Keating, DDS, MS

SDDS Member

140/90. It is reported that 30% of patients with hypertension are unaware of their disease and consequently untreated; and up to 60% of hypertensive patients who are taking medication have blood pressure that is not adequately controlled.2 Consequently, making blood pressure monitoring a routine for any dental procedure is a great benefit to your patients by ensuring they are well informed and by minimizing the risks associated with treating those patients who are unaware of the severity of their hypertension.

in excess of 180 or the diastolic pressure is in excess of 110, and that is to postpone elective dental treatment and refer the patient to a physician. Those who, in addition to the severely elevated pressure, are also experiencing symptoms such as headache, shortness of breath, chest pain, nosebleeds, or severe anxiety, may require urgent medical attention2. The guidelines below summarize the recommendations for treatment and referral to their physician based on blood pressure readings.

So what are the guidelines to be used for determining if treatment should be delayed?

In the textbook, Dental Management of the Medically Compromised Patient, the authors have provided a table which clearly delineates the guidelines for managing patients based on their blood pressure taken on the day of treatment. Since the majority of minor surgical and nonsurgical dental procedures done using local anesthetic are considered low risk, treatment can generally be provided with elevated blood pressure reading below 180/110.2 It is recommended that those patients with hypertensive readings greater than 160/100 should be evaluated by their physician within a month. For patients with readings greater than 180/110, they should be evaluated and treated immediately within the week. The guideline is very clear for those patients whose systolic blood pressure is

For those patients whose blood pressure warrants postponing elective dental treatment and referral to their physician, it is important to also obtain a written medical release. A medical release can be sent with the patient stating the blood pressure reading along with a request for the physician to report on their recommendations for that patient’s care.

TDIC suggests a faxable Medical Release form that can easily be returned from the physician’s office with their recommendations for the patient’s care.

From practical experience, when a patient is rescheduled and sent to their physician with a release, they are instructed that their physician must fax back the form prior to being rescheduled for care. I have observed as a general rule that it will be a few weeks before the physician will release that patient for dental care, depending on how

Guidelines: from the textbook, Dental Management of the Medically Compromised Patient BLOOD PRESSURE

DENTAL TREATMENT

MEDICAL CONSULTATION

< 120/80

Any treatment required

None required

> 120/80 but < 140/90

Any treatment required

Recommend patient see a physician

> 140/90 but < 160/100

Any treatment required

Recommend patient see a physician

> 160/100 but <180/110

Any treatment required monitor blood pressure during treatment

Refer patient for medical consultation

> 180/110

Defer elective treatment

Refer patient for medical consultation.

If symptomatic, refer immediately.

10 | The Nugget

Sacramento District Dental Society

challenging it was to effectively bring down that individuals blood pressure. On occasion, the physician will only suggest an anxiolytic to assist in lowering blood pressure on the day of treatment. In these situations where there has been medical clearance for treatment using oral sedation, medications such as Valium, Ambien, or Halcion can be utilized with the medical recommendation confirming that such a strategy would be beneficial.

Twenty five years ago, I admit it was a bit of a challenge getting staff accustomed to taking the pulse and blood pressure readings prior to my entering the operatory. During this transition period of making it a routine of taking blood pressure at every patient visit, I had the experience of having a patient with a blood pressure of 230/120. I called his physician, who wanted that patient forego dental treatment and be seen by a physician immediately. That evening this patient had a severe stroke leaving him severely disabled. Had I treated him, it would have been “caused by my dental procedure” and I would have likely been in court. Several months later, when this individual was brought in by his son for care, his family was very appreciative of all that we had done in trying to take care of their father and that we had taken the time to get him ensure he was seen by a physician. This one instance overcame any resistance by staff to monitoring blood pressure as a matter of routine.

How does one fit taking blood pressure into a busy dental practice? The easiest and least disruptive is to your schedule is to make it the chair side assistant’s duty to take both blood pressure and pulse readings after seating the patient in the operatory. The assistant asks how the patient is doing, catches up on the typical small talk, puts on the bib, answers questions, and takes a preoperative blood pressure.

I have two recommendations for implementing monitoring blood pressure.

The first is that taking the blood pressure not be the first item done after seating the patient. It will take a few minutes for the blood pressure to stabilize after walking from the waiting room to sitting down in the operatory. If the initial pressure seems high, waiting a few more minutes to let the patient calm, a second blood pressure reading can then be taken to assess the patient’s ability to proceed with treatment that day based on the guidelines for hypertension. If we get multiple readings above the threshold, we then cancel treatment and send the patient home with our faxable Medical Consultation form explaining our concerns. A sample statement on the fax might be: “Today the www.sdds.org

blood pressure readings were 179/115 and 185/110. Dental treatment using local anesthetic is needed. Please evaluate and let me know your recommendations for treatment”. Obviously if the patient happens to be symptomatic, 911 should be called.

The second recommendation I have is to chart that blood pressure reading. Looking back over multiple visits it is possible to track changes in blood pressure. Specific to this recommendation, I will share one other anecdotal report of a patient experience that makes this worthwhile. A patient who was having complex dental work involving multiple endodontic procedures, periodontal surgery and full mouth reconstructive procedures was referred to our office with a complaint of a dull ache in the lower jaw for several weeks. We were unable to locate a dental cause for his pain at that time. We did notice that he had a significant increase in his blood pressure compared to readings from other visits for treatment over the prior several months. The blood pressure was not over the guidelines, but because of the change we recommended he see his physician for evaluation and rescheduled to see if his lower jaw pain became more specific with time. The following week he missed his appointment.

We called to find out he went in to see his physician who took an EKG and immediately

sent him to the hospital where he had bypass surgery. We saw him later to reevaluate for the toothache he had been complaining of. The toothache went away immediately following the bypass and was determined to be cardiac angina pain referring to the mandible. So, having the blood pressure recorded over many visits serendipitously pushed this one patient off to see his physician where testing found led to cardiac surgery.

After the initial transition of implementing blood pressure monitoring into ones practice, taking blood pressure becomes part of the routine and staff then gets at ease with taking these vital statistics. In fact, the staffs gains an understanding of high blood pressure readings and point it out to you when a patient has higher than expected readings. Having a staff that is familiar and comfortable taking a blood pressure has a huge benefit if ever you should have a medical emergency that requires you to decide whether or not to call 911. Having the initial preoperative baseline blood pressure to compare the current blood pressure reading to gives you more information with which to make a decision to call for the paramedics.

Since instituting routine blood pressure monitoring, we have more than once been thanked by patients who feel that we have “saved their lives” by making them aware of their hypertensive health problem. 

References: 1. Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-1252 2. Little J, Falace D, Miller C, Rhodus N Dental Management of the Medically Compromised Patient, Seventh Edition, 35-49, St. Louis, Elsevier Mosby 2008

link of the month Help provide backpacks for Smiles for Kids patients, through a partnership with the CSUS Pre-Dental Club.

For more information on the CSUS Pre-Dental Wine Tasting event on April 8th and everything else their club has to offer, visit:

www.csus.edu/org/predental March 2011 | 11

Guidelines for Obtaining Medical Consultation for Patients Receiving Dental Treatment

By Art Curley, JD

Published guidelines for dental treatment, such as those by the American Heart Association and American Association of Orthopedic Surgeons are consensus recommendations for their specific area of concern. They cannot and do not stand alone as evidence of the standard of care. Indeed, evidence in any legal setting starts with either the spoken word or a written declaration under oath. For a guideline to come into evidence, an expert must testify that it represents the standard of care, unless it is given “judicial notice.”

dental treatment, should consider obtaining medical clearance before proceeding with such treatment. Relying solely on a guideline to make a decision as to collateral or incidental treatment, such as antibiotics, steroids or drug holidays, places the dentist at risk should a complication occur. The dentist could be at risk because it may be the opinion of the patient’s physician that treatment was contraindicated under the circumstances presented or that the collateral treatment or incidental treatment (such as antibiotics) was inappropriate.

Because each patient is different, guidelines cannot cover all situations at all times. Whether or not a patient needs premedication is ultimately within the purview of the physician familiar with their medical condition. What we are talking about is systemic non-dental conditions out of the maxillofacial area, such as the heart, prosthetic heart valves, prosthetic joints, systemic illnesses (HIV, hepatitis C, immunocompromised, diabetes, splenectomy) and pharmacological treatments such as blood thinners, steroids, bisphosphonates and immune suppressants. These conditions all reference medical conditions that are outside of the scope of licensure of a dentist. However dental treatment can impact other areas of the body and cause or aggravate illness, the treatment of which is within the scope of licensure for physicians, and not dentists. Therefore a dentist, having been apprised of a medical condition that might be impacted by proposed

Two years ago there was a case in New Jersey in which an oral surgeon provided IV sedation to a patient with a medical condition that could affect the airway during anesthesia. The surgeon relied on general surgical principles and guidelines.

There was an anesthetic complication and the patient died. The patient’s physician, at the malpractice trial, testified that had clearance been requested he would have either ordered that the patient be treated in the hospital or the surgery not be performed with sedation. The jury agreed with the physician and awarded $11 million to the surviving family. Had the surgeon obtained and documented medical clearance and then performed the surgery, there would not have been a claim against the dentist. Therefore in cases where patients may be considered medically at risk, as stated in guidelines or consensus statement, the treating dentist or surgeon is advised to consider obtaining and documenting medical clearance for dental treatment.

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The medical clearance should confirm that following the guidelines is recommended or, if not recommended, what are the physician’s specific recommendations for the care of that patient? The medical clearance advice from the physician can on occasion present a situation where there is a conflict between the advice and the dentist’s knowledge of applicable guidelines. When the physician’s advice is contrary to wellestablished guidelines or policies in consensus statements, a dentist cannot unilaterally override that advice based merely on their interpretation of the guidelines or policies.

It is been the experience of the author that merely arguing the guidelines with the consulting physician will not bring about any change in the medical advice or order.

Rather the dentist has two choices. The first is that the dentist can inform the patient that there is a conflict between the advice of the physician and established guidelines or policies and require the patient get a second opinion before performing treatment. If the second opinion concurs with the guidelines, that opinion should be documented by the dentist prior to proceeding with treatment.

Another option is to decline treatment based on the conflict, such as when the patient refuses to seek a second opinion, and inform the patient they will have to seek care elsewhere for the particular condition for which treatment was recommended. 

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Helping Those That Help Others (30 Years Real Estate Exp.)

Sacramento District Dental Society

www.sdds.org

March 2011 | 13

you

You are a dentist. You’ve been to school, taken your Boards and settled into practice. End of story?

The Dentist, the Business Owner

Happiness & Humor in the Office Good Business & Good for you

Not quite. Are you up to speed on tax laws, potential deductions and other important business issues?

In this monthly column, we will offer information pertinent to you, the dentist as the business owner.

By Marvin Greene, DDS Chicago Dental Society (Reprinted with permission) Happiness and humor in the office enhance employee and employer satisfaction, increase profit, heighten creativity and result in exceptional patient care. You do not have to transform your practice into a comedy club, but recognize that the little things in human relations reap huge rewards. Small changes in attitude, cooperation and respect can create major changes in your practice.

Dr. Paddi Lund, a general dentist in Australia, has authored Building the Happiness-Centered Business, published by Solutions Press of Australia. In his discourse, Dr. Lund illustrates how a happy staff is one of the most powerful business tools available to the dentist, or any businessperson. Our practice has incorporated many of his ideas. As a result, we interact much more positively with each other as well as with our patients.

We handle problems differently. We address negative behavior and energy quickly. We take responsibility for our actions and interactions.

If something goes wrong, we look at the system first to see what needs changing.

Patients are referred to and communicated with by their names, not by their procedure or symptom.

Content, happy staff members are much more likely to offer creative suggestions and ideas. An empowered staff is a more productive staff. Personally, I am more apt to buy something from a happy, warm and kind establishment, instead of a disinterested, unhappy and threatening one.

There is significant data to support the benefits of humor. Dr. William Fry, psychiatrist, humor researcher and former man of the year for the Association for Applied Therapeutic Humor, reports in the medical magazine Hippocrates the many physical benefits of laughter. He claims that laughter boosts cardiovascular 14 | The Nugget

fitness by increasing the respiratory response, as well as lowers blood pressure and heart rate.

It also reduces pain perception, stimulates circulation and increases oxygen tension. The net effect is that you feel better.

In the November 1995 issue of Pain, Drs. Weisenberg, Tepper and Schwarzwald, after testing 80 subjects, reported that pain perception was lessened when watching a humorous film in comparison to watching a neutral film or no film at all. Interestingly, watching a repulsive film showed the greatest decrease in pain perception.

The Journal of the American Medical Association published “The relationship with malpractice claims among primary care physicians and surgeons,” in its Nov. 19, 1997, issue. 124 doctors were videotaped during 10 consecutive office visits. The researchers found that the primary care physicians who have never been sued spent more time with their patients, used humor and encouraged patients to talk. No such differences were found among the surgeons.

Ben and Jerry’s Homemade, Inc. has their “Joy Gang.” Joy grants are awarded for creative ways to bring happiness to the workplace. The grants have varied from hiring a masseuse to providing a hot chocolate machine.

Humor experts exist and are frequently used by Fortune 500 companies. I had the pleasure of recently speaking with Dr. Steve Allen Jr., retired family practitioner, son of the famous comedian and humor expert.

I asked Dr. Allen how he would sum up laughter in the workplace. He said, “Humor and lightheartedness let you take a look at difficult situations from a different point of view.” He added that one needs to be very careful and must look at the “pluses and minuses” of the intended humor; you do not

want to tease people and be discriminatory.

Dr. Allen said it is essential to be able to laugh at yourself.

Humor must be used with no sarcasm and extreme sensitivity. A doctor needs to be

Approach each situation on a case-by-case basis. sincere, clear and non-offensive at all times.

Being lighthearted and friendly could be a valuable tool. As caregivers, each of us needs to strike a balance between professionalism and being a human being.

In my opinion, happiness and humor go hand in hand to create awesome patient care.

They enable individuals to feel better about themselves, which translates into so many positives for everyone involved. Therefore, remember to lighten up around your staff and patients to create rewards for all.  Dr. Greene is a board-certified oral and maxillofacial surgeon. He may be reached at (773)327-2400 and www.oralandcosmeticsurgery.com.

This article reprinted from the July/August 2006 CDS Review with permission from the Chicago Dental Society

SDDS HR hotline

1-800-399-5331 Sacramento District Dental Society

Sacramento district dental society foundation

A charitable 501-C3 organization

Your first look at Smiles for kids 2011 March 16, 2011 April 20, 2011

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June 2, 2011 www.sdds.org/SDDF_Broadway.htm

2011 Quick Stats: (as of Feb 15th — more forthcoming!)

25,000 kids screened 815 scheduled 36 offices open for treatment over 450 staff volunteers

A gala to benefit Sacramento District Dental Foundation

over 100 doctors (SFK Day) over 100 Adopt-a-Kid doctors 65–75 kids scheduled to receive orthodontic treatment over $350,000 of treatment provided on Smiles for Kids Day

Thank you to everyone who participated! www.sdds.org

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March 2011 | 15

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16 | The Nugget

Sacramento District Dental Society

NEW FEATURE! Engage social media marketing to establish branding, build your practice and protect your reputation

Being Social Social Media & Dentistry: Can the new ‘word of mouth’ help your practice grow?

By Rachel Azark Reprinted with permission from Chicago Dental Society

Social media, it’s sweeping the nation, and it’s everywhere you turn. The growth of Facebook is staggering, with 100 million users added to it in less than nine months; it took television 13 years just to reach 50 million users, according to data from the United Nations Cyberschoolbus website.

It’s no wonder it seems almost impossible to keep up with it all. But learning about social media and how to apply it to your practice could be worthwhile. It can help grow your practice and improve communication with your patients.

Eric Rieger, President and Founder of WEBIT Services (a computer tech company in Illinois), says, “They [dental practices] know they need to be out there, but they don’t know why or what or how to go about it and what the different options are available with Facebook.”

With so many options available to your practice to access the social media world, how do you make your office social media compliant?

Tracy Zander, marketing coordinator for West End Dental, said start with a plan. Ms. Zander said a dental practice must have a social media plan with goals for what you and your staff want to accomplish with it if you want to succeed. And, she added, you need guidelines for the use of social media with specific parameters, like making sure that someone is in charge of “what you’re doing out there.”

“There must be someone active with it on a routine basis because if you’re not active on it, then it’s doing nothing for you,” said Ms. Zander, who checks the West End Dental Facebook page at least four times a day. www.sdds.org

Ms. Zander noted that West End incorporated social media into its marketing program because direct mail wasn’t doing enough to grow the practice.

“Facebook is a more sophisticated word of mouth,” said Ms. Zander.

But now “word of mouth” has gone digital.

Even though users do not personally know anything about the posters of reviews on sites like yelp.com and Angie’s List, they listen to their advice.

“It’s a way to keep West End Dental at the forefront of their minds and to think that ‘my dentist goes the extra mile.’ Patients are then more apt to send their friends our way,” said Ms. Zander.

Facebook isn’t the only social media available to oral health professionals.

According to a 2007 national study by the market research firm Grunwald Associates, 96 percent of Generation Y has joined some form of social network.

According to Ms. Zander, dentists want more patients like the ones coming in the door now.

But, she said, direct mail pieces and a listing in the telephone book alone won’t guarantee you will get the same type of patients you have now.

YouTube is another social media venue, and it can be used with your Facebook page by linking to videos, Mr. Rieger said.

Ms. Zander pointed out that Facebook offers a means to reach potential patients through this electronic word of mouth.

Facebook offers the option of placing paid advertising, which she sees as a valuable marketing tool. According to Ms. Zander, you can target your ads to the friends of your “fans’” (now designated by Facebook as people who “like” your page). By doing this, you could obtain new patients without asking your current patients to refer their friends. According to Facebook’s advertising web page (www.facebook.com/advertising), you can target ads by location, sex, age, keywords, relationship status, job title, workplace or college.

How to create your Facebook page

In addition to its use in marketing, Facebook offers the dental practice the means to communicate with patients regularly.

By keeping your page current, a must in the world of social media, you can continue your patients’ oral health education outside of the office by posting useful tips on maintaining oral health at home. And anytime you have a special promotion on products or services, you should use social media as a way to inform your patients of the specials. Both Ms. Zander and Mr. Rieger agree that your Facebook page should be updated by posting one or two times a week.

continued on next page

Are you ready to put your dental practice on Facebook? Here are a few tips to get you started on creating your very own page.

1. Visit www.facebook.com/ pages/create.php 2. Choose local business under Create a Page 3. Pick your page name. Use the name of your practice 4. Fill in basic information like location, business hours and contact information 5. Start telling your patients to “like” your page (formerly known as becoming a fan) via word of mouth, e-mails to them or on paperwork they might receive in your office

March 2011 | 17

Testimony… continued from previous page

Four types of videos could be presented:

video recorder will do the job of producing videos in which you describe a procedure or give a tour of your office and upload it right on to YouTube.

• Patient interviews or testimonials • Two or three-minute videos on a particular procedure

In the world of social media, blogs have been around for a while.

• New sedation techniques • The use of brand new equipment in the office “To see or hear or listen to a doctor can be very reassuring before you actually go in for a consultation especially for potential patients,” said Mr. Rieger.

Christina Gualandi, office manager of Starved Rock Dental Spa, noted one YouTube posting

You don’t need sophisticated equipment to do a YouTube video.

A blog is another area where you can write about your own views on dentistry or your particular area of expertise. It is a way to provide detailed entries, which can’t be done on Facebook and Twitter.

“You wouldn’t want to post more than one or two times a week for fear of crossing the fine line of useful information and information overload, said Mr. Rieger. “You want to make it so it’s active, but you don’t want to have overload.”

A blog is just another useful tool to give a potential patient more information about the practice when they’re looking for a particular doctor.

where a dentist from Texas describes the Cerec technology in his office and shows the viewer the kid-friendly environment of the office.

Taking photos and videos of just what the office looks like can also be comforting to a potential, new client, he added.

You don’t need sophisticated equipment to do a YouTube video. A video camera like a Flip

Twitter could be called the “new kid on the block,” but there are mixed views regarding the phenomenon of Twitter.

Ms. Gualandi says Twitter has helped her network with other businesses; she sees it as being more useful in the business side of the practice as opposed to serving the patients.

“Twitter is a little bit harder to use and understand (than other social media),” said Ms. Gualandi.

“(Social media) is really so exciting! It is a learning process. The more time you spend with it, the better you’ll be with it,” said Ms. Gualandi.  Ms. Azark is the editorial assistant for the CDS Review (Chicago Dental Society).

Benefits of social media • Patients can stay current with the latest services their dentists provide • Dentists can show patients what continuing education courses they have attended • The office can introduce new products or special offers • Social media offers dentists a nonintrusive way to maintain constant communication with patients that have signed up to “like” their Facebook pages • It’s a great way to go green in the office and use less direct mail

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April 8, 2011 @ 7:00pm • Sac State Alumni Center $25/students $40/general admission • www.csus.edu/org/predental 18 | The Nugget

Sacramento District Dental Society

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Ameriprise Financial cannot guarantee future financial results.

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Financial planning services and investments available through Ameriprise Financial Services, Inc., Member FINRA and SIPC. Š 2009 Ameriprise Financial, Inc. All rights reserved.

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Thinking about buying or selling a dental practice? &DOO QRZ WR UHTXHVW \RXU IUHH %8<(5 6 *8,'( RU 6(//(5 6 *8,'( 7KH %X\HU V *XLGH DGGUHVVHV YDOXDWLRQV ORDQ SUHTXDOLÂżFDWLRQ KRZ PXFK FDQ VKRXOG \RX ERU URZ WD[ SODQQLQJ GLVFRYHULQJ IUDXGXOHQW FODLPV GXH GLOLJHQFH REOLJDWLRQV OHDVH WUDQVIHUDELOLW\ QRQ FRPSHWLWLRQ FODXVH LVVXHV OLDELOLWLHV FRQFHUQLQJ GHQWDO ZRUN SHUIRUPHG E\ VHOOHU SUDFWLFH VXV WDLQDELOLW\ JURZWK WHQDQW LPSURYHPHQWV HPSOR\PHQW FRYHQDQWV 26+$ FRPSOLDQFH EX\HUÂśV SUH 7KHVH FRPSUHKHQVLYH DQG LQIRUPDWLYH SDFNHWV SXUFKDVH FKHFNOLVW DQG PDQ\ PRUH DUHDV RI UHYLHZ FRQWDLQ HYHU\WKLQJ \RX 7KH 6HOOHU V *XLGH DGGUHVVHV SUH VDOH SDFNDJLQJ DQG JURRPLQJ \RXU GHQWDO SUDFWLFH IRU VDOH SDWLHQW DQG ÂżQDQFLDO UHFRUG FOHDQ XS WR IDFLOLWDWH VXFFHVVIXO ÂżQDQFLQJ SUHTXDOLI\LQJ EX\HUV DQG QHHG WR NQRZ DQG DGGUHVV SULRU WR HQJDJLQJ LGHQWLI\LQJ DYRLGLQJ ORRNLH ORRV PLQLPL]LQJ WD[ OLDELOLW\ OHDVH FRYHQDQWV WKDW FDQ VWDOO SUHYHQW VDOH LQ WKH VDOH RU SXUFKDVH FDUU\LQJ SDSHU WUDQVLWLRQLQJ RXW RYHU WLPH SURYLGLQJ SHULRGLF SDUW WLPH SRVW VDOH GHQWDO VHUYLFHV LI GHVLUHG SURWHFWLQJ \RXU VWDII HVFURZ VHOOHUÂśV SUH VDOH FKHFNOLVW DQG UHODWHG WUDQVLWLRQ FRQFHUQV RI D SUDFWLFH

WOOD & DELGADO Attorneys At Law

The Authority in Dental Law

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you

the dentist, the employer

Dealing with

employment Issues

You are a dentist. You’ve been to school, taken your Boards and settled into practice. End of story?

Not quite. Employee evaluations, hiring and firing, labor laws and personnel files are an important part of being an employer. Are you up on the changes that happen nearly EVERY January 1st?

In this monthly column, we will offer information pertinent to you, the dentist as the employer.

From Risk Management Staff (TDIC) Harmony among the office staff, common goals, established rules and good communication are essential to a smoothly functioning dental office. Without these, an office can be an uncomfortable place to work, as well as a breeding ground for liability.

Every dental office has its own culture, conditions of employment and benefits.

Clearly communicated workplace standards

When employees know what to expect and what is expected of them, you will have fewer complaints. prevent surprises and false expectations among management and employees. Established office guidelines protect you from potential employment practices liability claims and foster a more productive and creative team.

When employees know what to expect and what is expected of them, you will have fewer complaints and less absenteeism and turnover. Having a written employee manual is the starting point to implementing effective employment practices.

Your employee manual should reflect your employment practices. It is important for your manual to address office policies, procedures and protocols, including the administration of benefits and pregnancy leave. To prevent

allegations of wrongful termination or discrimination, establish guidelines for disciplinary actions and terminations, and include them in your employee manual.

Additionally, every office should have a written policy prohibiting on-the-job harassment, including sexual harassment, with an internal complaint procedure that an employee can use to file a confidential complaint. This policy should be included in your manual as well.

Once you begin using an employee manual, adhere to it strictly. Disseminate the employee manual to all employees, and obtain a signed acknowledgment that each employee received and read it. Keep the signed acknowledgement in their personnel file. A copy of the manual should always be accessible for employee access and review. To gauge how closely you are following the guidelines outlined in your employee manual, conduct a periodic audit of your day-to-day operations. Regularly review and update your manual to accommodate new laws and changes in your office. When you make changes to the manual, distribute those changes to all employees and obtain a signed acknowledgment that they received the changes.

It is also important to clearly designate whether your employees are at-will or for cause. With at-will employment, either the employer or the employee may lawfully terminate the employment relationship at any time as long as the termination does not

violate a specific law or is not discriminatory.

However, if the employment relationship is for cause then the specific terms of that agreement control the situations in which the termination is lawful. That is, employment can be expected to continue unless there is “cause” to terminate it. Cause can include inadequate or substandard work performance and inability to do the job, as well as gross misconduct, embezzlement, violation of a stated office procedure, or reduction in work force.

Further, employers may not base employment decisions on an individual’s age, race, sex, national origin, religious beliefs, color or ancestry, physical or mental disability, medical condition, marital status, sexual orientation, political beliefs, or any other basis protected by federal, state or local law, ordinance, or regulation. Basing employment decisions on the above factors would expose employers to liability for wrongful termination.

The growth of federal and state legislation dealing with employee discrimination and sexual harassment, the changing legal views on wrongful termination, and the increasing tendency of disgruntled employees to turn to the courts for retribution, have created a need for employment practices liability (EPL) insurance. Your professional liability carrier may offer EPL coverage. TDIC offers such coverage as an additional endorsement. As long as you have employees, you risk facing allegations of wrongful employment practices. 

Have you checked the web? The SDDS website is your source for CE, events, important announcements and more! Check it out at www.sdds.org 20 | The Nugget

Sacramento District Dental Society

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Š2010 Union Bank, N.A.

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March 2011 | 21

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Pregúntele a su médico sobre los suplementos de fluoruro para su bebé.

Comience el cepillado inmediato.

Lleve al bebé al dentista tan pronto como le salga el primer diente.

Ayude al niño a cepillarse los dientes e a usar el hilo dental hasta que cumpla nueve años.

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Starter Pack: 100 Smiling Kids Brochures (English) 50 Smiling Kids Brochures (Spanish) 10 Toddler Toothbrushes (assorted colors) 50 3.25” Magnets (shown above) 10 Infant Gum Massagers (assorted colors) (items above are also available individually)

www.sdds.org/1stTooth.htm

1st tooth OR 1st birthday © 2010 Sacramento District Dental Society

Link to your practice website on www.sdds.org! $300 for one year (renew for $100/year) SDDS members only, please.

Visit www.sdds.org/MembersOnline.htm for more info.

22 | The Nugget

Spotlight

“We held a dental office field trip on January 24th for kids ages 1 to 2 ½. It was the first visit for all except my granddaughter.

Everyone received a goodie bag with the ‘1st Tooth or 1st Birthday’ materials we bought from SDDS. They were a big hit!”

Dr. Timothy Durkin • Pine Grove, CA Sacramento District Dental Society

Committee Corner

You asked for this!

Nugget Survey 2009

Dental Health Committee:

The Well Baby Tooth Check Twenty-five years ago, the American Academy of Pediatric Dentistry established its recommendation that children be seen within six months of their first tooth appearing or by age one, whichever occurs first. Yet, today, the typical response from my dental colleagues, pediatricians and other physicians when asked by a parent is to “see the dentist at age three” or even age five. My own informal survey in 2009 of offices accepting Denti-Cal patients in Sacramento County indicated they had no protocol for and did not want to see a patient under age five.

The CDC, in its 10-year update on the state of Oral Health in the U.S., indicated the only area of dental health that had worsened from 1994 to 2004 was cavities in children aged two to five years old. The problem worsened by 30%!

My colleagues and I in practices limited to children routinely treat cavities in children ages two to five. I treat eight children monthly, average age three, whose cavities are

By H. Scott Thompson, DDS SDDS Dental Health Committee

so extensive they require general anesthetic to accomplish the treatment. I can list about 20 colleagues in the Sacramento area alone who do the same. Age three or five is too late.

at age four months and refer to a dental home when the first tooth appears. Do you have a well-thought and planned response for the new parents in your practice?

Two is too late!

Your preferred pediatric colleague would likely provide you with all the information, resources and training you want. Your SDDS

And yet... Babies don’t come with cavities.

The six-month-old and the 12-month-old in the mobile car seat in your hygiene room (with mom) do not have cavities. Are you and your staff prepared to counsel these new parents to insure those new teeth grow into healthy cavity resistant mouths? Can you identify the low risk infants and toddlers who you want to keep as the nucleus of a cavity free young population in your growing hygiene department? Can you identify the high risk patients who you would rather refer to a pediatric colleague? Can you identify incipient problems in these very young children and refer to a pediatric colleague for management before they are a major treatment challenge? The pediatricians have been learning and training to counsel parents on oral health

Babies don’t come with cavities!

Dental Health Committee also has and is developing more resources for you.

We all know that all the restorative and surgical intervention we do for our patients does absolutely nothing to improve the state of oral diseases in our patients. If we want to truly impact the cavities and periodontal disease of our young patients, we need to start before the disease starts. The first tooth deserves a dental home. 

2011 sdds Committee Meetings: Board of Directors

Foundation (SDDF)

Membership Committee

Mar 1 • May 3 • Sept 6 • Nov 1

Apr 5 • Sept 12 • Nov 17

Mar 15 • May 17 • Sept 21 • Nov 15

SDDS • 6:00pm

SDDS • 6:00pm

SDDS • 6:00pm

CE Committee

Golf Committee

Nugget Editorial Committee

Mar 22 • May 7 • Sept 20 • Nov 29

Mar 15

May 17 • Sept 27

SDDS • 6:00pm

SDDS • 6:00pm

SDDS • 6:15pm

CPR Committee

Leadership Dev. Committee

SacPAC Committee

Future meetings TBA

Mar 7 • Mar 29

2011 meetings TBA

SDDS • 6:30pm

Dental Health Committee SDDS • 6:30pm

Mar 21 • May 16 • Sept 12 • Nov 14

Ethics Committee SDDS • 6:30pm

Apr 27 • Sept 28 • Nov 16

www.sdds.org

SDDS • 6:00pm

SDDS • 6:00pm

Mass Disaster / Forensics Committee Location TBA • 6:30pm 2011 Meetings TBA

Committee meetings, CE courses and more available 24/7 on the SDDS website.

Visit www.sdds.org and click the “Calendar” button.

March 2011 | 23

You’ll find it here — and much more.

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since www.bankofamerica.com/practicesolutions

2011

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12/3/10 10:11 AM

D ENNIS NELSON

CPA, APC PLANNING & CONSULTING ASSOCIATES

Kim Parker, Executive VP Mari Bradford, HR Hotline Manager

since

2004

800.399.5331 www.employers.org

dentassist

Lisa Saiia, Director

since

2003

916.443.1113 www.dentassist.com

2011

916.979.7671 www.fechtercpa.com

2009

916-624-2800 800-649-6999 4095 Del Mar Ave. #13 Rocklin, CA 95677 www.descodentalequipment.com

since

2009

2011

www.joannetanner.com

construction

Olson Construction, Inc.

since

2004

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2010

2009

Jim Ryan, Sales Consultant

24 | The Nugget

Crest / Oral B

since

www.dentalcare.com

2002

Financial Services

Eagle West Group, Inc.

Chris Nunn

916.576.5650 www.firstus.org

since

2010

Professional Practice transitions

DENTAL

since

2003

Henry Schein Dental

Nicole Deuser, Regional Manager

since

2005

2003

Financial Services

Mano Vrapi

John Urrutia, CPA, Partner Chris Mann, CPA, Partner

since

2010

Financial Services

James Ryan

Lucas Rayburn

Patterson Dental

800.736.4688 www.pattersondental.com

Principal Financial Group

since

2010

916.773.3343 www.principal.com

Magazine

Resource Staffing Group

Sacramento Magazine

Kathy Olson

Becki Bell, Marketing Director

916.960.2668 www.resourcestaff.com

since

2002

Olivia Straine • Kerry Straine 916.568.7200 www.straine.com

916.452.6200 www.sacmag.com

Dental Supplies

Supply Doc, Inc.

Straine Consulting

2003

916.774-4208 www.muncpas.com

Dental Supplies

Practice Management & consulting since

916.626.3002 www.henryschein.com

Mann, Urrutia, Nelson, CPAs

Staffing Services

since

Dental Supplies

Liberty Mutual

916.649.1246 x55884 www.libertymutual.com/manovrapi

PATTERSON

Star Refining

800.333.9990 www.starrefining.com

Lauren Herman • 209.969.6468 Kevin McKittrick • 916.765.9101

home/auto/life Insurance

precious metal refining since

Dennis Nelson, CPA

916.367.4540 www.eaglewestgroup.com

2005

Jim Alfheim, President of Sales & Marketing

2009

Dental Supplies

Gordon Gerwig, Business Services Manager

RelyAid

since

916.772.4192 www.bluenorthernbuilders.com

916.624.2800 www.descodentalequipment.com

since

Dental Supplies

800.775.6412 916.431.8046 www.relyaid.com

2007

First US Community Credit Union

David Olson 209.366.2486 www.olsonconstructioninc.com

since

Tony Vigil, President

JoAnne Tanner, MBA

since

Marc Davis • Morgan Davis • Lynda Doyle

Dennis Nelson, CPA, APC

Financial Services

Dental Office Consulting

JoAnne Tanner, MBA • 916.791.2120

construction

Blue Northern Builders

dental Supplies

Fechter & Company

since

916.928.1068 www.asimedical.com

DESCO Dental Equipment

The Dental Equipment Specialists

Financial Services

Craig Fechter, CPA

2004

Financial Services

916.988.8583 www.cpa4you.com

since

Job Placement

Permanent & Temporary

since

Financial Services *All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. Loans greater than $250,000 may be eligible for a 20-year term. **Banc of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. � Bank of America and Banc of America Practice Solutions are trademarks of Bank of America Corporation. Banc of America Practice Solutions is a subsidiary of Bank of America Corporation. © 2010 Bank of America Corporation

Todd Andrews

since

Advisor

916.787.9988 www.ameripriseadvisors.com/ since violetta.s.terpeluk Want to know more? Contact your Practice Specialist today at

Andrews Construction, Inc.

916.743.5150 www.andrewsconstructioninc.com

Analgesic Services

*

Amin Amirkhizi, CEO

since

2010

Vendor Member B

2009

New office start-ups — get started with up to 100% project financing,* including design, construction, equipment and working capital.

877.311.7373 www.supplydoc.com

Sacramento District Dental Society

Vendor Member A

since

�

Technology

Tekfix Team

877.291.1099 www.tekfixteam.net

2011

since

2010

Wood & Delgado

916.533.6882 www.unionbank.com

Western Practice Sales

since

2007

800.641.4179 www.westernpracticesales.com

Vendor Members support Sacramento District Dental Society through advertising, special discounts to members, table clinics and exhibitor space at SDDS events. SDDS members are encouraged to support our Vendor Members as OFTEN AS POSSIBLE when looking for products and services. For more information on the Vendor Membership Program, visit www.sdds.org/vendor_member.htm

Jason Wood, Esq.

2010

Philip Kong

Tim Giroux, DDS, President John Noble, MBA

Vendor Members — their support keeps your dues low!

Legal Services

since

Transition Broker

Union Bank

Garrett Gatewood, President

since

Financial Services

1.800.499.1474 • 949.553.1474 www.dentalattorneys.com

vendor member spotlights: New this year!

New this year!

Banc of America Practice Solutions Banc of America Practice Solutions specializes in practice loans for physicians, dentists and veterinarians.

Customized loans for health care practices: • Loans for physicians, dentists and veterinarians • New practice start-up assistance • Practice sales and purchases Purchase & Start-up • We are specialists in health care practice financing.

• Practice sales & purchases • New practice start-ups • Commercial real estate programs Growth & Restructuring • We can help you expand your practice.

• Improvement & expansion financing • Equipment financing • Practice equity loan program

Our Products and Services: • Budgeting • Investment Services • Benefits Planning • Retirement Planning

• Estate Planning Design • College Education Planning • Cost Basis Reconstruction

The possibilities are endless. Let us guide you there with: • Reputation • Responsiveness • Experience • Accessibility Benefits for SDDS Members Complimentary 45-minute Financial Consultation. To schedule please contact:

Matt Fine, ChFC matt@eaglewest.us

Phil Hoover

Chris Nunn

chris@eaglewest.us

The Fountains at Roseville Location 1013 Galleria Blvd., Ste. 290• Roseville, CA 95678 Phone: (916) 367-4540 www.EagleWestGroup.com

(415) 891-8789 www.bankofamerica.com/practicesolutions

we love

our SDDS Vendor Members!

www.sdds.org

At Eagle West Group, our main focus is to help clients realize their full financial potential. Personalized financial and investment advice and planning, delivered with respect and honesty, are the cornerstone of our practice. We pursue this mission through strategies which helps reduce risk against market downturns even as we advance our clients’ investments.

Registered Representative, Securities offered through Cambridge Investment Research, Inc., a Broker/ Dealer, Member FINRA/SIPC. Investment Advisor Representative, Cambridge Investment Research Advisors, Inc., a Registered Investment Advisor. Cambridge and Eagle West are not affiliated.

March 2011 | 25

Weâ&#x20AC;&#x2122;re blowing your horn!

Congratulations to...

Dr. Ashkan Alizadeh, for joining fellow SDDS member Dr. Brian Steeleâ&#x20AC;&#x2122;s practice in Placerville.

Dr. Joan Burgren, for her son Robertâ&#x20AC;&#x2122;s acceptance in a summer investment banking analyst internship position with Deutsche Bank, headquartered in Frankfurt, Germany!

Have you called theâ&#x20AC;Ś

Have some news youâ&#x20AC;&#x2122;d like to share with the Society? Please send your information (via email, fax or mail) to SDDS for publication in the Nugget!

Dr. Timothy Durkin for hosting a dental office field trip on January 24th, in support of the â&#x20AC;&#x153;1st Tooth or 1st Birthdayâ&#x20AC;? campaign. (more info on page 22) Dr. Maryam Hoang and her husband, for their first baby on the way â&#x20AC;&#x201D; due July 2011.

Dr. Lisa Laptalo and her husband Luko, for their baby on the way â&#x20AC;&#x201D; due August 2011. ď Ž

â&#x20AC;Ś SDDS HR hotline?

1-800-399-5331

*G :PVS #BOL )BT 4UPQQFE -FOEJOH .BZCF :PV /FFE B $SFEJU 6OJPO Your Trusted Source For: t $PNNFSDJBM 3& QVSDIBTF t $POTUSVDUJPO t #VTJOFTT BDRVJTJUJPO PS FYQBOTJPO t &RVJQNFOU *OWFOUPSZ QVSDIBTF t 3FĂśOBODF t 8PSLJOH $BQJUBM

26 | The Nugget

A Proud Vendor Member of SDDS since 2004

(PSEPO (FSXJH #VTJOFTT 4FSWJDFT .BOBHFS

HPSEPO!ĂśSTUVT PSH

Sacramento District Dental Society

PLAN FOR THE BEST!

CALL TODAY! 916.784.6982 Free Consultation

DMS supports your practice growth.

Powerful results... in changing times and â&#x20AC;&#x153;regardless of insuranceâ&#x20AC;?.

Cost-conscious short & long-term services. www.dmsolutionsinc.com gayles@dmsolutionsinc.com Sacramento-7.5x4.875.pdf 1 3/9/10 9:47 AM

ProUeDUJnH EenUJsUs. IUâ&#x20AC;&#x2122;s all we Eo. t 1SPGFTTJPOBM -JBCJMJUZ t 0GmDF 1SPQFSUZ t &NQMPZNFOU 1SBDUJDFT -JBCJMJUZ t Workersâ&#x20AC;&#x2122; ComQFOTBUJPO t -JGF )FBMUI %JTBCJMJUZ t -POH 5FSN $BSF t #VTJOFTT 0WFSIFBE &YQFOTF t )PNF "VUP

Pam Trehub CA Lic. #0C87473

Jason Caluza CA Lic. #0D97803

&OEPSTFE CZ

800.733.0633 tdicsolutions.com CA Insurance Lic. #0652783 Coverage specifically underwritten by The Dentists Insurance Company includes professional liability, office property, and employment practices liability. Workersâ&#x20AC;&#x2122; compensation, life, health, disability, long-term care, business overhead expense, home and auto products are underwritten by other insurance carriers, brokered through TDIC Insurance Solutions.

www.sdds.org

March 2011 | 27

WESTERN PRACTICE SALES John M. Cahill Associates

Advertiser Index

~NATIONWIDE EXPOSURE~

Dental Specialty Referrals

LOCALLY OWNED

By Dentists, For Dentists

NeuBite Denture Center (Dr. Paul Raskin) . . . . . . . . . . . . . . 18

Dental Supplies, equipment, Repair

Accurate Handpiece Repair . . . . . . . . . . . . . . . . . . . . . . . . 22 DESCO Dental Equipment . . . . . . . . . . . . . . . . . . . . . 24, 27 Henry Schein Dental . . . . . . . . . . . . . . . . . . . . . . . . . . 22, 24 Patterson Dental Supply, Inc. . . . . . . . . . . . . . . . . . . . . . . . 24 Procter & Gamble Distributing Co. . . . . . . . . . . . . . . . . . . 24 RelyAid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Supply Doc, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Tim Giroux, DDS

Financial & Insurance Services

20/20 Financial Advisors of Sacramento, Inc. . . . . . . . . . . . 24 Ameriprise Financial . . . . . . . . . . . . . . . . . . . . . . . . . . . 19, 24 Banc of America Practice Solutions . . . . . . . . . . . . . . . 24, 25 Dennis Nelson, CPA . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 24 Eagle West Group, Inc. . . . . . . . . . . . . . . . . . . . . . 4, 24, 25 Fechter & Company, CPAs . . . . . . . . . . . . . . . . . . . . . . . . 24 First U.S. Community Credit Union . . . . . . . . . . . . . 24, 26 Liberty Mutual Insurance . . . . . . . . . . . . . . . . . . . . . . . . 24 Mann, Urrutia & Nelson, CPAs . . . . . . . . . . . . . . . . . . . 24 Principal Financial Group . . . . . . . . . . . . . . . . . . . . . . . . 24 TDIC & TDIC Insurance Services . . . . . . . . . . . . . . . . 13, 27 Union Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 25

Human Resources

Access Human Resources, Inc. . . . . . . . . . . . . . . . . . . . . . . . . 28 California Employers Association (CEA) . . . . . . . . . . . . . . . . 24

Testimonials Jon Noble, MBA

Mona Chang, DDS

Wood & Delgado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19, 25

Medical Gas Services

Analgesic Services, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Andrews Construction . . . . . . . . . . . . . . . . . . . . . . . . . 16, 24 Blue Northern Builders, Inc. . . . . . . . . . . . . . . . . . . . . 21, 24 Henry Schein Dental . . . . . . . . . . . . . . . . . . . . . . . . . . 22, 24 Olson Construction, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . 24

John Cahill, MBA

”Your personal dedication to making everything happen was a unique touch”

”It’s great to have you right here in the Sacramento area. You were always available and always full of advice. Thank you”

800.641.4179

Practice Sales, Lease, Management and/or Consulting

Dental Management Solutions . . . . . . . . . . . . . . . . . . . . . . 27 Henry Schein Dental . . . . . . . . . . . . . . . . . . . . . . . . . . 22, 24 JoAnne Tanner, MBA. . . . . . . . . . . . . . . . . . . . . . . . . . 19, 24 Straine Consulting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 TRI Commercial Real Estate (Gordon Stevenson) . . . . . . . . 12 Western Practice Sales . . . . . . . . . . . . . . . . . . . . . . . . . 25, 28

“The fact that you are a dentist adds a whole new dimension to your abilities as a broker, one which most other brokers cannot come close to”

”Your experience & knowledge coupled with your kind personal touch I believe makes you the best in the industry!”

Legal services

Office Design & Construction

This is what separates Western Practice Sales from other brokerage firms. As dentists and business professionals in your area, we understand the unique aspects of your dental practice and offer more practical knowledge than any other brokerage firm.

Dave Judy

wps@succeed.net adstransitions.com westernpracticesales.com

Publications

Sacramento Magazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Staffing services

dentassist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Resource Staffing Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Technology

Tekfix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Waste management services

Star Refining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

28 | The Nugget

Sacramento District Dental Society

Welcome to SDDS’s new members, transfers and applicants.

Important Numbers: SDDS (doctor’s line) . . . . . . . (916) 446-1227 ADA . . . . . . . . . . . . . . . . . . . (800) 621-8099 CDA . . . . . . . . . . . . . . . . . . . (800) 736-8702 CDA Contact Center . . (866) CDA-MEMBER

(866-232-6362) CDA Practice Resource Ctr . . cdacompass.com TDIC Insurance Solutions . . . (800) 733-0633 Denti-Cal Referral . . . . . . . . . (800) 322-6384 Central Valley Well Being Committee . . . . . (559) 359-5631

Keep us updated!

Moving?

Opening another office?

Offering new services?

Share your information with the Society!

We can only refer you if we know where you are; and we rely on having your current information on file to keep you informed of valuable member events! Give us a call at (916) 446-1227.

The more accurate information we have, the better we can serve you!

www.sdds.org

New Members

March 2011

Annie Barnes, DDS General Practitioner 1741 Professional Dr Sacramento, CA 95825 (916) 485-5539 Dr. Annie Barnes graduated from Loma Linda University in 2001 with her DDS. Her general practice is located Sacramento where she practices with her husband and fellow SDDS new member, Dr. Stephen Barnes. Drs. Barnes live in Carmichael.

Kirk Youngman, DMD General Practitioner 8908 Madison Ave Fair Oaks, CA 95628 (916) 536-5151 Dr. Kirk Youngman graduated from Washington University in 1983 with his DMD. He is currently practicing in Fair Oaks and lives in Folsom with his wife, Karilyn.

Stephen Barnes, DDS General Practitioner 1741 Professional Dr Sacramento, CA 95825 (916) 485-5539 Dr. Stephen Barnes graduated from Loma Linda University in 2004 with his DDS. His general practice is located Sacramento where he practices with his wife and fellow SDDS new member, Dr. Annie Barnes. Drs. Barnes live in Carmichael.

New Transfer Members:

Wel Grant Irwin, DDS co General Practitioner bac me 2335 American River Dr, Ste 307 k!

Sacramento, CA 95825 (916) 929-0331 Dr. Grant Irwin graduated from Loma Linda University in 1984 with his DDS. His general practice is located in Sacramento and he lives in Folsom with his wife, Debbie.

William Koett, Jr., DDS Wel co General Practitioner bac me 1820 Professional Dr, Ste 7 k!

Sacramento, CA 95825 (916) 972-9279 Dr. William Koett, Jr. graduated from the UOP Arthur A. Dugoni School of Dentistry in 2001 with his DDS. His general practice is located in Sacramento and he lives in Folsom with his wife, Alice.

Feroz Nawabi, DDS General Practitioner 1035 Suncast Ln, Ste 110 El Dorado Hills, CA 95762 (916) 941-0323 Dr. Feroz Nawabi graduated from the Herman Ostrow School of Dentistry of USC in 2004 with his DDS. He is currently practicing in El Dorado Hills and lives in Rocklin with his wife, Joan Haley.

Kenneth Silva, DDS Wel co General Practitioner bac me 16985 Placer Hills Rd, Ste D k!

Meadow Vista, CA 95722 (530) 878-0704 Dr. Kenneth Silva graduated from Indiana University in 1985 with his DDS. His general practice is located in Meadow Vista and he lives in Applegate with his wife, Tamara.

Nima Aflatooni, DDS Transferred from San Francisco Dental Society General Practitioner 9381 E Stockton Blvd, Ste 219 Elk Grove, CA 95624 (916) 670-1886 Dr. Nima Aflatooni graduated from the UOP Arthur A. Dugoni School of Dentistry with his DDS. He is currently practicing with his father in Elk Grove.

An Le, DMD Transferred from Santa Clara County Dental Society General Practitioner 9184 E Stockton Blvd Elk Grove, CA 95624 Dr. An Le graduated from the University of Connecticut in 2009 with her DMD and later completed a residency at the University of Texas - San Antonio in 2010. She is currently practicing in Elk Grove.

Chalise Morgan, DDS Transferred from Orange County Dental Society General Practitioner 4140 Mother Lode Dr, Ste 112 Shingle Springs, CA 95682 (530) 672-8059 Dr. Chalise Morgan graduated from the UCLA School of Dentistry in 2007 with her DDS and later completed a residency at the Lutheran Medical Center in 2008. She is currently practicing in Shingle Springs and lives in El Dorado Hills.

New Student Member: Zachery Castiglione UCSF School of Dentistry, 2011

New Applicants: Israel Armijo, DMD Jose Terraza, DDS Robert Wright, DDS, MS

CLIP OUT this handy NEW MEMBER UPDATE and insert it into your DIRECTORY under the “NEW MEMBERS” tab.

total membership (as of 2/11/11): 1,572 total active members: 1,318 total retired members: 199 total Dual members: 2 total affiliate members: 12

total student/ provisional members: 3 total current applicants: 3 total dhp members: 35

total new members for 2011: 10 March 2011 | 29

Sacramento District Dental Society Presents the 31st Annual MidWinter Convention & Expo

Under Under t the he

oar

dwal

February 3 & 4, 2011

… do wn b y t he C - e ( e - e

-e) …

at the Sacramento Convention Center

(L to R): CE Committee members Dr. Michael Forde and Dr. Jonathan Szymanowski (Chair) welcome attendees to the beach! • Registration is underway as doctors and staff check in for two days of fun in the sun. • Courses this year covered everything from practice management software and customer service to financial tips and licensure renewal requirements. • The 31st Annual MidWinter Convention provided plenty of time to socialize between classes, as we returned to the very convenient one-floor layout!

(L to R): The Expo Hall was completely SOLD OUT this year, with over 60 vendors to visit! • Lunch selections reflected the boardwalk theme, featuring subs, corn dogs and nachos, and were included in registration price! What a bargain! • The lunch break was a time to check in with colleagues and gear up for the next round of classes. • Dr. Dennis Peterson soaks up some rays before heading out to his next class.

MidWinter 2011

A Great Success!

560 attendees 25 speakers (L to R): Scott German (Fechter & Co, SDDS Vendor Member) presents Dr. Edi Guidi with the iPad he won in the Expo Hall! • Free massages provided by Anthem College — what a treat! • See you next year! (February 9 & 10, 2012) SDDS PRESENTS THE 31ST ANNUAL MIDWINTER CONVENTION & EXPO

“LOVED, LOVED, LOVED having the massage therapists available to rub my aching back!!! They definitely need to come back next year!!”

“Everything went very smoothly and the exhibits were great. My staff thought it was wonderful (won some prizes). Excellent organization.

Looking forward to next year!!”

From the 2011 MidWinter Survey 30 | The Nugget

36 classes 14 CE Units available in 2 days!

Expo sold out

UNDER THE BOARDWALKwith 60 vendors (152 reps)!

E E

“The committee and all of SDDS continue to make MidWinter a great benefit!

I managed to get 12 units in two days for a very reasonable price. You have great energy and, for a small show, you do big things!!”

Plus… Boardwalk food, corn dogs, nachos, beer, roller coasters and all …”Under the Boardwalk…

Down by the CE (E-E-E)” Thanks to all who attended to make this year the best in years!

Stay tuned for the Mardi Gras — February 9 & 10, 2012!

Sacramento District Dental Society

design your own dental suite offering generous tenant improvements for this 800 sq ft office space. Rent negotiation is available. The suite is in a three story midtown dental complex. (916) 448-5702.

11-10 Dream office shell — nicest / newest in sacramento! Build / design 2,000 sf to suit. Near Watt / El Camino, close to shopping. Great for new / existing practice, general / specialty. Call Dr. Favero (916) 487-9100. 03-C1 free rent — Fully equipped, 4 ops, Dentrix software, Arden area, great for starting new practice. Former location of 35 year practice. Contact Douglas Yee (916) 801-1707.

11-10

dentists serving dentists — Western Practice Sales invites you to visit our website, westernpracticesales. com to view all of our practices for sale and to see why we are the broker of choice throughout Northern California.

(800) 641-4179.

03-09 great location on madison ave in carmichael — 40 years established. No MediCal, no capitation.

Dr. retiring. Great, loyal patients and staff — will stay.

(916) 966-8567 mcdaniel.grant@yahoo.com.

12-10

operatory space to share with orthodontist or endodontist in general dental office on J Street and 51st Street. Contact Dr. Steven Brazis at (916) 731-5151 to discuss details if interested.

02-11 suite for lease — in Midtown Sacramento at 30th & P. Ideal for perio, endo or oral surgery. Improvements + allowance for modification. Signage, high visibility, on-site parking and freeway access. In the midst of Sutter’s medical campus expansion. (916) 473-8810. Lic. 01227233. 02-11 operatory space to share in Roseville. Contact Dr. Alan Pan at (916) 781-6688 to discuss details if interested. 03-C1

greater sacramento area multi-specialty office looking for an associate pediatric dentist and orthodontist 2–4 days/week. Ideal candidate is a skilled team player looking for long-term commitment. Fax resume to (916) 817-4376.

11-10

Stop the Screaming! In-office sedation services

by MD anesthesiologist • Pedo/Adults • Medi-Cal Provider • 20 years experience • Call (800) 853-4819 or info@propofolmd.com.

05-07 Locum Tenens — I am an experienced dentist, UOP graduate and I will temporarily maintain and grow your practice if you are ill / maternity leave or on extended vacation.

(530) 644-3438.

04-10 Locum Tenens — Loma Linda grad, 1980. Temporary dentist for emergencies, vacations and maternity leaves.

(530) 823-0502.

02-11

Have an upcoming presentation?

The SDDS LCD projector is available for rent!

Three days — $100 Members only please

Call the SDDS HR hotline with all Your burning questions —

1-800-399-5331

You asked for this!

New Classified Sections!

Nugget Survey 2009

Contact SDDS at (916) 446-1227 for more information.

Vacation homes • Misc items for sale • Home rentals / sales • Tickets

Selling your practice? Need an associate? Have office space to lease? Place a classified ad in the Nugget and see the results! SDDS member dentists get one complimentary, professionally related classified ad per year (30 word maximum; additional words are billed at $.50 per word). Rates for non-members are $45 for the first 30 words and $.60 per word after that. Add color to your ad for just $10! For more information on placing a classified ad, please call the SDDS office (916) 446-1227.

Deadlines are the first of the month before the issue in which you’d like to run.

H

”

A

L

L

March 2011 | 31 3‘-8

SDDS member dentists can place classified ads for free! www.sdds.org

Call SDDS at (916) 446-1227 for more information or to place a reservation.

PRSRT STD

915 28th Street Sacramento, CA 95816 916.446.1211 www.sdds.org

US POSTAGE PAID PERMIT NO. 557 SACRAMENTO, CA

Address service requested

sdds calendar of events March 1

4

Board of Directors Meeting 6:00pm / SDDS Office Continuing Education Removable Partial Dentures: Clinical Considerations

Alan Carr, DMD, MS

Hyatt Regency Sacramento

1209 L Street, Sacramento

6:30pm–8:30pm 7 Leadership Development Committee

6:00pm / SDDS Office

CE Committee

6:00pm / SDDS Office

For more calendar info, visit

www.sdds.org

8 General Membership Meeting

Benign & Malignant Tumors of the Neck & Skin

Barbara Burrall, MD

Spouse Night

Sacramento Hilton — Arden West

2200 Harvard Street, Sacramento

6:00pm Social

7:00pm Dinner & Program 10 Dental Health Sub-Committee

6:30pm / SDDS Office 15 Golf Committee

6:00pm / SDDS Office

Membership Committee

6:00pm / SDDS Office 16 SDDF Broadway Series

9–5

8:00pm / Sac Community Center

You asked for this!

Nugget Survey 2009

18

21

24

Member Forum Build Your Own Employee Handbook Mari Bradford (CEA) SDDS Office 915 28th Street, Sacramento 8:30am–12:30pm Dental Health Committee 6:30pm / SDDS Office Member Forum The Numbers of Your Practice: The Good, the Bad, Avoiding the Ugly

John Urrutia, CPA (Mann, Urrutia, Nelson, CPAs)

Sacramento Hilton — Arden West

2200 Harvard Street, Sacramento

6:30pm–8:30pm 29 Leadership Development Committee

6:00pm / SDDS Office

Save the date for the 32nd annual MidWinter Convention Tons of CE & a great time! you won’t want to miss it! February 9–10, 2012 earn

2

ce units!

6pm: Social & Table Clinics 7pm: Dinner & Program Sacramento Hilton, Arden West (2200 Harvard Street, Sac)

April 12, 2011:

Turn it On & Off: What’s New in Local Anesthesia

Presented by: Alan Budenz, MS, DDS, MBA

Course Objectives: • • • •

Understand causes of local anesthesia failures; have better knowledge to overcome these failures Provide more effective anesthesia for any dental treatment procedure Discuss sciences behind new anesthetic buffering and reversal agents being introduced to dental practitioners.

Apply the latest anesthetic agent technology to their daily practice, and describe new trends in achieving profound patient comfort.

April General Membership Meeting: Recruitment Night