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December 2013

TEXAS DENTAL


Set Your Site on

Oral Health

Visit the new and improved TDA.ORG today!

1 9 4 6 A u s t i P : 5 1 t d a . o

S I H 3 5 S t e 4 0 0 n , T X 7 8 7 0 4 2 - 4 4 3 - 3 6 7 5 r g


TEXAS Dental Journal Established February 1883

Cover

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Vol 130, No 12

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December 2013

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ABOUT THE COVER

Pictured on the front cover are the Greater Houston Dental Society’s (GHDS) Star Council members: Dr Greg Condrey of Sugar Land, General Chair Dr Michael Hodapp of Houston, Dr Lee Clitheroe of Sugar Land, and Dr Dean Hutto of Baytown. The GHDS’s 43rd annual meeting, Star of the South, will be March 27-29, 2014, at the George R. Brown Convention Center in Houston, Texas. To register or for more information about the meeting, “Visualizing the Future of Dentistry,” please visit starofthesouth.org or contact GHDS Meeting Planner Charlotte Bolls, 713-961-4337.

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TDA GOVERNANCE: CALL FOR NOMINATIONS CASE REPORT OF AN ORAL FIBROMA OCCURRING IN A PATIENT WITH FAMILIAL MULTIPLE LIPOMAS Lida Radfar, DDS, MS; Tyler Holt; Farah Masood, DDS, MS The authors present a case report on a simple oral mass in a patient who had an oral fibroma and lipomas in other areas.

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Spontaneous Regeneration of Bone After resection of central giant cell lesion: a case report Roger R. Throndson, DDS, FACD; John Mark Johnson, DDS The authors report a rare case of spontaneous bone formation after resection of a central giant cell granuloma in the anterior mandible of a pediatric patient and the importance of maintaining the periosteum during surgical resection.

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STAR OF THE SOUTH: visualizing the future of dentistry The 43rd annual Star of the South Dental Meeting “Visualizing the Future of Dentistry,” sponsored by the Greater Houston Dental Society, will be March 27-29, 2014, at the George R. Brown Convention Center in Houston, Texas. Earn CE credits and learn from top experts on the latest in today’s lasers, bonding agents, implants, 3D technology, orthopedic/orthodontic techniques, and oxygen/ozone therapy.

MONTHLYFEATURES

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President’s Message The View From Austin Oral and Maxillofacial Pathology Case of the Month Notice of Grant Availability Critically Appraised Topic of the Month In Memoriam Memorial and Honorarium Donors TDA 2013 Index of Feature Articles TEXAS Meeting Preview Texas Dental Journal l www.tda.org l December 2013

1228 Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management 1230 Calendar of Events 1232 Value for Your Profession 1236 2013 TDA Annual Session TEXAS Meeting Photo Contest Winner 1237 Advertising Briefs 1254 Index to Advertisers

Errata

The Texas Dental Journal regrets the inadvertent transposition of the author names and pictures in the November 2013 Texas Dental Journal “Oral and Maxillofacial Case of the Month.” The Journal apologizes for this oversight.

TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.


Editorial Staff

Editorial Advisory Board

BOARD OF DIRECTORS TEXAS DENTAL ASSOCIATION

Stephen R. Matteson, DDS, Editor-in-Chief Daniel L. Jones, DDS, PhD, Associate Editor Harvey P. Kessler, DDS, MS, Associate Editor Nicole Scott, Managing Editor Lauren Oakley, Publications Coordinator Barbara Donovan, Art Director Paul H. Schlesinger, Consultant

Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD William C. Bone, DDS Phillip M. Campbell, DDS, MSD Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Scott R. Makins, DDS Daniel Perez, DDS William F. Wathen, DMD Robert C. White, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS

The Texas Dental Journal is a peer-reviewed publication. Texas Dental Association 1946 S IH-35 Ste 400, Austin, TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 E-mail: tda@tda.org • Website: tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly, one issue will be a directory issue, by the Texas Dental Association, 1946 S IH-35, Austin, TX, 78704-3698, 512-443-3675. Periodicals Postage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35, Austin, TX 78704. Copyright 2013 Texas Dental Association. All rights reserved. Annual subscriptions: Texas Dental Association members $17. In-state ADA Affiliated $49.50 + tax, Out-ofstate ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affiliated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 NonADA Affiliated. For in-state orders, add 8.25% sales tax. Contributions: Manuscripts and news items of interest to the membership of the society are solicited. Electronic submissions are required. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. For more information, please refer to the Instructions for Contributors statement printed in the September Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles. Advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of the quality of value of such product or of the claims made of it by Texas Dental Journal is a member of the its manufacturer. American Association of Dental Editors. Member Publication

PRESIDENT David A. Duncan, DDS 806-355-7401, davidduncandds@gmail.com PRESIDENT-ELECT David H. McCarley, DDS 972-562-0767, drdavid@mccarleydental.com IMMEDIATE PAST PRESIDENT Michael L. Stuart, DDS 972-226-6655, mstuartdds@sbcglobal.net VICE PRESIDENT, NORTHWEST David C. Woodburn, DDS 806-358-7471, olddave1@gmail.com VICE PRESIDENT, NORTHEAST Jean E. Bainbridge, DDS 214-388-4453, jbainbridgedds@sbcglobal.net VICE PRESIDENT, SOUTHEAST Gregory K. Oelfke, DDS 713-988-0492, greg@oelfke.com VICE PRESIDENT, SOUTHWEST Yvonne E. Maldonado, DDS 915-855-2337, yvonnedent2000@yahoo.com SENIOR DIRECTOR, NORTHWEST Steven J. Hill, DDS 806-783-8837, sjhilldds@aol.com SENIOR DIRECTOR, NORTHEAST Jerry J. Hopson, DDS 903-583-5715, dochop@verizon.net SENIOR DIRECTOR, SOUTHEAST William S. Nantz, DDS 409-866-7498, wn3798@sbcglobal.net SENIOR DIRECTOR, SOUTHWEST Joshua A. Austin, DDS 210-408-7999, jaustindds@me.com DIRECTOR, NORTHWEST Charles W. Miller, DDS 817-572-4497, cwdam@sbcglobal.net DIRECTOR, NORTHEAST William H. Gerlach, DDS 972-964-1855, drbill@gerlachdental.com DIRECTOR, SOUTHEAST Karen A. Walters, DDS 713-790-1111, kwalters@sms-houston.com DIRECTOR, SOUTHWEST John B. Mason, DDS 361-854-3159, jbmasondds@aol.com SECRETARY-TREASURER Ron Collins, DDS 281-983-5677, roncollinsdds@yahoo.com SPEAKER OF THE HOUSE John W. Baucum III, DDS 361-855-3900, jbaucum3@msn.com PARLIAMENTARIAN Michael Vaclav, DDS 806-355-7463, drvaclav@suddenlinkmail.com EDITOR Stephen R. Matteson, DDS 210-215-1515, texdented@gmail.com INTERIM EXECUTIVE DIRECTOR Michael L. Stuart, DDS 512-443-3675, mstuartdds@sbcglobal.net LEGAL COUNSEL Mr. William H. Bingham 512-495-6000, bbingham@mcginnislaw.com

Texas Dental Journal l www.tda.org l December 2013

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Get ready for a monumental experience in our nation’s capitol. Attend the ADA 26th New Dentist Conference A Monumental Experience The Capital Hilton, Washington, D.C. • June 22-24, 2012

Convene in our nation’s Capitol Meet new and old colleagues and discuss the unique challenges and opportunities facing today’s new dentists (dentists less than 10 years out of dental school). Join the ADA New Dentist Committee for an all-inclusive weekend of networking, continuing education and camaraderie and discover how you can be a better dentist, a stronger leader and more effective communicator.

Scheduled speakers and CE courses include: Don’t miss… Unique networking opportunities

• Dr. Roger Levin, Set Your Practice on Fire: Strategies for Increasing Production and Creating a Superior Practice • Dr. Sam Low, Emerging Technologies and the Perio Patient • Dr. David Hornbrook, Hot Topics in Esthetic and Restorative Dentistry

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• Ms. Teri Yanovitch, Unleashing Excellence Through the Patient Experience

Breakfast and Learn sessions

• Dr. Donald Lewis, Employee Embezzlement and Fraud — Detection, Protection and Prosecution

Full day of leadership development All-inclusive lunches Fantastic Saturday night event

• Fresh Perspectives from Emerging Speakers Dr. Tanya Brown, Connecting the Dots — Create Powerful Patient Experiences Dr. Gautam Govitrikar, Risk Management for the New Dentist Dr. Ann Bynum, The Perfect Storm — Ride the Waves or Surrender to the Undertow Dr. Robert Delie, The Single Tooth Implant — Start to Finish Also, get your morning started at the all new Breakfast and Learn sessions being held on Saturday, June 23. Enjoy a hot breakfast and learn about select products and services that can help you be a better a dentist and achieve success.

Visit ADA.org/newdentistconf for more information and to register. Find us!

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President’s Message David Duncan, DDS, TDA President

I have seen our staff step up and conduct business in the professional manner to which we have grown accustomed. I have seen one of our own members, Dr Michael Stuart, volunteer and do an excellent job as the interim executive director.

I

hope this finds you well and full of the holiday spirit. Hard to believe another year has passed, and we find ourselves in the middle of the hustle and bustle of Christmastime. As I reflect on the first half of this presidency, it would be really easy to feel like things have gone awry. But as we all know, out of every struggle comes growth. I have seen our staff step up and conduct business in the professional manner to which we have grown accustomed. I have seen one of our own members, Dr Michael Stuart, volunteer and do an excellent job as the interim executive director. I have been humbled by the willingness of some past presidents to conduct the search for a new executive director. And, I have seen a board of directors bind together and complete the work of TDA in a timely and professional manner beyond compare. With the passing of another ADA annual session, we saw Dr Glen Hall of Abilene conduct an almost flawless House of Delegates. No surprise to those of us who have spent many a day in his Houses here in Texas! Congratulations, Glen! You are making us proud. I actually look forward to the coming year and the possibility of a new executive director. I am hopeful that the search progresses quickly and we are able to bring you news soon. The drive will be towards finding the right person for the job rather than getting the job done quickly, so I thank you for your patience in advance. In closing, I wish you and your families the happiest of holidays. May this next year be prosperous, healthy, and safe for us all.

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Texas Dental Journal l www.tda.org l December 2013


The View From Austin Stephen R. Matteson, DDS, FICD, Editor-in-Chief

Thank You, Reviewers The Editor of the Texas Dental Journal, on behalf of the Texas Dental Association, wishes to express his sincere appreciation to the manuscript reviewers for 2013. The quality of clinical science articles is largely dependent on the judgment and advice provided by these individuals. Below is the list of the reviewers for 2013. Dr Donald M. Belles Dr Charles Bloomer Dr David P. Cappelli Dr Cara Gonzales Dr Maria Gonzalez Dr Stephen J. Haney Dr Larry Herwig Dr Jeffrey Hicks Dr Arthur H. Jeske Dr Archie A. Jones Dr John D. Jones Dr Larry D. Jones Dr Raymond Koeppen Dr Howard S. McGuff Dr Rahma Mungia Dr William Nagy Dr Barry K. Norling Dr Kalu Ogbureke Dr Daniel Perez Dr Hugh P. Pierpont Dr H. Ralph Rawls Dr Ron Rhea Dr John Rugh Dr Richard R. Seals Jr Dr Ilser Turkyilmaz Dr William F. Wathen Dr. Leighton A. Wier Dr Robert C. White Dr Douglas B. Willingham Dr. Edward F. Wright

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Texas Dental Association Notice of Grant Availability 501(c)(3) Non-Profit Dental Organizations The Texas Dental Association (TDA) announces availability of financial assistance for qualifying 501(c) (3) non-profit organizations affiliated with dentistry. The monies are derived from TDA Relief Fund interest income earned over the previous fiscal year. Grantees will be determined by the TDA Board of Directors. Eligibility: Grantees must be 501(c)(3) non-profit organizations affiliated with dentistry. Application: Letters of interest detailing the proposed project and associated budget should be mailed to: TDA Board of Directors Attn.: Mr Terry Cornwell 1946 S IH 35 Ste 400 Austin, TX 78704 Deadline: Letters of interest must be postmarked no later than January 31, 2014. Approval: Letters of interest will be reviewed and considered by the TDA Board of Directors at its February 2014 meeting. Notification: All recipients will be notified in writing by May 15, 2014. Previous Recipients: In 2013, grants in the amount of $2,100 were awarded to each of the following Texas organizations for direct patient care related expenses: Christian Community Action (Lewisville); Community Health Center of Lubbock; Dentists Who Care (Edinburg); and San Jose Clinic (Houston). Additionally, $2,100 was awarded for Hurricane Sandy Disaster Relief. For more information, please contact TDA Governance Manager Terry Cornwell, 512-443-3675 or terry@tda.org.

Texas Dental Journal l www.tda.org l December 2013

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AGD Codes for all programs: 132 Anesthesia & Pain Control; 163 Conscious Sedation; 164 Oral Sedation The above continuing education programs fulfill the TSBDE Rule 110 practitioner requirement in the process to obtain selected Sedation permits. This is only a partial listing of sedation courses. Please consult our website for updates and new programs. Find us on the web at www.sedationce.com Call us at 214-384-0796 to register for any program

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ORAL and MAXILLOFACIAL PATHOLOGY LABORATORY Anne Cale Jones, DDS H. Stan McGuff, DDS

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Oral and Maxillofacial Pathology Case of the Month Clinical History A 30-year-old Caucasian male presented to an oral and maxillofacial surgeon (JH) with a pedunculated, firm ulcerated lesion on the dorsal surface of the tongue just anterior to the circumvallate papillae. The anterior portion of the tongue displayed an extensive nodular, bluish appearance (Figure 1). The right side of the hard palate, from the lingual sulci of the adjacent teeth to the midline, was swollen and spongy to palpation, and demonstrated a blue to purple discoloration (Figure 2). A slightly smaller purple macular discoloration was noted on the left hard palate. The patient stated that the lesions were non painful and were first noticed 2 months ago after scalding the oral mucosa after drinking hot coffee. The clinical impression of the dorsal tongue lesion was a pyogenic granuloma while the palatal lesion was thought to represent a burn, mucoepidermoid carcinoma, or melanoma. The patient’s past medical history was unremarkable except for an allergy to codeine and oral candidiasis, which was being managed with fluconazole by the patient’s physician. The patient denied cardiovascular, pulmonary, hepatic, and renal disease, diabetes, immunodeficiency, and drug abuse. The patient did not smoke and had

Anne Cale Jones, DDS, Department of Pathology, University of Texas Health Science Center at San Antonio, Texas. H. Stan McGuff, Jones McGuff Holbrook DDS, Department of Pathology, University of Texas Health Science Center at San Antonio, Texas. Jerome Holbrook, DDS, private practice, oral and maxillofacial surgery, Tucson, Arizona. Figure 1. Pedunculated, firm lesion arising from the dorsal surface of the posterior tongue just anterior to the circumvalate papillae. The center and anterior tongue displays a bluish tinge with a nodular appearance.

Figure 2. Enlarged blue to purple discoloration on the right side of the hard palate from the lingual sulci of the adjacent teeth to the midline. A smaller purple macular discoloration is noted on the left hard palate.

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no history of any hospitalizations, surgeries, or chronic illnesses. An excisional biopsy of the dorsal tongue lesion and an incisional biopsy of the lesion involving the right hard palate were performed and submitted for histologic examination.

Pathologic Findings

The tongue biopsy consisted of a gray lobulated piece of soft tissue measuring 1.2 x 1.0 x 0.6 cm, while the biopsy from the right hard palate consisted of a gray ellipse of soft tissue 0.8 x 0.5 x 0.3 cm. Microscopic examination of both specimens revealed partially ulcerated surface stratified squamous epithelium covered by a focally thickened layer of parakeratin interspersed with bacterial organisms. The underlying fibrous connective tissue was markedly cellular with the superficial portion containing numerous ectatic vessels surrounded by smaller vessels. The vessels were lined by bland appearing endothelial cells. The deeper connective tissue demonstrated a fascicular growth pattern composed of numerous spindle shaped, and round to oval shaped cells, exhibiting focal mitotic figures (Figure 3). Scattered slit-like spaces containing erythrocytes were noted in the surrounding connective tissue, along with extravasted erythrocytes, hemosiderin, and an acute and chronic inflammatory reaction. An HHV-8 (human herpesvirus 8) immunohistochemical stain, with appropriate positive and negative controls, revealed positive nuclear staining in the endothelial cells lining the ecstatic vessels, and in the spindle shaped and round to oval shaped cells in the deeper connective tissue (Figure 4).

Figure 3. Connective tissue demonstrates a fascicular growth pattern composed of numerous spindle shaped, to round and oval shaped cells. Focal ectatic vessels are noted in the upper left corner (original magnification 10x).

Figure 4. HHV-8 immunohistochemical stain demonstrates positive nuclear staining in spindle shaped and round to oval shaped tumor cells (original magnification 20x).

What is the most likely diagnosis? See page 1228 for discussion and answer. Texas Dental Journal l www.tda.org l December 2013

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Official Call for Nominations

Official Call for Nominations: Statewide Election of TDA President-elect

Official Call for Speaker of the House Nominations

CHAPTER VI, Section 30 of the TDA Bylaws state that the president-elect shall be nominated in turn clockwise from and by the members of each of the 4 divisions — Southeast, Southwest, Northwest, and Northeast. Every third year the president-elect shall be nominated on a statewide basis. The divisional rotation of the president-elect will continue in the intervening years.

Nominations for the elective office of TDA Speaker of the House may be submitted to TDA Secretary-Treasurer Dr Ron Collins. Only an active, life, or retired member in good standing of this Association shall be eligible. A curriculum vitae (CV) must accompany a letter of intent and the nominee will also have to sign a conflict of interest statement. If a CV is not submitted, the nominee must present his or her qualifications verbally before the House of Delegates. Nominations are in order at any time until the close of nominations at the beginning of the next to the last meeting of the House of Delegates; however, we request that nominations be made as early as possible so that membership eligibility can be verified.

Nominations statewide for the elective office of Texas Dental Association (TDA) president-elect may be submitted to TDA Secretary-Treasurer Dr Ron Collins. Only an active, life, or retired member in good standing of this Association shall be eligible. A curriculum vitae (CV) must accompany a letter of intent, and the nominee will also have to sign a conflict of interest statement. If a CV is not submitted, the nominee must present his or her qualifications verbally before the House of Delegates. Nominations are in order at any time until the close of nominations at the beginning of the next to the last meeting of the House of Delegates; however, we request that nominations be made as early as possible so that membership eligibility can be verified. Duties of the president are found in the Bylaws and include the following: a. To preside in the absence of the president. b. To assist the president as requested. c. To serve as an ex-officio member of the Board of Directors and the House of Delegates. d. To perform such other duties as may be provided in these Bylaws. e. To succeed to the office of president at the next annual session of the House of Delegates following his/her election as president-elect. f. To serve on the Council of Legislative and Regulatory Affairs. g. To serve as chair of the Committee of Component Society Presidents. Duties of the subsequent position of TDA president are also enumerated in the Bylaws and include the following: a. To serve as official representative of this Association in its contacts with governmental, civic, business, and professional organizations for the purpose of advancing the objectives and policies of this Association. b. To serve as an ex-officio member of the Board of Directors of the Association. c. To be presiding officer of the Board of Directors of this Association. d. To be the supervising authority of the executive director on behalf of the Board of Directors. e. To annually appoint the parliamentarian for the Association who shall serve as the speaker pro-tem of the House of Delegates, should it become necessary for the speaker to be absent. f. To call special sessions of the House of Delegates and Board of Directors as provided in Chapters IV and V of these Bylaws. g. To appoint, with approval of the Board of Directors, the members of all committees and such others as may be necessary to the work of the Association except as otherwise provided in these Bylaws. h. To submit an annual report to the House of Delegates at the first session concerning his/her activities during the year and presenting such matters as should be brought to his or her attention, or may require his or her action. i. To conduct annually a presidents-presidents-elect conference for component presidents and presidents-elect. j. To perform such other duties as may be provided in the TDA Bylaws. Nominations are to be mailed to TDA Secretary-Treasurer Dr Ron Collins, Texas Dental Association, 1946 S IH-35 Ste 400, Austin, TX 78704; or e-mailed to TDA Interim Executive Director Dr Michael L. Stuart, mstuartdds@sbcglobal.net. (Ref. TDA Bylaws, Chapter VI – Sections 30 and 90A,B)

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Duties of the speaker of the house are found in the Bylaws and include the following: a. To serve as an ex-officio member of the Board of Directors without vote. b. To serve as an ex-officio member of the Executive Committee without vote. c. To preside at all meetings of the House of Delegates. d. To determine the order of business for all meetings, subject to the approval of the House of Delegates, in accordance with Section 140B of this Chapter. e. To appoint tellers to assist him/her in determining the result of any action taken by vote. f. To appoint members of Reference Committees in consultation with the president, president-elect, and the immediate past-president by the first Board of Directors meeting of the calendar year. g. To notify the divisional officers and the Committee on Credentials, Rules and Order, prior to the annual session, the number of delegates and alternates necessary to constitute a quorum. h. To meet with the divisional officers prior to the meeting of the divisional caucuses at the annual session to review the Rules For Caucus Procedures, Nominations, and Elections. i. To appoint a parliamentarian pro tem,


should it become necessary for the parliamentarian to be absent during a session of the House of Delegates. j. When the need shall arise, appoint special committees to perform duties not otherwise assigned by these Bylaws, to serve until adjournment sine die of the session at which they were appointed. k. In the event that the divisional nominee for a particular office be declared ineligible, that the speaker of the House of Delegates shall direct the divisional caucus to reconvene to select a new nominee. l. The installation of officers shall be held during the closing meeting of the House of Delegates at such time as determined by the speaker and conducted by the retiring president or past-president. The term of new officers begins at the adjournment of the House of Delegates. m. The secretary of this Association shall serve as the secretary of the House of Delegates. In absence of the secretary, the speaker shall appoint a secretary of the House of Delegates pro-tem. Nominations are to be mailed to TDA Secretary-Treasurer Dr Ron Collins, Texas Dental Association, 1946 S IH-35 Ste 400, Austin, Texas 78704; or e-mailed to TDA Interim Executive Director Dr Michael L. Stuart, mstuartdds@sbcglobal.net. (Ref. TDA Bylaws, Chapter IV – Sections 100, 110A, 150C, 150D, Chapter V – Sections 10, 70Aa, and the TDA House Manual).

Official Call for Secretary-Treasurer Nominations Nominations for the elective office of TDA secretary-treasurer may be submitted to TDA Secretary-Treasurer Dr Ron Collins. Only an active, life, or retired member in good standing of this Association shall be eligible. A curriculum vitae (CV) must accompany a letter of intent and the nominee will also have to sign a conflict of interest statement. If a CV is not submitted, the nominee must present his or her qualifications verbally before the House of Delegates. Nominations are in order at any time until the close of nominations at the beginning of the next to the last meeting of the House of Delegates; however, we request that nominations be made as early as possible so that membership eligibility can be verified. Duties of the secretary-treasurer are found in the Bylaws and include the following: a. Examine the income and expenses of this Association and report at each meeting of the Board of Directors. b. Serve as recording officer and custodian of the records of the House of Delegates and the Board of Directors. c. Ensure that the minutes of the House of Delegates and the Board of Directors be maintained. d. Serve as secretary to the Executive Committee, without the right to vote. e. Serve as secretary to the House of Delegates. f. Serve as chair of the Budget Committee. g. Serve as chair of the Assets Oversight Committee. h. Serve as the secretary of the American Dental Association Fifteenth Trustee District Delegation. i. Perform such other duties as shall be specified by the Board of Directors and these Bylaws. Nominations are to be mailed to TDA Secretary-Treasurer Dr Ron Collins, Texas Dental Association, 1946 S IH-35 Ste 400, Austin, Texas 78704; or e-mailed to TDA Interim Executive Director Dr Michael L. Stuart, mstuartdds@sbcglobal.net. (Ref. TDA Bylaws, Chapter IV – Sections 70A-B, 110B; Chapter V – Sections 10, 70Aa, 80B; Chapter VI – Section 90G; Chapter VIII – Section 80)

Official Call for Editor Nominations Nominations for the elective office of TDA editor may be submitted to TDA SecretaryTreasurer Dr Ron Collins. Only an active, life, or retired member in good standing of this Association shall be eligible. A curriculum vitae (CV) must accompany a letter of intent and the nominee will also have to sign a conflict of interest statement. If a CV is not submitted, the nominee must present his or her qualifications verbally before the House of Delegates. Nominations are in order at any time until the close of nominations at the beginning of the next to the last meeting of the House of Delegates; however, we request that nominations be made as early as possible so that membership eligibility can be verified. Duties of the editor are found in the Bylaws and include the following: a. To be editor-in-chief of all journals and publications of the Association and exercise full editorial control over such publications, subject only to policies established by the House of Delegates, Board of Directors, and these Bylaws and provided such content is not in conflict with or contrary to the TDA’s established policies, legislative agenda, or advocacy efforts. b. To control the selection of scientific material published in the Journal. The editor may appoint associate editors, with the concurrence of the Board of Directors, to gather and/or review material for publication. Such associate editors shall serve as long as the editor deems necessary; but never longer than the term of the editor. c. To attend all open meetings of the Board of Directors and the House of Delegates of this Association, and the annual session of the American Dental Association. d. To hold no other elective office in this Association or the American Dental Association while serving as editor, except the editor may be elected as delegate or alternate delegate to the ADA House of Delegates from his/her respective division. Nominations are to be mailed to TDA SecretaryTreasurer Dr Ron Collins, Texas Dental Association, 1946 S IH-35 Ste 400, Austin, Texas 78704; or e-mailed to TDA Interim Executive Director Dr Michael L. Stuart, mstuartdds@ sbcglobal.net. (Ref. TDA Bylaws, Chapter VI – Section 90I)

Texas Dental Journal l www.tda.org l December 2013

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CASE REPORT

Abstract

Case Report of an Oral Fibroma Occurring in a Patient with Familial Multiple Lipomas

A wide variety of lesions may manifest in the oral soft tissues that could be confusing and challenging for the clinicians. These lesions could be as simple as trauma-induced ulcers that need about 2 weeks to heal, to a more complicated situation such as oral cancer. The key points in developing diagnosis and a possible treatment plan may include a comprehensive oral examination, simple understanding of normal oral tissue features, and knowledge of common oral lesions. This will help in the development of a differential diagnosis of the oral lesions/masses based on the risk factors in that particular patient. In this case report, we present a simple oral mass in a patient who had an oral fibroma and lipomas in other areas.

Lida Radfar, DDS, MS Tyler Holt Farah Masood, DDS, MS

Introduction Irritation fibromas are the most common benign soft tissue tumors seen in the oral cavity. This focal reactive hyperplasia occurs due to irritation or trauma. The mass includes granulation tissue and scar formation due to the repair process. The size of these lesions does not usually exceed 1 to 2 cm. The fibroma occurrence corresponds with intraoral areas that are prone to trauma such as the tongue, buccal mucosa, and labial mucosa (1).

Case Report A 79-year-old female presented to the University of Oklahoma College of Dentistry to get a new set of dentures. The patient was edentulous and had been wearing dentures for 58 years. She had no other complaints. Medical history was significant for controlled type 2 diabetes, hypertension, high

Radfar

Holt

Masood

Dr Radfar is a diplomate, American Board of Oral Medicine; associate professor of oral medicine, University of Oklahoma College of Dentistry, Oral Diagnosis and Radiology Department, Oklahoma City, OK. Tyler Holt is a senior dental student.

Key words: oral

Dr Masood is a diplomate, American Board of Oral and Maxillofacial Radiology; professor and director of radiology, Department of Oral Diagnosis & Radiology, University of Oklahoma College of Dentistry, Oklahoma City, OK.

lesions, lipoma, fibroma

Corresponding author: Lida Radfar, DDS, MS, 1201 N Stonewall, OKC, OK 73117; Phone: 405271-5988; Fax: 405-271-3158; E-mail: lida-radfar@ouhsc.edu. The authors have no declared potential conflicts of financial interest, relationships, and/or affiliations relevant to the subject matter or materials discussed in the manuscript.

Tex Dent J 2013;130(12): 1195-1199.

This manuscript has been peer reviewed. Texas Dental Journal l www.tda.org l December 2013

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cholesterol, temporal arteritis, deep vein thrombosis (2 years ago), and glaucoma. Her medications included lisinopril, lipitor, metformin, prednisone, and warfarin. She did not have history of smoking or alcohol use. The patient was estimated to have 40-50 lipomas on her body and 16 of them had been removed from her legs and arms in the past years. Patient reported that her mother, brother, and a grandmother had the similar nodules on their bodies. Examination revealed a round white-yellowish sessile nodule about 5x5 mm on the occlusal line of the left buccal mucosa (Figure 1). The nodule was asymptomatic, soft, and movable. The patient had been aware of that nodule for a long time. Discussion of the differential diagnosis lead the patient to show us the multiple lipomas on her arms. The masses on the arms varied in size (5-10 cm), each with the shape of a circular lump (Figure 2). Based on the history and clinical findings, a differential diagnosis was established, which included lipoma, fibroma, neurofibroma, and mucocele. Our patient was taking warfarin (10 mg/day). She had an INR of 1.8 (recommended level for biopsy is 2 to 3). Her prednisone dose (5 mg/ day) was low, which is considered under the physiologic limit, and thus, no adjustment was required prior to the surgical procedure. An excisional biopsy was performed under local anesthesia. A single intraoral mass was removed and sent in 10% formalin for histopathological examination. The patient tolerated the biopsy procedure well, and hemostasis was achieved without

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Figure 1. Mass on the buccal mucosa.

Figure 2. Lipoma on the arm and scar from previous lesion removal.

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CASE

complications. Hematoxiline and eosin (H&E) staining showed parakeratinized stratified squamous epithelium in association with a nodular proliferation of dense fibrous connective tissue within the lamina propria (Figures 3 and 4). The biopsy findings were consistent with fibroma. However, earlier, a very soft and whitish clinical appearance of the nodule and history of the patient lead us to adopt lipoma as working diagnosis (although treatment is not different). However, the histological exam did not show any fatty tissue but instead showed dense connective tissue. The lesion was treated by the excisional biopsy. Interestingly in this case we found an intraoral fibroma that clinically resembled lipoma, and this patient also reported a family history of lipomas.

Discussion of Differential Diagnosis Options Fibroma: It is commonly seen in the oral cavity. Fibroma may appear as a smooth-surface pink nodule, although it can appear white because of hyperkeratosis and ulceration due to irritation. Fibroma is a benign neoplasm. It is considered a hyperplasia of fibrous connective tissue due to irritation or trauma and does not have a risk of malignancy. Prevalence studies show a relatively common occurrence of fibromas (range 1.19/1000 to 77/1000) (1). Fibromas have a relatively easy management and are self-limiting. Simple excision is the preferred method of removal, and recurrence is rare with elimination of

irritation. They are also found to be more prevalent in males and older people (1). Familial multiple lipomas (FML) is a rare autosomal dominant hereditary disease that affects mostly extremities and trunk. There is huge fat accumulation, and multiple encapsulated lipomas are seen clinically (2). In the majority of the cases of FML, lipomas may be painless and the disease does not trouble patients. However, complications due to large fatty growths may include paresthesia of limbs, dyspnea, dysphasia, and sleep apnea. Madelung’s disease is an acquired form of lipomatosis. It is also known as benign symmetrical lipomatosis or multiple symmetrical lipomatosis. This occurs mostly in men and typical age of the patients is 30-60 years. It is a rare condition characterized by symmetrical growth or formation of fatty tumors or lipomas around the neck, shoulders, and arms, which is also referred to as Madelung’s collar (3). Another study found an association between this condition and alcoholism (4). Mediastinal lipomatosis is another rare but reported complication of long-term corticosteroid use (5). This is a benign condition, characterized as symmetric unencapsulated accumulation of fat in the mediastinum located mainly in the neck and shoulder region. Lipomas are benign tumors of fatty tissues. These slow-growing benign tumors appear typically in patients over 40 years old and are rarely seen in children. About 1-4% of lipomas are seen in the oral cavity. They represent 0.1-5% of all benign tumors in the mouth. The size can vary with a mean of 2.1 cm (6). Familial

REPORT

multiple lipomatosis that appear more on the trunks and extremities, is a rare hereditary syndrome (7). Our patient may have the condition but was not tested for it. Oral lipomas appear as smooth and soft nodules. They are asymptomatic, and most patients will not bring this nodule to the attention of their dentist, as they have noted it for months or years. They can appear yellow, but if deeper, the lipomas will appear pink in color. The most common location to find them is on the buccal mucosa. The tongue, floor of the mouth, and lips are less common sites. Lipomas consist of mature fat cells that may be encapsulated (1,6). Neurofibromas are uncommon lesions, derived from nerve fibers, the perineurium, the endoneurium and the neurolemmomal cells. In the oral cavity, the most common locations are tongue and buccal mucosa. They are the most common type of peripheral nerve neoplasm. The size and shape can vary but they appear as a smooth nodular mass. Neurofibromas are slow growing soft nodules that are usually asymptomatic. These masses can form solitarily or as part of systemic neurofibromatosis. The typical age that solitary tumors arise is in the young adult (7). Mucoceles are common asymptomatic benign lesions that appear as raised soft and sometimes light bluish masses inside the lower lips, buccal mucosa or floor of the mouth. Mucocele can be a salivary ductal cyst (true cysts or retention of saliva in the duct) or a mass from leaking saliva into floor of the mouth. When one occurs on the floor of the mouth, it is

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called a ranula. It can appear, usually following trauma, at any age, with no gender predilection (1). Other neural tumors such as schwanoma and solitary circumscribed neuroma may also be included in the differential diagnosis of this case.

Diagnosis and Management of Fibroma Removal of the lesion (excisional biopsy) is recommended for definite diagnosis as well as the treatment. Spontaneous recurrence of fibromas after surgical removal is rare (1). Familial multiple lipomatosis is a rare hereditary syndrome that our patient may have, but for which she was never tested. This patient remembers her grandmother, mother, and brother all having similar lesion (lipomas). She may have this rare hereditary syndrome herself, but her only son did not have it at the time, since the disease does not usually appear until after age 30 (7). Future studies in patients with familial multiple lipomatosis are needed to understand the effects of the syndrome in the oral cavity.

Figure 3. Note: Hematoxylin and eosin, x20 magnification: this section reveals soft tissue specimen composed of squamous mucosa.

Discussion of Patient’s Medications Patients on anticoagulants: The patients taking warfarin need special care with dental procedures. Warfarin is an anticoagulating agent that works by inhibiting vitamin K-dependent coagulation factors (factor II, VII,

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Figure 4. Note: higher magnification (x20) H&E staining: reveals a superficial layer of unremarkable stratified squamous epithelium associated with a nodular proliferation of dense fibrous connective tissue within the lamina propria.

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CASE

IX, and X) in patients prone for clot formation. Most common reasons to take warfarin include atrial fibrillation, mechanical heart valve, deep vein thrombosis and/or pulmonary embolism, recent heart attack, stroke, and heart failure. Warfarin takes full effect 72 hours after administration and has a half-life of 36 hours. In order to control bleeding in patients who are taking warfarin, prothrombin time (PT) and international normalized ratio (INR) are closely monitored. The normal range of PT is 11-13 seconds. Due to variability of reagents used in the laboratories, and to have a reliable number in measuring patients’ PT, the INR value is used. The INR was introduced by World Health Organization in 1983 (8). INR provides information about the clotting tendency of blood. Normal value of INR is 1.00. An INR of 2-3.5 is needed for dental procedures that may cause bleeding (9). Patients on Glucocorticoids: Our patient was taking prednisone for treatment of temporal arthritis. Temporal arthritis or giant cell arteritis is inflammation of temporal arteries (vasculitis). The etiology is unknown. It generally occurs in older adults over the age of 60, and females are affected more than males. It affects blood flow to the eye, and loss of vision can occur. Loss of vision can be prevented by immediate diagnosis and treatment. Temporal arteries are commonly affected, but this condition can happen to any other medium or larger artery. It is an emergency condition and the treatment of choice is administration of corticosteroids (10).

The patients taking corticosteroid for more than 2 weeks are at risk for developing adrenal suppression and may require prophylaxis dose of prednisone prior to some dental treatments including surgical procedures. The prophylaxis dose depends on the previous dosage and duration of the corticosteroid therapy. Patients who are treated with supraphysiologic dose of corticosteroids (>7.5 mg of prednisone or 30 mg of hydrocortisone equivalent per day) for 2 weeks or more are at risk of developing adrenal suppression. Adrenal suppression may last up to 1 year following corticosteroid treatment, but response to stress will return to normal after 2-4 weeks. Therefore, patients who stop treatment about 1 month before the dental treatment do not need a supplemental dose of corticosteroids. Patients who use doses higher than 7.5 mg of prednisone or 30 mg of hydrocortisone per day do require prophylaxis dose. They should be treated as a patient who has complete adrenal insufficiency and normal stress level. The recommended dose is doubling the patient’s daily dose on the day of treatment. Dentists may consult the primary physician if needed (11). In summary, we reported a patient with an intraoral fibroma and discussed the differential diagnosis and implications of her medications on patient management.

REPORT

2.

Leffell D.J., I.M. Braverman. Familial multiple lipomatosis: report of a case and review of the literature. J American Academy of Dermatol, 15 (1986), pp. 275–279. 3. Patricia A. Cronin (1), Eddie Myers1, H. Paul Redmond1, Seamus O’Reilly2 and William O. Kirwan1Lipomatosis: An Unusual Side effect of Cytotoxic Chemotherapy. 4. Hasegawa T, Tsuchihashi H, Okauma K, Haruna K, Mizuno Y. Et al. Benign symmetrical lipomatosis associated with alcoholism. J Dermatol 2008; 35:689-690. 5. Gombar S, Mitra S, Thapa D, Gombar KK, Pathak R. Anesthetic considerations in steroid-induced mediastinal lipomatosis. Anesth Analg 2004; 98:862–864. 6. Fregnani, E.; Pires, F.; Falzoni, R.; Lopes, M.; Vargas, P. Lipomas of the Oral Cavity: Clinical Findings, Histological Classification and Proliferative Activity of 46 Cases. International Journal of Oral & Maxillofacial Surgery 2003; 32:49-53. 7. Toy, B. Familial Multiple Lipomatosis. Dermatology Online Journal2003; 9:4. Available at: http://dermatology. cdlib.org/94/NYU/Jan2002/2.html#3 8. Greenberg, MS, Glick M, Ship, JA. Burket’s Oral Medicine, 11th edition, 2008, BC Decker Inc., Hamilton. P: 527. 9. Doonquah, L; Mitchell, A. Oral Surgery for Patients on Anticoagulant Therapy: Current Thoughts on Patient Management. Dental Clinics of North America 2012; 56:25-41. 10. http://www.rheumatology.org/ Practice/Clinical/Patients/Diseases_ And_Conditions/Giant_Cell_Arteritis. 11. Greenberg MS, Greenberg, MS, Glick M, Ship, JA. Burket’s Oral Medicine, 11th edition, 2008, BC Decker Inc, Hamilton. P: 415-416.

References 1.

Esmeili, T; Lozada-Nur, F; Epstein, J. “Common Benign Oral Soft Tissue Masses.” Dental Clinics of North America 2005; 49:223-240.

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CASE REPORT

Spontaneous Regeneration of Bone after Resection of Central Giant Cell Lesion: A Case Report Roger R. Throndson, DDS, FACD John Mark Johnson, DDS

Introduction Central giant cell tumor (central giant cell granuloma, giant cell lesion, giant cell tumor) formerly designated as a reparative granuloma is widely considered nonneoplastic and not reparative, but rather an aggressively destructive osteolytic lesion (1). These tumors are not unique to the jaw as they are found in long bones and are not odonotogenic in origin. The giant cells have osteoclast receptors and therefore represent osteoclast precursors or are themselves osteoclasts. In the jaws, central giant cell tumors present as painless clinical expansion with bluish tint because of its cortical and mucosal thinning and internal vascularity. Occasionally, the patient will report pain in the area due to rapid expansion that results in stretching the underlying periosteum. The peak range of occurrence is between 5 and 15 years of age but also reported as occurring from 2 to 80 years of age (1,2). Women are affected twice as frequently as men and the mandible is involved 3 times as frequently as the maxilla. This lesion is known to cross the midline and is more frequently located in the anterior aspect of the jaw. Radiographically, the central giant cell tumor is classically appreciated as a multilocular, radiolucent lesion with

Throndson

Johnson

Dr Throndson, associate professor and chief, Department of Surgery/Division of Oral and Maxillofacial Surgery, University of Texas Medical Branch-Galveston, Galveston, Texas.

AbstrAct There are several treatment modalities to date for central giant cell granuloma including conservative treatment and surgical treatment with often planned reconstruction of the bony defect. Spontaneous bone regeneration of mandibular defects following complete resection of mandible has rarely been reported in the literature. We report a case of spontaneous bone formation after resection of a central giant cell granuloma in the anterior mandible of a pediatric patient and the importance of maintaining the periosteum during surgical resection as a rare case report.

Key words: central giant cell, regeneration, treatment, periosteum

Dr Johnson, resident, Oral and Maxillofacial Surgery, Galveston, Texas. Author to whom correspondence to be addressed: John Mark Johnson, DDS, Resident, Oral and Maxillofacial Surgery, University of Texas Medical Branch-Galveston, 301 University Blvd, Galveston, TX 77555-0531. Cell: 501-278-0347; Fax: 409-747-7378; E-mail: jm3johns@utmb.edu.

Tex Dent J 2013;130(12): 1201-1209.

The authors have no declared potential conflicts of interest, relationships, and/or affiliations relevant to the subject matter or materials discussed in the manuscript. This manuscript has been peer reviewed.

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severely thinned and expanded cortices. It can also scallop the inferior border, displace teeth, and resorb interradicular bone as well as resorb tooth roots to some degree. Diagnosis of central giant cell tumor is by histopathological examination and confirming the presence of multinucleated giant cells in a background of ovoid to spindle-shaped mesenchymal cells. However, this presentation cannot be distinguished histologically from hyperparathyroidism or cherubism (1). There are several treatment modalities that have been discussed in the literature including more conservative nonsurgical treatment: intra-lesional steroidal injections, subcutaneous injections of calcitonin, and interferon injections. More aggressively, the lesion can be surgically treated with enucleation and curettage or complete resection of the lesion including surgical margins. This article reports a case of central giant cell lesion in a pediatric patient who regenerated bone to the anterior mandible after resection without graft placement. Very few cases have been reported of spontaneous regeneration of a large bony continuity defect of the mandible (33-40).

Case Report A 9-year-old Caucasian male presented to the oral and maxillofacial clinic by referral from an outside hospital oral and maxillofacial surgeon who previously examined the patient

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Figure 1. Pre-op Panorex.

5 months prior for swelling to the lower jaw. The outside hospital oral and maxillofacial surgeon performed an incisional biopsy of the lesion, and surgical pathology confirmed central giant cell granuloma to the patient’s anterior mandible. Initially, conservative treatment was undertaken with serial weekly intra-lesional injections of 15 cc Triamcinolone (10 mg/cc) and 1% Lidocaine at a 1:1 ratio via protocol of 1 mL/1 cm of tumor on panorex. After 6 weeks of treatment, the lesion was reported to be enlarging after subsequent injections with no clinical improvement. The patient’s treatment was then referred to our oral and maxillofacial clinic for further care. The patient’s past medical history, social history, and surgical history was significant for previous incisional biopsy to the lower mandibular lesion by the outside hospital oral and maxillofacial surgeon without anesthetic complication and subsequent steroid injections. Neither the patient nor the patient’s parents recalled any previous trauma. He reported no recent episodes of fever, chills, or nausea, and he denied any intraoral drainage or discharge. Our clinical examination of the patient revealed enlargement of the anterior mandible with obliteration of the vestibule as well as the labio-mental fold. The swelling extended from the left first premolar to the right primary second molar. Teeth #21-27 and R, S, and T presented with increased interdental spacing (diastemas) as well as mobility (class III mobility). There was no detectable thrill or bruit and the lesion was not tender to palpation. The cortical expansion appeared to be primarily buccal with minimal lingual expansion. On maximal opening, the interincisal distance was greater than 35 mm and his jaw movements were unrestricted. There was bilateral lower lip (V3) parasthesia that was present for several months. The remainder of the physical exam was remarkable for moderate-severe obesity with a BMI of 35 kg/m2. On radiographic examination, the orthopantogram showed a large, well-defined, osteolytic, multi-locular lesion in the anterior mandible extending from second premolar to second premolar bilaterally (w=12.5 cm x h=6 cm) (Figure 1).

Texas Dental Journal l www.tda.org l December 2013


CASE

Figure 6. CT pre-op.

Resorption of the dental roots was noted apically and displacement of the anterior mandibular teeth. Additionally, there appeared to be both superior and inferior expansion of the mandibular cortices. A preoperative CT image was taken and demonstrated large expansion mostly to the buccal aspect (Figure 6).

A comprehensive laboratory assessment to rule out hyperparathyroidism revealed: Parathyroid hormone 43 pg/mL (normal 10-55 pg/mL), potassium 4.2 mmol/L (normal 3.5-5.0 mmol/L), and calcium (serum) 10.4 mg/dL (normal 9.0-10.5 mg/ dL). The patient was considered medically stable and scheduled for surgical excision of the mandibular

REPORT

mass. The mass was removed by enucleation, curettage, and peripheral ostectomy, which resulted in a continuity defect extending from tooth T (first permanent premolar area) to first premolar on the contralateral side through an intraoral approach (Figure 2). A 2.5 mm reconstruction plate was placed with 3 screws in the proximal segments bilaterally to span the defect. The periosteum was maintained with reapproximation over the reconstruction plate and attachment of the glossal musculature. The wound was closed primarily and the patient’s postoperative course was unremarkable. We planned for later reconstruction of the mandible with an iliac crest graft. The patient’s panorex at his 2-month postoperative visit revealed evidence of bone formation at the inferior border of the mandible (Figure 3). At the 6-month follow up, the panorex showed bone formation from pre-molar to premolar spanning the entire defect (Figure 4). Surgery was then planned to remove the reconstruction bar that was no longer needed for fixation. The patient was later seen 2 years post resection and his panorex showed well-remodeled bone across the mandibular midline and reconstruction of the mandible was no longer warranted (Figure 5).

Discussion

Figure 2. 1-week post-op.

The initial differential diagnosis would include central giant tumor, “brown tumor” secondary to hyperparathyroidism, aneurysmal bone cyst, ameloblastoma, myxoma, and fibrous dysplasia.

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CASE

REPORT

usually occurring in patients with secondary hyperparathyroidism who develop excessive and autonomous PTH secretion from one or more parathyroid glands. Brown tumors arising in the jaws are a rare complication of secondary hyperparathyroidism, yet their incidence may be increasing due to the increasing length of survival in patients with chronic renal failure (32). Figure 3. 2-month post-op.

Unrecognized or untreated hyperparathyroidism can cause histologically identical lesions of the jaws as central giant cell tumor. These lesions are “brown tumors� due to the dark, reddish-brown coloration of the tumor grossly, a feature that results from prominent intralesional hemorrhage and hemosiderin deposition (32). Hyperparathyroidism

can be primary, secondary, or tertiary. Primary hyperparathyroidism is seen with increased production of PTH (parathyroid hormone), typically due to hyperplasia or neoplasia of one of the parathyroid glands. Secondary hyperparathyroidism usually occurs as a consequence of chronic renal insufficiency or failure. Tertiary hyperparathyroidism is rare,

Figure 4. 6-month post-op.

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Aneurysmal bone cysts are most commonly found in children and young adults with a mean age of 20 years. In the jaws, they occur most often in the mandible and more frequently in the posterior region of both maxilla and mandible. As these lesions do occur in the jaws, they occur more frequently in long bones and the vertebral column. The most common clinical presentation is a bony swelling of rapid onset, often with some degree of associated pain


CASE

REPORT

Figure 5. 2-year post-op.

Table 1. Results of Corticosteroid Therapy with Literature Review First author

No. of Patients

Administration and Dose

Effect

Follow-up

Terry (1994) 4

Triamcinolone 10 mg/mL and Marcaine 0.5%, 1:1; 2 mL per 2 cm of the lesion, once a week for 6 wks

Kremer (1994) 1

Triamcinolone 10 mg/mL and lidocaine 0.5%,1:1; Complete remission 3 mL, once a week for 5 wks

3 yr

Rajeevan (1998) 1

Triamcinolone 10 mg/mL and lidocaine 0.5%, 1:1; Complete remission 2 mL per 2 cm of the lesion, once a week for 6 wks

10 mo

Khafif (2000) 1

Triamcinolone 40 mg/mL and Marcaine 0.5%, 1:1; once a week for 6 wks

Complete calcification 24 mo of the lesion

Kurtz (2001) 1

Triamcinolone 10 mg/mL and Marcaine 0.5%, 1:1, 2 mL per 2 cm of the lesion, once a week for 6 wks

Complete remission after 18 mo 2 treatment sessions

Carlos (2002) 4

Triamcinolone 10 mg/mL and Marcaine 0.5%, 1:1; 6 mL, variable number of injections (3-20). Additional surgery in 3 patients

Variable from considerable regression to complete remission

Complete remission in all patients

16-36 mo

2-7 yr

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Table 2. Results of Human and Salmon Calcitonin Therapy by Literature Review First author

No. of patients

Human/ salmon

Administration and dose

Duration

Effect

Follow-up

Harris (1993) 4 h/s Injection, 100 IU/day/nasal 12-14 mo spray 200 IU/day

Complete remission with additional surgery in 2 patients

14-72 mo

De Lange (1999) 4 H

Injection, 50-100 IU/day/ 12-15 mo nasal spray, 200 IU/day

Complete remission

7-36 mo

Pogrel (1997) 2 h/s

Injection, 100 IU/day/nasal spray, 200 IU/day

19-21 mo

Complete remission

13-14 mo

O’Regan (2001)

1

H

Injection, 100 IU/day

15 mo

Partial remission

30 mo

Pogrel (2003)

9

S

Injection, 100 IU/day

19-27 mo

Complete remission

26-50 mo

Dominguez Cuadrado (2004)

1

S

Nasal spray, 100 IU/day

12-19 mo

Complete remission

12 mo

Beck-Mannagetta 1 S Nasal spray, 100 IU/day 13 mo (2004) De Lange (2006) 14 S Nasal spray, 200 IU/day 12-15 mo

Complete remission with additional surgery

62 mo

No response-partial remission

6 mo

Vered (2007) 5 S Nasal spray 200-400 IU/day 13-14 mo

Partial response with additional surgery

10-24 mo

Borges (2008) 4 S

Partial remission

?

Subcutaneous 100 IU/day and nasal spray 200 IU/day

6-28 mo

?: Data not available.

Table 3. Results of Interferon 2 Alpha Therapy with Possible Additional Therapy First author

No. of patients

Collins (200)

1

Administration and dose Injection 1 x 106 IU/day

Kaban (2002) 8 Injection 2.3 x 106-3.10 x 106 IU/day Busaidy (2002) 5 ? Goldman (2005) De Lange (2006)

1 Injection 1.51 x 106-9.10x106 IU/day 2 Injection 3 x 106-9.10 x 106 IU/day

Duration

Effect

Follow-up

9 mo

Complete remission

>3 mo

None

6-8.4 mo

Complete remission

12-72 mo

Curettage

2 mo

Partial remission

—

None

8 mo

Partial remission

4 mo

Curettage

10-14 mo

Partial remission

>6 mo

None

Partial-complete remission

>3 mo

Curettage

>6 mo Kaban (2007) 16 Injection 3 x 106 IU/day ?: Data not available.

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Additional surgery


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REPORT

Table 4. Results of Surgical Treatment Modalities with Literature Review First author

No. of patients

Aggressive/ nonaggressive

Curettage/resection

Follow-up

Overall recurrence rate

Anderson (1973)

32

?

Curettage

>4 mo

12.5%

Chuong (1986)

17

8/9

Curettage, radiation therapy in 4 patients

24-380 mo

41.0%

Eisenbud (1988)

37

?

Curettage and resection

2-16 y

11.0%

Whitaker (1993)

47

26/21

Curettage

Mean 48 mo

49.0%

Bataineh (2002)

18

18/18

Resection

1-9 y

5.6%

De Lange (2005)

80

16/64

Curettage

0-10 y

26.3%

Rawashdeh (2006)

12

8/4

Curettage

2-9 y

16.7%

Kruse-Losler (2006)

26

10/16

Curettage and resection

9 mo – 12 yrs

11.5%

Tosco (2008)

18

11/7

Resection (>5mm)

Mean 68 mo

0%

?: Data not available.

or discomfort. Radiographically, these lesions appear as either unilocular or multilocular radiolucencies that may have focally indistinct margins. Marked cortical expansion and thinning are often observed. Ameloblastoma is the most common odontogenic neoplasm and commonly seen in young adults with peak incidence between 20 and 35 years of age with no sex predilection. The most common site is the third molar area of either jaw with 75% in the mandible (1). Radiographically the lesion presents with an expansile radiolucency that may be either unilocular or multilocular, but will have a well-demarcated border. The most common clinical presentation is painless expansion of the jaw that can displace teeth as well as the inferior alveolar canal, invade the maxillary sinus, and lead to root resorption.

The odontogenic myxoma is a benign, non-metastatic tumor that shows infiltrative growth. Its origin is from odontogenic mesenchyme and typically presents on radiograph with multilocular radiolucency, which has been described as “honeycombed.” Age distribution ranges from 5 to 65 years, but its peak age range is 15 to 30 years. The odontogenic myxoma is evenly distributed throughout the jaws and can cause tooth displacement, root resorption, as well as displacement of the inferior alveolar canal. Fibrous dysplasia usually presents as an asymptomatic, slowly expanding portion of bone primarily developing in children and teenagers with few cases developing after the age of 25 years. Although classic presentation is “ground glass” opacification radiographically, earlier stages of the lesion can present primarily as radiolucencies.

Several modalities of treatment have been performed over the years, both nonsurgical (Tables 1-3) and surgical (Table 4) for central giant cell tumor. Nonsurgical treatment has been described as using intralesional steroid injection protocol of Trimacinolone 10 mg/mL and marcaine 0.5%, 1:1 with some variations of the mixture (Table 1) which is injected into the lesion using 1 mL for each 1 cm of the tumor, as noted on a panoramic radiograph (1,3-4,6-11). This is performed weekly for 6 weeks. Marx reported this protocol has resolved 45% of central giant cell tumors, with the remaining 55% either failing to respond or redeveloping shortly after injections. Another nonsurgical technique includes daily subcutaneous injections of 50-100 IU of salmon and/or human calcitonin for 9 months to 1 year (Table 2) with a delayed response noted from 4 to 6 months after initial treatment (3,12-14,42-47). Other

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CASE

REPORT

nonsurgical treatment includes the use of interferon alpha-2a or interferon alpha-2b at a dose of 3,000,000 units/m2 administered once per day via subcutaneous injection for 2 to 14 months (5,15-21) with some variation (Table 3). Surgical treatment consisting of enucleation and curettage of the lesion is to date the most frequently applied therapy with a range of 11%-50% success rate (1,22-29,41) (Table 4). Total resection of the lesion with 0.5cm margins is considered to have a higher success rate, especially with more aggressive lesions, lowering the recurrence as low as 6% (22). Resection surgical therapy is most commonly performed with planned secondary reconstruction. In our case, the lesion was not responding to conservative treatment with intra-lesional injections; therefore, the treatment chosen was resection with planned reconstruction of the mandibular continuity defect with iliac hip graft. However, spontaneous regrowth of the mandible was seen in this patient and reconstructive surgery was no longer warranted. Kazanjian first reported a case of spontaneous regeneration of bone following resection of the mandible in 1948 with very few publications of spontaneous regrowth since (30). He accredited the regeneration of bone possibly due to preservation of the periosteum. The periosteum is a specialized fibrous membrane that is a well-vascularized “osteogenic organ”(31). Periosteum is anchored through Sharpey’s fibers and is composed of 2 discrete layers:

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the outer fibrous layer containing fibroblasts, vessels and fibers of Sharpey and the inner cambium layer containing nerves, capillaries, osteoblasts and undifferentiated mesenchymal stem cells. This cambium layer serves as a reservoir of undifferentiated pluriopotential mesenchymal cells, able to differentiate into chondrogenic and osteoblastic lineages and as a source of growth factors playing an important role in the healing and remodeling process at the outer surface of the cortical bone. In infants and children, the periosteum is thicker, more vascular, and the healing potential is very active. It is this osteogenic phenomenon that we believe is the basis of genesis of spontaneous bone regeneration seen in our patient by the preservation of the periosteum during resection.

Conclusion We report a case of central giant cell lesion that did not respond to initial intra-lesional steroid injections; however, the patient responded favorably to surgical resection of the lesion with spontaneous bone regeneration of the continuity defect. This case report emphasizes the important of preservation of the periosteum and its growth factors for healing in a pediatric patient as well as the rarity of spontaneous regeneration of a mandibular continuity defect. References 1. Marx RE, Stern D. Oral & Maxillofacial Pathology: A Rationale for Diagnosis and Treatment. 2 ed. Quintessence, Illinois; 2012.

Texas Dental Journal l www.tda.org l December 2013

2. Neville BD, Damm DD, Allen CM, Bouquot JE. Oral & Maxillofacial Pathology. 2 ed. WB Saunders, Philadelphia; 2002. 3. Lange J, Akker HP, Berg H. Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. Oral Surg Oral Med Oral Pathol 2007;104:603-615. 4. Nogueira RLM, Teixeira RB, Cavalcante RB, Ribeiro RA, Rabenhosrt SHB. Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant-cell granuloma in 21 cases. Int. J. Oral Maxillofac. Surg. 2010;39:1204-1210. 5. Kaban LB, Troulis MJ, Wilkinson MJ, Ebb D, Dodson TB. Adjuvant antiangiogenic therapy for giant cell tumors of the jaws. 2007;65:2018-2023. 6. Terry BC, Jacoway JR. Management of central giant cell lesions: an alternative to surgical therapy. Oral & Maxillofac Surg Clinics of North America. 1994;6(3):579600. 7. Kremer C, Millesi W, Watzke M. Local injections of corticosteroids for central giant cell granuloma. Int J Oral Maxillofac Surg 1994;23:366-8. 8. Rajeevan NS, Soumithran CS. Intralesional corticosteroid injection for central giant cell granuloma. Int J Oral Maxillofac Surg 1998;27:303-4. 9. Khafif A, Drempl G, Medina JE. Treatment of giant cell granuloma of maxilla with intralesional injection of steroids. Head Neck 2000;22:822-5. 10. Kurtz M, Mesa M, Alberto P. Treatment of central giant cell lesion of the mandible with intralesional glucocorticosteriods. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2001;91:636-7. 11. Carlos R, Sedano HO. Intralesional corticosteroids as an alternative treatment for central giant cell granuloma. Oral Surg Oral Med Oral Patho Oral Radiol Endod. 2002;93:161-6. 12. Harris M. Central giant cell granulomas of the jaws regress with calcitonin therapy. Br J Oral Maxillofac Surg 1993;31:89-94. 13. Pogrel MA, Regezi JA, Harris ST, Godring SR. Calcitonin treatment for central giant cell granulomas of the mandible: report of two cases. J Oral Maxillofac Surg 1999;57:848-53.


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14. Pogrel MA. Calcitonin therapy for central giant cell granuloma. J Oral Maxillofac Surg 2003;61:649-653. 15. Kaban LB, Troulis MJ, Ebb D, August M, Hornicek FJ, Dodson TB. Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws. J Oral Maxillofac Surg 2002;60:1103-1111. 16. Kaban LB. Biomedical technology revolution: opportunities and challenges for oral and maxillofacial surgeons. Int J Oral Maxillofac Surg 2002;31:1-12. 17. Kaban LB, Dodson T, Wilkinson M, Troulis M, Ebb D, August M. Antiangiogenic therapy for the management of aggressive giant cell lesions of the jaws. J Oral Maxillofac Surg 2006;64(suppli 1): 41-2. 18. Collins A. Experience with anti-angiogenic therapy of giant cell granuloma of the facial bones. Ann Roy Australas Coll Dent Surg 2000;15:170-5. 19. Busaidy B, Wong MEK, Herzog C, Flaitz C, Marchena J, Eftekhari F. Alpha interferon in the management of central giant cell granuloma: early experiences. J Oral Maxillofac Surg 2002(suppl);60:86-7. 20. de Lange J, van den Akker HP, van den Berg H, Richel DJ, Gortzak RAT. Limited regression of central giant cell granuloma by interferon alpha after failed calcitonin therapy: a repot of two cases. Int J Oral Maxillofac Surg 2006;35:865-9. 21. Goldman KE, Marshall MK, Alessandrini E, Bernstein ML. Complications of alpha-interferon therapy for aggressive giant cell lesion of the maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:285-91. 22. Bataineh AB, Al-Khateeb T, Rawashdeh MA. The surgical treatment of central giant cell granuloma of the mandible. J Oral Maxillofac Surg 2002;60:756-61. 23. Eisenbud L, Stern M, Rothberg M, Sachs S. Central giant cell granuloma of the jaws: experiences in the management of thirty-seven cases. J Oral Maxillofac Surg 1988;46:376-384. 24. Andersen L, Fejerskov O, Philipsen HP. Oral giant cell granulomas: a clinical and histological study of 129 new cases. Acta Pathol Micorbiol Scand 1973;81:606-16. 25. Whitaker SB, Waldron CA. Central giant cell lesions of the jaws. Oral Surg Oral Med Oral Pathol 1993;75:199-208.

26. de Lange J, van den Akker JP. Clinical and radiologic features of central giant cell lesions of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:464-70. 27. Chuong R, Kaban LB, Kozakewich H, PerezAtayde A. Central giant cell lesions of the jaws; a clincopathologic study. J Oral Maxillofac Surg 1986;44:708-13. 28. Rawashdeh MA, Bataineh AB, Al-Khateeb T. Long-term clinical and radiological outcomes of surgical management of central giant cell granuloma of the maxilla. Int J Oral Maxillofac Surg 2006;35:60-6. 29. Kruse-Losler B, Diallo R, Gaertner C, Mischke KL, Joos U, Kleinheinz J. Central giant cell granuloms of the jaws: a clinical, radiologic and histopathologic study of 26 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:346-54. 30. Kazanjian VH. Spontaneous regeneration of bone following excision of section of the mandible. Oral Surg. 32(1948) 242. 31. Konstantinos NM, Papatheodorou LK. The healing potential of the periosteum molecular aspects. Injury, Int. J. Care Injured 2005;36S:S13-S19. 32. Throndson RR, Sexton SB. A mandibular central lesion with unusually rapid growth. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2004;98:4-9. 33. Ruggiero SL, Donoff RB. Bone regeneration after mandibular resection: report of two cases. J Oral Maxillofac Surg 1991;49:647-652. 34. Adebayo ET, Fomete B, Ajike SO. Spontaneous bone regeneration following mandibular resection for odontogenic myxoma. Annals of African Medicine. 2012;11(3):182-5. 35. Ihan Hren N, Miljavec M. Spontaneous bone healing of the large bone defects in the mandible. Int J Oral Maxillofac Surg. 2008;37(12)1111-6. 36. Espinosa SA, Villanueva J, Hampel H, Reyes D. Spontaneous regeneration after juvenile ossifying fibroma resection: A case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2006;102(5):e32-5. 37. Ogunlewe MO, Akinwande JA, Ladeinde AL, Adeyemo WL. Spontaneous regeneration of whole mandible after total mandibulectomy in a sickle cell

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

REPORT

patient. Journal of Oral and Maxillofacial Surgery. 2006;64(6):981-4. Pramono DC. Spontaneous bone regeneration after mandible resection in a case of ameloblastoma – A case report. Annals of the Academy of Medicine Singapore. 2004;33(4 SUPPL.):59S-62S. Martins WD, De Castro Avila LF. Partial spontaneous bone regeneration subsequent to mandibulectomy. Journal of Contemporary Dental Practice. 2004;5(3):108-20. Chiapasco M, Rossi A, Motta JJ, Crescentini M. Spontaneous bone regeneration after enucleation of large mandibular cysts: A radiographic computed analysis of 27 consecutive cases. Journal of Oral and Maxillofacial Surgery. 2000;58(9):942-8. Andersen L, Fejerskov O, Philipsen HP. Oral giant cell granulomas: a clinical and biological study of 129 new cases. Acta Pathol Microbiol Scand 1973;81:606-16. De Lange J, Rosenber AJWP, van den Akker JP, Koole R, Wirds JJ, van den Berg H. Treatment of central giant cell granuloma of the jaw with calcitonin. Int J Oral Maxillofac Surg 1999;28:372-6. O’Regan EM, Gibb DH, Odell EW. Rapid growth of giant cell granuloma in pregnancy treated with calcitonin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:532-8. Dominguez CL, Martinez GC, Plasencia DJ, Suner M. Intranasal calcitonin therapy for central giant cell granuloma. J Cran maxillofac Surg 2004;32(suppl 1):244-5. Beck-Mannagetta J, Krenkel C, Kassmann H, Prokop E. Ein fortschritt in der therapie des zentralen riesenzellgranuloms: Additive verabrichung von calcitonin nasalspray. Stomotologie 2004;101.4:71-8. Vered M, Buchner A, Dayan D: Giant cell granuloma of the jawbones – a proliferative vascular lesion? Immunohistochemical study with vascular endothelial growth factor and basic fibroblast growth factor. J Oral Pathol med 2007;35(10):613-619. Borges HO, Machado RA, Vidor MM, Beltrao RG, Heitz C, Filho MS: Calcitonin: a non-invasive giant cells therapy. Int J Pediatr Otorhinolaryngol 2008;72(7):959963.

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MARCH 27-29, 2014

SOS STAR OF THE SOUTH

VISUALIZING THE FUTURE OF DENTISTRY GEORGE R. BROWN CONVENTION CENTER

n

HOUSTON, TEXAS

To register or for more information about the 2014 Star of the South Dental Meeting, please visit starofthesouth.org or contact Ms Charlotte Bolls, 713-961-4337.

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Texas Dental Journal l www.tda.org l December 2013


Chairman’s Message

C

ome join us at the 43rd annual Star of the South Dental Meeting, “Visualizing the Future of Dentistry,” and see how new technologies, materials, and techniques are changing the way we practice dentistry today! Whether you are new to dentistry, want to explore what the latest and greatest dentistry has to offer, or wish to provide education for your entire team, this meeting will guide you in the exploration of new innovations that can make your practice more efficient, profitable, and exciting. This year’s topics focus on a wide range of techniques. Learn from some of the top experts on the latest in today’s lasers, bonding agents, implants, 3D technology, orthopedic/orthodontic techniques, oxygen/ozone therapy or other methods of treatment currently performed in your office. Have you ever been curious about what it is like to fly in space, or what it takes to climb Mount Everest? What affects do these extreme environments have on our bodies? This year, we will feature some very special guests speaking on these very topics. Dr Scott Parazynski, a former astronaut, flight physician, and the first person to have both flown in space and summit Mount Everest, will discuss practices in extreme medicine, and how our bodies react to the conditions of these environments. Dr Mike Barratt, a current astronaut, flight physician, and author and co-editor of Principles of Clinical Medicine for Space Flight, will discuss the long-term effects of spaceflight on the human body, and the hurdles we face for long-term exploration. Former astronaut Jerry Ross, the first person to launch from Earth and into space 7 times, and an astronaut instrumental in building the International Space Station, will be speaking about his adventures in space, followed by a book signing for his new book, Spacewalker, an excellent read on the family life of astronauts. Come visit our exhibit hall and discover the latest in 3D technology. Recent innovations have made CAD CAM restorations faster and easier than ever before. Updates in digital scanning and digital radiography are changing the way we practice. With this new technology, implants are placed more quickly and easily, and procedures are becoming less traumatic to the patient. Take advantage of the opportunity to try out the fastest hard and soft tissue lasers on the market. You will be amazed at how efficient and reliable these new lasers have become. Be sure to check out the latest in wide field optics, you might be surprised at what you have been missing. Be sure and spend a little extra time with all of our exhibitors this year. We hope you will be as excited as we are about the incredible advancements taking place in dentistry right now! Be sure to join us in the exhibit hall on Thursday and Friday afternoons for our exhibit hall happy hour. It is a great way to socialize after a day of learning. On Thursday, we will follow our happy hour with our lift off reception in front of the Exhibit Hall. You will have a chance to mingle with colleagues, friends, and exhibitors while enjoying food and drink and being entertained by live music. Don’t miss our SOS Friday night party. This year, we will feature The Klocks who will play a variety of live music from the ’70s, ’80s, ’90s, as well as today’s hits. If you haven’t heard them play yet, you are in for a real treat. Feast on the scrumptious hors d’ oeuvres, chat with friends, and then dance the night away. It is a party you don’t want to miss!

On behalf of the staff, volunteers, and officers of the Greater Houston Dental Society, and the Star of the South Council, we look forward to providing you with a fun and informative opportunity to expand your horizons in the field of dental science. We look forward to the opportunity to serve you! Michael H. Hodapp, DDS, MAGD 2014 Star Chairman Texas Dental Journal l www.tda.org l December 2013

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Special Events Win a New iPAD Air Attendees that register for 12 or more hours of continuing education at the 2014 Star of the South will be entered into a drawing to win a new iPad Air tablet. Three winners will be drawn on Saturday, March 29th, at 12:00 pm.

Exhibit Hall Happy Hours Thursday, March 28, and Friday, March 29 4:00 pm – 6:00 pm. As you shop the exhibits, enjoy complimentary beer and wine on Thursday and Friday from 4:00 pm to 6:00 pm at one of the cash bar lounges in the exhibit hall.

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Texas Dental Journal l www.tda.org l December 2013


GHDS Lounge Booth 439 Take a break at the GHDS Lounge – grab a refreshment, relax and visit with friends and colleagues, and gather information on GHDS membership, benefits, social activities, and events. The GHDS Lounge will also include: • Meet the astronauts who will offer book signings and photos for autographing • The exhibit hall cash drawing

The Thursday “Lift Off” Reception Sponsored by Greater Houston Dental Specialists Thursday, March 28

n

6:00 pm – 7:30 pm.

The “Lift Off” reception will be held in front of the exhibit hall as the hall closes. Enjoy entertainment and light refreshments before heading out for the evening.

The SOS Friday Night Party Sponsored by Patterson Dental Friday, March 29

n

6:00 pm– 9:00 pm

The SOS Friday Night Party will feature The Klocks who play a variety of music from the ’70s, ’80s, and ’90s as well as today’s hits. Enjoy visiting with friends and colleagues and dancing the night away. Party favors, hors d’ oeuvres, free beer, and a cash bar will be included. Free to all registered attendees! Texas Dental Journal l www.tda.org l December 2013

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2014 Clinician Preview

Ms Cindy Abreu

Front Office / Computer

Dr Damon Adams Materials

Dr Christos Angelopoulous

Dr Joel Berg Pediatrics

Cone Beam CT

Dr Raymond Bertolotti

Dr Patricia Blanton

Dr Charles Hoopingarner

Dr Warren Karp

Anesthesia

Adhesion

Dr Catherine Flaitz

Dr Doug Lambert

Dr Eduardo Lorenzana

Oral Pathology

Oral Cancer Detection

Nutrition

Lasers

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Dr Jonathan Bregman

Texas Dental Journal l www.tda.org l December 2013

Cosmetics

Periodontics / Implants


Dr Jose Luis Mompell

Ms Lynn Mortilla Hygiene

Aging / Women’s Oral Health

Caries / Evidence Based Dentistry

Dr William Nudera

Dr Jeffrey Okeson

Dr Alfonso Piñeyro

Dr Jacqueline Plemons

Bone Graft — Implants

Endodontics

TMD Occlusion

Dr Linda Niessen

Implants

Dr Brian Novy

Periodontics

Dr William Roddy

Dr Jose-Luis Ruiz Prosthodontics / Restorative

Dental Sleep Medicine

Dr Skip Truitt

Ms Bethany Valachi

Dr Jorge Vera

Implants

Orthodontics

Ergonomics

Dr Kent Smith

Endodontics

Texas Dental Journal l www.tda.org l December 2013

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Memorial and Honorarium Donors to the Texas Dental Association Smiles Foundation

In Memory of: Faye Buford Dr Don Lutes

Jesse M Taylor, DDS Drs Don & Mary Maggard

Dan Moore, DDS Dr Mike Giesler

Jo Seburg Nueces Valley District Dental Society

Roger Mills Nueces Valley District Dental Society

In HONORARIUM: Jen Banton, RDH Dr Susan Loche Your memorial contribution supports: • •

educating the public and profession about oral health; and improving access to dental care for the people of Texas.

Please make your check payable to:

TDA Smiles Foundation, 1946 S IH 35, Austin, TX 78704

Thomas John Kennedy of Texas, DDS, PLLC Progressive, team-oriented practice seeking full-time associate dentists in DFW, Austin, San Antonio and Houston. Provide dental care in surroundings geared toward patient satisfaction. Starting salary of at least $150,000 (five days per week with minimum 5 years experience) with innovative, production-based bonus structure. Full benefits package includes 401(k), licensure payment, paid vacations/ holidays, health, life and malpractice insurance. Earn what you deserve now, not later. Please contact me in complete confidence for more details: Dr Tom Kennedy Office: 800-658-2177 Facsimile for CVs: 800-393-5188 drtom@oksupportgroup.com

In Memoriam Those in the dental community who have recently passed Allen, Donald A. Tyler, Texas January 26, 1953 – October 25, 2013 Good Fellow, 2003 Allen, Zoel G. Perryton, Texas May 23, 1932 – October 5, 2013 Good Fellow, 1989 • Life, 1998 • Fifty Year, 2013 Arnim, Ben F. Houston, Texas August 10, 1914 – September 14, 2013 Good Fellow, 1966 • Life, 1979 • Fifty Year, 1990 Barnett, Walter B. Jr Bandera, Texas October 29, 1932 – October 29, 2013
 Good Fellow, 1980 • Life, 1999 • Fifty Year, 2008 Calder, John R. Denton, Texas August 25, 1923 – October 22, 2013 Good Fellow, 1977 • Life, 1988 • Fifty Year, 2002 Conrad, Robert S. Houston, Texas October 19, 1960 – October 17, 2013 Gray, James D. Eastland, Texas September 7, 1917 – October 11, 2013 Good Fellow, 1980 • Life, 1984 • Fifty Year, 2004 Hawkins, Darrell V. Bacliff, Texas August 22, 1936 – October 8, 2013 Life, 2001 Pratt, Gordon A. Bryan, Texas May 20, 1925 – September 23, 2013 Good Fellow, 1975 • Life, 1990 • Fifty Year, 2000 Villegas, Rafael R. San Antonio, Texas August 17, 1953 – August 9, 2013

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TEXAS DENTAL JOURNAL 2013

Index of Feature Articles (by Author) Afrashtehfar, Kelvin I., DDS, FADI; Afrashtehfar, Cyrus, DM, MD; Predictable Immediate Loading of Mandibular Implants; July 2013; Vol. 130, Number 7:596. Allahdina, Karim; Jacob; Connor, Joseph, DDS; Critically Appraised Topic of the Month: Light-cured Resinbased Sealants Have a Significantly Higher Long-term Retention Rate than Fluoride-containing Light-cured Resinbased Sealants; July 2013; Vol. 130, Number 7:618.

Bhattacharya, Aditi, BDS, MDS, PhD; Crossland, Jay A, DDS; Wright, John M, DDS, MS; Oral and Maxillofacial Pathology Case of the Month; Necrotizing Sialometaplasia; February 2013; Vol. 130, Number 2:124. Black, Richard C., DDS; Calvert, Jess; The Texas 83rd Legislative Session — Guest Editorial; February 2013; Vol. 130, Number 2:116. Black, Richard C., DDS; 83rd Legislative Summary; October 2013; Vol. 130, Number 10:982.

Assi, DDS; Pope, DDS; Kessler, Harvey, DDS; Oral and Maxillofacial Pathology Case of the Month: Foreign Body Giant Cell Reaction to Cosmetic Filler Material Radiesse; July 2013; Vol. 130, Number 7:582.

Black, Richard C., DDS; National Update: ADA Council on Governmental Affairs; October 2013; Vol. 130, Number 10:1010.

Barasch, Andrei; Cunha-Cruz, J.; Curro, F. A.; Hujoel, P.; A. H. Sung; D. Vena; Voinea-Griffin, A. E.; Risk Factors for Osteonecrosis of the Jaws; April 2013; Vol. 130, Number 4:299.

Blum, Gary, DDS, MS; Bouquot, Jerry, DDS, MSD, FICD, FACD, FRCM (UK); Dorn, Samuel, DDS, FACD, FICD, FPFA; Oral and Maxillofacial Pathology Case of the Month: Cemental Tear and Chronic Periodontitis; June 2013; Vol. 130, Number 6:500.

Barasch, Andrei; Gilbert, Gregg H.; Spurlock, Noel; Funkhouser, Ellen; Persson, Lise-Lotte; Safford, Monika M.; Random Plasma Glucose Values Measured in Community Dental Practices; April 2013; Vol. 130, Number 4:291. Bautista, Lorraine; Huynh-Ba, Guy, DDS; Critically Appraised Topic of the Month: In Patients with Peri-Implantitis, Access Flap Surgery May Be More Effective Than Mechanical Debridements in Terms of Clincal Attachment Gain Although Both Treatments Lead to Improved Clinical Parameters; November 2013; Vol. 130, Number 11:1112.

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Borna, Neda; Phillip, Judy; Brown, Ronald, DDS; Critically Appraised Topic of the Month: Remineralizing Agents with Casein Phosphoprotein-Amorphous Calium Phosphate (CPP-AP) Can Promote White Spot Regression for Orthodontic Patients; October 2013; Vol. 130, Number 10:1030. Capps, Chad, DDS; Guest Essay: My Experience with Oral Cancer; August 2013; Vol. 130, Number 8:676. Collins, Ron, DDS, MAGD; Restoration of Congenitally Missing Maxillary Lateral Incisors Using Mini Implants; July 2013; Vol. 130, Number 7:610.

Texas Dental Journal l www.tda.org l December 2013

Condrey, James D., DDS; Dental Practice Models in Texas; October 2013; Vol. 130, Number 10:996. Cortell Reisman, Karen, MS; Guest Essay: From Poster Child to Good Health; August 2013; Vol. 130, Number 8:672. Crow, Janet; Adkins, Jay C., DDS; Making an Impression, October 2013; Vol. 130, Number 10:1004. Devine, Bill P., DMD; What Dentists Should Know About Sickle Cell Disease; November 2013; Vol. 130, Number 11:1123. Duncan, David A., DDS; Incoming President’s Address, May 5, 2013; June 2013; Vol. 130, Number 6:514. El-Kweifi, Omar; Valdez, Ernest, DDS; Ellis, Edward, DDS; Critically Appraised Topic of the Month: Risk of Developing Alveolar Osteitis Post-Operatively Following Dental Extraction is Positively Correlated to Smoking; August 2013; Vol. 130, Number 8:703. Epstein, Joel B., DMD, MSD, FRCD(C), FDS RCS(Edin); Güneri, Pelin, DDS, PhD; Boyacioglu, Hayal, PhD; Abt, Elliot, DDS, MS, MSc; The Limitations of the Clinical Oral Examination in Detecting Dysplastic Oral Lesions and Oral Squamous Cel Carcinoma; May 2013; Vol. 130, Number 5:410. Felkner, Jordan; Teixeira, Erica C.; Critically Appraised Topic of the Month: Survival Rate for Single Tooth CAD/CAM Restorations is Similar to Conventional Dental Restorations; April 2013; Vol. 130, Number 4:334.


Fellows, J. L.; Rindal, D. B.; Barasch, A.; Gullion, C. M.; Rush, W.; Pihlstrom, D. J.; Richman, J.; ONJ in 2 Dental Practice-based Research Network Regions; April 2013; Vol. 130, Number 4:311.

FACD; Litaker, Mark S., PhD; Pihlstrom, Daniel J., DDS; Amundson, Craig W., DDS; Gordan, Valeria V., DDS, MS, MSCI; Rubber Dam Use: During Routine Operative Dentistry Procedures; April 2013; Vol. 130, Number 4:337.

Fernández, Rafael, DDS; Rincón, Juan G., DDS; Surgical endodontic management of an invasive cervical resorption class 4 with mineral trioxide aggregate: A 6-year follow-up; January 2013; Vol. 130, Number 1:31-38.

Gilbert, Gregg H., DDS, MBA; Tilashalski, Ken R., DMD; Litaker, Mark S., PhD; McNeal, Sandre F., MPH; Boykin, Michael J., DMD, MS; Kessler, Allen W., DMD; Outcomes of Root Canal Treatment in DPBRN; April 2013; Vol. 130, Number 4:351.

Flaitz, Catherine M., DDS, MS; Nichols, C. Mark, DDS; Oral and Maxillofacial Pathology Case of the Month: Severely Dysplastic Oral Wart; January 2013; Vol. 130, Number 1:18-19. Flaitz, Catherine M., DDS, MS; Carlin, Nathan, PhD; Living in Limbo: Ethics and Experience in a Conversation About Persistent Oral Lesions; August 2013; Vol. 130, Number 8:682.

Gordan, Valerie V., dds, ms, msci; Riley, Joseph L. III, PhD; Marins De Carvalho, Ricardo, DDS, PhD; Snyder, John; Sanderson, James L. Jr, DMD; Anderson, Mary; Gilbert, Gregg H, DDS, MBA, FAAHD; Methods Used by Dental Practice-based Research Network Dentists to Diagnose Dental Caries; April 2013; Vol. 130, Number 4:321.

Freeman, Kim, MA, DMD, MS; Dental Artifacts: Wilcox-Jewitt Obtunder Syringe; July 2013; Vol. 130, Number 7:622.

Hicks, Jeffery L., DDS; Hendricson, William D., MS, MA; Partida, Mary N., DDS, MPH; Rugh, John D., PhD; Littlefield, John H., PhD; Jacks, Mary E., MS; Career Transition and Dental School Faculty Development Program; November 2013; Vol. 130, Number 11:1115.

Freeman, Kim, MA, DMD, MS; Dental Artifacts: Tube A Goes Into Hole B; October 2013; Vol. 130, Number 10:1046.

Huber, Michaell A., DDS, and Sankar, Vidya, DMD, MHS; It’s Not Just an “Oral Cancer” Exam; May 2013; Vol. 130, Number 5:426.

Galanis, Aurelija, DDS, MSc; Ali, Mohsin, BDS, MSc, PhD; Belles, Donald, DDS, MS; Koeppen, Raymond G, DDS, MS; A Comparison of Facebow and Dento-Facial Analyzer Mountings; October 2013; Vol. 130, Number 10:1047.

Israelson, Hilton, DDS; American Dental Association 15th District Trustee’s Address, May 2, 2013; June 2013; Vol. 130, Number 6:508.

Freeman, Kim, MA, DMD, MS; Dental Artifacts: Time for the Cure; March 2013; Vol. 130, Number 3:216.

Galeone, Richard J.; Learning Curves; January 2013; Vol. 130, Number 1:14. Gilbert, Gregg H., DDS, MBA, FAAHD,

Johnson, Russell, DDS; Anderson, David; Bakko, Daniel, DDS; Critically Appraised Topic of the Month: Bisphenol-A Exposure from Dental Sealants is Minimal and Does Not Cause Increased Morbidity or Mortality; March 2013; Vol. 130, Number 3:214.

Jones, Anne Cale, DDS; McGuff, H. Stan, DDS; Holbrook, Jerome, DDS; A Diagnosis of Multiple Odontogentic Keratocysts in Association with Nevoid Basal Cell Carcinoma Syndrome (NBCCS); December 2013; Vol. 130, Number 12:1224. Jones, Daniel L., DDS, PhD; Guest Editorial: Oral Cancer: What to Do?; May 2013; Vol. 130, Number 5:408. Jones, Daniel L., DDS, PhD; Rankin, K. Vendrell, DDS; Oral Cancer: FAQ; May 2013; Vol. 130, Number 5:438. Kacher, John E., DDS; Oral and Maxillofacial Pathology Case of the Month: Histoplasmosis; March 2013; Vol. 130, Number 3:198. Kalu U.E. Ogbureke, BDS, MSc, DMSc, JD, FRCPath; Alex Bachoura, DDS; Oral and Maxillofacial Pathology Case of the Month: Multiple Odontogenic Keratocysts in Association with Nevoid Basal Cell Carcinoma Syndrome (NBCCS) November 2013; Vol. 130, Number 11:1100. Kusbel, Marisol; Smith, Yves, DDS; Deahl, Thomas, DDS; Critically Appraised Topic of the Month: Oral Appliance Therapy and CPAP Demonstrate Similar Improvements in Mild to Moderate Obstructive Sleep Apnea; February 2013; Vol. 130, Number 2:146. Lipski, Mariusz, DDS, PhD; Buczkowska-Radlińska, Jadwiga, DDS, PhD; Góra, Monika, DDS, PhD; Loss of Sight Caused by Calcium Hydroxide Paste Accidentally Splashed into the Eye During Endodontic Treatment: Case Report; June 2013; Vol. 130, Number 6:527. Long, S Jerry, DDS; Guest Editorial: Save Dentistry! Take a Colleague to Lunch; October 2013; Vol. 130, Number 10:976.

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McCarley, David, DDS; TDA Testifies in Support of Patient Protection and Safety — House Bill 1480; October 2013; Vol. 130, Number 10:994. McGuff, H. Stan, DDS; Jones, Anne Cale, DDS; Davis, Thomas L. , MD; Perez, Francisco M., DMD, MSD; Oral and Maxillofacial Pathology Case of the Month: Melanoma In Situ (Mucosal Lentiginous Melanoma); October 2013; Vol. 130, Number 10:972. Naidu, Aparna, DDS, MS; Kovach, Todd A., DDS, MD; Wright, John M. DDS, MS; Schow, Sterling R. DMD; Oral and Maxillofacial Pathology Case of the Month: Non-Hodgkin’s Lymphoma; April 2013; Vol. 130, Number 4:286. Nauert, Philip L., DDS; Change Exchange: Pocket Change for Political Change; October 2013; Vol. 130, Number 10:1022. Oates, Thomas W, DMD, PhD; Mungia, Rahma BDS, MSC; Guest Editorial: National Practice-based Research: Translating Research in Everyday Clinical Practice; April 2013; Vol. 130, Number 4:288. Ogbureke, Kalu U.E. , BDS, MSc, DMSc, JD, FRCPath; Bachoura, Alex, DDS; Oral and Maxillofacial Pathology Case of the Month: Multiple Odontogenic Keratocysts in Association with Nevoid Basal Cell Carcinoma Syndrome (NBCCS); December 2013; Vol. 130, Number 12:1100. Peppard, Mark, DDS; ADPAC Speaks Softly; October 2013; Vol. 130, Number 10:1023. Plemons, Jacqueline M., DDS, MS; Rankin, K. Vendrell, DDS; Benton, Elain, RDH, CTTS; Oral Health Care in Cancer Patients: You Can Make a Difference!; August 2013; Vol. 130, Number 8:682.

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Raja, Rameez, BDS; Vigneswaran, Nadarajah, BDS, DMD; Oral and Maxillofacial Pathology Case of the Month: Erythema Migrans (Ectopic Migratory Glossitis/Ectopic Geographic Tongue); August 2013; Vol. 130, Number 8:666. Rankin, K. Vendrell, DDS; E Cigarettes: What’s Known, What’s Unknown; May 2013; Vol. 130, Number 5:446. Reagan, J.C.; Wright, Edward, DDS; Critically Appraised Topic of the Month: No Strong Evidence Exists for the Use of Mouth Guards to Prevent Concussions; July 2013; Vol. 130, Number 7:534. Reyes, Ashley, DDS; Norman, Sarah, DDS; Piper, James II, DDS; Critically Appraised Topic of the Month: Similar Success of Immediate, Early, and Conventionally Loaded Impants; January 2013; Vol. 130, Number 1:40. Robledo, Juliana, DDS; Rominger, James W., DDS, MD; Oral and Maxillofacial Pathology Case of the Month: Pyogenic Granuloma; May 2013; Vol. 130, Number 5:404. Roberts, Matthew B., DDS; Dental Quality Alliance: Measuring Quality in Dentistry; October 2013; Vol. 130, Number 10:1006. Rowan, Spencer; Hua, Jack; Hargreaves, Ken, DDS; Critically Appraised Topic of the Month: Penicillin Not Effective for Preoperative Irreversible Pulpitis Pain; May 2013; Vol. 130, Number 5:436. Schmitz, John P., DDS, PhD; Layered Socket Grafting™ Using an Anorganic Bovine Bone Mineral-Collagen Composite; January 2013; Vol. 130, Number 1:21-29. Shigeta, Yuko; Ogawa, Takumi; Tomoko, Ikawa; Clark, Glenn T., Enciso,

Texas Dental Journal l www.tda.org l December 2013

Reyes; Soft palate length and upper airway relationship in OSA and nonOSA subjects; March 2013; Vol. 130, Number 3:203. Sibley, David, DDS; A View from the Capitol; October 2013; Vol. 130, Number 10:988. Stuart, Michael L., DDS; Outgoing President’s Address, May 2, 2013; June 2013; Vol. 130, Number 6:502. Stuart, Michael L., DDS; Guest Essay: Be Smart and Be Aware!; August 2013; Vol. 130, Number 8:670. Stuart, Michael L., DDS; The Texas State Board of Dental Examiners — Regulating the Profession; October 2013; Vol. 130, Number 10:1000. Taylor, Ben, DDS; Guest Essay: A FAST Lesson in Stroke Treatment; June 2013; Vol. 130, Number 6:494. Tillman, David, DDS; Guest Essay: Time is a Gift; August 2013; Vol. 130, Number 8:674. Turkyilmaz, Ilser, DDS, PhD; Volkan Asar, Neset, DDS, PhD; A Technique for Fabricating a Milled Titanium Complete-arch Framework Using a New CAD/CAM Software and Scanner with Laser Probe; July 2013; Vol. 130, Number 7:586. Vujicic, Marko, PHD; Israelson, Hilton, DDS; Guest Editorial: Dentistry’s Watershed Moment; November 2013; Vol. 130, Number 11:1104. Wade, Herbert L. Jr, DDS; Medicaid and the Children’s Health Insurance Program; October 2013; Vol. 130, Number 10:1018. Witherspoon, David E., BDSc, MS; Small, Joel C., DDS, MBA; Regan, John D., DDS, MSc, MS; Missed Canal Systems are the Most Likely Basis for


Endodontic Retreatment of Molars; February 2013; Vol. 130, Number 2:127.

Official 2013–2014 Directory of Members; September 2013; Vol. 130, Number 9.

83rd Legislative Summary: Excellence in Patient Advocacy; October 2013; Vol. 130, Number 10:1003.

Woodburn, David C., DDS; The Voice of Dentistry in Texas; October 2013; Vol. 130, Number 10:1024.

83rd Legislative Session: The Council on Legislative and Regulatory Affairs October 2013; Vol. 130, Number 10:990.

TEXAS Meeting — The 143rd Annual Session of the Texas Dental Association; January 2013; Vol. 130, Number 1:47-70.

83rd Legislative Session: Meet the TDA Legislative Team; October 2013; Vol. 130, Number 10:992.

The 2013 Gold Medal for Distinguished Service — Dr Paul E. Stubbs, November 2013; Vol. 130, Number 11:1108.

Worsham, Debrah J., DDS; Oneacre, Lee P.; The ACA Impact on Texas Dentists; October 2013; Vol. 130, Number 10:1014. Zimmermann, Richard, DDS; Seitz, Stefanie, DDS; Evans, Jim, PhD; Bonner, Justin, DDS; CAD/CAM and Lithium Disilicate: An Anterior Esthetic Case Study; February 2013; Vol. 130, Number 2:141.

83rd Legislative Session: TDA Legislative Resource Guide; October 2013; Vol. 130, Number 10:1028.

Zimmermann, Richard, DDS; Seitz, Stefanie, DDS; Magness, Brent, DDS; Wieck, Blaine; Using CAD/ CAM Technology to Create a 10-Unit Zirconia Fixed Partial Denture — A UTHSCSA Dental School Case Report; October 2013; Vol. 130, Number 10:1039. Zafer, Naila; Rodriguez, Brenda; Lozano-Pineda, Juanita, DDS; Critically Appraised Topic of the Month: Stannous Containing Fluoride Dentifrice is Effective in Reducing Oral Malodor; December 2013; Vol. 130, Number 12:1188. Other Official Call to the TDA 2013 House of Delegates; March 2013; Vol. 130, Number 3:189. Texas Dental Association 2012 Financial Report, 2014 Proposed Budget, and 2014 Budget Explanation; March 2013; Vol. 130, Number 3:218. El Paso Dental Conference; June 2013; Vol. 130, Number 6:520.

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the

NAVIGATOR guidance for your dental career

1946 IH 35 Ste 400 • Austin, TX 78704 P: 512-444-3675 F: 512.443.3031

tda.org


PREVIEW My Marketing Makeover Mark Hyman, DDS

Dr Hyman is a teaching assistant at the Pankey Institute and an adjunct professor at The University of North Carolina School of Dentistry and maintains a private practice in Greensboro, NC.

Every day my team and I help patients to be healthier and have beautiful smiles. Patients come to us wanting complete smile makeovers striving for improved health and beauty. So that’s what we do, make over their smile — completely change the appearance of their smile so that they can be confident to let people see the real them. Confidence is empowering. A beautiful smile attracts people to them — make people want to get to know them better, talk with them, ask them on a date, offer them a job, and so on. The right smile can open a world of opportunities up to someone. Sometimes it isn’t the patient who needs the makeover but the doctor. Just like our patients, we, too, need a makeover. We want to attract more adult, comprehensive patients to our practice. In order to have a greater number of new patients, we need patients to be attracted to our practice and get to know what we have to offer. What we needed was to recreate our brand, our website, our marketing. Someone who could help attract new patients to our practice by showing us for who we are. I had to formulate a plan. This is a plan that any practice can follow to get it started down the right path.

Dr Mark Hyman’s Class Schedule at the Texas Meeting: Take This Job and Love It Thursday, May 1, 2014 • 8:30 am - 11:30 am Beauties and Beasts. . .The Greatest Hits and Misses of Cosmetic Dentistry Thursday, May 1, 2014 • 1:30 pm - 4:30 pm The Top 20 Game Changers of 2014 Friday, May 2, 2014 • 8:00 am - 11:00 am

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STEP 1 Hire a Professional

Just like our

Hire someone — a company — who knows how to market dental practices. This one was easy. I chose Jameson, who was already advising my practice on our management and clinical systems. If you don’t use Jameson, use someone other than a friend of a friend or a local outfit. Choose a company who not only understands marketing but also understands dentistry. The right company will guide you to the best path that reflects you, your practice, and connects you with patients.

STEP 2 Be Willing Change can be difficult, but it can also propel you forward. We broke out of our box and completely changed the direction of our website. We went bold, big, and beautiful. The results have been dramatic. The Google analytics show increased pages per visit, increased time per visitor, and a reduced bounce rate. The bounce rate is the measurement of how many people clicked through to another page on your site as opposed to “bouncing” off once on your site. Our patients love it. And prospective patients have a better idea of the care they will receive when entering my practice.

STEP 3 Internal Marketing

patients, we, too, need a makeover. We want to attract more adult, comprehensive patients to our practice. In order to have a greater number of new patients, we need

As my friend and marketing advisor Misty Absher Clark says, “People must see, feel, hear, and experience your message 5 to 7 times consistently before they will act on it.” This is true of any marketing that you do whether it is internal or external marketing. A great way to help support your marketing message is with your patient appointment reminder system. Many of these systems have great ways to market to patients internally as well as help with your social media. I chose Smile Reminder/Solution Reach to help us with our marketing efforts and patient reminders. It is a great software that allows me to send out e-mails, newsletters, manage my webutation, and more. Jameson, my marketing company, custom designed my enewsletter template to ensure that my brand was consistent and resembled my website.

patients to be attracted to our practice and get to know what we have to offer.

STEP 4 Social Media Like it or not, social media is here to stay. I had a business page and a personal page, yet we weren’t using the pages properly. Part of our marketing makeover consisted of branding the pages to show consistency. Secondly, there was overlap from our practice page and my personal page. In an effort to keep with the 5 to 7 approach, we had to combine the pages. My personal page is now focused on friends and family. While the business page is geared towards patient education, promoting the practice, and connecting with existing and Texas Dental Journal l www.tda.org l December 2013

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prospective patients. Finally, we assigned a Facebook Champion to rally the team to create valuable content on Facebook and update YouTube with videos from my news appearances. Having one person who champions the social media effort has allowed us to become more effective with our social media. We are intentional in how we post. This is because Katie, our champion, does a fantastic job of motivating the team to come up with great ideas for posting.

STEP 5 Practice Brochure The practice brochure was completely revamped to resemble the website. Brochures are an effective way to market the practice still today. Sending a brochure to new patients helps to communicate your message to them. It is part of the 5 to 7 approach and sets the stage for the initial appointment. It must also be consistent with your website and other marketing material. Every piece of marketing must connect to the next. It should all look like they belong together. The marketing makeover of our practice has begun. There is more to do, and will always be more to do. What we have learned is that marketing is a dynamic and ever-changing world. Keeping up with trends as well as knowing patients’ expectations, how they seek information, and choose their dental care providers is imperative to any successful marketing strategy. Long gone are the days of simply putting up a sign and asking for referrals. Now, patients not only want to be referred by friends, but they also seek to validate their choice by searching for you on the web, reading about you on the web, and getting to know you via social media. Yes, we needed a marketing makeover‌and I suspect that we’ll be making over our marketing again and again in years to come to continue to attract the patients we want and need.

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Join us on Facebook, Twitter and LinkedIn! The Texas Dental Association has created groups on Facebook, Twitter and LinkedIn. The goal of these groups is to provide updates on events and current issues. If you do not have a Facebook or LinkedIn account, you can set one up in minutes! Questions? Contact Stefanie Clegg, TDA web & new media manager at (512) 443-3675 or stefanie@tda.org

Join us on facebook.com/texasdental or groups.to/texasdental Follow us on twitter.com/theTDA Get LinkedIN at linkedin.com, search “Texas Dental Association�


Oral and Maxillofacial Pathology Diagnosis and Management

Kaposi Sarcoma Oral and Maxillofacial Pathology Case of the Month (from page 1184)

Clinical Features

Kaposi sarcoma (KS) was first identified by Moritz Kaposi in 1872 and described as a rare lesion involving the skin of elderly males. This neoplasm is now considered to represent an intermediate-grade vascular malignancy with a variable prognosis, depending upon the clinical presentation. All cases are caused by infection with Kaposi sarcomaassociated herpesvirus (KSHV; HHV-8), a human herpesvirus. The tumor arises from endothelial cells of likely lymphatic origin. Four clinical types of KS are recognized: classic form, endemic form, transplantation-associated form, and human immunodeficiency virus (HIV)-related form. The classic form of KS usually occurs in elderly males of Mediterranean descent. The lesions present as multiple blue-topurple plaques or nodules on the skin of the lower extremities. The lesions are asymptomatic and tend to pursue a benign clinical course. The endemic form of KS arises in sub-Saharan Africa and demonstrates a variable clinical course. Some lesions are indolent while others are aggressive and exhibit extensive lymph node and organ involvement. Most cases of endemic KS occur in children or

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young adults. The transplantationassociated form occurs in recipients of solid organs. The disease is thought to arise as a result of cellular immune suppression following drug use to prevent organ rejection. In this setting, KS tends to pursue an aggressive course with widespread dissemination to multiple organs. The HIV-related form of Kaposi sarcoma is thought to be acquired through transmission of HHV-8 through homosexual or bisexual behavior. However, alternate transmission pathways are possible. KS often presents as the first sign of HIV infection and is an indicator of disease progression to the acquired immunodeficiency syndrome (AIDS). It also represents the most prevalent AIDS-associated malignancy. The oral mucosa is a common site of involvement with the hard palate and maxillary gingiva typically affected. Extension into the underlying bone may occur potentially resulting in tooth mobility. Kaposi sarcoma initially presents as a macular blueto-purple lesion that slowly becomes elevated or nodular in appearance due to an increase in tumor burden. Surface ulceration leads to pain and discomfort. In this patient population the disease may involve other mucosal surfaces, cutaneous sites, or visceral organs.

Texas Dental Journal l www.tda.org l December 2013

The incidence of KS associated with HIV infection has steadily decreased in recent years due to the advent of highly active antiretroviral therapy (HAART). Not only has this therapy been associated with regression in the number of reported cases of KS, but in those patients who are treated with HAART, KS tends to pursue a less aggressive clinical course. Depending on the clinical presentation and the medical status of the patient, KS can be treated with surgery, radiation therapy, chemotherapy, immunotherapy, and/or laser therapy. The current case of KS was unusual for several reasons. Although the patient was being treated for oral candidiasis with fluconazole, he was reportedly in good health, and denied any major medical issues or immunodeficiency. The patient first began to experience oral discomfort following scalding the mucosa after the consumption of hot coffee. Shortly thereafter, he noticed a “growth� on the dorsal surface of the posterior tongue which led to a referral to an oral and maxillofacial surgeon (JH). Although involvement of the dorsal tongue by KS may occur, the most common oral mucosal sites are the hard palate and the maxillary gingiva. It is important for health care practitioners to recognize that lesions that may clinically resemble a pyogenic granuloma may, in fact,


be a manifestation of a more significant systemic disease process. All such lesions should be excised and submitted for histopathologic examination.

Follow-up The patient was found to be HIV positive and was referred to a local hospital HIV clinic. He is currently receiving 10 cycles of chemotherapy with liposomal doxorubicin. The patient has not returned to the oral and maxillofacial surgeon but has reported verbally that the oral mucosa is pink in color and appears normal. This finding is not common when immunocompetence returns following appropriate treatment. His current viral load is undetectable since his immunodeficiency is being treated with Stribild, a recently approved once-a-day combination pill to treat HIV infection in adults who have not been previously treated for HIV infection. References 1. Sapp JP, Eversole LR, Wysocki GP. Contemporary Oral and Maxillofacial Pathology, 2nd Ed. St. Louis: Mosby, 2004:232-233. 2. Regezi JA, Sciubba JJ, Jordan RCK. Oral Pathology Clinical Pathologic Correlations, 5th Ed. Saunders/Elsevier, 2008: 115-117. 3. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology, 3rd Ed. St. Louis: Saunders/ Elsevier, 2009: 270-271,557-559. 4. Ganem D. KSHV infection and pathogenesis of Kaposi’s sarcoma. Annu Rev Pathol 2006: 1(2): 273-296. 5. Epstein JB, Cabay RJ, Glick M. Oral malignancies in HIV disease: changes in disease presentation, increasing understanding of molecular pathogenesis and current management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005: 100(5):571-578. 6. Lager I, Altini M, Coleman H, Ali H. Oral Kaposi’s sarcoma: a clinicopathologic study from South Africa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003: 96(6):701– 710. 7. Martinez V, Caumes E, Gambotti L, Ittah H,Morini JP, Deleuze J, Gorin I, Katlama C, Bricaire F, Dupin N. Remission from Kaposi’s sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy. Br J Cancer 2006: 94(7):10001006.

PLACE YOUR NEXT DISPLAY AD HERE! Display advertising in the Texas Dental Journal is one of the best ways to reach the majority of Texas dentists. The Texas Dental Journal is the official publication of the Association. Established in 1883, it is the longest, continuously published dental journal in the Americas and second in the world to the British Dental Journal. Published monthly, the Journal’s circulation exceeds 9,000, its readership exceeds 50,000, and it’s the only statewide publication of its kind to reach the majority of Texas Dentists. TDA Perks Partners, allied groups, and non profits receive discounts! For more information, contact TDA Publications Coordinator Lauren Oakley lauren@tda.org 512-443-3675 ext 150 Texas Dental Journal l www.tda.org l December 2013

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CALENDAR OF EVENTS JANUARY2014 26-28

The American Dental Association will host its annual presidents-elect conference in Chicago, IL. For more information, please contact the ADA, 211 E Chicago Ave Ste 730, Chicago, IL 60611-2678. Phone: 312-4402500; FAX: 312-440-2707; Website: ada.org.

FEBRUARY2014 30-1

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The Dallas County Dental Society will host its annual Southwest Dental Conference in Dallas, TX. For more information, please contact Jane Evans, Southwest Dental Conference Director, DCDS, 13633 Omega Rd, Dallas, TX 75244. Phone: 972386-5741; FAX: 972-233-8636; E-mail: jane@dcds.org; Website: swdentalconf.org. Texas Texas Dental Dental Journal Journal ll www.tda.org www.tda.org ll December December 2013 2013

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The TDA Smiles Foundation will hold a 60-chair Texas Mission of Mercy in Houston. For more information, please contact Foundation Director Judith Gonzalez at TDASF, 1946 S IH35 Ste 300, Austin, TX 78704; Phone: 512-448-2441; E-mail: judith@tda.org; Website: tdasmiles.org.

MARCH2014 27-29

The Greater Houston Dental Society will host its annual Star of the South dental meeting in Houston. For more information, please contact Ms Charlotte Bolls, meeting planner, GHDS, One Greenway Plz Ste 110, Houston, TX, 77046. Phone: 713-961-4337; FAX: 713-961-3617; E-mail: cbolls@ ghds.org; Website: starofthesouth.org.


APRIL2014 3-5

11-12

26-28

The Louisiana Dental Association will host its annual session and New Orleans Dental Conference at New Orleans Morial Convention Center in New Orleans, LA. For more information please contact Ms Normalee Ward, LDA, 2121 N Causeway Blvd, Ste 153, Metairie, LA 70001; Phone: 504-834-6449; FAX: 504-838-6909; E-mail: norma@ nodc.org; Website: nodc.org. The Arkansas State Dental Association will host its scientific annual session at Statehouse Convention Center in Little Rock, AR. For more information, please contact Ms Angela Rogers, ASDA, 7480 Hwy 107, Sherwood, AR 72120; Phone: 501-834-7650; FAX: 501-834-7657; E-mail: angela@angelarogersgroup. com; Website: arkansasdentistry.org. The Oklahoma Dental Association will host its annual meeting at the Cox Convention Center in Oklahoma City, OK. For more information, please contact Ms Lynn Means, ODA, 317 NE 13th St, Oklahoma City, OK 73104; Phone: 405-848-8873; FAX: 405-848-8875; E-mail: lmeans@okda. org; Website: okda.org.

MAY2014 1-4

The Texas Dental Association will host its annual Texas Meeting at the Henry B. Gonzalez Convention Center in San Antonio, Texas. For more information, please contact Sandy Blum, annual session director,

TDA, 1946 S IH 35 Ste 400, Austin, TX 78704; Phone: 512-443-3675; FAX: 512-443-3031; E-mail: sblum@ tda.org; Website: texasmeeting.com.

19-21

The American Dental Association will host its annual Washington Leadership Conference in Washington, DC. For more information, please contact Brian Sodergren, ADA, 1111 14th St, NW Ste 1100, Washington, DC 20005; Phone: 202-789-5168; FAX: 202-7892258; E-mail: sodergrenb@ada.org; Website: ada.org.

JUNE2014 6-7

The Texas Academy of General Dentistry will host its annual New Dentist Conference at the Omni Southpark Hotel in Austin, Texas. For more information, please contact Lindsey Robbins, education director, TAGD, 409 W Main St, Round Rock, TX, 78664; Phone: 512-244-0577; FAX: 512-244-0476; E-mail: lindsey@ tagd.org; Website: tagd.org.

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The TDA Smiles Foundation will hold a 14-chair Texas Mission of Mercy in Mineral Wells. For more information, please contact Foundation Manager Judith Gonzalez at TDASF, 1946 S IH35 Ste 300, Austin, TX 78704; Phone: 512448-2441; E-mail: judith@tda.org; Website: tdasmiles.org.

THE Texas DenTal Journal’s CALENDAR will include only meetings, symposia, etc., of statewide, national, and international interest to Texas dentists. Because of space limitations, individual continuing education courses will not be listed. Readers are directed to the monthly advertisements of courses that appear elsewhere in the Journal. Texas Dental Journal l www.tda.org l December 2013

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Provided by TDA Perks Program

value for your

profession

Disability Income Insurance: What’s Your Plan if You Become Too Sick or Injured to Work? By Eric Tiedtke, CFP, TDA Financial Services Insurance Program

N

o matter where you work, how old you are, or what stage your practice is in, you should have a plan ready in the event that you become unable to work because of an illness or injury. If you don’t, you risk your lifestyle and practice—everything for which you’ve worked so hard. This applies if you are just starting out, building your practice, or beginning to consider selling your practice. Here are some statistics to consider: • • •

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92% of disabilities are the result of illnesses rather than accidents (1). More than 90% of disabling accidents and illnesses are not work related (2). More than half of wage earners believe they have a 2% or less chance of becoming disabled during their working years. In reality about 1 in 4 Americans entering the work force today will become disabled before they retire (3).


More than half of wage earners believe they have a 2% or less chance of becoming disabled during their working years. In reality about 1 in 4 Americans entering the work force today will become disabled before they retire (3). As these statistics illustrate, if you become disabled, it’s much more likely to be because of an illness than a surfboarding accident or your occupation. (Neck and back problems will always be a part of dentistry, but new practice techniques and equipment are reducing these types of injuries.) It may seem unlikely that these statistics could relate to your situation one day, particularly if you’re young and healthy. However, having good health now doesn’t mean you won’t become ill later, and ignoring a risk does not make it go away. Happily, many diseases that once were terminal are now being managed as chronic illnesses—cancer being one of the more prominent ones. Unfortunately, side effects of treatment—such as fatigue, loss of sensitivity in extremities (hands) and tremors—are commonplace. Your life might be saved, but your practice might not be. Planning your future with this in mind is arguably one of the most important things you can do. In the event you’re unable to work because you become disabled through an accident, injury, or illness, your financial future will still be secure if you purchase disability income insurance. There are different types of disability income insurance, and you should understand them before you select coverage. The major types include the following:

Major Types of Disability Income Insurance • • • • •

Disability Income: for your income and buyouts Reducing Term Disability: for business loans Lump Sum Disability: provides a 1-time payment of up to $1 million for permanent disability Business Overhead: for fixed expenses of a practice Retirement Protection: for retirement plan contributions

These policies can be used together or separately to give you the type of risk protection you need; however, disability income insurance is typically the first and most important coverage. The following is a brief overview of key features you should look at when considering or reviewing a policy. Texas Dental Journal l www.tda.org l December 2013

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value for your

profession

Key Features of Disability Income Insurance Guarantees •

Guaranteed non-cancellable policies are owned by the individual. The insurance company cannot change the premium or policy provisions as long as the premiums are paid. Guaranteed renewable policies are individually owned. The policy provisions cannot be changed, but the insurance company reserves the right to increase the premium. Guaranteed issue policies, typically offered through an association or employer group, are usually guaranteed renewable and based upon one continuing to be a member of the group. These policies can be cancelled at any time as the group, rather than the individual, controls the policy.

Definition of Total Disability

Dentists should look first for a true, specialty, own-occupation definition of total disability for the entire benefit period. Under this definition, a dentist’s benefits will not be reduced or eliminated if he or she works in another occupation (which could be a different dental specialty). This means a dentist is not penalized or forced to change careers because of a disability. This type of definition gives a dentist the best opportunity to achieve a reasonable income again.

Benefit Period

Lifetime benefits are best, and just as critical for new dentists as they are for older dentists; however, fewer insurers are offering them. Benefits paid to age 65, 67, or 70 should be the minimum option. Significant life events such as a second marriage, the purchase of a bigger house, buying or constructing an office building, purchasing newer equipment, or paying college education expenses for children often occur much later than they did with previous generations. These life changes coupled with higher debt loads often mean dentists have higher monthly expenses at a time when retirement is not far away. This can result in the need to work longer, because one’s planned retirement age is becoming “flexible,” which often means later. You want your disability coverage to match this flexibility if possible.

The following are policy options: Residual Disability

This is one of the more complex features of a disability policy, and one of the most important. This provision covers a disabled dentist who continues to practice. A claim made by a dentist in this situation may be more likely than one for total disability. Think this is unlikely? How about accidents, surgeries, and illnesses that—because of treatment or rehab—limit the procedures one could do, or how long he or she could work each day?

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Dentists should look first for a true, specialty, ownoccupation definition of total disability for the entire benefit period. Under this definition, a dentist’s benefits will not be reduced or eliminated if he or she works in another occupation (which could be a different dental specialty). This means a dentist is not penalized or forced to change careers because of a disability.


The better policy definitions only require a disabled dentist to have a 20% loss of income, which allows one to continue to work and not be penalized for doing so. Some policies require proof not only of loss of income but also of time worked or duties performed. A second benefit in many policies is the recovery benefit, which can pay benefits to dentists who continue to suffer a loss of income even after they are back to practicing full time. Some polices will pay up to age 65. Most others limit such payments to 12 to 24 months.

Elimination or Waiting Period

This is the period of time before the policy starts paying benefits. Options range from 30 to 365 days. Think of this as a deductible, because you’ll need to have enough savings to cover your expenses (business and personal) during this time. Better policies don’t require that days be consecutive to count towards the elimination period.

Future Purchase Options

This option is inexpensive, very important, and unfortunately often overlooked. It allows you to increase your coverage as your income rises without going through medical underwriting. The lack of this rider could literally cost you hundreds of thousands of dollars in lost benefits because of a change in your health.

Cost of Living (“COLA”) Rider

This rider will increase disability payments to a dentist on claim if there has been an increase in the cost of living over the prior 12 months of the claim.

Student Loan Repayment Rider This rider reimburses $500-$2,000 per month to cover student loan payments in the event of total disability.

Catastrophic Benefit Rider

This pays an additional lump sum based upon inability to perform “activities of daily living.” This could replace 100% of your predisability income in the event of severe total disability.

Exclusions/Limitations

Some policies don’t cover disability caused by extreme hobbies you may choose to undertake, such as hang gliding, racing, parachuting. But there are also exclusions on coverage for expenses incurred as a result of events you have no control over, such an act of war or terrorism (for example, the Boston Marathon Bombing or 9/11). Preferably these events would be covered. Another area of exclusions is related to the leading causes of disability (approximately 18%) in the United States: mental/nervous disorders (eg, depression, anxiety) and substance abuse. Some policies have a 2-year limitation on this type of claim, or don’t pay benefits at all. If you have a history of these conditions, most companies will exclude them from coverage. Therefore, it’s critical you don’t allow an incomplete diagnosis or a trial prescription to relieve a temporary condition to be a part of your medical history. Feeling depressed because of a death in the family or feeling stressed is common. Don’t let something minor be viewed in your medical history as ongoing treatment for depression or anxiety. This could cause these conditions to be excluded from coverage or your application to be denied. After seeing the statistics and insurance options in this article, you might feel overwhelmed. But if you have the proper type of disability coverage in place as part of a comprehensive financial plan, you won’t need to be concerned at all.

These policies will ensure that if you become disabled, you could have one or all of the following: • •

• • •

A guaranteed increasing, tax-free, income for the rest of your life. The ability to pay the staff, rent, and overhead expense—even if you can’t work. The freedom to work part-time or in a new occupation, if you choose to, without jeopardizing your benefits. The ability to pay off your business loans. The ability to pay off your student loans. The ability to continue to accumulate retirement savings.

You can control some of the uncertainty of the future by planning to protect your lifestyle if you are too sick or injured to work. Disability income insurance provides you the assurance of knowing your income and practice will continue even if you can’t work. References 1. CDA 2012 Consumer Disability Awareness Survey 2. JHA 2002 U.S. Group Disability Rate and Risk Management Survey 3. Social Security Administration Fact Sheet, January 2012. For information regarding TDA Financial Services Insurance Program, to discuss disability or other types of insurance options, or receive a proposal, please call 800-677-8644 or visit tdamemberinsure.com. For information regarding other TDA Perks programs, please visit tdaperks. com or call 512-443-3675.

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Texas Dental Association 143rd Annual Session 2013 TEXAS Meeting Photo Contest Photographer: Joseph C. Sullivan, DDS, of San Marcos Title: “Always Alert� Category: Natural Wonders Information on the 2014 TEXAS Meeting Photo Contest is available on texasmeeting.com.

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ADVERTISING BRIEFS Practice OpportunitieS ABBEVILLE DENTISTRY: We are seeking an honest, hard-working, patient-focused dentist who wants to contribute to a culture of caring, nurturing, and skilled professionals. If you have the desire to be a part of a team where you can focus on patients and not worry about the headaches that come with the business side of dentistry, please call us. If you are seeking an environment that provides stability, growth and continuing education, we’d like to share with you how you can fit into that plan. Twenty years ago, I started my practice simply dedicated to serving my patients and community. Now, I’m privileged to guide over 10 practices and 80 wonderful staff. I’ve turned the administrative, operations, and marketing efforts over to people who enjoy doing those sorts of things so our doctors and staff can focus on their patients. I’ve also been able to provide young doctors with an environment where they can grow and practice what they love doing without the worry of costly overhead or administrative headaches. At the same time, offering the potential for significant income and a great life balance. You’ll enjoy a great environment with no egos and no political barriers. We’re growing and need a few quality individuals

ADVERTISING BRIEF INFORMATION SUBMISSION AND CANCELLATION DEADLINE: 20th, 2 months prior to publication (eg, November 20th for January issue) MONTHLY RATES: First 30 words = $40; each additional word = 10¢ Ads must be submitted via e-mail, fax, or web through tda.org and are not accepted by phone. Journal editors reserve the right to edit copy of classified advertisements. Any dentist advertising in the Texas Dental Journal must be a member of the American Dental Association. Advertisements must be not quote revenues or gross or net incomes; only generic language referencing income will be accepted.

to join us in creating something truly special. We’re forming a new, interactive, fun environment that kids and their parents will find refreshing and exciting. If you’d like to talk about this opportunity, please give me a call. I’d be happy to share the vision, the success, and the expectations we have while answering your questions candidly and openly. I hope you’ll consider this position and give me a call. Britt Bostick, DDS, 806-438-5745 or e-mail bbost35821@aol.com. ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS AREA: 5 general dentistry practices available (North Dallas, Richardson, East Dallas, and Dallas); 2 orthodontic practices available (Plano, Carrollton). FORT WORTH AREA: 1 general dentistry practice (West Fort Worth). NORTH TEXAS: 2 pediatric practices. HOUSTON AREA: 1 general dentistry practice available; 1 orthodontic practice available. SAN ANTONIO AREA: 1 general dentistry practice available. EAST TEXAS AREA: 2 general dentistry practices. WEST TEXAS AREA: 1 general practice available. AUSTIN AREA: 1 general dentistry practice available. BRYAN/COLLEGE STATION AREA: 1 general dentistry practice available. OKLAHOMA AREA: 1 general dentistry practice available. For more information and current listings, please visit our website at www.adstexas.com or call ADS Watson, Brown & Associates at 888-419-5531. AMARILLO: General dentist for a locally owned practice looking to provide care for our patients as well as build their own patient base. Ownership opportunity available. Please contact Britt Bostick, DDS, bbost35821@aol.com or call 806-438-5745.

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ADVERTISING BRIEFS AMARILLO: Pediatric dentist for a locally owned practice looking to provide care for our patients as well as build their own patient base. Ownership opportunity available. Please contact Britt Bostick, DDS, bbost35821@aol.com or call 806-438-5745. AMAZING PRACTICE SELL: (Sherri L. Henderson & Associates, LLC) Northeastern Oklahoma Green Country. This great general practice draws from 5 large surrounding counties and is 35 minutes from Tulsa. Busy traffic location; 1,550 sq ft 2 ops, 1 hygiene op, and 1 additional shared hygiene op. The doctor is retiring after 45 years in practice. Great production potential and chance to own or lease half of the beautiful free-standing building (3,100 sq ft). Pictures available — #3001. Call Sherri at 972-5621072, www.slhdentalsales.com. ARLINGTON / FORT WORTH: Associate position available. Full-time dentist and specialist needed to join our successful dental group in Arlington and Fort Worth. Interested candidates should e-mail CV to txdentaljobs@gmail.com. ARLINGTON, EULESS, SAN ANTONIO: Soumava Sen, DDS, PC, seeks dentists for offices in Arlington, Euless, and San Antonio. Must have DDS and valid Texas dental license. E-mail resumes to lcuica@hotmail.com. ASSOCIATE FOR TYLER GENERAL DENTISTRY PRACTICE: Well-established general dentist in Tyler with over 30 years experience seeks a caring and motivated associate for his busy practice. This practice provides exceptional dental care for the entire family. The professional staff allows a doctor to focus on the needs of their patients. Our office

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is located in beautiful east Texas and provides all phases of quality dentistry in a friendly and compassionate atmosphere. The practice offers a tremendous opportunity to grow a solid foundation with the doctor. The practice offers excellent production and earning potential with a possible future equity position available. Our knowledgeable staff will support and enhance your growth and earning potential while helping create a smooth transition. Interested candidates should call 903-5090505 and/or send an e-mail to steve.lebo@sbcglobal. net. Associate needed for dental office in small, quaint town. Potential for practice purchase. Call 361-645-8148. ATTRACTIVE EAST TEXAS DENTAL PRACTICE: SLH Dental Sales is looking for a qualified buyer that would like the opportunity to immediately transition into a general dentist office. This well-established practice has been in its current location since 1993 and is in a beautiful home surrounded by many professional buildings and a stable community. The current dentist is transitioning, and both the practice and building are for sale. This predominantly feefor-service practice contains 2 dentist operatories and 2 hygienist operatories, along with a welcoming reception area, business and private offices, lab, etc., with room for expansion. For more information, please contact our office at 972-562-1072, e-mail sherri@slhdentalsales.com, or visit our website at www.slhdentalsales.com (video available). Listing #3005. AUSTIN: Progressive, patient-centric office is seeking an experienced dentist; must be friendly, caring,


ADVERTISING BRIEFS and professional. Opportunity is available (if desire) for practice ownership. Serious inquiries e-mail fahoosha@gmail.com, mike@miloinc.com. AUSTIN AREA: Associate dentist needed in busy, privately owned group practice. Our present associate dentist is moving, so a good opportunity for someone to take over her schedule. See our website at advancedfamilydentist.com. For more information, please contact Jeffery or Cortni at 512-257-2483. AUSTIN PEDIATRIC PRACTICE SEEKING FULL-TIME ASSOCIATE: Great benefits! Progressive, fast-paced practice. Capable caring staff. We are looking for a bright career-oriented pediatric dentist to join an organization committed to providing high quality dental care to children and adolescents. Our dental team strives to offer exceptional care with integrity. Send your confidential resume to dentalresume27@ yahoo.com for consideration. AUSTIN, SAN ANTONIO, AND DALLAS AREA PRACTICE OPPORTUNITIES MCLERRAN & ASSOCIATES: RIO GRANDE VALLEY (ID #T224): This is an established general/cosmetic family practice with a large, predominantly fee-for-service patient base and excellent location on a high traffic thoroughfare near major retailers. The practice has annual revenue of 6 figures and solid net cash flow despite the office being open only 3 days per week, not being in network with any PPO plans, and doing very little external marketing. The office boasts 5 fully-equipped operatories, digital X-ray units, pano, and computers in each operatory. SAN ANTONIO (ID #T218): This general family practice on the northwest side of San Antonio, just outside of loop 410, is located in a high traffic retail location and

presents a unique opportunity to attract and retain patients. The practice is located in a turn-key, 7 operatory (6 equipped) office, boasts an active patient base of approximately 1,400 patients, and an average of approximately 100 new patients per month. The practice has collected high-6 figures in the last 12 months with strong cash flow. This is an excellent opportunity with tremendous upside potential. SAN ANTONIO (ID #T215): Established in 2003, this general family practice is located in a 1,875 sq ft, 4-operatory office space within an affluent area of San Antonio. The practice boasts a large, PPO/fee-for-service patient base, experienced/ committed staff, and annual revenue averaging in the mid 6 figures over the last 3 years. WEST TEXAS (ID #T211): Associate to purchase opportunity in this thriving, well-established periodontal specialty practice located in low competition and growing area. SAN ANTONIO (ID #T209): Located on the east central side of town in a medical/dental building, this established pediatric specialty practice has seen consistent revenue in the mid-6 figures with low overhead. Excellent stand-alone or satellite office! SAN ANTONIO (ID #T206): Established, 2-location general family practice with total collections in the mid-6 figures on a limited schedule and no external marketing. Low overhead and tremendous upside potential will make this a great starter opportunity. SAN ANTONIO (ID #T185): Wellestablished periodontal specialty practice available for purchase. Contact us now for more information on this excellent opportunity. SAN ANTONIO (ID #T159): This oral surgery practice has a solid referral base, great location, attractive build-out, excellent equipment, and stable revenue/cash flow. The practice owner is available for a transition. SAN ANTONIO (ID #T181): Low overhead general family

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ADVERTISING BRIEFS practice located in 4-operatory, paperless, and digital office. Large Medicaid/PPO patient base, well-established location and upside potential make this a solid opportunity. EAST OF SAN ANTONIO (ID #T140): Quality, comprehensive family practice located in freestanding building with 3 equipped operatories. This practice has seen strong growth the last 3 years and is a great opportunity for doctor looking for a practice in lower competition area near San Antonio. The practice and real estate are available for purchase. HILL COUNTRY WEST OF AUSTIN (ID #T220): This established, fee-for-service, general family practice is located in a scenic, growing hill country town about an hour from Austin. The practice is located in a large free-standing building and currently has 2 equipped operatories with 4 additional (unplumbed) treatment rooms available for expansion. Revenue has consistently been in the low-6 figures per year with very low overhead, no involvement in discounted insurance/PPO plans, limited marketing and a limited schedule. This practice presents an opportunity to get into a well-established office with strong cash flow at far less than the cost of a startup. Both the practice and real estate are available for purchase. SOUTH OF AUSTIN (ID #T219): This is an opportunity to purchase a small, established practice in a growing community just 20 minutes south of Austin. The practice has a fee-for-service/PPO patient base, annual revenue of 6 figures and 3 fully-equipped operatories. This office has strong upside potential and would be a great starter practice or satellite location. AUSTIN (ID #T210): This large oral surgery practice has an established, diverse referral base and 2 attractive locations in the Austin area. The practice boasts incredibly strong gross collections and strong profitability over the past few years and

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still offers the opportunity for further growth. The sellers are looking for a dual degree doctor (DDS, MD) to purchase 50% or 100% of the practice and are willing to continue working part-time for several years following the sale to maintain production and transfer the referral relationships. KILLEEN AREA (ID #T213): This is an opportunity to purchase a small, established general dentistry practice with solid cash flow and a predominantly fee-for-service/ PPO patient base. Even with reduced office hours, the office realized annual revenues of in the mid6 figures over the last 3 years. This practice has tremendous upside potential, evidenced by the fact that it collected in the high-6 figures in 2009. The office has 4 fully equipped operatories and is located within a professional building right in the heart of a high traffic vicinity of the Killeen/Fort Hood area. This is a great starter practice for any motivated and eager dentist! WACO AREA (ID #T189): Well established family practice in low competition area. Minimal investment, strong upside potential and opportunity to own real estate makes this an attractive opportunity. Contact McLerran & Associates: David McLerran or Brannon Moncrief in Austin 512-900-7989, San Antonio 210-737-0100, practice sales, appraisals, buyer representation, and lease negotiations. to request more information on our listings, register at www.dental-sales.com. AUSTIN: A well-established pediatric practice is seeking an energetic dedicated full-time pediatric dentist. We have an extensive client base with continued growth. Our office is a leader in all aspects of pediatric dentistry including sedation and anesthesia dentistry. We have 3 offices with stateof-the art technology and a highly trained support staff. We are looking for the right fit for our practice.


ADVERTISING BRIEFS Ideally, someone who is looking for a long-term opportunity. New grads are welcome to apply. Please e-mail resume to tal@austinchildrensdentistry.com. AWESOME PRACTICE IN EAST TEXAS FOR SALE: SLH is looking for a qualified associate or new graduate, with an option to buy, that would like the opportunity to immediately transition into a general dentistry practice in this growing town of East Texas. The owner is willing to stay for a negotiated amount of time if necessary to ensure a smooth transition. The location of the practice is near the hospital in a beautiful scenic area surrounded by many professional buildings. The staff is excited and ready for a new member and future owner that will allow their current dentist to pursue other opportunities. The office space is 1500 square feet with 4 treatment rooms equipped, 2 private offices, and 6 highly experienced employees. The new practitioner will lease space from the group dental practice. The group practice occupies a portion of the building complex and is looking to transfer ownership of the patient base and/or equipment within 6 months. For more information contact our office at 972-5621072 or e-mail sherri@slhdentalsales.com or visit our website at www.slhdentalsales.com. #3050 CB (pictures can be made available). BROWNSVILLE SEEKING ASSOCIATE: Established general dental office in Brownsville (30 minutes away from South Padre Island) is seeking a caring, energetic associate. We are a busy office providing dental care for mostly children. Our knowledgeable staff will support and enhance growth and earning potential allowing the associate to focus on patient dental care. Interested candidates should call 956546-8397.

DALLAS / FORT WORTH: Area clinics seeking associates. Earn significantly above industry average income with paid health and malpractice insurance while working in a great environment. Fax 312-9449499 or e-mail cjpatterson@kosservices.com. DALLAS AREA: New and beautiful general dentistry practice on I-30 near Rockwall. Over 5 years of clinical experience required. Perfect for dentists who refer endo! Pay based on collections. PPO and Medicaid accepted; M-F, 2:00 pm – 8:00 pm, and Saturdays available. Visit www.mockingbirddentalgroup.com. DENTALONE PARTNERS is opening new offices in Austin and the surrounding areas. Each practice is unique in that it has an individual name like Preston Hollow Dental Care or Waterside Dental Care. Our patient base consists of approximately 70% PPO and 30% fee-for-service. All our offices have topof-the-line Pelton and Crane equipment, digital X-rays, and intra-oral cameras. We offer competitive compensation packages with benefits. To learn more about working with one of DentalOne Partner practices, please contact Andrew Risolvato at 972755-0838 or andrew.risolvato@dentalonepartners. com. DENTALONE PARTNERS is opening new offices in Dallas and the surrounding areas. Each practice is unique in that it has an individual name like Preston Hollow Dental Care or Waterside Dental Care. Our patient base consists of approximately 70% PPO and 30% fee-for-service. All our offices have topof-the-line Pelton and Crane equipment, digital X-rays and intra-oral cameras. We offer competitive compensation packages with benefits. To learn more about working with one of DentalOne Partner

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ADVERTISING BRIEFS practices, please contact Andrew Risolvato at 972755-0838 or andrew.risolvato@dentalonepartners. com.

cases done at El Paso’s Children’s Hospital. Excellent opportunity. Contact 719-671-5617 or tparco@ dentalquestions.com.

DENTALONE PARTNERS is opening new offices in San Antonio and the surrounding areas. Each practice is unique in that it has an individual name like Preston Hollow Dental Care or Waterside Dental Care. Our patient base consists of approximately 70% PPO and 30% fee-for-service. All our offices have topof-the-line Pelton and Crane equipment, digital X-rays, and intra-oral cameras. We offer competitive compensation packages with benefits. To learn more about working with one of DentalOne Partner practices, please contact Andrew Risolvato at 972755-0838 or andrew.risolvato@dentalonepartners. com.

DENTISTS: Associate general dentist wanted. Fulltime or part-time, proficient in endodontics and simple extractions. Our practice performs root canal treatment for Medicaid and PPO patients, children and adults, under guidance of experienced endodontists. Great opportunity to learn while you earn. Minimum of 2 years experienced required. Please contact endo.dr.888@gmail.com.

DENTALONE PARTNERS is opening new offices in the upscale suburbs of Houston. Each practice is unique in that it has an individual name like Gulf Breeze Dental Care or Waterside Dental Care. All of our offices have top-of-the-line Pelton and Crane equipment, digital X-rays, and intra-oral cameras. Our patient base consists of approximately 70% PPO and 30% fee-for-service. We offer competitive compensation packages with benefits. To learn more about working with DentalOne Partner practices, please contact Andrew Risolvato at 972-755-0838 or andrew.risolvato@dentalonepartners.com. DENTISTS: A practice of 1 year looking for a BC/ BE pediatric dentist to come on board as employee with possible buy-in. This is an all pediatric dentists’ office. You would be working next to a BC pediatric dentist. Good terms with great pay and work hours. Must be able to get Board Certified within 1 year. OR

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DFW AREA: Seeking general dentists and specialists. Our offices are located in the Dallas / Fort Worth area. We are looking for caring, energetic associates. New graduate and experienced dentists welcome. We offer benefits, a helpful working environment and an opportunity to grow. We accept most insurance and Medicaid. Please submit your resume via e-mail to jennifer@smileworkshop.com or call our office at 214-757-4500. EAST DALLAS practice for sale near White Rock Lake and Arboretum. Practice established in 1957. It is presently being worked from 8:00 am to 12:00 pm 4 days per week. Has 2 operatories with very low rent. A perfect practice for a senior dentist looking for something to do or a younger dentist wanting to supplement his income. Minimum investment required. Please call 972-740-9454. EAST TEXAS: Well-established dental practice seeks caring, proficient, and motivated dentist for associate employment. Our office is located in a mid-sized town with abundant outdoor activities including hunting and fishing and a “small town”


ADVERTISING BRIEFS atmosphere. We offer all phases of dentistry. Interested candidates should e-mail correspondence and resume to mloon242@aol.com.

equipment. Located on east side of El Paso. For more information please contact Dr Oscar Vargas at 915276-2242.

EDINBURG: Falcon Dentistry PA dba Falcon Dental Center seeks dentist in Edinburg. Doctor of Dental Surgery degree required. Texas Dental License required. Qualified applications may submit resume directly to Atlantis Gloria Moya, office manager, via fax at 956-287-4926 or via e-mail at falcondentistry@ gmail.com

EL PASO: We are hiring a skilled and compassionate dentist to join our stable and successful practice. We are seeking a highly professional dentist with a knack for general dentistry. Prospective candidates must be dynamic, fun loving, and looking for a longterm commitment. Our practice is highly productive affording our providers an opportunity to attain competitive compensation. If interested, please forward your CV to annette@vistahillsfamilydental. com.

EL PASO PRACTICE FOR SALE: Large west side El Paso practice in a professional building with strong collections. Each treatment room has large windows with fantastic views. The practice is computerized and has digital X-rays. Majority full fee with some PPO plans. Visit tx-pt.com or call at 214-460-4468; rich@tx-pt.com. EL PASO: Full-time position for a general dentist. Do not waste your best years at dead-end jobs. Great earning potential and future partnership option. Affordable El Paso Dental is looking for a Texaslicensed dentist to work full-time in our office in El Paso, TX. Applicant must be licensed in the state of Texas and have 1 year of experience. If interested please submit a resume to the following e-mail address: drdarj@gmail.com. Please provide an accurate contact number and e-mail address. EL PASO: Selling a state-of-the-art general practice with orthodontic patients. Building is 6,000 sq ft for sale or lease. Whole building available. Partnership also available as well as many other options. Building is beautiful and only 1 year old with 11 ops fully equipped with digital X-rays, Softdent, Adec, Marcus

EP DENTISTRY 4 KIDS: (epd4k.com/www.facebook. com/epd4k) is searching for associate dentists to join our teams in El Paso. Our practice provides care primarily for children from 6 months to 21-yearsold. As an associate, you will examine, diagnose, and provide treatment counseling to patients in a comprehensive manner. You will also be trained on treatment via conscious sedation. We are closely knit company which is wholly internally owned. The best way to describe the company is as a co-op. Many associates have gone on to become members of the co-op and enjoy the benefits of ownership. Requirements: Prefer general and pediatric dentists with 2 to 3 years minimum experience and eligible to practice dentistry in Texas. However, other candidates that prove capable will be considered. Please submit your resume to brentcroberts@gmail. com. A comprehensive benefits package is offered. You’ll be guaranteed a minimum of 6 figures. The package also includes medical and vision insurance plans, 401K opportunities, malpractice insurance and in-house CE opportunities. EOE.

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ADVERTISING BRIEFS GALVESTON: Well-established, successful practice of 35 years needs full-time associate dentist for FFS/ PPO practice. Experienced staff, new equipment, Galveston. Senior owner loves to teach sedation, implants, and other surgical procedures. No Medicaid, No DHMO practice in 6 ops, 2 surgical suites, all operatories computerized with digital X-ray and intra-oral cameras; digital panoramic X-ray; paperless charts for easy documentation. Visit www.todaysdentistrytexas.com. The Galveston area is just 25 minutes south of Clear Lake, which has planned communities with superior schools, multiple educational, recreational, and cultural venues as well as access to all of the Houston cultural and sport venues, shopping and restaurants. We are minutes away from all types of water sports including several large marinas. http://goo.gl/maps/lWkF. Possibility of buy-in and partnership possible after an interim term. Interview today! E-mail CV to kkcarroll10yahoo. com or call 832-385-8875. GARY CLINTON DALLAS OUTLYING COMMUNITY PRACTICE FOR SALE: Four minutes from the downtown area of this growing, beautiful, nice-sized community. Near a lake; wonderful schools. Four operatories; average gross. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27-year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete Professional Certified Appraisals for which Congress has set guidelines under the North

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American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214503-9696. WATS 800-583-7765. GARY CLINTON DALLAS PRACTICE NEAR TRINITY RIVER GREENBELT FOR SALE: Doctor retiring for health reasons; well-established 30+-year-old practice. High demand lower income area. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27 year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete Professional Certified Appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-5039696. WATS 800-583-7765. GARY CLINTON FAR NORTH AUSTIN PRACTICE FOR SALE: Very beautiful area with hills and lakes. Established general practice in the number 1 growth area in Texas. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27-year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts


ADVERTISING BRIEFS (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete Professional Certified Appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765. GARY CLINTON FORT WORTH AREA EXCELLENT PRACTICE FOR SALE: Adult restorative practice; doctor retiring for health reasons; great Southwest area. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27 year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete Professional Certified Appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765.

GARY CLINTON HOUSTON PRACTICES FOR SALE: H-1 NORTH OF HOUSTON AREA. Premier practice; Near 7-figure gross with 5 operatories; exceptional recall; 30+ years; well-established. Digital equipment. Hygiene profits will cover debt service. H-2 Northwest Houston in Lake Houston Area. Well established practice. High-6 figures estimated gross on 3 days. Excellent recall. This is a 7-figure practice waiting to happen. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27-year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete Professional Certified Appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765. GARY CLINTON NORTH OF DENTON AREA GENERAL PRACTICE FOR SALE: D-1 Denton Practice: Five operatories; nice equipment; 30-plus-year dentist retiring. Flexible transition; No low fee plans. Contact Gary Clinton 214-503-9696. GARY CLINTON PANHANDLE & WEST TEXAS PRACTICES FOR SALE: W-1 7-figure collections; 60% net on 4 days a week. Only dentist in small community. Progressive family dentist retiring to Texas Dental Journal l www.tda.org l December 2013

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ADVERTISING BRIEFS travel. Upgraded equipment. Nice office. Doctor will sell or lease building. P-1 Amarillo/Panhandle Area Well-established practice; excellent operating profits. A free appraisal can be very costly to one party or both. Gary Clinton is a senior dental appraiser, a 27year member of the Institute of Business Appraisers, Inc., now the National Association of Certified Valuators and Analysts (“NACVA”). I follow the business valuation standards of the North American Business Valuation Standards Counsel, NABVSC. Experience is critical in this most complex of business transitions. “For 40 years you’ve seen the name...a name you can trust.” I personally handle every sale/transition and complete Professional Certified Appraisals for which Congress has set guidelines under the North American Business Valuation Standards Council. If buyer purchases your building with the practice, there is no additional charge. Every call is very confidential. General and specialty appraisals and practice sales. 100% funding available. DFW 214-503-9696. WATS 800-583-7765. GARY CLINTON, BROKER/SENIOR APPRAISER OF GENERAL & SPECIALTY PRACTICES WITH 40 YEARS IN DENTISTRY: We need sellers for general and specialty practices! We have pre qualified buyers. When we sell your practice, if you own your office, there is no real estate commission. Gary Clinton — PMA. I need practices in or near Austin, San Antonio, DFW and Houston area and other metro Texas locations which are in high demand. Call me confidentially. 1-880-583-7765 or 214-503-9696 Dallas area. GENERAL: Golden Triangle (Port Arthur): Six-figure gross and very high net income practice in small gulf coast town. Dentist earns 6 figures per year for work 4 days a week; 2,200 sq ft with 6 fully equipped

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operatories, 4 dentist and 2 hygiene. Extensively remodeled in 2001. Real estate for sale. Single tenant, stand-alone building, 30-plus space parking bordered by 2-lane street and residential area. High patient growth. Patients from major employers such as Shell, DuPont, Texaco, Chevron, and Shell. Call DDR at 800-930-8017 or www.ddrdental.com. GENERAL: Houston (Bellaire/Post Oak): Terrific growth practice with great facilities nested in neighborhoods and schools. Fronts high traffic Chimney Rock. Interior and equipment rebuilt in 2009. Total of 8 operatories plumbed with 4 operatories in use. Free-standing building with 7,000 total sq ft also for sale. Call DDR AT 800-930-8017 or www.ddrdental.com. GENERAL: Houston (I-45 North) Six-figure gross with high net income. Six-figure income for dentist. Growth opportunity within patient base. Well cared for facilities with 7 operatories. Call DDR AT 800-9308017 or www.ddrdental.com. GOLIAD: Associate/buy-in partnership opportunity available in high producing and high collection practice. 100% fee-for-service practice. If you have excellent communication skills, a light touch and above average skills, we should meet. Our practice uses Cerec technology, places and restores implants, is 100% digital and has a high emphasis on cosmetic dentistry. Great emphasis on patient comfort with oral sedation used extensively. Our town has an excellent school district and our patients have a great appreciation for quality dentistry. Visit our website at www.goliaddentalcare.com. Call Dr Dan Garza at 361-645-2381 or e-mail dmolar@sbcglobal.net.


ADVERTISING BRIEFS HOUSTON AND SAN ANTONIO: Care For Kids, a pediatric focused practice, is opening new practices in the San Antonio and Houston area. We are looking for energetic full-time general dentists and pediatric dentists to join our team. We offer a comprehensive compensation and benefits package including medical, life, long- and short-term disability insurance, flexible spending, and 401(K) with employer contribution. New graduates and dentists with experience are welcome. Be a part of our outstanding team, providing care for kids of Texas. Please contact Anna Robinson at 913-322-1447; e-mail arobinson@amdpi.com; FAX: 913-322-1459. HOUSTON AREA: Great opportunity for a pediatric dentist. A part-time position available now in the Houston area. Flexible scheduling and a great work environment. Already established a flow of patients. Requirements: Texas State license. For more information, please e-mail mydentalsmile@gmail. com. LAREDO: We are looking for a pediatric dentist for a rapidly growing practice. Strong referral sources. Hospital cases performed twice a week at local hospital. State-of-the-art practice with digital X-rays and charts. If part-time, then dentist can fly in to see patients and still maintain living at their current city. Partnership in future is an option if candidate interested. Please e-mail t2tpdlaredo@gmail.com. LAREDO / MCALLEN: If you are looking for a great opportunity to join an amazing team with ownership potential and minimal administrative responsibility, this is it! We are looking for a motivated and personable individual with a positive attitude who

is passionate about working with children. Our 3 locations offer a modern environment with all digital records and X-rays. We offer in-office oral conscious sedation and general anesthesia at local hospitals. Our emphasis is on exceptional patient service, team member development and having a lot of fun. Our compensation package includes a percentage of collections with a daily guarantee, plus 401k, medical, vacation, and holidays. Our mission is to positively impact the lives of our patients, their families and our team members. If you would like to be a part of this amazing team please call Dr Guzman at 956-607-0732 or e-mail drguzman@ littleheroesdentistry.com. LONGVIEW PEDIATRIC PRACTICE SEEKING FULLTIME ASSOCIATE: Sherri L. Henderson & Associates, LLC is looking for a qualified associate to transition into an active pediatric dental practice. The associate will be working with a knowledgeable staff and a great new patient flow. This practice is dedicated to performing high quality dental care to the children and adolescents of the surrounding communities. The dentist/owner established the practice 14 years ago, and offers a future opportunity to buy-in. This beautiful pediatric practice is 5,000 sq ft, with 4 doctor chairs and 4 hygiene chairs, plus a quiet room and a new patient room. A full-time schedule of 4.5 days per week is offered, with salary based on 40% of production. Health insurance and benefit plans are negotiable. For more information, please contact our office at 972-562-1072, e-mail sherri@slhdentalsales. com, or visit our website at www.slhdentalsales.com (Photos available). Listing #3435.

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ADVERTISING BRIEFS MIDLAND: One of the fastest growing cities in Texas needs a dynamic, caring, patient-focused dentist to join our growing practice. Associate and buy-in opportunities are available. Please contact Dr Britt Bostick, DDS, at bbost35821@aol.com or call 806438-5745.

out PRN. High net on 4 days a week. Mid-sized community. W-1 West Texas Central Area. Oral surgeon retiring; Flexible transition. Seller phase out. High net over 50%. Mid-sized community. All are confidential. Gary Clinton, Oral Surgery Appraiser. 1-800-583-7765.

NORTH TEXAS: Pediatric dentist needed for busy north Texas practice. Enjoy life in Sherman, Texas, a family-oriented city with the convenience just 1 hour north of Dallas, but without the hustle and bustle of the big city! Excellent practice opportunity for motivated and nurturing pediatric dentist seeking full-time associate with potential for partnership. Practice has a great reputation and is committed to providing quality comprehensive care for our patients and families in a fun and relaxed atmosphere. Stateof-the-art facility with highly trained and dedicated staff. Competitive compensation and benefits. Fee-for-service, limited Medicaid. Must possess high personal standards, strong work ethic, excellent technical and communication skills, and be willing to treat the full range of pediatric dental patients. Opportunities for in office conscious sedation, IV sedation and hospital dentistry. Please e-mail resume/CV to bth1@cableone.net.

PEDIATRIC PRACTICE FOR SALE: Very large private pediatric practice in large metropolitan area in Texas, mix of PPO and Medicaid in a beautiful, free-standing 5,000 sq ft building with 10 chairs. Highly profitable private practice established 30 years. Texas Practice Transitions, Inc. Rich Nicely has been serving Texas dentists since 1990. Visit www.tx-pt.com or call at 214-460-4468; rich@tx-pt.com.

Oral surgeon needed. Oral surgeon will be busy for a full day or 2 with implant and bone grafts. Competitive pay. Flexible in scheduling. Please call 361-387-3442. ORAL SURGERY PRACTICES: D-1 DALLAS SUBURBAN MID-SIZED CITY. Very nice office. Bread-and-butter practice. Three-day-a-week practice; excellent referral base. SA-1 San Antonio Fast Growing Outlying Community. Lakes, Hill Country beauty; highly rated schools. Flexible transition. Will phase

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READY TO SELL — CORPUS CHRISTI AREA: Sherri L. Henderson & Associates. The DDS is relocating to another city. This cosmetic and general dentistry practice was established in 1982 in a professional office complex with 1,400 sq ft and 3 existing treatment rooms. This location would make a great place for a start-up or satellite practice and it has plenty of space next door for expansion. The location is on one of the busiest streets with access to Padre Island Drive. This is a cash basis practice with a dedicated loyal staff and great revenue potential. The current owner has extensive experience with TMJ and sleep apnea and would be willing to return to the practice periodically if the new owner was interested. #3070 (pictures available). Contact 972562-1072 or e-mail sherri@slhdentalsales.com www. slhdentalsales.com. SAN ANTONIO NORTH WEST: Associate needed. Established general dental practice seeking quality oriented associate. New graduate and experienced


ADVERTISING BRIEFS dentists welcome. GPR, AEGD preferred. Please contact Dr Henry Chu at 210-684-8033 or versed0101@yahoo.com.

confidential. Call on our experience to assist you in making that transition dream become a reality. Call 972-562-1072 or e-mail sherri@slhdentalsales.com, website slhdentalsales.com.

SAN ANTONIO: Pediatric dentist. Well-established and growing pediatric practice is seeking a caring and energetic associate for a full-time and parttime position. We offer excellent production with incredible earning potential, vacation and other benefits. New graduates are welcome. Please submit your resume to velezluke@yahoo.com.

SUGAR LAND, CYPRESS, PEARLAND AND THE WOODLANDS: Full- and part-time positions available. Well established and rapidly growing practices that offer great financial opportunity. High income potential and future equity position. E-mail CV to Dr Mike Kesner, drkesner@madeyasmile.com.

SLH DENTAL SALES (Sherri L. Henderson & Associates): Consulting and staging for your transition! Let us help you make a transition plan. We can analyze the market, review your current patient base, secure the staff, spruce up the office space, and much more. We specialize in practice transition consulting and can assist you in a plan to help you create all the right conditions to begin that step from retiring to starting up a new practice. Our team has decades of hands-on experience in the dental market place as practice owners, employees, and management advisors. ASSOCIATES, PARTNERS AND BUYERS AVAILABLE. Are you seeking an associate, partner, or buyer? SLH has qualified candidates ready in all parts of Texas looking for your specific practice profile. There are many graduates as well as very experienced dentists looking for the opportunity to transition into your already established practice. These dentists have great people skills, case presentation experience and can be a very valuable and reliable addition to your bottom line. Contact us. If you are unsure about the right timing or simply would like to talk about the opportunities, call us today for a complimentary consultation in person or by telephone. All contact with you is strictly

TEXAS PRACTICE TRANSITIONS: Rich Nicely has been serving Texas dentists since 1990. Visit www. tx-pt.com or call at 214-460-4468; rich@tx-pt.com. ORTHODONTIC PRACTICES: Five-chair orthodontic practice in McKinney. Eight-chair orthodontic office in Arlington. PEDIATRIC: Very large private pediatric practice in large metropolitan area in Texas, mix of PPO and Medicaid in a beautiful, free-standing 5,000 sq ft building with 10 chairs. Highly profitable private practice established 30 years. MCKINNEY: Mid-sized collections in 5 treatment rooms in a beautifully finished facility, paperless, 100% digital practice with a digital pano. NORTH TEXAS: Large prosthodontic practice 30 minutes from Dallas, premier free-standing building with 7 ops, 100% digital, 100% full fee. RURAL, 30 MINUTES FROM DALLAS: Smaller practice in a nice free-standing building, digital X-rays, 100% full fee. DALLAS SUBURB: Large practice, 6 ops, 100% digital, 1,900 full-fee patients, 8 days of hygiene. WEST TEXAS: Small practice in Panhandle area. ONE HOUR NORTH OF HOUSTON: Medium-sized full-fee practice, freestanding building, digital X-rays. EAST TEXAS: Very low overhead, medium sized full-fee practice in freestanding building.

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ADVERTISING BRIEFS THE HINDLEY GROUP, LLC Dental Practice Sales -NEW LISTING! WEST TEXAS PRACTICE FOR SALE: Practice in same location for over 34 years! This general dental practice is open 4.5 days per week, 1,250 sq ft, with 3 fully-equipped operatories as well as a space for hygiene. Middle, upper-middle class patient demographic, mostly insurance with some cash revenues. WEST HOUSTON PRACTICE FOR SALE: Small general dental practice with high percentage restorative revenues. Average 8 new patients per month. Two fully-equipped operatories with 1 additional hygiene room and another room plumbed for expansion. Digital pano. Same location for 13 years. cash and insurance revenues. Motivated seller! Excellent opportunity for start up at low cost. SOUTH OF HOUSTON, TEXAS COASTAL PLAINS GENERAL DENTAL PRACTICE FOR SALE: Wellestablished for 28 years and in same location for last 17. Strong revenues and healthy profit margin on 4 days per week! 2,500 sq ft building with 4 fullyequipped operatories also for sale. Experienced, dependable staff. Great opportunity! WEST CENTRAL TEXAS PRACTICE FOR SALE: 25-year-old wellestablished family dental practice for sale. Open 4.5 days per week. 2,400 sq ft building with 4 fullyequipped operatories. Three direct digital X-Ray units in operatories plus numerous other upgrades to equipment and building, which is also for sale. Steady new patient growth and outstanding staff.

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NORTHWEST HOUSTON GENERAL DENTAL PRACTICE: Well established, very traditional practice with moderate fee-for-service revenues and healthy profit margin. Open 4 days a week. 1,200 sq ft facility with 3 fully-equipped operatories. Doctor retiring. NORTH OF HOUSTON GENERAL DENTAL PRACTICE: Very well established practice in the same location for 31 years. Moderate cash revenues with some PPO insurance. Practice open 4 days per week. 2,200 sq ft with 2 fully-equipped operatories and 3 additional plumbed. Loyal, experienced staff. Doctor is retiring. ALBUQUERQUE, NEW MEXICO GENERAL DENTAL PRACTICE: Same location for 8 years. Three fullyequipped operatories. Steady growth with 20-40 new patients per month. Significant Medicaid with growing PPO revenues. Call 800-856-1955 or e-mail jenny@thehindleygroup.com WACO: Great associate opportunity. Waco practice looking for motivated associate with a desire to join a PPO/fee-for-service practice. Great pay, great work environment with 2 other dentists and top notch staff. Please contact Dr Johnson at 435-237-2339 or e-mail at johnson.2978@gmail.com. WESLACO: Private practice is looking for a licensed full-time general dentist. Hours are Monday through Friday, 8:00 am to 5:00 pm. Call 956-655-8295.


ADVERTISING BRIEFS Office Space BEAUMONT: New beautiful orthodontic office for lease, completely furnished and equipped on the best location in Beaumont; 6-chair bay, 2 business offices. 2300 sq ft with lots of supplies. For more information, please call 409-861-2851 or e-mail drtsyler@gmail.com. DALLAS AND ROCKWALL: Orthodontic or other specialty office for lease to share with owner. Furnished and equipped. Dallas office is 4,000 sq ft in Lake Highlands area with 2,500 sq ft leasable

residence above. Rockwall office is 1,800 sq ft in antique building and furnishings. E-mail rcppc@ sbcglobal.net. EAST TEXAS DENTAL PRACTICE: Malakoff, Texas, dental practice for sale. Malakoff is near Athens, Texas. Dentist retiring due to health. General practice established in this location in 1974. Location will make a great place for a start-up or satellite practice due to numerous surrounding small towns. The practice, equipment and real estate are available for purchase. Lot on main highway is also available for future office site. There is a great potential for growth. Current practice is only 3 days a week. For

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James L. Dunn, Trustee Texas Dental Journal l www.tda.org l December 2013

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ADVERTISING BRIEFS more information contact either of the following: Stanley Fulgham, 817-657-7239, 9:00 am to 8:00 pm Monday through Saturday or e-mail to stanleyf@ sbcglobal.net. Donna Fulgham, 214-642-2038 9:00 am to 8:00 pm or e-mail to rodneyshouse@comcast. net. EL PASO: Lease space previously occupied for 23 years by oral surgeon. Plumbed for gases and suction; 2 operatories, 2 consult rooms; large storage area; finance room; private office; kitchen/lounge. Just off the busiest street on the westside. Located in between 2 general dentists and orthodontist next door. Well kept building. Very reasonable rent. Contact Rick Ponsford at 915-581-4440 or 915-5260109. EL PASO: New dental offices for lease at Renova Plaza. Seeking complimentary specialties to 3 general practitioners and 1 periodontist. Suites can be finished to suit. Highest quality architecture and construction in upscale neighborhood; strong demographics. Agent: Etzold & Co, 915-845-6006. FORT WORTH: Fully equipped dental suites for lease in growing North Fort Worth. Ideal for dental specialist — oral surgeon, endodontist or periodontist. Please contact Jennifer at 817-3662268. GRANBURY: Great location, high visibility, and traffic. Approx 6,000 sq ft building, approx 3,000 sq ft of dental; 6 ops. For lease or possible sale. Call 817-2639014 or e-mail jeremy@mirandadentistry.com. HOUSTON / LEAGUE CITY: Medical/office space available for lease in a stellar location, right outside the largest school in Texas with 4,200 students on

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Texas Dental Journal l www.tda.org l December 2013

campus. In a fast growing area with a lot of young families, located close to the waterfront, boardwalk, Gulf Coast beaches, Houston downtown, NASA, and Hobby Airport. Home to one of the state’s top rated Independent school districts, stunning yet affordable waterfront neighborhood developments, NASA, BOEING, UTMB. Contact Vijay Bhagia 832-618-0652 or eduvillageland@gmail.com. NORTH TEXAS DENTAL PRACTICE OPPORTUNITIES: Lewis Health Profession Services has multiple career opportunities available in the greater Dallas/ Fort Worth area. Practices for sale, associate opportunities, finished out dental offices, and specialty practice opportunities. Lewis Health Profession Services has 30 years experience in dental practice transitions, with over 1,000 successful transitions completed. Dentistry is our only business. We confidentially deal with all clients. Lewis Health Profession offers seller representation, buyer representation, opportunity assessments, associate placement and strategic planning services. Please check out our website at www.lewishealth.com for current opportunities. Contact Dan Lewis at Lewis Health Profession Services 972-437-1180 or dan@ lewishealth.com for additional information. ROUND ROCK: Orthodontist needed next to dentist in high growth high traffic area in Round Rock, north of Austin in one of the fastest-growing counties. For more information, e-mail john@herronpartners.com or call 512-457-8206. SAN ANTONIO 4-OPERATORY PRACTICE FOR SALE: We have outgrown the space, looking to relocate. Space is perfect for a specialist. Transition available. The space is located right off the Dominion Country Club golf course in San Antonio. Very modern,


ADVERTISING BRIEFS tranquil, pleasant location, granite countertops, plumbed for nitrous, second floor with balcony. Please contact Dr Stratton at 210-687-1150 or e-mail tiffini@dominiondentalspa.com. SEGUIN: Orthodontic office space for lease in. Office was phased down when orthodontist retired. Office is equipped and functional. Great for a start up or a satellite location. E-mail inquiries to lmassadds@ gmail.com.

for sale EQUIPMENT FOR SALE: New handheld portable X-ray unit. New intraoral wall X-ray unit, new mobile X-ray on wheels. New chairs/units operatory packages, new implant motors. Everything is brand new, with warranty. Contact nycfreed@aol.com.

miscellaneous EXPERTS IN DENTAL BOOKKEEPING JN & Associates, LLC is a professional certified bookkeeping service. Our services free up your time by taking over compliance and back office tasks. www.jnabookkeepers.com Contact us at 512-4325029. You run your business, we watch your books! LOOKING TO HIRE A TRAINED DENTAL ASSISTANT? We have dental assistants graduating every 3 months in Dallas and Houston. To hire or to host a 32-hour externship, please call the National School of Dental Assisting at 800-383-3408; Web: schoolofdentalassisting-northdallas.com.

EQUIPMENT FOR SALE: Panoramic/Ceph (1), panoramic X-ray (1), 70 KVP x-rays (3), dental chairs (3), dental lights (3), Porter N2O units (3), Steri Source Sterilization Center (1), and misc items. Inquire with Nora or Bev 361-992-9500 or e-mail beverly@paulkennedydds.com.

Interim Services HAVE MIRROR AND EXPLORER, WILL TRAVEL: Sick leave, maternity leave, deployment, vacation or death, I will cover your office. Call Robert Zoch, DDS, MAGD, at 512-263-0510 or drzoch@yahoo.com. OFFICE COVERAGE for vacations, maternity leave, illness. Protect your practice and income. Forest Irons and Associates, 800-433-2603 (EST). Web: www. forestirons.com. “Dentists Helping Dentists Since 1983.� Texas Dental Journal l www.tda.org l December 2013

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ADVERTISERS ADS Watson, Brown & Associates ......................690 AFTCO ....................................................................667 A.J. Riggins ............................................................661 American Academy of Facial Esthetics ...............668 Anesthesia Education and Safety Foundation ..........................................................664 DDR Dental Trust ...................................................727 Dental Handpiece Repair Guy ..............................669 Dental Post .............................................................678 Dental Practice Specialists ...................................705 Dental Spots.......................................................Insert Dental Systems ......................................................680 The Professional Recovery Network (PRN) addresses personal needs involving counseling Dental 3D Solutions ...............................................667 services for dentists, hygienists, dental students Dental Trust ............................................................691 and hygiene students with alcohol chemical DJ Bhola CPAor .........................................................661 dependency, or any other mental or emotional Fortress Insurance ................................................654 difficulties. We provideGary impaired profesClintondental — PMA .............................................658 sionals with the supportHanna, and means toAttn. confidenMark — at Law .................................706 tial recovery. HighTex...................................................................661 Hindley Group ........................................................680 If you or another dental professional are conJKJ Pathology........................................................668 cerned about a possible impairment, call the Kennedy, Thomas John, DDS, P.L.L.C. ................707 Professional Recovery Network and start the .................................................651 recovery process today.Medical If youProtective call to get help North Dallas Anesthesia .......................................678 for someone in need, your name and location Ocean Dental..........................................................655 will not be divulged. The Professional Recovery OSHA ............................................ Inside Back Cover Network staff will ask for your name and phone Paragon ..................................................................691 numbers so we may obtain more information Patterson Dental ..........................Inside Front Cover and let you know that something is being done. Professional Recovery Network...........................730 Professional Solutions..........................................662 Resolve Dental Lab ...............................................706 Statewide Toll-free Helpline Shepherd, Boyd W. ................................................681 800-727-5152 Sherri L. Henderson & Associates .......................657 Emergency 24-hourSmart Cell: Training, LLC ..............................................706 Smile Brands/Bright Now Dental .........................662 512-496-7247 TDA Financial Services Insurance Program ..........................................654/Back Cover TDA Member Spotlight ..........................................702 TDA Perks Program ...............................................663 Professional Recovery Network Texas Dental 12007 Research Blvd. SuiteJournal 201 Classifieds.........................729 Texas Dental Journal Display Ads .......................705 Austin, TX 78759 TEXAS Meeting ......................................................659 www.rxpert.org UTHSCSA Dental School ......................................665 UTHSCSA / South Texas Pathology Lab .............661 Veatch Consulting .................................................669 Waller, Joe ..............................................................681

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DEC 2013 Texas Dental Journal