SFDDA Fall Issue

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Volume 56, No. 2 www.sfdda.org Fall 2014

LET’S TALK

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Preliminary Program Features: Ethan Pansick, D.D.S., M.S David Feinerman, D.M.D., M.D. “Digital Workflow: Surgery to Prosthetics” Sponsored by:

Annette Yelin, Esq

Lee Weiss, D.D.S. “Airway Management Certification"

“Legal Issues that May Affect You and Your Dental Practice”

Ravindra Nanda BDS, MDS, PhD Duran Mootry, CRDH, MPS “Introduction to Hygiene Local Anesthetic Course”

Program is subject to change

Esthetics and Biomechanics Based Management of the Smile Zone Presented by: (Orthodontic Problems)”

President’s Message Marcos Diaz, D.D.S. Membership Has Its Privileges.

How many times have we heard this? Well… this time, you had better think and realize there is more behind this statement than meets the eye. Now, more than ever, this concept needs to hit home. We are bombarded every day with so many ads, and so easily delivered right to our businesses, homes, computers, or mobile devices, thanks to all of the advancements of technology. Information which may truly be important to us, and which we need to recognize and be aware of, has a tendency to get washed down or to simply be ignored, and in many cases, does not to have its intended effect. This could even be viewed as the “boy who cried wolf” effect, so to speak.

The ability to join “something” is at everyone’s fingertips.

Many of us opt to join a club, society or an association more because of convenience, cost, or depending on what continuing education courses are being offered, rather than what exactly is at the core of their existence. Membership in the triparite, South Florida District Dental Association (SFDDA), Florida Dental Association (FDA) and American Dental Association (ADA), has a major core valueand goal of making it possible for every member dentist to succeed. In fact, the FDA’s Mission Statement is, “Helping Members Succeed.” It is all about YOU, and not THEM! That is a pretty important and lofty statement.

Their goal is to support the dentist and their staff, and to provide access to whatever professional resources are needed to make this happen. In essence, their staff is an extension of your staff. When we as dentists succeed, the association succeeds as well. Therefore, our desire and our need to belong becomes of paramount importance. The value in being a member and belonging is your insurance for the existence and future of your profession. We need more of you to go out and recruit dental colleagues who do not belong to our association. It is your call of duty.

Aside from the many benefits of belonging to the SFDDA, such as our awesome new website, excellent meetings like the great Miami Winter Meeting, and all our affiliate meetings (please see our executive director’s article on membership benefits in this issue), no other “association,” “society” or “club” will stand up and fight for you, for your dental profession, or for your dental rights against others, whether you are physically present or not. It is like a security system. Your membership is a sixth sense that you are granted when it comes to supporting and defending you within the profession of dentistry. Now more than ever, it pays to belong. Do it because it is the right thing to do.

Cost of: New Basic Life Support CE SFDDA Course: New CDT 2015 Dental Procedure Codes: Attending the 2015 Miami Winter Meeting: Attending the 2015 FDC Meeting in Orlando FL: Attending the 2014 ADA Meeting San Antonio:

Members $ 50.00 $ 49.95 $295.00 FREE $180.00

Non‐ Member $ 75.00 $ 74.95 $500.00 $505.00 $750.00

Cost to Member for belonging to the Tripartite System, SFDDA, FDA and ADA:

Priceless! *More member costs comparisons can be found on page 13 3

Rules Governing Administration of Anesthesia by Dentists, Past and Present: Navigating Through the Most Recent Rule Changes Richard A. Mufson, D.D.S., Editor Many member dentists and staff have been asking questions regarding recent Rule changes enacted by the Board of Dentistry (BOD) regulating the administration of anesthesia in Florida (Chapter 64B5-14.001 – 14.010, Florida Administrative Code). A relative lack of awareness, and in many cases, unknowing or unintentional violations, of the laws and rules of anesthesia delivery, have also become more apparent in recent years. This article will attempt to communicate and summarize the “do’s” and “don’ts” of these regulations, both past and present, with a review of the rationale for, and nature of, the most recent changes.

Examples of the more frequently asked questions have included those such as, (1) “May a physician anesthesiologist (MD, DO) or certified nurse anesthetist (CRNA) come into my office and sedate or put my patients asleep for dental treatment?”

(2) If so, “May an anesthesia-trained ‘dental’ professional, such as an oral and maxillofacial surgeon (OMS) or dental anesthesiologist (DA), also come into my office and perform the same anesthesia services?”

(3) If so, “Do I need anesthesia training and/or anesthesia permit?”

(4) “May the anesthesiologist or OMS/DA bring in their own anesthesia monitoring equipment, or do I need to have the equipment permanently maintained and inspected in my own office?”

(5) “Is the depth of anesthesia limited to my own training and/or permit level, or may the anesthesia provider administer any level or depth of anesthesia desired or required for my patients?”

(6) “Must I, or may I, bring a patient to an anesthesiologist’s or oral surgeon/DA’s office, or am I permitted to have the anesthesia performed in my office?”

First, some basic history: Where have we come from?

Since the late 1980’s, the regulations, or “Rules,” governing our practice of office-based anesthesia were significantly expanded, and many feel, improved for the better, relative to “raising the bar” of competence and patient safety.

A number of important items were introduced, beginning with specific definitions of the varying types or levels of anesthesia.

In addition to those for local anesthesia and nitrous oxide analgesia, important anesthetic and physiologic differences between conscious sedation and deep sedation/GA were written

into rule language, setting one level apart from the other.

These distinguishing features specifically relate to whether a given patient, in response to pharmacologic agents administered by any route, is induced into a level of anesthesia which either maintains protective reflexes and the ability to maintain an airway independently and/or respond appropriately to physical stimulation and verbal command - as in conscious sedation, or whether these qualities are partially/completely lost - as in deep sedation/general anesthesia respectively. For a more complete and detailed list of these definitions, please refer to Rule 65B5-14.001 (the web address for downloading appears at the end of this article).

Based on one’s education, training, experience and intent relative to type/depth of anesthetic to be delivered, the BOD also mandated that a dentist apply for, and obtain, an anesthesia permit for either conscious sedation (or “pediatric conscious sedation” for pediatric dentists) or deep sedation/GA. In 2002-2003, the BOD responded to safety concerns relating to the heavily marketed technique of non-anesthesia trained/permitted dentists sedating patients with multiple successive doses of an oral medication. The BOD developed a Rule disallowing conscious sedation, by any route (including oral), without appropriate training and permitting. A separate definition or category was also placed into BOD Rule – “Minimal Sedation (anxiolysis)” – which would allow a non-permitted dentist to relieve anxiety (but not “sedate,” i.e., produce a depressed level of consciousness) by limiting the technique to a “single enteral sedative or narcotic…not to exceed the maximum recommended dose (as per the manufacturer).”

The same issue of concern also prompted the BOD to place a warning into the Rules (under Prohibitions, 64B5-14.002) of the “potential overdosing threat due to the unpredictability” of giving multiple doses of an oral medication (aka “titrating” or “stacking”) for the purpose of sedating a patient.

The BOD developed another new rule at that time - which many perceived as an attempt to “give something back” to non-permitted dentists who argued or felt upset the BOD had “taken something away.” Never before allowed in the absence of an anesthesia permit – any dentist would be able to give a single enteral dose of a sedative medication in combination with nitrous oxide. continued on next page

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Although located in the section of rules on “Advertising” (64B5-4.002), the BOD also disallowed the practice of using the term, “sleep dentistry” in any advertisement “unless the licensee possesses a valid general anesthesia permit.”

The BOD also developed yet another rule soon thereafter disallowing the use of certain medications in the absence of a dentist possessing a general anesthesia permit (under Prohibitions, 64B5-14.002[8] ), which include propofol, methohexital, thiopental, etomidate and ketamine.

More on Anesthesia Inspection and Permitting: A long list of emergency medications, equipment and specific monitoring devices have also been etched into BOD requirements since the late 1980’s. Blood pressure and pulse oximetry monitoring have been required for conscious sedation delivery.

For deep sedation/GA delivery – additional monitoring consisting of EKG, and more recently, end-tidal CO2 , have been required, as well as a higher level of auxiliary staff required to participate within the operatory (minimum 3 versus 2).

As a part of the permitting process, the BOD has also required inspection of one’s office facility for proper size/dimensions, staff, and moreover, appropriate emergency medications and equipment (such as airway devices, positive pressure oxygen) and monitoring equipment. It has also historically been required that all monitoring equipment be permanently maintained within the inspected office, as opposed to the concept of “mobile equipment,” for incoming or outgoing itinerant practice, which has heretofore not been allowed.

Another important concept of the permitting and inspection process is a long held tenet by the BOD that it is not only the person – i.e., the dentist – who is granted a permit by the BOD, but moreover, the inspected office facility. Therefore, the concept of going to multiple office locations, if those facilities are not on record as having been inspected and permitted – has also not been allowed.

With increasing frequency of late, a number of itinerant practitioners have engaged in the practice of traveling around a given city or region of our state for the purpose of providing surgical and/or anesthesia services, in multiple uninspected offices, or in some cases, even to different cities throughout the state, and while doing so perhaps unaware, and unknowingly in violation, of BOD Rules.

CRNA is allowed by rule to work within the office of a deep sedation/general anesthesia permitted dentist, but not within the office of a dentist with a conscious sedation-permit. The rationale related to the question of whether a dentist with lesser anesthesia training could be expected to safely supervise a practitioner with a greater level of training and/or depth of anesthesia planned or provided. However, although this has reportedly been the BOD’s interpretation and intent, the language for this has not been clearly spelled out within the laws/rules, and has therefore not been frequently enforced.

BOD Allows Physicians Anesthesiologists (MD/DO) In Pediatric Offices: In 2007, a new BOD rule allowed physician anesthesiologists to come into the offices of pediatric dentists. Among the reasons prompting this change included a perceived lower level of anesthesia training, combined with an increasing frequency of negative anesthesia outcomes, including patient deaths, within pediatric offices, both in Florida and nationwide. However, this is certainly not to imply that anesthesia mishaps have been limited to one specialty, as they clearly have not. Access to care was another consideration, as a great many special needs children with emotional and behavioral challenges would benefit from this newer and safer anesthetic option.

Numerous discussions would then follow among participants in BOD anesthesia meetings and conference calls, among FDA members appointed to an ad hoc anesthesia committee to study this issue, and among other interested groups.

As a result, many of the same questions appearing at the beginning of this article were brought forth, discussed, and debated. Would the new change be limited to MD/DO’s and exclude our own highly trained dental personnel? Would it be limited to pediatric offices only? Could a dentist with no anesthesia training or permit be allowed to benefit from the services of an outside provider? Would mobile versus fixed/permanent equipment be allowed? The single question undoubtedly having undergone the most debate centered around whether the depth of anesthesia would be restricted to the “same level” as one’s training/permit, or whether “any level” would be allowed.

And Finally… the New Changes: Within the past two years, these questions were debated, answered, and the BOD responded with significant changes in the rules governing anesthesia delivery.

Utilizing the Services of Other Anesthesia Providers: It has also been against BOD Rule, prior to recent changes, for a dentist with no anesthesia training/permitting to utilize the services of a permitted dentist (OMS/ DA), CRNA, or anesthesiologist, whether in their own office or within the facility of the anesthesia provider.

As a result, all anesthesia permit holders: (a) may use the services of either an MD/DO anesthesiologist or OMS/DA, and who (b) may deliver “any level” of anesthesia necessary or desired, and who (c) may also bring in their own mobile equipment if so chosen.

The question of having a CRNA come into one’s office has been somewhat less clear. The BOD has long held that a

However, the new rules and changes come with significant caveats and conditions. continued on page 7

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“Anesthesia” cont, from page 5

When a physician (MD/DO) anesthesiologist is utilized: Treatment must take place in the permit holder’s BODinspected office (excluding treatment in a JCAHCO accredited hospital or outpatient surgical facility), which must also meet the supply, equipment, facility and staff requirements for the depth of anesthesia planned or provided (i.e., for deep sedation/GA, additional requirements include EKG, endtidal CO2, and minimum 3 auxiliary staff in operatory). Mobile equipment, if used, must be available for required BOD inspection, and the dentist must supply reports of inspection (valid for 12 months). The equipment must be available for all required inspections, and in the event of any adverse incident.

The MD/DO is also “responsible for the anesthesia procedure.” The dentist must also maintain a complete copy of anesthesia records in the chart, which must include the license numbers identifying the treating dentist, MD anesthesiologist, and all other personnel involved.

When an OMS/DA (general anesthesia permit holder) is utilized: Treatment may be performed either in his/her own BOD-inspected office or in the office of a dentist who holds a valid anesthesia permit of any level. In the latter case, the office must similarly meet all additional supply, equipment, facility and staff requirements if deep sedation/GA is planned or performed. The treating dentist and anesthesia provider are “both responsible” for adverse incident reporting. Mobile equipment, if used, has the same requirements as those applying to MD’s. Dental treatment must also be performed by a dentist with a valid anesthesia permit of any level.

Anesthesia for Dentists Without an Anesthesia Permit: A dentist without an anesthesia permit/training has previously not been allowed by statute or BOD rule to treat a patient under conscious sedation or deep sedation/GA - until this past year, when a new rule was developed (64B514.0036), whereby a BOD-permitted anesthesia provider (OMS/DA) may now provide such services for another dentist (MD/DO’s were not included in this section of the rules).

However, as with the other rule changes, there are caveats and conditions.

The treatment must take place in the BOD-inspected office of the anesthesia provider/permit holder, who shall remain with the patient from the onset of anesthesia, and have no other patients induced under anesthesia, until the patient is discharged. More significantly, the treating non-permitted dentist must take a minimum of four hours of CE in airway management (credited toward the 30 hours required for all dentists each biennium), and repeat the same required course every four years.

It is also important to mention that two distinct types of airway courses are being, or have been, developed for approval

Table 1 Recent Changes - At A Glance M May ay dentists dentists uutilize tilize a phy physician sician (MD, (MD, DO) DO) aanesthesiologist nesthesiologist iinn the sedation or se dation the office office ffor oorr ggeneral eneral anesthesia? anesthesia?

M ay dentists dentists utilize anesthesia utilize a g eneral anesthesia May general p ermitted dentist the office office dentist (OMS, (OMS, DA) DA) iinn the permitted eneral anesthesia? anesthesia? for se dation oorr ggeneral for sedation

May dentists utilize utilize a CRNA May dentists CRNA? (same evel as as permit permit holder holder only) (sa me llevel onl y ) D, DO, DO, O MS, DA DA se date a patient May an M MD, OMS, sedate any lev el” ooff aanesthesia nesthesia (conscious (conscious to “any level” eep se dation/gen anesthesia), anesthesia), sedation/gen ssedation, edation, ddeep entist’s ttraining/permit raining/permit llevel? ev el? regardless re gardless ooff ddentist’s providers bring bring in in their their own own May anesthesia anesthesia providers mobile equipment? equipment

Before

After

NO O

Y YES* ES*

NO

YES*

YES

YES*

N/A N /A

YES*

O NO

YES*

for more more details details With Caveats aveats and and Conditions Conditions please please see see Table Table 2 for *W ith C -R Richard A.. Muf Mufson, DDS ichard A fson, D DS

by the BOD: (1) One is specifically formatted to teach the dentist with little or no anesthesia/ airway management training (and must consist of 2 hours of didactic and 2 hours of hands on training).

(2) The second type is for anesthesia-trained and permitted dentists who must take such a course (once every two bienniums) as part of the previously mandated four hours of anesthesia/emergency hours each biennium.

The course design and information required for the non-anesthesia trained dentist is unique relative to a greater scope and depth as compared to the course for permitted dentists with previous anesthesia/airway training and experience. The importance of understanding this difference would be to assure that one participates in the correct course, as they are not interchangeable for the purposes of compliance with BOD rule and/or license renewal.

May a qualified “anesthetist” (CRNA) provide anesthesia services for dentists? This has been one of the most confusing and challenging questions to accurately answer – and reportedly, even among BOD members.

According to previous and current BOD members, and other sources who closely follow the BOD, a number of varying issues through the years have been discussed at meetings, voted upon, and approved. However, to the surprise of those involved in the process – this may not always result in the same language appearing in the final rule as previously discussed and voted upon. This scenario “may” also have occurred with a rule recently put forth regarding the role of CRNA’s in our offices (64B5-14.0038). continued on page 8

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“Anesthesia” cont. from page 7 SFDDA 2014-2015 Officers and Executive Council President MARCOS DIAZ, D.D.S. (954) 659-9990 President-Elect ELAINE DEROODE, D.D.S. (305) 373-7799 Vice President PIERO PALACIOS, D.D.S. (305) 274-3113 Secretary Mark A. Limosani, D.M.D., Msc (954) 800-3453 Treasurer RODRIGO ROMANO, D.D.S., M.S. (305) 667-8766 Immediate Past President

For years preceding the recent changes, the intent or interpretation of the BOD, if not clearly spelled out in statute or rule, has been to allow only deep sedation/GA permitted dentists to utilize a CRNA in their office, but not dentists with a conscious sedation permit. The rationale for this, as mentioned earlier, included the question of whether a dentist with less anesthesia training could effectively or safely supervise a provider with a higher level, or in performing a deeper level of anesthesia than the dentist would be trained or permitted to provide.

According to the current rule (64B5-14.00368), and notwithstanding the fact that some feel the language may revert to that which was originally voted upon (and more reflecting the language in the preceding paragraph) – a permitted dentist may, under “direct supervision,” utilize the services of a CRNA. However, the supervising dentist must have a valid permit for, and maintain all equipment, supplies and staff required for, the level of sedation the anesthetist will administer to the patient.

The scope of this article, although admittedly quite expansive compared to most, was not intended to cover each and every aspect of our anesthesia laws and rules. For a complete version, or any questions, please go to:

JEANNETTE PENA-HALL, D.M.D. (305) 667-8766

http://floridasdentistry.gov/Forms/law-and-rule-booklet-nov-2013.pdf

Young Member ESTEBAN LEON, D.M.D. Trustees & FDA Line Officer Michael D. Eggnatz, D.D.S., FDA 2nd Vice President (954) 217-8888

Dr. Mufson is the Editor of SFDDA newsletter and may be reached at (305) 935-7501 or mufsonoralsurg@aol.com.

Jorge Centurion, D.M.D., Trustee 305-662-22167

The South Florida District Dental Association Nominating Committee is seeking candidates for the following:

Beatriz Terry, D.D.S., Trustee (305) 279-2828 Alternate Trustees Jeannette Peña Hall, D.M.D. Rodrigo Romano, D.D.S., M.S. Delegates to the Executive Council from the Affiliates Societies Carlos Sanchez D.M.D. (MDDS) Heberto Salgueiro, D.M.D. (MDDS) Richard Mufson D.D.S (ND/MBDS) Isaac Garazi, D.M.D. (ND/MBDS) Joseph Pechtor, D.M.D. (SBDS)

Finally…a place to send those difficult patients!

SFDDA Young Member FDA Trustee Incumbent is Dr. Beatriz Terry

Affiliate Society Presidents Esteban Leon, D.M.D. (MDDS) Simon Kaswan, D.D.S.(ND/MBDS) Joseph Pechter, D.M.D. (SBDS) Richard A. Mufson, D.D.S., Editor Yolanda Marrero, Managing Editor Jackie Quintero, Advertising Manager SFDDA NEWSLETTER Copyright: © SFDDA 1996 Published by the South Florida District Dental Association 420 S. Dixie Highway, Suite 2E Coral Gables, FL 33146 Send announcements and correspondence to the Editor: 420 S. Dixie Hwy, 2-E Coral Gables, FL, 33146-2271 Phone: (305) 667-3647 FAX: (305) 665-7059 or email to: sfdda@sfdda.org Disclaimer: Opinions stated in the SFDDA Newsletter are not necessarily endorsed by the South Florida District Dental Association, its Executive Council or Committees. Advertisements printed should not be construed as an endorsement by the Association of the company, product or service.

SFDDA Secretary

Dr. Harold Menchel limits his private practice to treatment of TMD and orofacial pain in Coral Springs.

TMD Headache Neuropathic pain Sleep disordered breathing (OSA) Dr. Menchel coordinates treatment with restorative dentists, orthodontists, endodontists, and oral surgeons for these complex patients.

Dr. Menchel has been in practice in S. Florida since 1981. He received the majority of his training at the University of Florida Parker Mahan Facial Pain Center under the tutelage of Drs. Mahan and Gremillion from 1992Ǧ 1999. He achieved the prestigious Diplomate of the American Board of Orofacial Pain in 2000.

Treatment includes: (partial list) Splint therapy, medical management, physical therapy, joint mobilization, diagnostic and therapeutic injections.

All referrals will be respected and appreciated.

1720 University Drive, Suite 301, Coral Springs, FL 33071 (954) 345Ǧ2264 website; tmjtherapy.com

FDA Alt, Trustee Incumbent is Dr. Jeannette Peña Hall Candidate Applications are available at sfdda.org under leadership resources or Call (305) 667-3647 to request an application.

Deadline to submit applications is December 1, 2014

Table 2

Permit Type/Level

C onscious S edation

Pediatric Conscious Sedation

Deep Sedation/ General Anesthesia

Who may use MD/DO Anesthesiologist?

Yes*

Yes*

Yes*

Who may use OMS or DA?

Yes*

Yes*

Yes*

Any Level Anesthesia?

Yes*

No Permit

No** *

Yes ** (see below)

Yes*

Yes

Yes**

*If the following conditions are met: 1. MD/DO: (a) Treatment must take place in the BOD-inspected permit holder’s office (author’s comment: exclusive of treatment performed in JCAHCO-accredited hospital or surgical center), and (b) MD/DO is “responsible for the anesthesia” and for adverse incident reporting. (c) Treating dentist shall maintain copy of complete anesthesia records in patient’s dental chart, must also include name, license number of MD/DO and all personnel involved.

2. OMS/DA: (a) Treatment may take place in either his/her own BOD-inspected office or office of a dentist who holds a valid anesthesia permit of any level. (b) Dental treatment must be performed by a dentist/permit holder. (c) Both the dentist and anesthesia provider are “responsible” for adverse incident reporting.

3. Office must comply with, and undergo BOD inspection for, additional requirements (facility, supply, equipment, including EKG, end-tidal CO2, minimum 3 trained staff in operatory) for deep sedation/GA. May anesthesia provider bring in “mobile” equipment (thus also helping conscious sedation dentist comply with adding EKG, CO2)?

Who may use CRNA? Any level Anesthesia?

May a dentist with No Anesthesia Permit Utilize a Permitted Dentist (OMS/DA*)? *MD/DO not included in this section of rule

Yes – If the following conditions are met: 1. All equipment must be available for required BOD inspections (for MD/DO – dentist must supply reports of inspections; licensed health care manager may perform; is valid for 12 months).

2. All equipment must be made available immediately for adverse incident inspections.

Yes*

Yes*

Yes

No*

No*

Yes

(must remain within level of permit holder)

Yes – If the following conditions are met: 1. Treatment must take place in permit holder’s BOD-inspected office, 2. Permitted dentist shall remain with patient from onset of anesthesia until discharge, 3. Permitted dentist shall have no other patient induced under anesthesia or begin performance of any other anesthesia services until patient is discharged.

4. Non-permitted dentist must take a minimum of four hours CE in airway management (credited toward mandatory 30 hrs), and repeat the same requirement every four yrs.

- Richard A. Mufson, DDS 9

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FOR THE PUBLIC PROFESSIONAL RESOURCES MIAMI WINTER MEETING

Have you had an opportunity to visit the new SFDDA Website?

Please be reminded that the use of this member’s only section is a privilege of membership. Please do not give your information to non-members of the American Dental Association.

If you haven’t yet visited the new website, we encourage you Another useful feature of the website is the calendar. When to do so and explore all of the new features that have been specifically designed with you, our member, in mind.

you click on an event, you will be able to get times, locations, lecture information and even directions through an interactive map.

The new site has more information regarding the dental profession and links to many other organizations at your fingertips.

The latest news will be posted on the home page as well as the latest issues of the SFDDA Newsletter.

If you are interested in joining an affiliate, you can click on the affiliate links for details on their current boards and links to their own websites and meeting information.

The new “members only” section provides you with form letters, members only benefits made available by sponsors of the SFDDA. Other important benefits for members includes the employent services which allow members to search for potential employees or associates and post job opportunities.

The site was updated to provide the public with direct access to you via a referal link that allows them to search for a member dentist by specialty, zip code or name. In order for us to place you on the referral link, it’s important that you update and make any corrections to your information before November 21, 2014. This link will be live and available to the public on that date. In order to login and update your information please follow these simple instructions: Click on the “Tooth” located on the upper right hand side of the screen where it says “Login.” It will take you to the login screen. Once there, your “User Name” will be your ADA Number, and your “first time use” password will be: your last name, all lower case letters, followed by an exclamation point (!) , and the first four numbers of your ADA number Example:

Username: 1234567 Password: smith!1234

Once you are at your personal information page, make sure to change your password to protect your account.

If for any reason your login does not work, and you are sure that you are a member of the American Dental Association through the SFDDA, please call us right away at (305) 6673647.

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The SFDDA website is a living document which means that it can be shaped and modified as needed. We welcome your suggestions and ideas to improve the site and make it work for you.

“I renew my tripartite membership because I know that my profession would lose part of its identity and influence in society, if the American Dental Association were to not exist. I feel the need.” - Jeannette Peña Hall, DMD “No other ‘association, society or club’ will stand up and fight for you against anyone in support of your dental profession and dental rights regardless if you are physically present or not; it is like a home security system.

The membership is your sixth sense when it comes to defending you and ensuring an on-going support of our dental profession.” - Marcos Díaz, DDS “I joined the FDA, as compared to all the other groups out there, because this IS THE ONLY ORGANIZATION that protects the profession from insurance and governmental intrusions. This is my family’s source of a livelihood, it deserves the BEST!” - Jorge Centurion, DMD “Through the stimulating lectures and engaging social events, members are kept informed about new trends in our profession, and they get to meet new dentists in the community and socialize with colleagues in an atmosphere that promotes friendship, professionalism, and collegiality.” - Joseph Pechter, DMD “If you want to protect your practice, your patients, and your profession, while you expand your personal and professional horizons, develop friendships, and avail yourself of the tools to supercharge your career, then renew your membership. And for practically $3.00 a day (coffee and donuts) you can enjoy your member benefits from graduation to beyond retirement.” – Orlando Dominguez, DMD “You should renew your membership because no one else will fight for you; give you great savings on various insurances and supplies like your association.” - Carlos Sanchez, DMD “I belong to organized dentistry because it is the only organization, through our tripartite membership, that has the capacity to advocate on behalf of the profession while engaging governmental and regulatory agencies at the local, state and national level.” - Mike Eggnatz, DDS “I renew my ADA membership because I know firsthand that the ADA is always working on our behalf to improve, defend and promote our beloved profession.” - Cesar Sabates, DDS “I renew my membership to support those that dedicate their time to representing my voice and ensuring that the fate of our profession remains in the hands of the practitioners.” - Mark Limosani, DMD, Msc

The House of Delegates is the ADA's legislative and governing body and it meets once a year, during the annual meeting. The 473 members of the House of Delegates speak for the more than 158,000 dentist members of the association and for the dental profession in the United States.

Pictured above are members of the 17th District Delegation at work, including Dr. Jeannette PeĂąa Hall, who also found time to have some fun in San Antonio!

Pictured right are the newest inductees to the International College of Dentists.

Among those honored were SFDDA Members (center, from L-R), Drs.Esteban Leon (holding the District 17 sign), Jorge Ramirez (standing), and Richard C. Mariani.

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Left: ADA Welcomes President George W. Bush as Distinguished Speaker at the Annual Meeting.

Above: Installation of Maxine Feinberg, DDS as ADA President.

Left & Below: A little R&R for the 17th District Delegates & Company: Pictured left bottom to top: Drew Eason, Drs. Rodrigo Romano, Cesar Sabates, Irene Marron, Beatriz Terry, Jeannette Hall, Chris Cowell, Ralph Attanasi, Ethan Pansick, Dr. Michael Eggnatz& Marian Eggnatz, Drs. Zac Kalarical, Joleene Paramore & John Paul.

Below: Bottom to top: Dr & Mrs. Rick Stevenson, Dr. & Mrs. Chuck Hoffman, Drs. Beatriz Terry & Edy Guerra, Dr. Jolene Paramore, Drs. Zak Kalarical & Jeannette Peña Hall, Dr. Cesar Sabates

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EMV Terminal Migration How it May Affect your Dental Practice When it comes to paying for the stuff we buy, most of us swipe the plastic to pay for it. That appears to be on the verge of changing as major banks roll out what are called EMV cards or “chip cards”, designed to foil the likes of data breaches that hit Target, Neiman Marcus and now, Home Depot. The cards are embedded with a microchip, a small gold or silver rectangle seen on the front of a card.

EMV is short for Europay MasterCard Visa. The microchip cards have been commonly used in Europe and other countries since 1995. Also known as IC Cards (Integrated Circuit Cards) or "smart cards", it works off of a "chip and pin" process that is dynamic and not static. Dynamic means the authorization information is encrypted and constantly changes.

The magnetic stripe, which will also be available for use on new cards, is very 1960s. The data on it is static, making an easy target for thieves.

While not calling the chip card hack-proof, it is much stronger.

It's basically encrypted, and for every transaction, there's a cryptogram code that actually rotates. Breaches are not going to go away, but what the chip card will do is make the data that's available, make that not as valuable to the criminals.

So between the cards, the terminals and all parties involved, it is really about establishing a technological platform for the next generation of payments - a chip-based EMV smart card.

EMV is considered more secure because it’s harder to copy account numbers and security codes from chips than from the magnetic strips on most cards used in the United States. EMV cards create a unique code for each transaction, making them more difficult to hack or counterfeit than striped cards.

In addition to banks issuing the cards, merchants including dental offices will have to be able to accept them. While compliance is not mandated, the liability for fraud will fall on the dental practitioner that did not upgrade their system. So, if you have a chip card, but your dental office is not able to accept it, your dental practice would be liable for any fraud, according to new credit card standards.

Beginning in October 2015, you will stop swiping the credit card. Instead, you will insert your card into a slot, just like people do in much of the rest of the world, where the machine will read a microchip, not a magnetic stripe. The U.S. is the last major market to still use the old-fashioned swipe-and-sign system, and it’s a big reason why almost half the world’s credit card fraud happens in America, despite the country being home to about a quarter of all credit card transactions.

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Once the country transitions to the new system — which includes credit cards embedded with a microchip containing security data — these kind of hacking attacks will be much more difficult to pull off.

The EMV terminal migration is coming though and both MasterCard and Visa have set October 2015 as an important deadline in the switch. Much of the rest of the world switched to chip and PIN cards years ago. For MasterCard, now is the time even though it introduced its’ roadmap for migration back in 2012.

The “liability shift” is a big moment in the changeover. When the liability shift happens, what will change, is that if there is an incidence of card fraud, whichever party has the lesser technology will bear the liability.

So if a dental practice is still using the old system, where they can still run a transaction with a swipe and a signature, they may be held liable for any fraudulent transactions if the customer is using a chip card. And the same goes the other way – if the dental office has the new terminal, but the bank hasn’t issued a chip and PIN card to the customer, the bank would be liable.

One important thing to know is that it’s not as if everybody just got to the starting line now, there has been a lot of work on this that has already happened. Banks who issue cards in many cases are already issuing cards with the chip, and they have been issuing them to customers who travel overseas.

According to researcher Javelin Strategy & Research, a division of Greenwich Associates, “There is a potential delay in that to upgrade to an EMV certified terminal there is a high cost—$500 to $1,000 per payment terminal” – which might impact the dental office if it were to purchase one from their current processor - But more importantly, the EMV terminal must be certified. To certify any one EMV make/model terminal is $150,000 and takes 6-9 months for a processor to receive that certification at this moment in time.

Quantus has already been deploying EMV certified terminals since the end of July 2014. And for dentists who are members of the South Florida District Dental Association (SFDDA), who switch their credit card processing to Quantus Solutions, the EMV terminals are available free, or, Quantus can upgarde the equipment they already to be able to handle the new cards.

Contact Quantus at 800-698-5150 to request your EMV terminal today. This is another group benefit offered to every Member dentist of SFDDA and brought to you by Quantus Solutions, a proud partner of the SFDDA.

Please Welcome our Newest Members: Moghaddan Bahmadi, DMD Osbel Borges, DMD Ericka I. Felix, DMD Daynet Fraga, DMD Grisell Gomez, DDS Eitan Y. Gross, DMD Gloria Henao, DMD

Carlos A. Llapur, DMD Sandra Miller-Sheriff, DMD Jamie B. Saltz, DMD Elizabeth T. Ziadie, DDS Myriam Berrahil, DMD Francisco J. Blanco, DMD Angela Cooper, DDS

Francisco J. Espinosa, DMD Omar F. Osman, DDS Katherine H. Rodriguez, DMD Concepcion Sanchez-Garcia, DMD Brian A. Tschirhart, DDS Sasan Sani, DMD Arnold Rothman, DDS

Join your local affiliate society...

At the SFDDA, there are three affiliate societies: North Dade Miami Beach Dental Society, South Broward Dental Society and the Miami Dade Dental Society. Each one is located in an area near your practice or your home, making it easy for you to attend meetings. Call and join one today.

2014-2015 SFDDA  Affiliate Societies Miami Dade Dental Society

North Dade - Miami Beach

South Broward Dental Society

Dr. Esteban Leon

Dental Society

Dr. Joseph Pechter

leondmd@yahoo.com

Dr. Simon Kaswan

(954) 981-0012

(305) 651-7760

15

IT PAY$ TO BE AN SFDDA MEMBER At the SFDDA, we like to think that our members are special. Trying to create new benefits for members is an ongoing task. And this year, for members who pay their 2015 dues, we have some exciting benefits to offer.

Did you ever wonder how much your membership in the tripartite (ADA, FDA, SFDDA) is worth? Let us look at the typical savings for SFDDA members during the course of one year.

If you attend the Miami Winter Meeting as a member of SFDDA, you have access to an outstanding program and speakers at a very nominal cost, and your registration includes your meals throughout the day, parking and the President’s Reception. An average charge for this type of event from an outside provider would likely cost you over $1000. At that rate, you can save up to $700 just by taking some of your continuing education courses at the Miami Winter Meeting.

The charge to non-ADA members to register for the Miami Winter Meeting is $500, and is considerably higher than for members. In addition, we keep track of the CE courses you take with us.

If, once in your career, you are in a position to take advantage of the SFDDA's Peer Review process, you may also be saving in legal fees, which may range from $500 to more than $10,000. Even if this were at the lower end - let's use a figure of $1,000, the peace of mind that you will have if the Peer Review Committee successfully mediates a problem before it becomes a lawsuit is priceless.

According to the American Dental Association, for each new patient in your office, you can allow for two return visits and two referrals from the patient’s friends, co-workers, relatives, etc. If you are referred one new patient per year by the SFDDA, either over the phone or through the online Dentist Locator Service, you may realize income of $1,000 or more.

If you use the SFDDA's Placement Service to find staff members for your office rather than going through an employment agency or placing a classified ad in the local newspaper you may realize a savings of $500 to $1000.

And then there are movie theatre discounts. SFDDA members and their families and staff are able to purchase discounted tickets to all AMC and Regal Cinema Movie Theaters for under $7. With the cost of movie tickets well over $10, this could be a significant savings to SFDDA members. Enjoy evenings and holidays at the movies, and don't feel like you are paying a week's wages just for tickets.

Now think of the intangible benefits of membership in the ADA, the FDA and the SFDDA. Think about the legislative changes, both statewide and national, that have benefited you and your profession over the last decade or more. This is due to the excellent lobbying efforts made by organized dentistry on your behalf. In fact, three major bills supported by the FDA , withing this past year alone, were signed into law - SB86 Non Covered Services, SB520 Dental Workforce Survey Public Records Exemption, and HB97 Sovereign Immunity (see SFDDA Newsletter Summer Issue 2014 for complete details on these laws). Your SFDDA delegation to the FDA House of Delegates also rallied the FDA to successfully lobby the Board of Dentistry to oppose and postpone the recently proposed records rules changes, which were felt to be legally harmful to the dental profession in Florida. All of the aforementioned is worth even more than the dollar savings you receive with your membership.

Consider also the opportunities you have to interact with fellow professionals in both a social and an educational setting and the networking opportunities organized dentistry provides for you.

As you can see, the cost of your membership is repaid many times over and definitely worth keeping. Please renew and please recruit.

There is always a need for dentists to organize behind their profession.

Please do not ever hesitate to call the SFDDA office and suggest ideas for new and beneficial programs or services that the SFDDA can provide. Our main telephone numbers are (305) 667-3647 (Dade County) and (800) 344-5860. We welcome your calls at any time.

Let’s do the math on how much value SFDDA Members receive: $ 700 - $1000 MWM Registration Fee and Continuing Education $1000+ Legal Fees (Peer Review) $ 500 - $1000 Employment Service/Placement Savings $1000+ New Patient Referral $ 3200 - $4000 Financial Benefits Available to SFDDA Members That’s over twice as much as what you pay for membership and this does not include the value of benefits receieved from the ADA and the FDA! 17

Advocacy Working for the Dental Profession Everyday FDA Director of Govermental Affairs, Ms. Joe Anne Hart (pictured left), was invited to attended the first meeting of the Miami Dade Dental Society in Coral Gables, September 9th.

She spoke directly to the membership about the role of government and the importance of advocacy today, after which she introduced three legislators who work to support the issues that are important to the dental profession, Senator Anitere Flores and Representatives Jose Diaz and Erik Fresen.

Fundraisers* and award presentations help develop relationships with legislators and others who live and work in your area and who may affect your practice and the care you deliver.

One way in which you can help is by becoming a Legislative Contact Dentist (LCD). This program is essential to building strong relationships with Senate and House members and educating them on the dental profession’s legislative priorities.

Contact the FDA Governmental Affairs Office and get involved. (850) 224-1089.

They were presented with this year’s legislative awards as follows: Rep. Jose Felix Diaz, FDA’s 2014 Legislator of the Year and both Rep. Erik Fresen and Sen. Anitere Flores received the “2014 Dr. Lewis Earle Legislative Service Award”.

* Fundraiser for Rep. Jose Javier Rodriguez at the home of Drs. Beatriz Terry and Edy Guerra pictured here with: Dr. Richard Mufson, Rep. Jose Javier Rodriguez, Dr. Orlando Dominguez, Dr. Mike Eggnatz, Ms. Yolanda Marrero

l-r: Rep. Jose Felix Diaz, Dr. Esteban Leon, Sen. Anitere Flores and Rep. Erik Fresen General Practices Boynton Beach

Gross

4 ops FFS/PPO

$600K

Net $148K

Coral Springs

5 ops Digital x-ray and pan

Ask $130K

Delray Beach

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Davie 6 ops PPO/HMO/FFS Miami Gardens 3 ops PPO/FFS/HMO Ft. Lauderdale 3 ops FFS/PPO Digital x-ray

$550K $98K $435K $113K Under Contract

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SOLD

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$375K

$120K

SOLD SOLD

W. Palm Beach 3+1 ops FFS/PPO Digital x-ray (2 days/wk)

Under Contract

Tamarac

$400K

4 ops FFS/PPO/HMO (3 days/wk)

$75K

Specialty Practices Hialeah

Pedodontic - Associate

Boca Raton

Associate GP or Pedo for pedo only office

2 days/week

Practice Ready Facilities Miami Shores

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Ask $350K

Miami (Kendall) 4 ops 2000 sf Fully Equipped Like New

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Hallandale

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** Net is Buyer Projected Net Income and Assumes 100% Financing of the Purchase Price **

To inquire about any of these, or for a complete list of available opportunities, please visit us at ADSflorida.com or call 954.431.3624 Local Representative: Stuart M. Auerbach, DDS ADS Florida, LLC - Licensed Real Estate Broker

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Classifieds

OPPORTUNITIES AVAILABLE PART TIME: High quality prosthodontist and periodontist needed for selective cases at my office. Please call or e-mail. David Vine, D.D.S.dvine@davidvinbedentist.com ORAL SURGEON, ENDODONTIST, GENERAL DENTIST: Excellent opportunity for associate dentist position available.

FT or PT, could lead to partnership. Start working immediately, Three locations, Miami/Homestead / Kendall area, state-ofthe-art facilities. Please call 786-404-6246 or/ and fax resume to 305-728-0582, or email to newapplicants@altimadentalgroup.com BEAUTIFUL MIAMI BEACH: location dental office in the Sheridan Center ( http://davidvinedentist.com ). Underutilized facility with two very competent dental assistants. Looking for general dentist or specialist to lease 3 to 4 days a week. Please call Dr. David Vine ( 305.538.1115or email: dvine@davidvinedentist.com ).

ORTHODONTIST WANTED: We are a growing dental group looking for an Orthodontist to join our dental team. Excellent compensation. English/Spanish required.

Call Manuel 305.915.2953

PEDIATRIC DENTIST WANTED: Excellent opportunity for Pediatric Dentist to share office space in a well established Orthodontic practice in Plantation Fl. Office is available 1-3 days per week. Ideal location in a spacious & modern facility located directly next to a large Pediatrician group practice. Perfect situation for an initial start up or satellite office location. Contact: pltnortho@gmail.com A BLOCKBUSTER OPPORTUNITY: Full or part time for General Dentists, Pedodontists, Periodontists, Oral Surgeons, Orthodontists and Endodontists. Generous compensation with unlimited potential.

Guaranteed referrals. Join our group specialty care practice with a significant general dental component. Established in 1975 in Aventura, Coral Springs, Delray Beach, Boynton Beach, Stuart, Ft. Pierce and Melbourne. Call: Kelly Oliver at (954) 4610172. Fax resume to: (954) 678-9539.

Email: careers@dentaland.net.

FLORIDA (SOUTHEAST AND ORLANDO): Seeking experienced General Dentists and Specialists to come grow with us! We offer excellent earning potential and the opportunity to focus on patient care in our state-of-the-art facilities. We take care of the administration (insurance claims, payroll/staffing, marketing, etc.) for you so that you can enjoy a work-life balance again! Take the next step in your career and apply online ww.gentledentalgroup.com/career or email your CV tocareers@gentledentalgroup.com today!

GENERAL DENTIST: Needed in Dade Co 30HR WK. Excellent salary . Holiday and Ins Pay 615-202-8864 or 615-300-8621

GENERAL DENTIST WANTED: Hialeah, Pembroke Pines or Kendall area, excellent compensation and bonus with guarantee income. Eng/Spanish required.

Call Manuel 305.915.2953

GENERAL / SPECIALIST: Ft/Pt Great opportunity for General Dentist / Specialist.

Excellent compensation, bonus and partnership positions. Multiple locations in South Florida. Please fax resume to (305) 7701232 or call Kathy (954) 430-2188 or email to haroldhui@aol.com The College of Dental Medicine at Nova Southeastern University: Located in Ft. Lauderdale, seeks prosthodontic dentists to serve one or two days a week as adjunct faculty in the Prosthodontic Dentistry Section.

Requirements: DDS/DMD or equivalent, advance education certificate studies in prosthodontic dentistry; Florida dental license preferred. Apply online at www.nsujobs.com to Adjunct Faculty under center name HPD/College of Dental Medicine. A letter of interest, C.V., and three professional letters of reference are required. For additional information, contact Dr. Sharon Siegel, Chair for Prosthodontic Section, scsiegel@nova.edu

OFFICE SPACE-SALE OR RENT DOWNTOWN MIAMI OFFICE: Looking for an Endodontist or Orthodontist to share space. Two plumbed ops fully furnished. Situated near downtown Miami & Brickell. Newly renovated with valet parking. Contact: drmiller@webperio.com DELRAY: 1000 sq. ft. office in one story professional plaza. Busy intersection. Rent includes free dental equipment (3 operatories), instruments, supplies and patients.

Lock-in long term low cost lease $1325 per month (no common area fees) This office is only available until end of this year. Call Dr. Lawrence Landis 561- 302-2221 e-mail lmlmrl@bellsouth.net

Want to buy, sell, hire, or announce?

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Place advertising in the SFDDA Newsletter Call Ms. Jackie Quintero at (305) 667-3647 ext. 13.

Or visit us on-line at www.sfdda.org

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21

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sfdda If you don’t read anything else in this newsletter, at least read this.

The South Florida District Dental Association (SFDDA) is one of the six component organizations throughout Florida that make up the Florida Dental Association (FDA), and part of the tripartite structure of organized dentistry which includes the American Dental Association (ADA).

The association was incorporated in the state of Florida in October, 1922 with only 35 charter members. Today it operates as a non-profit association under section 501(c)(6) of the IRS Code with over 1000 members throughout Monroe, Miami Dade and South Broward counties.

Centrally located in Coral Gables, the SFDDA is host to three affiliate societies located throughout our district. Our local affiliates consist of Miami Dade Dental Society, serving South Miami Dade County, North Dade-Miami Beach Dental Society, which serves North Miami Dade County and Miami Beach, and South Broward Dental Society, encompassing areas from Hallandale to Weston.

Each affiliate holds monthly continuing education meetings, where there is plenty of opportunity to receive CE credits, and to build both personal and professional relationships with your fellow dentists. The affiliate meetings also serve to inform members of many issues occurring within organized dentistry, including those on the legislative front which so much affect our dental profession.

Our organization leadership is made up of dedicated volunteers working together for the betterment of the dental profession on behalf of all its members. They include a 21 member council made up of the executive board and representatives from each affiliate society. Our Executive Council meets at least five times annually. Some council members are also delegates who attend the FDA House of Delegates in January and June. Other members of the SFDDA serve as representatives on various FDA Councils and Committees, and a smaller number of the group also represent us on a national level as members of the ADA delegation from Florida.

If you have ever thought, “Why should I join the ADA? There a plenty of others already doing the work for me?”

If so, let me ask you to think about this again.

Why join?

The old adage, “there is strength in numbers” is very much the truth. In order for the ADA, FDA and SFDDA to shape and enact changes in legislation, and in order to maintain the dental profession in the manner in which it was intended to be – numbers do count. It would certainly be more difficult for state boards, legislative bodies and other regulatory agencies to ignore 80% of the practicing dentists in the country (which, although an ideal number, is 20-25% or so higher than our current diminishing membership numbers), than it would be to ignore a group who comprise a much smaller percentage of the sum total of the profession they represent (i.e., such as the American Medical Association, of which only 20% or less of physicians in the US belong as members).

As for all of those volunteers doing the work for you – and yes, admittedly, not everyone is inclined, cut out, or has the opportunity, to serve as a volunteer leader in the tripartite (and that’s okay) – please keep in mind that you, as a grassroots members, are more important than anyone else, because the volunteer leadership is “there” for you, and “because” of you, and is working on your behalf.

If you are not a member of the ADA, please review the benefits, and the philosophical reasons for why you should join, and then, “just do it.” Become a member. A membership application has been conveniently enclosed for this purpose. And to those of you who are members, please do not hesitate to renew right away when you receive your membership renewal. Please also consider giving the enclosed application to someone else you may know who is not, but could be, and should be, a member of organized dentistry. Tell them why you belong.

Within the tripartite, you will find education, camaraderie and accomplishment. There is work to be done, and it cannot be done without you.

For more information on membership benefits including employment services & referal service visit www.sfdda.org

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