Texas Dental Journal October 2015

OCTOBER 2015

October October2015 2015

TEXAS TEXASDENTAL DENTAL

The Texas Dental Journal

Vol. 132, Issue 10

The The84th 84thLegislative LegislativeSession SessionininReview Review

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Texas Dental Journal l www.tda.org l October 2015 791

TEXAS DENTAL JOURNAL Established February 1883

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Vol 132, No. 10

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October 2015

810 ABOUT THE COVER The dome of the Texas capitol. Photo credit: ©istock.com/@nkimages

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LEGISLATIVE LANDSCAPE Legislative Landscape Dr Matt Roberts View from the Capitol Dr David Sibley The Council on Legislative and Regulatory Affairs Meet the TDA Legislative Team TDA “Excellence in Patient Advocacy Award” The Dental Education Loan Repayment Program: A Strategy for Reducing Barriers to Dental Care in Texas Dr Fred T. Philips Texas Dental Schools and the TDA: A Professional Partnership Dr James D. Condrey The Texas State Board of Dental Examiners — Sunset Review in Texas Dr David A. Duncan Texas Dentists Care—Dentists Connecting With Patients Dr Jay C. Adkins Brushing Up on Oral Health: Medicaid, CHIP and the Public Health Safety Net Dr Herbert L. Wade, Jr The Advocacy Academy Dr Rita Cammarata and Ms Janet Crow Are You Smarter Than the Average Dentist? Dr Lisa Heinrich-Null and Dr Debrah Worsham Electronic Health Records and the Dentist Dr Lee P. Oneacre, Dr Mark Peppard TDA Strategic Plan 2020: Helping All TDA Member Dentists Succeed Dr Duc “Duke” M. Ho TDA Legislative Resource Guide

MONTHLYFEATURES 799 800 812 856 856 858

Critically Appraised Topic of the Month Oral and Maxillofacial Pathology Case of the Month President’s Perspective Memorial and Honorarium Donors In Memoriam Value for Your Profession

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862 865 866

869 882

TEXAS Meeting Preview Calendar of Events Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management Advertising Briefs Index to Advertisers

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

Editorial Daniel L. Jones, DDS, PhD, Editor Staff Harvey P. Kessler, DDS, MS, Associate Editor

K. Vendrell Rankin, DDS, Associate Editor Billy Callis, Managing Editor Hannah Atteberry, Publications Coordinator Barbara Donovan, Art Director Paul H. Schlesinger, Consultant Nicole Scott, Consultant

Editorial Advisory Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia DDS, PhD Board William L.C.Blanton, 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, MS 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 Email: tda@tda.org • Website: www.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 2015 Texas Dental Asociation. 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 Association of not constitute a guarantee or endorsement by the Association of Dental Editors and the quality of value of such product or of the claims made of it by Journalists. its manufacturer.

Board of Directors

PRESIDENT Craig S. Armstrong, DDS 832-251-1234, drarmstrong01@gmail.com PRESIDENT-ELECT Rita M. Cammarata, DDS 713-666-7884, rmcdds@sbcglobal.net IMMEDIATE PAST PRESIDENT David A. Duncan, DDS 806-355-7401, davidduncandds@aol.com VICE PRESIDENT, SOUTHEAST Karen A. Walters, DDS 713-790-1111, kwalters@sms-houston.com VICE PRESIDENT, SOUTHWEST John B. Mason, DDS 361-854-3159, jbmasondds@aol.com VICE PRESIDENT, NORTHWEST Charles W. Miller, DDS 817-572-4497, cwdam@sbcglobal.net VICE PRESIDENT, NORTHEAST William H. Gerlach, DDS 972-964-1855, drbill@gerlachdental.com SENIOR DIRECTOR, SOUTHEAST Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net SENIOR DIRECTOR, SOUTHWEST Vivian A. Teegardin, DDS 956-428-5322 vteegardin@yahoo.com SENIOR DIRECTOR, NORTHWEST W. Kurt Loveless, DDS 806-797-0341, wklovedds@gmail.com SENIOR DIRECTOR, NORTHEAST Dennis E. Stansbury, DDS 903-561-1122, drstansbury@gmail.com DIRECTOR, SOUTHEAST Lance V. Sanders, DDS 512-345-4334, lvzplace@sbcglobal.net DIRECTOR, SOUTHWEST Victoria A. Vickers, DDS 210-349-4424, vickersdds@ mastersdentalgroup.com DIRECTOR, NORTHWEST Scott A. Morse, DDS 817-277-5341, drmorse@sbcglobal.net DIRECTOR, NORTHEAST Jacqueline M. Plemons, DDS 214-369-8585, drplemons@yahoo.com SECRETARY-TREASURER* Cody C. Graves, DDS 325-648-2251, drc@centex.net SPEAKER OF THE HOUSE* John W. Baucum III, DDS 361-855-3900, jbaucum3@gmail.com PARLIAMENTARIAN** Gregory W. Rashall, DDS 936-336-5171, rashdent@sbcglobal.net EDITOR** Daniel L. Jones, DDS, PhD 214-828-8350, djones@bcd.tamhsc.edu *Non-voting member **Non-member attendee

Texas Dental Journal l www.tda.org l October 2015 793

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Oral and Maxillofacial Pathology Case of the Month Clinical History An otherwise healthy 38-year-old male presented for periodontal evaluation with complaints of gingival enlargement and bleeding that had been present for at least one year. Examination revealed areas of granular to papular and nodular gingival hyperplasia with erythema, erosion, ulceration and yellow-tan surface exudates (Figures 1-3). Lesions were present in all 4 quadrants.

The patient had no complaints of discomfort or sensitivity. Periodontal probing depths ranged from 1 to 6 millimeters with bleeding on probing. Probing depths greater than 3 millimeters were localized to the

Figure 1

H. Stan McGuff, DDS, Department of Pathology, School of Medicine, The University of Texas Health Science Center at San Antonio Anne Cale Jones, DDS, Department of Pathology, School of Medicine, The University of Texas Health Science Center at San Antonio John D. Olson, MD, PhD, Department of Pathology, School of Medicine, The University of Texas Health Science Center at San Antonio Rick H. Heard, DDS, MS, Private Practice, Periodontics, Victoria, Texas.

Figure 2

Figures 1-3. Clinical images showing erythematous, hyperplastic and erosive gingival lesions with focal yellow-tan surface exudates.

Figure 3

800 Texas Dental Journal l www.tda.org l October 2015

McGuff

Jones

Olson

Heard

Figure 4. Oral radiographs showing localized areas of mild horizontal bone loss. areas of gingival hyperplasia. None of the involved teeth demonstrated significant mobility. Radiographs showed localized areas of mild horizontal bone loss (Figure 4). All teeth were vital. The patient had no associated systemic constitutional symptoms, skin lesions, ocular complaints, or lymphadenopathy.

He denied consumption of alcohol or tobacco use. There was no associated dysphagia, odynophagia, otalgia, hoarseness or voice changes.

The patient failed to demonstrate improvement with scaling and root planning followed by a 3-month recall. A granulomatous process such as granulomatosis with polyangiitis (Wegener’s) and sarcoidosis were considered in the differential diagnosis. An incisional biopsy of the maxillary right posterior buccal gingiva was performed under local anesthesia.

Pathologic Findings The biopsy specimen was received in a container of 10% neutral buffered formalin labeled with the patient’s and doctor’s names and as “gingival facial #1 and 2.” The specimen consisted of 2 tan-gray-brown soft tissue fragments measuring 0.8 x 0.7 x 0.3 cm in aggregate.

Figure 5. Inflamed gingiva with erosion and fibrinous surface pseudomembrane (Original magnification: 4X).

Examination of the histologic sections revealed inflamed mucosal soft tissue fragments consisting of reactive stratified squamous surface epithelium with underlying edematous congested granulation tissue and collagenous fibrovascular connective tissue (Figure 5). There were numerous interspersed small-caliber to irregular ectatic thin-walled vascular channels lined by plump reactive endothelial cells. The inflammatory infiltrate consisted of neutrophils, lymphocytes, plasma cells and histiocytes. The surface epithelium displayed hyperplasia with elongated anastomosing rete ridges, acanthosis, spongiosis, exocytosis and irregular parakeratosis. There were areas of surface erosion with thick fibrinopurulent exudates. Foci of pink hyaline material were noted Texas Dental Journal l www.tda.org l October 2015 801

Oral and Maxillofacial Pathology, continued

in the superficial lamina propria (Figure 6). A fluorescent Congo red stain for amyloid was negative. A Fraser-Lendrum PTAH stain showed the hyaline material and surface exudates to be positive (Figures 7-8). This indicated that the deposits were consistent with fibrin. The controls were appropriate. No interface lichenoid changes, epithelial acantholysis, sub-basal epithelial vesiculation, granulomatous inflammation, vasculitis, necrosis, or viral cytopathic changes were identified.

Clinical laboratory tests were significant for a plasminogen antigen level of 1.5 mg/dl (normal range: 7.5 -15.5 mg/dl) and a plasminogen activity level of 19% (normal range: 78-130%).

What is the most likely diagnosis?

Figure 6. Submucosal deposits of pink hyaline material within the connective tissue of the lamina propria (Original magnification: 10X).

See page 866 for the answer and discussion.

Figures 7-8. Fraser-Lendrum PTAH staining of the hyaline submucosal deposits and surface pseudomembranous exudates (Original magnification: 10X).

802 Texas Dental Journal l www.tda.org l October 2015

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We invite you to attend the 2016 Star of the South Dental Meeting. “It’s All About That Team!”

We have put together a group of speakers that will take your team to the next level. As well as a team of educators to help us better treat our patients! Don’t miss it! www.starofthesouth.org 713-961-4337 TX-AUG-2015.pdf

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Texas Dental Journal l www.tda.org l October 2015 805

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806 Texas Dental Journal l www.tda.org l October 2015

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Legislative 84th Legislative Session in Review

President’s Perspective Dr Craig S. Armstrong TDA President

…as dentists, we fill many roles: scientist, scholar, healer, leader, business person, and advocate—for our patients, and for our profession. Our patients may know us simply as their friendly neighborhood dentist, but we are so much more.

The Texas capitol building is stately. Massive. Grand. And it isn’t just to impress tourists, or compliment the Austin skyline. This grandeur reflects the gravity of the issues that are discussed and decided there. Dentists face many legislative and regulatory issues that directly affect the way we answer our life’s calling, which is giving our patients the best care.

These issues—how we practice, how we make clinical and professional decisions, and how we keep our patients safe and healthy—are complex, and don’t begin or end at the capitol, however. This issue of the Journal contains the most relevant, wideranging, and hard-hitting insights in the entire Texas legislative and regulatory arena.

In this issue, you will learn how TDA successfully lobbied to lower taxes for dentists, to require insurance companies to give patients their full benefits, and to prevent unwarranted scope of practice expansions, along with seven other dental issues TDA has worked toward in the legislature. You will also learn how the Texas State Board of Dental Examiners (TSBDE) is up for Sunset Review for the first time in 12 years, and what that could mean for the future of dentistry. You will learn about the issues facing you, as a Texas dentist, for the next legislative session and how TDA is working for you. You will learn about TDA’s Council on Legislative and Regulatory Affairs (CLRA), and TDA’s legislative team, the groups that spearhead TDA’s pro-dentist, propatient efforts. You will learn about the TDA Strategic Plan, and how TDA has focused our efforts over the next 5 years to help all members succeed. You will learn how TDA is working with the American Student Dental Association (ASDA) to engage dental students in organized dentistry. You will learn about new developments in Medicaid, CHIP, and the public health safety net, and what they mean. You will learn how Texas dentists are tackling the access to care issue that affects so many of our citizens. You will gain insight into the Dental Education Loan Repayment Program, and how dental school loans relate to treating underserved patients. You will learn about the Texas dental schools’ relationship with TDA. And you will learn essential information on electronic record-keeping requirements for dentists.

These insights come in addition to the new research that the Journal brings you each month. After all, as dentists, we fill many roles: scientist, scholar, healer, leader, business person, and advocate—for our patients, and for our profession. Our patients may know us simply as their friendly neighborhood dentist, but we are so much more. As you stand up for your patients and profession, can you afford not to be informed? As you absorb this vital information, it will empower and inspire you. Dentistry is our calling, because we are up for the challenge. As TDA works for dentists and patients, remember: we are here to help you succeed. After all, you—the dentist—are TDA.

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ontents 814

Legislative Landscape Dr Matt Roberts

820

View from the Capitol Dr David Sibley

822

The Council on Legislative and Regulatory Affairs

824

Meet the TDA Legislative Team

826

TDA “Excellence in Patient Advocacy Award”

828

The Dental Education Loan Repayment Program: A Strategy for Reducing Barriers to Dental Care in Texas Dr Fred T. Philips

830

Texas Dental Schools and the TDA: A Professional Partnership Dr James D. Condrey

832

The Texas State Board of Dental Examiners — Sunset Review in Texas Dr David A. Duncan

836

Texas Dentists Care—Dentists Connecting With Patients Dr Jay C. Adkins

840

Brushing Up on Oral Health: Medicaid, CHIP and the Public Health Safety Net Dr Herbert L. Wade, Jr

844

The Advocacy Academy Dr Rita Cammarata and Ms Janet Crow

846

Are You Smarter Than the Average Dentist?

Dr Lisa Heinrich-Null and Dr Debrah Worsham

848

Electronic Health Records and the Dentist Dr Lee P. Oneacre, Dr Mark Peppard

850

TDA Strategic Plan 2020: Helping All TDA Member Dentists Succeed Dr Duc “Duke” M. Ho

854

TDA Legislative Resource Guide Texas Dental Journal l www.tda.org l October 2015

813

Legislative Landscape

Dr Matt Roberts, Chair Council on Legislative and Regulatory Affairs

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THE OCTOBER ISSUE OF THE TEXAS DENTAL JOURNAL focuses its attention on organized dentistry in the legislative and regulatory arenas. Much of what we do in our offices every day is controlled by the Texas legislature, made up of 150 members of the Texas House of Representatives and 31 members of the Texas Senate, and the Texas State Board of Dental Examiners (TSBDE), made up of 15 members including 8 dentists, two dental hygienists, and 5 members of the public.

In addition, Texas statewide officials—including the governor, lieutenant governor, and comptroller—have significant authority over the regulation of dentistry. and complexity of the regulation of dentistry, it is imperative that organized dentistry commit adequate resources toward ensuring our voice is not only present, but heard in all legislative and regulatory forums where dentistry is considered. As the old saying goes, “if you aren’t at the table…you’re likely on the menu.”

Texas Dental Journal l www.tda.org l October 2015 815

©DenisTangneyJr/istock.com

The practice and regulation of dentistry and dental hygiene are governed in state statute by the Dental Practice Act (DPA) contained in the Texas Occupations Code. The TSBDE is charged with interpreting and enforcing the DPA and the other statutes affecting dentistry as well as implementing rules to protect public health and safety. Given the depth

The TDA’s Council on Legislative and Regulatory Affairs (CLRA) is made up of TDA member dentists from around the state who have expertise in the legislative and regulatory arenas.

CLRA is charged with working with the legislature and the regulatory entities to represent the Association and implement its policies as set by the House of Delegates and Board of Directors. The TDA legislative “team” (TDA Department of Legislative and Regulatory Affairs staff and legislative consultants) work closely alongside CLRA members to assist with achieving organized dentistry’s goals.

I have been a member of CLRA for over thirteen years and it is now my privilege to serve as chair of the council, a position I have held since June 1, 2015. I would like to take a moment of personal privilege to thank my predecessor, Dr Richard Black of El Paso, for his stellar service and leadership during his tenure as CLRA chair, a position he held for over nine years. Dr Black’s role as chair of CLRA resulted in major successes for TDA and all of dentistry and it will be my goal to continue to build on the incredible accomplishments of CLRA under Dr Black’s chairmanship.

Dentistry is forever indebted to Dr Black for his service as chair of the Council on Legislative and Regulatory Affairs.

84th Legislative Session Review The Texas Legislature meets in a regular session every two years in odd numbered years for 140 days. The 84th Regular Session began Tuesday, January 13, 2015 and adjourned sine die on Monday, June 1, 2015. The TDA had a very aggressive legislative agenda with many issues and due to the incredible work of TDA members, CLRA, TDA leadership, and the legislative team, TDA has its most successful session in recent memory.

Before covering the accomplishments of the session, I would like to highlight a few of the over-arching issues we faced at the Capitol.

Change is constant at the Capitol.

Members come and go, issues flare up and flare out, and party politics create conflict and harmony. The 84th legislative session will be remembered as the session of change amongst the leadership. For the first time

ever, all statewide-elected officials were new—the governor, lieutenant governor, comptroller, attorney general, agriculture commissioner, and land commissioner. In addition, there were many new members of the Texas House of Representatives and the Texas Senate. For stakeholders like the TDA, the change created many unknowns. What would the new governor set as priorities? How would the lieutenant governor run the senate? Who would the lieutenant governor assign to committees? How would the new members of the House and Senate work together? How would the flow of the process change from the past? In addition to the officeholder changes and subsequent changes in process, like every session, there were over-arching issues which contribute to setting the overall tone—the budget is always a driver, ethics reform, gun rights, education, transportation, criminal justice, Tea Party influence, Medicaid expansion, and many more. These issues and the personnel changes dominated

This issue of the Journal will highlight many of the issues organized dentistry faced during the recently concluded 84th legislative session and highlight issues on the horizon. On behalf of CLRA and the legislative team, thank you for being a member of organized dentistry and enjoy this issue of the Journal.

Comptroller Hegar speaking to TDA Legislative Day participants

816 Texas Dental Journal l www.tda.org l October 2015

the precious time allotted to the process–only 140 days. The TDA had to compete against these issues and elbow its way into the process in order to prevent the bad and pass the good. Against the odds, the TDA legislative team found a way to accomplish virtually every goal on the legislative agenda. Here are some highlights:

Tax Relief – House Bill 7 by Rep Drew Darby (R–San Angelo)

All Texas dentists will receive significant tax cuts as a result of TDA action in the 84th Legislative Session.

The TDA successfully advocated alongside other stakeholders for elimination of $200 on dentists’ annual license fee and a 25% permanent rate cut to the state franchise tax. In addition to the rate cut, a majority of dental offices are now eligible to use the “E-Z computation and rate” to calculate and file their franchise tax.

Dental Insurance Coordination of Benefits – House Bill 3024 by Rep Bobby Guerra (D–McAllen)

Texas dental patients will now receive the full benefit of their secondary dental insurance plans. The TDA successfully advocated passage of House Bill 3024 authored by Rep Bobby Guerra (D–McAllen) requiring state regulated dental insurance plans to better coordinate primary and secondary insurance coverage.

HB 3024 prevents secondary carriers from using coverage terms to avoid payment. The balance on a dental claim is now clarified as the full, allowable amount of coverage, and not an arbitrary or confusing standard. This new requirement lowers patients’ out-of-pocket cost and protects them from unexpected balances, making dental care more affordable, cost-predictable, and accessible.

Scope of Practice

As in previous legislative sessions, there were many attempts to expand

the scope of practice of non-dentists.

Per TDA policy, we opposed and defeated several scope of practice expansion proposals including House Bill 1940 by Rep Senfronia Thompson (D–Houston) creating a lesser-educated and trained mid-level dental provider and, alongside the Texas Society of Anesthesiologists, we defeated House Bill 1409, also by Rep Senfronia Thompson (D–Houston), permitting dental hygienists to administer local anesthetic.

Dental Service Organizations (DSOs) – Senate Bill 519 by Senator Charles Schwertner (R–Georgetown)

The TDA continues to work to enhance patient safety and protection at practices not wholly-owned by dentists. Senate Bill 519 by Senator Charles Schwertner (R–Georgetown) requires dental support organizations (DSOs) to register with the state.

Information included in this registration will further help the Texas State Board of Dental Examiners to identify DSOs and enforce existing state law against illegal ownership and non-dentist influence of dentists and dental practices.

Prevented Rate Cuts and Eliminated Red Tape in the Medicaid Program

Dr Thomas Janson of Houston with Rep Harold Dutton, Jr

Not only did the TDA help prevent budget cuts to dental Medicaid, we also supported legislation that reduces hassles for Medicaid participating dentists. Passage of House Bill 1661 by Rep Bobby Guerra (D–McAllen) allows dentists who must temporarily be absent from their practice to bill for Medicaid services provided by a substitute dentist—maintaining continuity of care for patients. In addition, passage of Senate Bill 200 by Senator Jane Nelson (R – Flower Mound) eliminates unnecessary criminal background checks for Medicaid providers and streamlines enrollment Texas Dental Journal l www.tda.org l October 2015 817

by consolidating the enrollment and credentialing process. Also, passage of Senate Bill 207 by Senator Chuy Hinojosa (D–McAllen) clarifies the definition of fraud and establishes clear timelines and criteria for Medicaid fraud investigations by the Office of the Inspector General.

(R–Gatesville). The legislation expands the list of eligible locations that may offer the coronal polishing certification course. Passage of this measure will allow dental assistants in rural areas of the state to access the course which will increase the number of them qualified to perform the procedure.

Eliminated Controlled Substance Registration Backlogs

Texas dentists will no longer be forced to haggle with the state over controlled substances registration due to passage of Senate Bill 195

by Senator Charles Schwertner (R– Georgetown). Effective September 1, 2016, the state’s controlled substance registration program at the Department of Public Safety and the fee associated will be eliminated.

Going forward, dentists will only need a federal Drug Enforcement Administration registration.

Additionally, the Texas prescription drug monitoring program will be administered by the Texas State Board of Pharmacy and dentists will pay a smaller fee than before resulting in additional savings to Texas dentists.

Preserved Dentists’ Independent Professional Judgment

TDA strongly advocated to protect dentists’ independent professional judgment through action to defeat House Bill 2330 by Rep John Zerwas (R–Richmond). The proposal would have taken existing rules governing improper influence on professional judgment, amended them, and locked them in statute. This approach would have resulted in a vastly different regulatory environment. Additionally, the bill would have prevented the dental board from taking any future action on certain rules to enforce the Dental Practice Act. The TDA believes and defends the principle that The Texas State Board of Dental Examiners must maintain its ability to properly regulate dentistry—regardless of practice setting—in order to properly protect patients and dentists.

TDA President Dr Craig Armstrong with Rep Bryan Hughes

Funding for Dental Schools

TDA successfully worked with the dental schools and the legislature to secure additional state funding including $72 million to Baylor College of Dentistry for capital projects. TDA also partnered with the schools in an attempt to change the funding methodology for dental school clinic operations. The legislature fell short of addressing this effort and TDA will likely work for it again next session.

Improved Access to Dental Care

Increasing access to dental care is always a top priority of the TDA. This session, lawmakers reinstated some funding for Texas’ Dental Education Loan Repayment Program to help dentists afford to practice in rural and underserved areas of the state. This program helps reduce the number of adults and children with untreated dental disease by providing access now to patients in need. More funding for this valuable program is needed and TDA will continue to work to secure it.

Additionally, more dental assistants will be able to perform coronal polishing. TDA joined with the Texas Academy of General Dentistry, Texas Academy of Pediatric Dentistry, and the Texas Academy of Oral and Maxillofacial Surgeons for passage of House Bill 2849 by Rep JD Sheffied

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Also, with TDA support, Senate Bill 550 by Senator Carlos Uresti (D–San Antonio) was finally passed after many years of consideration by the legislature. The law requires dental insurance to be included with health insurance in child support orders.

Enhanced Texas’ Oral Health Infrastructure

TDA amended the Health and Human Services Commission (HHSC) sunset bill—Senate Bill 200 by Senator Jane Nelson (R–Flower Mound)—to mandate HHSC’s dental director be a Texas-licensed dentist. This ensures that all HHSC dental programs are led by a dentist who has the appropriate level of education and training that the dental director position demands.

This list of accomplishments is perhaps the most robust TDA has ever had in a legislative session. From tax cuts to insurance to Medicaid, this list of successes contains something beneficial to every TDA member dentist and dental patient in the state of Texas. The recipe for success contains many ingredients but the most important and valuable is the TDA member. The grassroots action of TDA members from all over Texas is remarkable and we need each and every member now more than ever.

Get to know your state representative and state senator, educate yourself on the issues, support DENPAC, and respond to TDA calls to action. The success of TDA in the legislative and regulatory arenas is dependent upon you!

On the Horizon – A Brief Look Ahead Your CLRA council and TDA staff are already working on issues for the 85th legislative session slated to begin in January 2017. These issues include: n

Texas State Board of Dental Examiners—Sunset Review—the TSBDE is under Sunset Review this interim and next session. The process is designed to review agency operations and increase efficiencies. We are involved in the process and contributing to it in an effort to ensure any changes are in line with TDA policy. We will be active participants throughout the process.

n

Access to Care—there are areas in Texas that need more dentists. Recent data supports the need for approximately 350 dentists in the right areas of the state to solve access issues. Loan assistance is a proven program designed to place dentists in areas of need. The solution to access issues in Texas does not include a lesser-educated and trained mid-level provider. The solution is getting the dentist in front of the patient and loan assistance programs achieve that goal.

n

Scope of Practice issues—we will continue to work against all scope issues that do not conform to TDA policy.

n

Patient Protection and Safety—accountability is important at all dental practices and we will continue to work to ensure dental patients are properly protected.

n

Medicaid—reimbursement rates must be fair in order for the Medicaid dental program to be viable. We will continue to work to increase funding to Medicaid dental.

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Dental School Funding—state funding to the dental schools should be equitable. In terms of school clinic operations, the funding should be formula driven and transparent. We will continue to work alongside the schools in support of their efforts to modify the manner in which clinic operations are funded.

Texas Dental Journal l www.tda.org l October 2015 819

View From the Capitol EVERY LEGISLATIVE SESSION IS CHALLENGING AND UNIQUE. The 2015 session will be remembered as a changing of the guard. Every non-judicial statewide office holder was new and there were big changes at the state capitol with many new faces in the house and senate. The changes meant new leadership, new governing philosophies, new committee members, and new challenges for organized dentistry. Not only did TDA weather the storm of change, TDA advocacy efforts Dr David Sibley

TDA Lead Legislative Consultant

succeeded in achieving the most successful legislative session in recent history for dentists and dental patients. Here are a few highlights from my perspective.

It was a great session for tax reductions.

TDA worked alongside other stakeholders to successfully advocate elimination of the $200 annual occupations tax. The legislature first levied the “occupations tax” on all professionals, including dentists, during difficult financial times. In addition to dentists, physicians, lawyers, engineers, architects and others in Texas have been paying a $200 annual occupation tax since 1991. While no tax is popular, the occupations tax is particularly hated and rightfully so.

Our traditional license fees, minus the occupations tax, bring in more money than is needed for the operation of the Texas State Board of Dental Examiners.

The occupations tax served no direct purpose in the licensing and regulation of dentistry and TDA action helped terminate it. Good riddance!

and dentists paying the state franchise tax will receive a 25% rate reduction—a significant accomplishment. It is also worth mentioning that while taxes were being reduced we were able to prevent budget cuts to Medicaid—an issue that is always on the table for consideration.

The state franchise tax was reduced.

The legislature reformed the tax in 2003 and there have been issues with it ever since. TDA worked with lawmakers this past session to modify the tax structure

Scope of practice is always an issue and TDA legislative efforts prevented passage of bills that would have unnecessarily expanded the scope of non-dentists.

Bills were defeated which would have

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It was a good session for patients with dental insurance plans. TDA helped write legislation to guarantee dental patients will receive the full benefit of their secondary dental insurance plans.

Passage of House Bill 3024 requires state regulated dental insurance plans to coordinate primary and secondary insurance coverage. This new requirement lowers patients’ outof-pocket cost and makes dental care more affordable, cost-predictable, and accessible.

©demerzel21/Bigstock.com

The House of Representatives Chamber of the Texas State Capitol building during the changing of the guard.

created a new, lesser educated, lesser trained mid-level dental provider and permitted administration of local anesthesia by dental hygienists. TDA has policy against both of these issues and we defeated them.

The legislature once again addressed issues with Dental Service Organizations (or “DSOs”). As most are aware, a DSO is an entity that provides patient care but is not wholly-owned by a dentist or dentists.

These entities operate throughout the country and many are publicly held. Investors find dentistry and

DSOs to be good investments but the emphasis on profits can and sometimes does make the interests of patients secondary. Passage of Senate Bill 519 this session requires DSOs to register with the state and disclose basic data about their operations including ownership and certain financials. It is responsible for the state to properly understand and regulate these entities in order to properly hold them accountable for their business practices and their dealings with dental patients.

These are just a few of the TDA accomplishments from the recent session. Your legislative team spent enormous time and energy representing you on these issues and many more. The TDA’s legislative success hinges on participation from the membership. The TDA needs each and every member involved. Educate yourself on the issues, get to know your house and senate members, contribute to DENPAC, and respond to legislative action alerts from the TDA. If we are to continue our winning ways, we must have you involved.

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The Council on Legislative and Regulatory Affairs THE COUNCIL ON LEGISLATIVE AND REGULATORY AFFAIRS (CLRA) makes certain that the Texas Dental Association (TDA) has an effective voice in the legislative process and state government.

CLRA works with the legislative and regulatory affairs staff and TDA contract legislative consultants to implement the Association’s legislative agenda and maintain positive working relationships with legislators, state officials, and allied professional groups.

In conjunction with component societies, the council informs members about governmental actions and mobilizes the TDA’s grassroots organization. The council also works with regulatory agencies to help ensure a competitive marketplace for dentists and quality dental care for all Texans.

Dr Matthew B. Roberts, Chair

General dentist from Crockett, former TDA president, former member of the American Dental Association (ADA) Council on Access, Prevention and Interprofessional Relations, and former member of the Commission on Dental Accreditation. Dr Roberts is serving his 12th year on CLRA.

Dr Jay C. Adkins, Member

General dentist from Lubbock, former TDA Board of Directors member, and former member Texas State Board of Dental Examiners Dental Hygiene Advisory Committee. Dr Adkins is serving his fourth year on CLRA.

Dr Rita M. Cammarata, Member

Pediatric dentist from Houston, current TDA president-elect, former TDA Board of Directors member, former Greater Houston Dental Society president, and current member ADA Council on Dental Practice. Dr Cammarata is serving her first year on CLRA.

Dr David A. Duncan, Member

General dentist from Amarillo, current TDA past-president, former TDA Board of Directors member, former Panhandle Dental Society president, and former member of the ADA Council on Dental Practice. Dr Duncan is serving his eighth year on CLRA.

Dr Lee P. Oneacre, Member

Oral surgeon from Carrollton, former TDA Board of Directors member, former Dallas County Dental Society president, and former member of the ADA’s Council on Access, Prevention and Interprofessional Relations. Dr Oneacre is serving his ninth year on CLRA.

Dr Fred T. Philips, Member

General dentist from Corpus Christi, former Nueces Valley Dental Society president, current DENPAC representative for the Nueces Valley Dental Society, and current faculty for the dental hygiene program at Del Mar College.

Dr James D. Condrey, Consultant

General dentist from Missouri City, former Greater Houston Dental Society president, former member of the ADA Council on Governmental Affairs, and former vice-chair of the ADA political action committee (ADPAC). Dr Condrey is serving his 15th year on CLRA.

Dr Mark Peppard, Consultant

General dentist from Austin, served on ADPAC and former TDA Board of Directors member. Dr Peppard is serving his 10th year on CLRA.

Dr Herbert L. Wade Jr, Consultant

Pediatric dentist from Bryan, former TDA president, former ADPAC vice-chair, and former chair of the TDA’s political action committee (DENPAC). Dr Wade is serving his 25th year on CLRA.

Dr Debrah J. Worsham, Consultant

General dentist from Center, former ADPAC vice-chair, and former DENPAC chair. Dr Worsham is serving her 17th year on CLRA.

Dr Lisa Heinrich-Null, DENPAC Chair

General dentist from Victoria, current DENPAC chair, former president of the Guadalupe Valley Dental Society, and current Guadalupe Valley Dental Society Legislative Action Committee chair. Dr Heinrich-Null is serving her second year on CLRA.

Ms Janet Crow, Alliance of the TDA Member

From Spring, former Alliance of the TDA president. Ms Crow is serving her sixth year on CLRA.

Row 1 (L-R) Dr Matthew B. Roberts, Chair (El Paso) Dr Jay C. Adkins (Lubbock) Dr Rita M. Cammarata (Houston) Row 2 (L-R) Dr David A. Duncan (Amarillo) Dr Lee P. Oneacre (Carrollton) Dr Fred T. Philips (Corpus Christi)

Row 3 (L-R) Dr James D. Condrey (Missouri City) Dr Mark Peppard (Austin) Dr Herbert L. Wade (Bryan)

Row 4 (L-R) Dr Debrah J. Worsham (Center) Dr Lisa Heinrich-Null (Victoria) Ms Janet Crow (Spring) Texas Dental Journal l www.tda.org l October 2015 823

Meet the TDA Legislative Team

Dr David Sibley is the TDA’s

lead legislative consultant and a board certified oral and maxillofacial surgeon. He served in the Texas Senate for a decade, including four sessions as chairman of the powerful Senate Committee on Business and Commerce, a post to which he was appointed by both a Democratic and a Republican lieutenant governor. Dr Sibley’s legislative accomplishments, including managed care and civil justice reforms, earned him Texas Monthly’s designation as one of the state’s 10 best legislators in 1993, 1997, and 1999, and an honorable mention in 1995. He is a graduate of Baylor University, Baylor Law School, and an honor graduate of Baylor College of Dentistry. A sixthgeneration Texan, Dr Sibley and his wife Pam live in Waco.

Jess Calvert is the TDA’s director of public affairs. He serves as TDA’s in-house legislative consultant and oversees the day-to-day operations of the TDA Department of Legislative and Regulatory Affairs including policy, DENPAC, and the contract legislative consultants. He began his career as an analyst at the Legislative Budget Board (LBB), where he was assigned to general government and natural resource agencies. After leaving the LBB, he served on the staff of the Texas House of Representatives Committee on Appropriations as an analyst assigned to education, criminal justice and the judiciary. Prior to coming to work at the TDA, Jess was employed at GMAC, where he managed several residential finance programs. A native of Austin, Jess earned a BA degree from Texas Tech University and a master of public administration degree from Texas State University.

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Nora Del Bosque is a contract legislative consultant to TDA. Nora formerly worked as an associate to past TDA legislative consultant Dick Brown. Prior to that, she worked in public affairs and public relations for the Miller Brewing Company, serving as an industry lobbyist in Arizona, Colorado, New Mexico, and Texas. Before joining Miller Brewing Company, she worked in the Texas Legislature as chief clerk for the House Committee on Appropriations and as a legislative aide to the House Ways and Means Committee and for the late Rep. James Hury (D-Galveston).

A native of Abilene, Nora earned a BA degree from the University of Texas at Austin.

Susan Ross is a contract legislative

consultant to TDA and a former director of public affairs for the Association. Prior to representing the TDA, she represented the nursing home industry for the Texas Health Care Association and worked as an aide to 2 influential legislative consultants, Bill Pewitt and Jack Gullahorn. Susan first came to the capitol in 1993 as an aide to Sen. Dan Shelley (R-Crosby). A native of Crosby, she earned a BS degree from Texas A&M University.

Diane Rhodes is the TDA’s policy manager. She works on legislative and regulatory issues and serves as staff liaison to the Texas State Board of Dental Examiners, the Council on Legislative & Regulatory Affairs, the Council on Dental Education, Trade & Ancillaries, and the Committee on Access to Dental Care in Medicaid & CHIP. Prior to coming to the TDA, Diane worked in the Division of State Grants in the governor’s office and as a legislative aide to Rep. Tom Ramsay (D-Mt. Pleasant). A native of Waco, Diane earned a BA degree from Baylor University.

Leigh Ann Montague is the manager of DENPAC, the TDA’s political action committee. She leads DENPAC’s statewide marketing and fundraising efforts, and coordinates meetings and fundraisers associated with DENPAC. Leigh Ann has a background in commercial property management and special event planning. She has extensive knowledge in marketing, computer networking, and communications. A native of Wimberley, Leigh Ann holds a BA in marketing from Texas State University.

Texas Dental Journal l www.tda.org l October 2015 825

TDA “Excellence in Patient Advocacy Award” THE TEXAS DENTAL ASSOCIATION LEGISLATIVE TEAM works closely with Texas lawmakers to represent the interests of dentists and dental patients. TDA is honored to recognize 4 lawmakers who were instrumental in assisting the association with its legislative goals during the 84th legislative session. The TDA commissioned Ronadro, a nationally renowned Texas sculptor, to design the “Excellence in Patient Advocacy Award,” a unique work of art in bronze relief that portrays a dentist caring for a patient.

The 4 legislators who will receive TDA “Excellence in Patient Advocacy” awards are:

THE HONORABLE BOBBY GUERRA (D–MCALLEN) State Rep R.D. “Bobby” Guerra represents Texas House District 41 which includes the cities of McAllen, Mission, Edinburg, Palmhurst, Palmview, Alton, and Pharr. Rep Guerra was elected to the Texas House in 2012 and currently serves on the House Committees on Public Health, Insurance, and Local & Consent Calendars. In the 84th legislative session, Rep Guerra authored House Bill 3024, the TDA’s dental insurance coordination of benefits legislation, and House Bill 1661, Medicaid substitute dentist legislation, and was a champion of all TDA issues.

826 Texas Dental Journal l www.tda.org l October 2015

THE HONORABLE JUAN “CHUY” HINOJOSA (D–MCALLEN) State Senator Juan “Chuy” Hinojosa represents State Senate District 20 which includes Brooks, Hidalgo, Jim Wells, and Nueces Counties. Senator Hinojosa was elected to the Texas Senate in 2002 and currently serves on the Senate Committees on Finance, Agriculture, Water and Rural Affairs, Criminal Justice, and Natural Resources and Economic Development.

In the 84th legislative session, Senator Hinojosa sponsored House Bill 3024 in the Senate and authored Senate Bill 207 which clarifies the definition of fraud and establishes clear guidelines and criteria for Medicaid fraud investigations by the Office of Inspector General.

THE HONORABLE MARISA MARQUEZ (D–EL PASO) State Rep Marisa Marquez represents Texas House District 77 which includes much of El Paso including downtown.

Rep Marquez was elected to the Texas House in 2008 and currently serves on the House Committees on Appropriations, Administration, and Culture/Recreation/Tourism. In the 84th legislative session, Rep Marquez worked closely with the TDA team to garner support amongst House members for and against issues in line with the TDA legislative agenda. Rep Marquez is the daughter and niece of TDA member dentists in El Paso.

THE HONORABLE J.D. SHEFFIELD (R–GATESVILLE) State Rep J.D. Sheffield represents Texas House District 59 which includes Comanche, Coryell, Erath, Hamilton, McCulloch, Mills, San Saba, and Somervell Counties. Rep Sheffield was elected to the Texas House in 2012 and currently serves on the House Committees on Public Health, Appropriations, and Rules & Resolutions. In the 84th legislative session, Rep Sheffield authored House Bill 2849 which expands the list of eligible locations that may offer the coronal polishing course to dental assistants. In addition, Rep Sheffield played a key role in assisting TDA defeat several scope of practice bills and legislation that would have negatively affected the TSBDE’s ability to regulate DSOs.

The Dental Education Loan Repayment Program: A Strategy for Reducing Barriers to Dental Care in Texas AS OF JANUARY 2015, THERE WERE 16,111 DENTISTS DELIVERING COMPREHENSIVE DENTAL CARE TO TEXANS including children, adults, elderly, and disabled (1).

According to Dr Eric Solomon, Professor, Public Health Sciences, Texas A&M University, Baylor College of Dentistry, approximately 500-800 new dentists enter Texas’ workforce each year, which is leading to a steady decrease in the number of underserved areas of the state since 2009 (email communication, October 2014).

Dr Fred T. Philips

Council on Legislative and Regulatory Affairs

The growth of dentists in Texas mirrors the national trend. The American Dental Association (ADA) predicts that dental school graduations will exceed dentist retirements.

The net increase of practicing dentists will exceed the corresponding growth of the US population. An October 2014 report by the ADA’s Health Policy Institute shows the number of dentists practicing per 100,000 people has climbed more than 4% from 2003 to 2013 and is projected to climb 1.5% from 2013 to 2018 and 2.6% by 2033 (2).

During the 84th Legislative Session, the Texas Dental Association (TDA) brought attention to the importance of dental education loan repayment and the legislature reinstated funding for the Dental Education Loan Repayment Program (DELRP) for the 2016-2017 biennium. The purpose of the DELRP, authorized by the legislature in 1999, is to recruit and retain qualified dentists to provide dental services in areas of the state that were underserved with respect to dental care (4).

Although Texas has the largest underserved population in the country, Texas ranks high in terms of the percentage of the underserved whose dental needs are being met, at 64%.

According to federal data, Texas only needs approximately 350 dentists practicing in the right areas of the state to fully meet the needs of the remaining underserved population (3). This number represents less than 3% of the total dental workforce in the state. Loan repayment assistance is a proven, cost effective means of getting dentists into communities with unmet dental needs.

Dentists participating in the DELRP agree to practice general or pediatric dentistry for at least 12 consecutive months in DHPSAs at approved practice sites including Community Health Centers and Federally Qualified Health Centers or other practice locations serving populations that the state determined were critically underserved. The participating dentists also agree to accept Medicaid and not deny services based on a patient’s inability to pay (5).

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©Stephanie Zieber/istock

The maximum annual loan repayment for an eligible dentist providing fulltime service is $10,000 annually (7).

A total of $194,000 was awarded to 20 applicants in 2010. The DELRP was fully subscribed almost every year since its inception. The program was funded by state general revenue and tuition set-asides mandated by statute (6).

One factor among the complex factors affecting the accessibility of dental services in Dental Health Professional Shortage Areas (DHPSA) is the supply of dentists currently providing care within identified areas of need. The DELRP will provide an excellent incentive to recruit and retain qualified dentists to provide dental services in areas of the state that are underserved with respect

References

to dental care. History clearly demonstrates that loan repayment programs succeed in addressing dental workforce challenges, and positively affect access to dental care for vulnerable Texans by connecting dentists with patients in need.

1.

2.

Data does not support the need for a new, less-educated and less-trained oral health care provider that will remove the dentist from the patient.

The data supports the need for 354 dentists in the right areas of our state.

The TDA will continue advocating for the legislature to increase funding and expand the DELRP to be an option for more dentists. Loan repayment incentives continue to play an important role in bringing more dental care to underserved Texans.

3.

4.

5.

6.

Texas State Board of Dental Examiners, January 2015.

Munson B, Vujicic M. Supply of dentists in the United States is likely to grow.

American Dental Association Health Policy Institute. Available from: http://www.ada. org/~/media/ADA/Science%20and%20 Research/HPI/Files/HPIBrief_1014_1.ashx.

Accessed April 10, 2015.

Solomon E. Dentists in underserved areas of Texas. Scheduled for publication Texas Dental Journal.

Texas Education Code Chapter 61, Subchapter V Repayment of Certain Dental Education Loans.

Texas Higher Education Coordinating Board. Overview loan repayment programs. January 2010.

Texas Administrative Code Chapter 21, Subchapter R, §§21.560–21.566, concerning the Dental Education Loan Repayment Program.

Texas Dental Journal l www.tda.org l October 2015 829

Texas Dental Schools and the TDA: A Professional Partnership THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON SCHOOL OF DENTISTRY, THE UT HEALTH SCIENCE CENTER AT SAN ANTONIO SCHOOL OF DENTISTRY, AND THE TEXAS A&M UNIVERSITY BAYLOR COLLEGE OF DENTISTRY all have reputations for graduating exceptional dentists and allied team members, conducting groundbreaking research and providing critically needed oral health care to Dr James D. Condrey Council on Legislative and Regulatory Affairs

underserved populations.

During the recent legislative session, the Texas Dental Association (TDA) partnered with the dental schools to affect funding changes to dental clinic operations. Under the proposal, clinic funding would be based on the rolling two‐year average number of patient visits to the school‐owned dental clinics. In order to cover the full cost of each student‐treated patient at a dental school’s educational clinic, the formula would provide $45 per patient visit. Currently, dental clinical operations strategy is not tied to any metric or formula. This is why the three schools have such a wide difference in clinic funding.

Balancing clinic costs helps maintain the supervised clinic experience, which is a vital part of the education and training of future

830 Texas Dental Journal l www.tda.org l October 2015

generations of dentists and dental hygienists.

Through the clinical experience, students gain knowledge and competency in caring for underserved, elderly, and special needs patients.

Despite everyone’s best efforts, no new funding happened this session for dental clinic operations although the TDA plans to once again partner with the dental schools on a similar effort in 2017. The Association recognizes the importance of partnering with dental education on common causes to educate highly competent and engaged practitioners for the state.

Dentists at TDA Legislative Day

Students at TDA legislative day Texas Dental Journal l www.tda.org l October 2015 831

The Texas State Board Sunset Review in Texas THE TEXAS LEGISLATURE FIRST REQUIRED DENTISTS TO BE LICENSED IN 1897 by having district judges appoint local boards of practicing dentists. In 1911, the Legislature created a state agency known as the “Texas State Board of Dental Examiners (TSBDE)” to license dentists (1). Over time, the board was extended to encompass dental hygienists, dental laboratories and dental technicians.

Dr David A. Duncan TDA Past President

The dental board has grown significantly from its modest beginnings. The TSBDE now has as its mission to regulate the practice of dentistry and safeguard the dental health of Texas by ensuring that only qualified persons are licensed to provide dental care and ensuring that violators of laws and rules regulating dentistry are sanctioned appropriately (2, 3).

The TSBDE currently has 15 members: 8 dentists, 5 public members, and 2 dental hygienists. Board members serve staggered 6-year terms and are appointed by the governor, who also appoints the presiding officer. The board elects a secretary each year. Two statutorily created committees provide assistance to the TSBDE in matters involving dental hygiene and dental laboratories—the Dental Hygiene Advisory Committee (DHAC) and the Dental Laboratory Certification Council (DLCC).

It’s been approximately 12 years since the dental board has gone through the sunset review process, and during this legislative interim, the TSBDE is one of 31 agencies under review by the Texas Sunset Commission for the 2016-2017 cycle. While standard legislative management is focused upon agency compliance with legislative guidelines, the sunset process asks the

832 Texas Dental Journal l www.tda.org l October 2015

basic question: “Should a state agency be continued?”

Readers might wonder why the process is called “sunset” review. In government terms, “sunset” means that a specific agency, program, or law will expire on a particular date, unless it is reauthorized by the legislature. In other words, anything with a “sunset” date will cease to exist after a set period of time unless the legislature reauthorizes it (4).

The Texas Sunset Advisory Commission is a 12-member legislative commission tasked with assessing the continuing need for a state agency. The sunset process works by setting a date on which an agency will be abolished unless legislation is passed to continue its functions. This creates a unique opportunity for the legislature to look closely at each agency and make fundamental changes to an agency’s mission or operations if needed (5).

Sunset Commission staff work closely with each agency under review to assess the need for the agency, propose statutory and/or agency management changes, and develop the legislation to enact any proposed changes.

©istock.com/ franckreporter

of Dental Examiners —

Texas Dental Journal l www.tda.org l October 2015 833

Current members of the TSBDE are: • Rudolfo “Rudy” G. Ramos Jr, DDS, (presiding officer), a general dentist from Houston; • Steven J. Austin, DDS, a general dentist from Amarillo; • Kirby Bunel Jr, DDS, an oral and maxillofacial surgeon from Texarkana; • James W. Chancellor, DDS, a general dentist with a Certificate in Anesthesiology (University of Texas Medical Branch – Galveston) from San Antonio; • D. Bradley Dean, DDS, a periodontist from Frisco; • Christy Leedy, DDS, a general dentist from Abilene; • Jason A. Zimmerman, DDS, a pediatric dentist from Ft Worth; • M. David Tillman, DDS, a general dentist from Ft Worth; • Lois Palermo, RDH, a dental hygienist from League City; • Renee Cornett, RDH, a dental hygienist from Austin; • Lewis White, JD, and attorney and public member from Humble; • Emily A. Christy, the director of political affairs for USAA and public member from San Antonio; • Tim O’Hare, JD, an attorney and public member from Farmers Branch; • Whitney Hyde, a court administrator and public member from Midland; and • Vacancy.

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Sunset staff utilizes specific criteria established by the legislature to evaluate each agency’s programs and functions (5). Staff review typically takes from three to eight months.

During this time, sunset staff collects information from varied sources.

An important part of the review process is agency’s “Self-Evaluation Report” (SER). The SER identifies problems, opportunities, and issues that the agency wants considered in the sunset review. Sunset staff also solicits input and discussion of agency functions from stakeholders and the public. After all data is collected, sunset staff evaluates it and then publishes a staff report that includes recommendations for statutory changes by the legislature and management recommendations to improve an agency’s internal operations (5).

After the sunset staff report is published, the commission holds public hearing(s) allowing the public and stakeholders to comment on the report and raise additional issues relating to the agency. The commission considers all input as it formulates the sunset legislation.

The commission meets after the public hearing(s) to review the input received, make decisions on staff recommendations, and discuss any new issues that came from testimony. Additional testimony is not taken during this meeting, but the commission may call resource witnesses as needed (5).

The final report from the commission must include a recommendation to abolish or continue the agency and often has other recommendations to improve an agency’s operations.

If the commission recommends continuation of an agency, the

commission must provide draft legislation to the Legislature to continue the agency for up to 12 years, and correct other problems identified during the sunset review (5).

As stated above, an agency is automatically abolished unless the Legislature passes legislation to continue the agency. Some readers may recall that the legislature did not continue the TSBDE after its 1992 sunset review, in part because of disagreements over the content of the sunset bill between the Texas Dental Association (TDA) and the Texas Dental Hygienists’ Association.

Subsequently, the dental board was abolished in 1993, but re-constituted by the legislature in February 1995 (6).

In 2001, the legislature again had concerns about the TSBDE and moved the Board’s sunset date from 2005 to 2003 (7). The legislature can bring an agency up early for sunset review when it determines that an agency needs special attention. In 2001, the legislature had worries about the dental board’s ability to enforce against violators of the Dental Practice Act. Therefore, a main focus of the 2002-2003 review was to determine if the dental board’s enforcement activities sufficiently protected the public and if board itself was, “best constituted to meet the challenges of enforcing the [Dental Practice] Act and overseeing the agency” (8).

The 78th Legislature continued the TSBDE until September 1, 2015.

Senate Bill 263, the sunset legislation, reduced the size of the board from 18 to 15 members and required the board to coordinate better with the Health and Human Services

Commission on Medicaid issues.

The legislation also mandated that the board’s annual financial report include certain information related to cases handled by the board under Medicaid, to develop and implement a policy requiring use of appropriate technology to enhance the board’s performance, to streamline dentist licensing processes, and to enhance informal settlement of complaints, cease and desist orders, and X-ray certifications for dental assistants (9).

TDA legislative staff is working closely with the TSBDE and the commission to ensure that Texas dentists are represented during the sunset process. Areas of particular interest to the TDA include ensuring that the agency has the financial and staffing resources necessary to enforce the Dental Practice Act and protect the public, the financial and staffing resources necessary for organizational excellence, and the financial and staffing resources necessary to improve overall agency effectiveness.

Updates as the sunset process moves forward will be published in the TDA Today and The Root.

3, Subtitle D, Chapters 251 et.seq.

3. Texas State Board of Dental Examiners Mission Statement.

Web site. http://www.tsbde.state. tx.us/.

4. Texas Sunset Advisory Commission, Frequently Asked Questions. Web site. https:// www.sunset.texas.gov/about-us/ frequently-asked-questions#Whyis-it-called-sunset.

5. Texas Sunset Advisory Commission, Sunset in Texas, 2013-2015. Texas: Texas Sunset Advisory Commission. Available from https://www.sunset.texas. gov/public/uploads/files/reports/ Sunset%20in%20Texas.pdf.

6. Texas Government Code, §325.011 and §325.0115.

7. Texas Senate Bill 309, 77th Legislature (2001).

8. Texas Sunset Advisory Commission, Sunset Staff Report.

State Board of Dental Examiners.

Texas: Texas Sunset Advisory Commission, February 2002.

9. Texas Senate Bill 263, 78th Legislature (2003).

For more information about attending TSBDE meetings or visiting the board’s offices, please contact TDA Policy Manager Diane Rhodes at the TDA central office.

References

1. Texas Sunset Advisory Commission, Summary of Results.

State Board of Dental Examiners.

Texas: Texas Sunset Advisory Commission, July 2003.

2. Texas Occupations Code, Title 1, 2,

Texas Dental Journal l www.tda.org l October 2015 835

Texas Dentists Care— Dentists Connecting With Pa

Dr Jay C. Adkins Council on Legislative and Regulatory Affairs

836 Texas Dental Journal l www.tda.org l October 2015

LUXURY. They are essential. The Texas Dental Association (TDA) is committed to decreasing the number of adults and children with untreated dental disease by supporting programs that provide treatment to people in need of dental care. The goal is to make Texans healthier through access to a dentist.

©bigstock.com/apomares

— atients

HEALTHY TEETH AND GUMS ARE NOT A

Texas Dental Journal l www.tda.org l October 2015 837

With the 84th Regular Legislative Session over, the TDA is focusing on interim projects to connect dentists with patients; reducing the number of people who visit the emergency room for dental conditions. Hospital emergency departments are increasingly bearing the burden of oral health emergencies by lowincome adults, a large portion of which are preventable (1).

Throughout Texas, TDA member dentists are leading community-based movements providing dental care to those suffering from untreated dental disease.

As of July 1, 2015, Texas has 40 projects under the Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver that are increasing, enhancing and expanding dental services.

Many of the waiver projects are intended to reduce emergency room (ER) department visits for dental conditions. These ER diversion projects are serving Texans in urban areas—Houston, Dallas/Ft Worth, San Antonio—and small communities in East Texas, Dimmit County, Guadalupe Valley, Dalhart, and McAllen. Over the next year and a half, the TDA will publicize the ongoing commitment of Texas’ dentists to reduce the burden on community emergency rooms. The Association is also identifying specific dental health professional shortage areas (DHPSA) and providing technical assistance for component dental societies to create at least one new ER diversion project in each identified DHPSA. Dentists throughout Texas are already mobilizing community resources to get patients out of the ER and into the dental chair, the right place for the right treatment. According to a 2014 article in the American Dental Association news, adults

without health coverage in Crockett, Texas, no longer have to rely on the local hospital’s emergency room to treat their dental problems.

Local physicians and the East Texas Medical Center Hospital Emergency Department are referring about 200 patients to the C.O. Murray Clinic, staffed by volunteer dentists. TDA member dentists in San Antonio are part of an 1115 Waiver project with the University of Texas Health Science Center at San Antonio Dental School that created an emergency dental clinic for treating patients presenting with urgent dental conditions including oral infections, abscesses, pain and fractured dental restorations. Those are just two examples of the ways in which Texas dentists are meeting the dental needs of Texas’ citizens.

Community Health Centers (CHCs) also serve a valuable role in linking dentists to patients and keeping patients out of the ER. TDA member dentists working in CHCs, or privately contracting with CHCs, provide a range of dental services including preventive, restorative, and emergency care. Patients benefit because quality dental care can be delivered by dentists quickly and efficiently, preventing more serious dental problems before they occur and alleviating much of the backlog experienced by hospital ER departments when patients use the ER for treatment of largely preventable dental conditions.

The federal government recently announced $169 million in Affordable Care Act funding to 266 new health center sites in 46 states (2). CHCs in Texas received 11 awards totaling $7,261,501 to bring dental care to 41,575 patients in some of the most underserved areas of the state (3).

CHCs in Pleasanton, Marshall, San Antonio, Houston, Conroe, Albany,

838 Texas Dental Journal l www.tda.org l October 2015

and Austin received funds to expand their delivery of primary health care services including dental care.

Every Texan deserves comprehensive dental care provided by a dentist.

Be on the lookout for more exciting examples of how dentists in Texas are reducing ER costs for hospitals and preventing dental disease before it starts under the project header, “Texas Dentists Care—Dentists Connecting with Patients.” TDA’s goal is to help all Texans attain their best oral health.

1. American Dental Association, Health Policy Resources Center.

Dental-Related Emergency Department Visits on the Increase in the United States. Chicago: American Dental Association, April 2013.

2. During National Health Center Week, HHS announces an additional $169 million in Affordable Care Act funding to 266 community health centers [news release]. Washington DC: US Department of Health and Human

Services, Health Resources and Services Administration; August 11, 2015. http://www.hhs.gov/ news. Accessed August 26, 2015.

3. US Department of Health and Human Services, Health Resources and Services Administration.

Texas FY 2015 New Access Point Awards. Washington DC: Web site. http://bphc.hrsa. gov/programopportunities/ fundingopportunities/ NAP/0815awards/tx.html.

©bigstock.com/Wavebreak Media Ltd

References

Texas Dental Journal l www.tda.org l October 2015 839

Brushing Up on Oral Health: Medicaid, CHIP and the Public Health Safety Net THE TEXAS DENTAL ASSOCIATION (TDA) HAS A LONG-STANDING HISTORY of encouraging member dentists to participate in Medicaid, the Children’s Health Insurance Program (CHIP), and other public health programs that provide needed dental care for adults and individuals with special health care needs (1).

Dr Herbert L. Wade, Jr Council on Legislative and Regulatory Affairs

The most recent information from the Texas Health and Human Services Commission (HHSC) shows that the 3,087 actively participating dentists are effectively treating the more than 3,000,000 Medicaid and CHIP enrolled children (2,3). The number of active participating dentists continues to climb steadily every quarter.

Although on the surface the number of active participating dentists may not appear adequate to treat all enrolled children, 2014 federal statistics reveal that 69% of Texas children enrolled in Medicaid received dental services (4). State CHIP data indicates that approximately two-thirds of CHIP members had at least one dental visit (66%) during the program year, which is higher than the national average of 48% (5).

Texas should celebrate Medicaid on its 50th birthday as well as the federal government’s decision to extend CHIP funding for two more years. As Medicaid and CHIP evolve, they

continue to focus upon being increasingly innovative and dynamic in securing the triple aim of better care for individuals, better health for populations, and lower per-capita healthcare costs.

It’s also important to remember that adequate funding and dentist participation are the cornerstones of strong Medicaid and CHIP dental programs. Texas is fortunate to have dedicated dentists actively participating in both programs—putting good oral health within reach of Texas’ most vulnerable citizens.

But the impact that dentists are making in the lives of Texans goes beyond the delivery of needed dental care to children. In fact, the state is on target to meet, and in some instances even surpass certain Healthy People 2020 oral health objectives, identified

by HHSC’s new Dental Director Dr Marguerite Laccabue (see chart next page).

©shutterstock.com/Khalchenko Alina

Texas Dental Journal l www.tda.org l October 2015 841

Healthy People 2020 Healthy People 2020 Objective

Baseline Measurement

Texas

Success

Reduce the proportion of children aged 3 to 5 years with dental caries experience in their primary teeth

33.3% of children aged 3 to 5 years had dental caries experience in at least one primary tooth in 1999-2004

30%

Texas has 31% for caries experience for first year Head Start children (6)

Texas is ahead of the national baseline and positioned to meet the target

Reduce the proportion of children aged 3 to 5 years with untreated dental decay in their primary teeth

23.8% of children aged 3 to 5 years had untreated dental decay in at least one primary tooth in 19992004

21.4% 21.6% of first Year Head Start children had untreated decay (6)

Texas is ahead of the national baseline and positioned to meet the target

Reduce the proportion of children aged 6 to 9 years with dental caries experience in their primary and permanent teeth

54.4% of children aged 6 to 9 years had dental caries experience in at least one primary or permanent tooth in 1999-2004

49%

66.8% from the Basic Screening Survey (7)

Texas needs to continue efforts to achieve the objective

Reduce the proportion of children aged 6 to 9 years with untreated dental decay in their primary and permanent teeth

28.8% of children aged 6 to 9 years had untreated dental decay in at least one primary or permanent tooth in 1999-2004

25.9%

25.9% from the Basic Screening Survey (7)

Texas met the objective as of 2012-2013

Increase the proportion of children aged 6 to 9 years who have received dental sealants on one or more of their permanent first molar teeth

25.5% children aged 6 to 9 years received dental sealants on one or more of their first permanent molars in 1999-2004

28.1%

51% from the Basic Screening Survey (7)

Texas is far surpassing the objective

Increase the proportion of children, adolescents, and adults who used the oral health care system in the past year

44.5% of persons aged 2 years and older had a dental visit in the past year in 2007

49.0%

58.8% of adults in Texas visited a dentist in 2012 (8)

Texas is far surpassing the objective

Increase the proportion of the US population served by community water systems with optimally fluoridated water

72.4% of the US population served by community water systems received optimally fluoridated water in 2008

79.6%

Texas is at 79.6% (9)

Texas met the objective

842 Texas Dental Journal l www.tda.org l October 2015

Healthy People 2020 Target

During the recent legislative session, the TDA successfully advocated for adequate funding for the Medicaid dental program, comprehensive safeguards to protect Medicaid providers subject to OIG investigation and enforcement activities, and continued improvements in program administration by HHSC…

These statistics demonstrate that Texas has it right. By requiring a dentist-to-patient relationship in the Texas Dental Program (ie, Medicaid and CHIP), Texas preserves the dentist’s ability to make clinical decisions based on an individual patient’s needs. The patient’s oral health care is delivered in a complete, accessible and familycentered manner by a licensed dentist, thereby helping to eliminate duplicate or unnecessary services, and unnecessary costs.

During the recent legislative session, the TDA successfully advocated for adequate funding for the Medicaid dental program, comprehensive safeguards to protect Medicaid providers subject to Office of Inspector General (OIG) investigation and enforcement activities— Senate Bill 207 (Senator Juan “Chuy” Hinojosa D–McAllen), and continued improvements in program administration by HHSC—Senate Bill 200 (Senator Jane Nelson R–Flower Mound). Notable administrative improvements include requiring HHSC to create a single consolidated Medicaid provider enrollment and credentialing process, and creating a centralized internet portal through which dentists can enroll in the program. Additionally, Senate Bill 200 requires Medicaid managed care organizations to formally re-credential Medicaid providers along the same timeline as the single, consolidated Medicaid provider enrollment and credentialing process.

Notable OIG improvements include changing the definition of “fraud” in Government Code, sec. 531.1011(4) to specify that the term does not include unintentional technical, clerical, or administrative errors, shortening OIG timelines for case investigations, and making State Office of Administrative Hearing decisions final in payment hold hearings. OIG is also discontinuing the custom extrapolation process and instead will be using “RAT-STATS,” the primary statistical tool used by federal OIG’s Office of Audit Services.

Nationally, many dentists are struggling with the effects of the Affordable Care Act’s “Recovery Audit Contractor Program” in which private contractors, “Recovery Audit Contractors” (RACs), are hired to review Medicaid provider activities including claims audits, identifying overpayments, etc. According to the American Dental Association, many well-meaning dentists are receiving significant and sometimes arbitrary fines for unintentional, often minor infractions when there was never any intent to defraud the government.

Due to the TDA’s efforts, that is not the case for Texas dentists. TDA staff worked closely with HHSC legal staff and OIG staff to exclude dentists from Texas’ RAC program.

Although other entities may claim to effectively advocate for dentists participating in Medicaid, CHIP, and public health dental programs, the state’s top legislative and agency decision makers seek the TDA’s

presence and guidance. All of the TDA’s advocacy efforts, both legislatively and within applicable state agencies, have directly resulted in program changes that improved Texas dentists’ experience with public health dental programs, and led to significant improvements in the delivery of dental care to Texans.

References

1.

2.

Texas Dental Association. Policy 66-2010-H. Texas Health and Human Services Commission. THSteps Active Provider Participation Report 1996-2015. Texas: Texas Health and Human Services Commission, June 17, 2015.

3. Texas Health and Human Services Commission. Children’s Health Coverage.

Texas: Web site. http://www.hhsc.state. tx.us/research/index.shtml.

4. Centers for Medicare & Medicaid Services.

CMS-416 Annual EPSDT Participation Report – FY 2014.

5. Institute for Child Health Policy at the University of Florida Texas External Quality Review Organization, Texas Children’s Health Insurance Program Dental Quality of Care Measures Contract Year 2012.

Florida: The Institute for Child Health Policy University of Florida, January 2015.

6. Texas Department of State Health Services, Division of Family and Community Health Office of Program Decision Support.

Second Assessment of Child Dental Health Status As Required by Frew v. Janek, March 2014.

7. Texas Department of State Health Services, Division of Family and Community Health Office of Program Decision Support. Texas Third Grade Oral Health Basic Screening Survey Results, April 2015.

8. Texas Department of State Health Services, Division of Family and Community Health Office of Program Decision Support. Texas Adult Oral Health and the Behavior and Risk Factor Surveillance System. Texas: Web site. https://www.dshs.state.tx.us/ chs/brfss/.

9. Centers for Disease Control and Prevention. 2012 Water Fluoridation site: http://www.cdc.gov/ Texas Dental Statistics.

Journal l Web www.tda.org l October 2015 fluoridation/statistics/2012stats.htm.

843

844 Texas Dental Journal l www.tda.org l October 2015

The Advocacy Academy We must make it our priority and goal to share our knowledge and empower future dentists. The Advocacy Academy at Texas dental schools is designed to accomplish just that.

Dr Rita Cammarata

Ms Janet Crow

WHAT IS THAT OLD SAYING? KNOWLEDGE IS POWER! We certainly agree with this world

In January 2015, students from the American Student Dental Association (ASDA) Houston Chapter, led by Ms Glennis Katzmark DS2, implemented the Advocacy Academy in Houston. The Academy was developed as a 5-day lecture series to teach and promote the importance of organized dentistry, dental advocacy, and political action. Lectures were held Monday - Thursday during the lunch hour and consisted of a 30-minute presentation and 10-minute Q & A. Presenters included the TDA director of public affairs, dental school faculty, TDA leadership, and local practicing dentists. Lunch or snacks were provided at each session and the series concluded with a happy hour celebration on Friday afternoon.

Students attending all 5 days were eligible to win 1 of 2 door prizes presented at the closing event. The event was a wonderful success.

up to us to teach what we know to

The Advocacy Academy event held at the University of Texas School of Dentistry at Houston inspired a record number of Houston dental students to participate in TDA Legislative Day held in Austin during the 84th legislative session. The message is clear— students and young dentists want to be politically active, and presented with the right tools and opportunities —they can have amazing results. The TDA and DENPAC, organized dentistry’s political action committee, strongly support the Advocacy Academy event created by ASDA. In 2016, TDA and DENPAC are teaming up with ASDA to continue the event in Houston and expand it to Dallas and San Antonio in an effort to educate and inspire the next generation of dentists. ASDA, TDA, and DENPAC can’t do it alone…we need your help!

future generations of dentists and

How can you help?

renowned philosophy, but also believe that power lies not in knowledge alone, but in the sharing of knowledge. For those of us dentists who are seasoned veterans, advocacy is second nature and we know the importance of it. It is

encourage them to be politically active.

Advocacy Academy events will be held at all three dental schools in 2016. The TDA and ASDA are seeking support from dentists and organizations to help fund these important events. Sponsorship funds will be combined with funds contributed by DENPAC and the Houston, Dallas, and San Antonio ASDA chapters. Please help us inspire a new generation of dentists through mentorship and education! See the available sponsorship levels below: n Associates—$100 n Bachelors—$250 n Masters—$500 Sponsors will receive recognition on all signage and print materials and be recognized in the TDA Today.

For more information or to become a sponsor, please contact DENPAC Manager Leigh Ann Montague at lmontague@tda.org or 512-443-3675.

Texas Dental Journal l www.tda.org l October 2015 845

Are You Smarter Than the Average Dentist?

AS DENTISTS, WE HAVE COMPLETED 4 YEARS OF UNDERGRADUATE STUDIES, 4 years of dental school, and countless continued education hours. We can tell you how to extract a molar, perform a crown, and diagnose gum disease. We consider ourselves intelligent, educated, and resourceful dental care professionals. However, what they didn’t teach us in dental school is the significant role the legislature Dr Lisa Heinrich-Null DENPAC chair

Dr Debrah Worsham

Former ADPAC board member Former DENPAC chair

plays in our practice and how we treat our patients.

The Texas Dental Association Political Action Committee, DENPAC, exists to monitor any legislative issues related to the practice of dentistry and relay that information to our members. It is DENPAC’s job to research candidates for state office and help elect individuals who are concerned with the practice of dentistry and the oral health of Texas citizens, ensuring that the dental community has a voice at the Texas Legislature.

This year, DENPAC’s priority will be to educate TDA members on the fundamentals of dental politics and advocacy. However, we are aware that politics is not always a stimulating subject.

In an effort to make the learning process a little more exciting, DENPAC is holding the “Are You Smarter than the Average Dentist?” challenge. Dentists will be encouraged to learn more about the

846 Texas Dental Journal l www.tda.org l October 2015

legislative and regulatory process, dental issues, grassroots advocacy, and political action by challenging them to “outsmart” their colleagues. A strategically placed question along with the correct answer will be highlighted in 5 consecutive issues of the TDA Today. Members will be instructed to take note of all questions and answers throughout the contest. In April 2016, all TDA members will receive an electronic questionnaire comprised of all questions included in the series. Members answering all questions correctly will earn a chance to win a CABO SAN LUCUS GETAWAY! Look for the contest’s official launch in the October TDA Today. Take the challenge and find out if you are smarter than the average dentist?

©Jakub Jirsak/Bigstock.com

Texas Dental Journal l www.tda.org l October 2015 847

Electronic Health Records and the Dentist

Dr Lee P. Oneacre

Council on Legislative and Regulatory Affairs

Dr Mark Peppard

Council on Legislative and Regulatory Affairs

848

DESPITE ALL EFFORTS TO MOVE FORWARD WITH THE USE OF ELECTRONIC HEALTH RECORDS (EHR), a large gap remains in the dental industry. Many dentists still rely on paper charts or are not using electronic communication systems capable of sharing patient health information outside the individual dental practice. This lack of interconnectivity means that scores of dentists are only operating inside their own information silos, without the ability to access a patient’s health information or share a patient’s dental information with other health care professionals in a protocol compliant with the Health Insurance Portability and Accountability Act. Unlike the medical profession, which has seen exceptional growth in EHR adoption primarily through hospital systems, the dental profession remains a long way from fluid participation in the Nationwide Health Information Network (NwHIN)—a set of standards, services, and policies that enable secure health information exchange (HIE) over the internet. The NwHIN is a common platform for nationwide health information exchange across diverse entities. NwHIN standards and services are used by federal agencies, health care providers, health information exchanges, and consumers to securely exchange health information at both the national and local level. The NwHIN is a fundamental requirement for achieving nationwide HIE, one of the primary goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act (1).

Why is dentistry stagnant? One of the biggest hurdles to EHR adoption is the lack Texas Dental Journal l www.tda.orgofl available October 2015 funds for capital investments.

Small and solo practioner dental practices often operate on a tight budget which doesn’t leave room for EHR investment. Therefore, most EHR adoption among dentists has been limited to large practices and dental service organizations. However, it’s not all about money. Dentists that have the funding are finding few options when it comes to EHR systems that meet the unique workflow needs of a dental practice.

What is the dentist to do? Before making any investments in technology, a dentist should assess whether the practice is ready to transition from paper to EHRs and whether the practice is better suited to upgrading the existing EHR system, or purchasing a new certified version. The American Dental Association recommends an EHR product that incorporates dental records, dental imaging, and practice management on a single platform as opposed to trying to interface standalone products (2). There are not many fully functional electronic dental record systems that qualify as true EHRs.

Despite the HIE challenges facing the dental profession, Texas is still full steam ahead with statewide HIE implementation. The 84th Texas Legislature was eventful for the Texas Health Services Authority (THSA) and HIE in Texas. The Texas Health Services Authority (THSA) is a public private entity mandated by the Texas Legislature in 2007, and is responsible for coordinating the implementation of health information exchange in Texas. The THSA oversees HIETexas, a secure network of local and private HIEs, enabling health care providers to electronically exchange patients’ health information across Texas and the nation (4). Most notably this session, the legislature adopted Senate Bill 203 by Senator Jane Nelson (R-Flower Mound) that transitions the THSA from a publicprivate partnership to a private nonprofit entity in 2021 (5).

In additional HIE news, House Bill 2641 by Representative John Zerwas (R-Fort Bend) establishes the authority of an HIE to access and transmit specified health-related information among health care providers including dentists. It also

designates the authority of health care providers and certain other entities to report such information through an HIE. The legislation also ensures that providers submitting information to an HIE are protected against litigation if the HIE or another provider accessing the information uses it in a way that violates state or federal privacy and security laws relating to the disclosure of protected health information (6).

6.

Legislature Regular Session. Available from: URL: http://www.capitol.state. tx.us/tlodocs/84R/billtext/pdf/SB00203F. pdf#navpanes=0.

House Bill 2641, 84th Texas Legislature Regular Session. Available from: URL: http://www.capitol.state.tx.us/ tlodocs/84R/billtext/pdf/HB02641F. pdf#navpanes=0.

No matter how slowly dentistry may be entering the HIE, dentists are integral to the overall success of universal EHR implementation. Take the time to become educated about available EHR products and take a close look at your workflow to understand how particular EHRs handle workflow and patient care. The TDA remains a trusted source of EHR information for Texas’ dentists and will continue its efforts to improve HIE participation for dentists in Texas.

References 1.

2.

3.

4.

5.

Nationwide Health Information Network (NwHIN). Available from: URL: http:// www.healthit.gov/policy-researchersimplementers/nationwide-healthinformation-network-nwhin.

American Dental Association. Electronic Dental Records Implementation.

Available from: URL: http://www. ada.org/en/member-center/ member-benefits/practiceresources/dental-informatics/ electronic-health-records/ehrfaq-index/electronic-dentalrecords-implementation.

Certified Health IT Product List. Available from: URL: http://oncchpl.force.com/ ehrcert.

Texas Health Services Authority. Available from: URL: http:// hietexas.org/aboutthsa/overview.

Senate Bill 203, 84th Texas

©shutterstock.com/wavebreakmedia

Many available packages being marketed to dentists qualify on some levels, but do not meet all EHR qualifications. Interested dentists can find certified EHRs and EHR modules from the Certified Health Information Technology (IT) Product List from the Office of the National Coordinator (ONC) for Health Information Technology (HIT) Certification Program (3).

Texas Dental Journal l www.tda.org l October 2015 849

TDA Strategic Plan 2

Helping All TDA Member Dentist IN MAY 2015, THE TEXAS DENTAL ASSOCIATION’S (TDA) HOUSE OF DELEGATES (HOD) approved a new 5-year strategic plan for the Association. Instead of a voluminous and complicated plan, it is a very simple onepage document with the singular mission of “Helping All TDA Member Dentists Succeed.”

Dr Duc “Duke” M. Ho TDA Board Member

850 Texas Dental Journal l www.tda.org l October 2015

2020:

ts Succeed

Texas Dental Journal l www.tda.org l October 2015 851

Immediately following the plan’s adoption, the TDA Board of Directors, all TDA councils and committees, and TDA staff began developing tasks to stay aligned with the strategic plan’s mission to help all TDA member dentists succeed. This includes current 2017 budgeting that keeps councils and committees focused on achieving strategic plan goals.

According to the document, TDA Strategic Plan 2020 “…is based on a set of goals and a workflow, or process, for determining how best to allocate the TDA’s resources over the several years. As with any plan, it is subject to revision based on changes in organized dentistry or the challenges we face. Further, this plan focuses less on the ‘what’ and more on the process for making decisions and instilling discipline into the Association’s activities.”

Specifically, the goals provide a framework for the TDA’s strategic decision making—a guide for the Association in determining where to allocate resources for new or existing programs.

GOALS: n

n

n n

n

n

Increase NON-DUES revenues by 3-4% annually (based on for-profit subsidiary) Achieve NET GAIN in combined program areas with revenue streams (based on fixed cost savings of 1-2%) Increase MARKET SHARE by 1/2 -1% annually Maintain 95% RETENTION RATE and INCREASE CONVERSION RATE of new dentists Structure of TDA will provide valuable RESOURCES TO COMPONENT SOCIETIES TDA will have DATA ON MEMBER NEEDS

In addition to clearly articulating goals, the strategic plan identifies work areas that the TDA needs to do well in order to be a strong association. Those areas include membership growth and retention, governance structure and policy, and support of the membership boards, councils, and committees.

The strategic plan also highlights the Association’s core assets, which, taken together, become the platform for delivering member value that is greater than what the member could afford on their own. Assets are the valuable tools the TDA has to work with to achieve strategic planning goals, and the assets need to be maintained throughout strategic plan implementation. The TDA’s core assets include the Association itself, the TDA Smiles Foundation, TDA Financial Services, Inc. (FSI), DENPAC, outward facing brand and messaging, financial strength, and organizational capacity of TDA volunteers, staff, and Alliance.

A premier TDA core asset is advocacy, and the Association has a proven track record of successfully representing the profession and ensuring the best possible dental care for the citizens of Texas. As the state’s leading oral health advocate, the TDA not only advances a legislative agenda determined by member dentists, but tirelessly fights for things that matter to member dentists and the patients they serve. The TDA’s ongoing advocacy efforts both preserve the profession and continue the tradition that Texas dentists determine their own future.

In closing, the TDA’s strategic plan puts the focus where it should be, on the members. However, successfully implementing the plan will be an ongoing process wherein the TDA leadership and staff work

852 Texas Dental Journal l www.tda.org l October 2015

together to identify programs and services with the highest member value. Budgetary and programmatic decisions must deliver value to all members—past, present, and future.

As a part of implementation, the TDA’s Future Focus Committee will report periodically on the progress and status of the plan including a final year-end summary report for the 2016 HOD. This is an exciting time for the TDA. Seizing this moment brings the TDA closer to not only helping all

members succeed, but building a stronger professional association in the process. The TDA Board of Directors welcomes your continued input as we all work together in the shared mission of serving the member dentist, first and foremost.

TDA dentists at legislative day Texas Dental Journal l www.tda.org l October 2015 853

TDA Legislative Resource Guide Resources The staff at the Texas Dental Association stands ready to assist you. Please use this tear-out as a guide to identify staff members who are knowledgeable in areas of legislative and regulatory affairs. If you have questions or need assistance with any of these entities, or others not listed, please give us a call.

General Legislative & Regulatory Questions 1946 S IH35, Ste 400 Austin, TX 78704 P (800) 832-1145 F (512) 443-3031 Director of Public Affairs Jess Calvert (800) 832-1145 ext 132 Policy Manager Diane Rhodes (800) 832-1145 ext 122 DENPAC 1946 S IH35, Ste 400 Austin, TX 78704 P (800) 832-1145 F (512) 443-3031 Director of Public Affairs Jess Calvert (800) 832-1145 ext 132 DENPAC Manger Leigh Ann Montague (800) 832-1145 ext 131

Texas State Board of Dental Examiners 333 Guadalupe Tower III, Ste 800 PO Box 13165 Austin, TX 78701 P (512) 463-6400 F (512) 463-7452 www.tsbde.state.tx.us TDA Staff: Diane Rhodes (800) 832-1145 ext 122 Office of Inspector General Dr Linda Altenhoff, Chief Dental Officer 11501 Burnet Rd. Building 902 Austin, Texas 78758 P (512) 491-1106 E-mail: Linda.Altenhoff@ hhsc.state.tx.us TDA Staff: Diane Rhodes (800) 832-1145 ext 122 Texas Department of State Health Services Oral Health Program Vacancy, Public Health Dental Director 1100 West 49th Street, Austin, Texas 78756-3199 P (512) 776-7323 F (512) 776-7256 TDA Staff: Diane Rhodes (800) 832-1145 ext 122

Insurance Department of Insurance Consumer Protection (800) 252-3439 www.tdi.state.tx.us/ consumer/complfrm.html TDA Staff: Lee Ann Johnson (800) 832-1145 ext 134

Medicaid and CHIP Texas Medicaid & Healthcare Partnership Contact Center General Inquiries Line: (800) 925-9126 Provider Enrollment: (800) 925-9126 option 2 Texas Health Steps Dental: (877) 847-8377 DentaQuest 1-800-685-9971 http://dentaquestnetwork. com/texas/ MCNA Dental 1-855-PRO-MCNA (1-855-776-6262) http://www.mcnatx.net/ contract TDA Staff: Diane Rhodes (800) 832-1145 ext 122 Professional Recovery Network Statewide Toll-free Help Line: (800) 727-5152 TDA Staff: Diane Rhodes (800) 832-1145 ext 122

854 Texas Dental Journal l www.tda.org l October 2015

X-Ray Unit Certification Texas Department of State Health Services Radiation Control Program Attn: Registration 1100 W 49th St Austin, TX 78756-3189 P (512) 834-6688 F (512) 834-6690 www.dshs.state.tx.us/ radiation/default.shtm TDA Staff: Diane Rhodes (800) 832-1145 ext 122

Prescriptions DEA Diversion Control Program www.deadiversion. usdoj.gov TDA Staff: Diane Rhodes (800) 832-1145 ext 122

TDA Legislative Resource Guide Infection Control and OSHA Occupational Safety and Health Administration (OSHA) US Department of Labor Occupational Safety and Health Administration 200 Constitution Ave Washington, DC 20210 (800) 321-OSHA (6742) www.osha.gov/SLTC/ dentistry/index.html TDA Staff: Diane Rhodes (800) 832-1145 ext 122

Area OSHA Offices: Austin (512) 374-0271 Corpus Christi (361) 888-3420 Dallas (972) 952-1330 El Paso (915) 534-6251 Fort Worth (817) 428-2470 Houston (N) (936) 760-3800 Houston (S) (281) 286-0583 Lubbock (806) 472-7681 San Antonio (210) 472-5040

Environmental Regulations Texas Commission on Environmental Quality (TCEQ) Registration: Reporting Section PO Box 13087 Mail Code 129 Austin, TX 78711-3087 (512) 239-6632 (Automated system; select option #2) www.tceq.state.tx.us

Tax Issues Texas Comptroller of Public Accounts PO Box 13528 Capitol Station Austin, TX 78711-3528 (800) 252-1381 www.window.state. tx.us TDA Staff: Diane Rhodes (800) 832-1145 ext 122

TDA Staff: Diane Rhodes (800) 832-1145 ext 122

Texas Dental Journal l www.tda.org l October 2015 855

MEMORIAL and HONORARIUM Donors

In MEMORIAM

to the Texas Dental Association Smiles Foundation

who have recently passed

IN MEMORY OF:

Bobby Clarence Battles

Dr Johnny W Shriver Bernard and Sybil Stratman

Those in the dental community

Athens, TX December 4, 1941 – June 10, 2015 Good Fellow: 1993 • Life Member: 2006

James Marian Brunette

Bernard and Sybil Stratman

Paris, TX August 22, 1926 – September 4, 2015 Good Fellow: 1980 • Life Member: 1991 50 Year: 2009

Dr Robert R McCausland

Grady W Bryan

Bernard and Sybil Stratman

San Angelo, TX September 17, 1959 – September 7, 2015

Dr Fred Potter

Robert Charles Cozart

Dr and Mrs Thomas Phillips Sr

Commerce, TX October 5, 1924 – August 30, 2015 Good Fellow: 1974 • Life Member: 1989 50 Year: 1999

Dr Robert L Tocker

David Brewster Sandy Blum

Marvin Wayne Humphries Tyler, TX April 5, 1935 – September 6, 2015 Life Member: 2001 • 50 Year: 2012

Joe H Ledford

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

856 Texas Dental Journal l www.tda.org l October 2015

Richardson, TX May 14, 1934 – September 25, 2015 Good Fellow: 1991 • Life Member: 2000 50 Year: 2015

Troy Nathan Moser Whitehouse, TX April 19, 1922 – September 1, 2015 Good Fellow: 1981 • Life Member: 1987 50 Year: 2004

Rodney McClain Phillips Beaumont, TX September 29, 1938 – August 26, 2015 Good Fellow: 1995 • Life Member: 2004 50 Year: 2012

Anesthesia Education & Safety Foundation

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OUR MISSION: To provide affordable, quality anesthesia education with knowledgeable and experienced instructors, both in a clinical and academic manner while being a valuable resource to the practitioner after the programs. Courses are designed to meet the needs of the dental profession at all levels.

OUR GOAL: To teach safe and effective anesthesia techniques and management of medical emergencies in an understandable manner.

WHO WE ARE: We are licensed and practicing dentists in Texas, and we understand your needs. While other providers are in the process of contemplating program development, our courses have met the ADA Guidelines for more than 10 years. The new anesthesia guidelines were recently approved by the Texas State Board of Dental Examiners. As practicing dental anesthesiologists and educators, we have established continuing education programs to meet these needs.

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Here are the distinct advantages of the webcast (contact us at 214-384-0796 to see which courses are available for webcast): 1. You can receive continuing education credit for simultaneous live lecture CE hours.

2. There is no need to travel to the program location. You can stay at home or in your office to view and listen to the course.

3. There is not a post-test after the webcast course concludes, so you will receive immediate CE credit for attendance 4. You can enjoy real-time interaction with the instructor, utilizing a question & answer format

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Here are the advantages of the ONLINE Enteral Sedation Renewal (contact us at 214-384-0796 to see which courses are available): 1. You can select specific recorded modules to construct a customized and online Enteral Renewal program to receive CE credit.

2. There is no need to travel to the program location. You can stay at home or in your office to view and listen to the recording.

3. There is a short post-test after each online recording concludes, so you will receive CE credit for attendance

Pediatric and Adult Protective Stabilization Course (PAPS©): Houston, Texas: Friday, December 11, 2015 Credit & Time: 8 hours lecture; 7:30 am – Registration; 8:00 am – Presentation start time Nitrous Oxide/Oxygen Conscious Sedation Course for Dentists (Please call us for details):

Dates & Locations: Credit: Time:

Nov. 13 (Houston); Dec. 5 (McKinney) 14 hours (clinicians must complete the online portion, first) 7:00 am – Registration; 7:30 am – 5:00 pm – Clinical Presentation

Level 1 Initial Minimal Sedation Permit Courses:

*Hybrid program utilizes the convenience and efficiency of online material in lieu of 1 day of live class time. The participant has the important live time to cover material which cannot be done via online material. This material must be completed prior to the live sessions.

McKinney, Texas: *Friday, December 4, 2015 and online Houston, Texas: *Thursday, November 12, 2015 and online Credit: 18 hours lecture with 20 clinical experiences Time: 7:00 am – Registration; 7:30 am – 5:00 pm – Presentation Level 2 Initial Moderate Sedation by Oral Administration Permit Course (must be present for the clinical session):

*Hybrid program utilizes the convenience and efficiency of online material in lieu of 1 day of live class time. The participant has the important live time to cover material which cannot be done via online material. This material must be completed prior to the live sessions.

McKinney, Texas: *Fri-Sat, December 4-5, 2015 and online Houston, Texas: *Thurs-Fri, November 12-13, 2015 and online Credit: 24 hours lecture/participation with clinical experiences and 3 live sedations Time: 7:00 am – Registration; 7:30 am – 5:00 pm – Presentation Level 1 to Level 2 Transitional Moderate Sedation Permit Course (must have a Level 1 permit): McKinney, Texas: Saturday, December 5, 2015 Houston, Texas: Friday, November 13, 2015 Credit: 8 lecture/participation hours with clinical experiences and 3 live sedations Time: 7:00 am – Registration; 7:30 am – 4:30 pm – Presentation w Level 1 and Level 2 Enteral Sedation Renewal Courses (only 1 day needed to renew): McKinney, Texas: Friday, December 4, 2015 Houston, Texas: Thursday, November 12, 2015 Credit & Time: 8 hours lecture; 7:00 am – Registration; 7:30 am – 5:00 pm – Presentation ACLS or PALS Renewal combined with a Level 2 Enteral Sedation Renewal Courses: (You must be current in ACLS or PALS; This course is for ONLY Level 2 Permit holders)

McKinney, Texas: Friday, December 4, 2015 Houston, Texas: Saturday, November 14, 2015; or Friday, December 11, 2015 Credit & Time: 8 hours lecture/participation; 7:00 am – Registration; 7:30 am – 5:00 pm – Presentation ACLS (Advanced Cardiac Life Support) & PALS (Pediatric Advanced Life Support) Initial Programs*: McKinney, Texas: Friday, December 4, 2015 (8:00 am to 4:00 pm – Presentation time) Houston, Texas: Friday, November 13, 2015 (4:00 pm to 10:00 pm – Presentation time) Credit: 8 hours lecture/participation * This initial ACLS or PALS course requires a prerequisite that must be completed online prior to the live program

AGD Codes for all programs: 341 Anesthesia & Pain Control; 342 Conscious Sedation; 343 Oral Sedation All continuing education programs fulfill TSBDE Rule 110. Find us on the web at www.sedationce.com Call us at 214-384-0796 to register for any program

Provided by TDA Perks Program

value for your

profession The Affordable Care Act (Obamacare) Update — THIRD TIME’S A CHARM? OR THIRD STRIKE?

By Eric Tiedtke, CFP TDA Financial Services Insurance Program

T

here are a lot of changes coming in the last few months of this year related to health care and health insurance. Some will impact you and your coverage and some will not. However, it’s critical that after November 1, you review your options so you can plan for your coverage that goes in effect on January 1, 2016.

The next and third open enrollment period for health plans under the Affordable Care Act begins November 1, 2015 (for plans with the effective date of January 1, 2016). Since ACA was passed and implemented, the law had multiple changes, waivers, and deferments. Add the House’s multiple votes to repeal the law, lawsuits at state and federal levels, and high-profile Supreme Court decisions, and you’ll understand why there’s still so much confusion and uncertainty about the law.

What’s changed? What might change?

And probably most importantly, what types of rate increases and plan changes can we expect? Below is a summary of the significant changes and developments affecting ACA going forward.

©iStock.com/iculig

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The Supreme Court Decision

Do You Know the 3 R’s?

In June, the Supreme Court made its ruling regarding whether people who purchased an On-Exchange plan via the Federal Exchange (like we utilize in Texas) were eligible for a subsidy. The Supreme Court ruled the law’s intent could not have been to exclude people who purchase a plan on the Federal Exchange from a subsidy, so the lawsuit was dismissed. The opposite ruling would have eliminated the subsidy from approximately 80% of the plans, and made the insurance unaffordable with a widespread dropping of plans no longer subsidized. The entire ACA marketplace potentially would have imploded, unless Congress passed a new law, or executive or legal action kept that from happening in the short term.

The ACA required all plans to be guaranteed issue, have no exclusions for pre-existing conditions, and provide certain mandated coverage.

Consequently, the health-insurance industry lobbied hard for protection in return for its support. The ACA 3 R’s program was the result. ACA’s risk adjustment, reinsurance, and risk corridors programs are designed to work together to offset potential effects of adverse selection and risk selection to carriers. Many health insurance companies are reporting huge losses on their 2014 block of individual business (one Texas company is reporting a $400 million loss), but are having some of the losses offset by these programs.

However, these programs—the risk corridors in particular—are scheduled to be eliminated by the end of 2016.

Unless there are significantly fewer claims and if there are no legislative changes, 2017 rates will increase significantly.

The Supreme Court decision upheld the law’s language, and removed the last major lawsuit that could have eliminated the law’s very foundation.

There are a few other changes that could be accomplished legislatively, such as eliminating the tax on medical devices or additional taxes on higher incomes; however, the soonest anything substantial could be done to the law would be after the 2016 presidential election. Any other legislative efforts would be vetoed by the president. The bottom line is: the ACA is the law and will not change until 2017, at the earliest.

The 3 Amigos The ACA was supposed to provide more options, competition, and lower prices for consumers; and of course if you liked your plan, you were supposed to be able to keep it.

But the opposite happened, as many TDA members whose association or individual plans were cancelled know. Unless you’re self-insured or have a “grandfathered,” church, or ERISA plan, you have an ACA plan (assuming you’re not just self-insuring and paying the tax). Unfortunately, the health insurance market has gone from having 15-20 companies in 2010

to a handful since 2014; and the market continues to shrink. Another has exited the market in the past few months, and of the remaining 5 largest companies, 2 are being purchased by competitors. This could shrink the Texas health insurance market to only three national companies (The 3 Amigos) with a handful of hospital-system based plans in limited parts of the state.

This consolidation is all about size and scale, and trying to create efficiencies by having more insureds.

The market for new insureds is projected to be limited, because of the increases in Medicaid enrollment and the millions that simply won’t sign up. This means the only way companies can now grow is by buying another company or companies and its insureds. The plans all must offer the same mandated benefits, so the only significant way to reduce plan costs are through their managed-care networks. Get ready for more HMOs, EPOs, limited PPO networks and provider and hospital conflicts.

Most insurance companies are already very efficient from a staffing and technology standpoint, so they’ll try and get additional savings when negotiating with hospitals and providers. This will continue the growth of Accountable Care Organizations (ACO), where hospital networks buy provider groups, and physicians become employees rather than work solo or in a group practice.

Certain insurance companies will have arrangements with certain hospital groups. This will probably accelerate the trend of independent physician and physician group practices being bought or joining an ACO. It will simply become unprofitable to be a small or independent provider in the medical field. Large state Texas Dental Journal l www.tda.org l October 2015 859

PPO networks might become more regional with certain insurance companies becoming the dominant carrier in, say, Houston, but not in Dallas or San Antonio.

The networks will change. Expect some very high-profile and contentious public negotiations between insurance companies and hospital groups. The provider networks will be the decisive factor in the premium, and become the most essential area to review. When using your insurance, it will be critical that you know the provider is in the specific network (for instance, don’t simply ask if the provider takes Aetna or Blue Cross). You’ll also need to double check that nothing’s changed from one visit to the next.

Potential Penalty Alert A provision in the ACA prohibits employers from paying for employee health insurance that’s not group insurance. Under this rule, the IRS may fine non-complying employers $100 a day per employee, up to a maximum of $500,000. The fine appears to apply even to businesses with less than 50 employees—the same businesses that are exempt from ACA’s health care mandates.

This is something that you need to be aware of, however, a bipartisan group of lawmakers in Congress announced plans to undo the rule via legislation. The proposed bill would remove the fine for businesses with fewer than 50 employees. The Obama administration has so far signaled openness to the proposed change.

What Does this Mean for My Premium?

The 2016 filed rate increases for all companies selling policies in Texas range from 10-99%! These rates still have to be reviewed and approved, but don’t expect them to be significantly less. Additionally, the plan rates are based on your actual age; so your premium can be higher just because you’re a year older—even if there was no rate increase.

What are Some Options?

Higher-Deductible Plan or HSA

First, think about how you actually use your healthcare. Here are some situations where having a lower deductible, office copay and RX copay plan would likely be worth the extra cost: • You and your family see your physicians more than 3 times a year.

• You have a child or spouse that’s accident prone.

• You need high-cost meds on a monthly basis.

However, if you and your family don’t visit the physician often, you probably don’t need the lower deductible, office copay and RX copay plan. A higher deductible plan or HSA will help on your premium.

If you have a family member or members that frequently use health care, but you don’t, you might want to get a lower-deductible plan for them, and a higher-deductible plan for yourself.

860 Texas Dental Journal l www.tda.org l October 2015

Consider the Out-of-Pocket Maximum

The ACA plans are comprehensive because of the mandates, and all have the same benefits and coverage. The most important thing you need to look at when determining what plan you’ll select is: what your total out-ofpocket maximum is—both in and out of network. This number is the total of your deductible, coinsurance and copayments on a calendar-year basis before the insurance will pay covered charges at 100%; ie this is your risk exposure—what you’re responsible for before insurance covers the rest.

For 2016, the maximum out-ofpocket for an individual is $6,550 and $13,100 for a family. This is for in-network expenses; double that or more for out-of-network expenses.

Also depending on your plan, your out-of-pocket expense could be less.

When comparing individual plans between companies, certainly look at the premium, but make sure you also look at your out-of-pocket cost—not just the deductible. For example, the out-of-pocket maximum for the following are the same. But plan “A” may cost 15% less.

A) $3,000-deductible plan with 100% coinsurance B) $1,000-deductible plan with 80% coinsurance of the next $10,000 When comparing networks make sure you’re looking at PPO to PPO—not PPO to EPO or HMO. Make sure you understand what your out-of-network coverage is and how it works.

If you haven’t looked at HSA plans or didn’t think they made sense previously, you should revisit them.

They offer the lowest premium; and with the tax deductibility of the contribution (as much as $7,650 for a family), they can be a great way to build up a self-funding account for future medical expenses. The earnings

and interest accumulate tax free, you own and control the funds, and they’re not a use-it-or-lose-it vehicle.

Small Group Coverage

Small-group coverage might be less expensive than the individual market in 2016, especially if paid by the practice.

Providing small-employer health insurance can be a good way to retain and attract high-quality employees while offering a lot of flexibility on plan designs. For instance, you can offer more than one plan with your group and pay for a base plan that’s less expensive for employees (perhaps an HMO); and have a different plan for you and your family. Additionally, the plan can include life insurance and short-term disability coverage.

JKJ Pathology Oral Pathology Laboratory

The changes and other developments are not particularly promising, and not a lot can be done until we know what the new rates and plans will be. The best course of action to take is to stay informed, be ready to review and compare your coverage and options, and remember we’re all in the same boat; hopefully it’s not the Titanic!

• Available for consultation by phone or

Disclaimer: This article was submitted in July, so a few changes will have happened by the time it’s published.

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If you’d like more information or to discuss insurance options, please contact TDA Financial Services Insurance Program at 800-677-8644 or visit tdamemberinsure.com.

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Protecting your patients, limiting your liability

Texas Dental Journal l www.tda.org l October 2015 861

PREVIEW Selecting an Implant Platform in a Difficult Economy Robert Margeas, DDS

Introduction ©iStock.com/mitya73

Dental implants have emerged as a preferred solution to replace missing or damaged teeth, as they allow restorations with optimal functional and esthetic results without damaging surrounding healthy teeth or tissues. With an increasing number of dental implant systems on the

Dr Robert Margeas’ Class Schedule at the Texas Meeting: Friday, May 6, 2016 8:30-11:30 AM Everyday Dentistry…More Than Everyday Esthetic Results — Lecture Friday, May 6, 2016 1:30-4:30 PM From Single Tooth to Full Mouth Reconstruction Using Implants — Lecture Margeas

Saturday, May 7, 2016 8:30-11:30 AM Immediate Provisionalization of Anterior Implant — Workshop

Dr Margeas received his DDS from the University of Iowa, College of Dentistry in 1986 and completed an AEGD residency in 1987.

He is currently an adjunct professor in the Department of Operative Dentistry at the University of Iowa. Dr Margeas is board certified by the American Board of Operative Dentistry and is a Fellow of the Academy of General Dentistry. He lectures on esthetic dentistry and has published numerous articles on the subject. Dr. Margeas maintains a private practice with a focus on comprehensive esthetic restorative dentistry in Des Moines, Iowa. Restoring implants since 1988.

862 Texas Dental Journal l www.tda.org l October 2015

Keeping all of these factors in mind will help general dentists cut through the “clutter” of implant providers, and select the best partner from a clinical and operational efficiency perspective.

market and the growing pressures of today’s economic climate, it can be tempting for a dentist to choose a less expensive implant platform to reduce costs for his office and patients.

However, not all dental implant platforms are created equal—implant quality has a direct impact on patient satisfaction, and can eventually factor into the cost of running a practice.

So, why choose a “premium” implant provider in a recession?

Several factors beyond cost must be considered when choosing an implant platform to help satisfy increasing patient expectations.

Have you selected a platform that is easy and efficient to use? Are you working with an established company that offers local representation, technical support, and a warranty on its products? Does the company continually invest in research and development, ensuring that you can count on safe products that incorporate the latest technological advances? Is there a body of peerreviewed clinical data validating the products and technologies?

Keeping all of these factors in mind will help general dentists cut through the “clutter” of implant providers, and select the best partner from a clinical and operational efficiency perspective.

©iStock.com/alphaspirit

Keeping up with the Competition In order to compete in today’s dental market, it is important for general dentists to collaborate with local specialists to incorporate dental implant restorations into their practices. Dentists who are committed to improving their knowledge and skills when it comes to restorative treatment options will not only be able to reap the resulting financial benefits to their practice, but also remain on the cutting edge of technology, ensuring superior patient outcomes and satisfaction.

Currently about 100,000 dental implant procedures are performed each year, and that represents just a small portion of the potential number of patients who could benefit from dental implants. As dental implants continue to become safe and efficient procedures to perform, dentists who keep an inventory in their office can turn an implant restoration around very quickly, enabling the patient to walk out with a smile and increase office profitability.

When it comes to the benefits of dental implants, the patient always comes first.

For patients, dental implants represent a treatment solution that is closest to having their natural teeth and allows them to enjoy a higher quality of life. And for the dentist, patient satisfaction is always a win, resulting in increased referrals and a healthier business.

Today’s Economy and the Restorative Dentist Despite the clinical reasons for incorporating implants into a practice, the recession’s impact on dentistry cannot be ignored. An American Heart Association survey found that 57 percent of people say the economy has affected their ability to take care of their health and 22 percent have skipped a routine dental care appointment. Presumably, the number of patients opting out of what could be considered elective procedures is even higher. Of the 151 million Texas Dental Journal l www.tda.org l October 2015 863

PREVIEW people affected by tooth loss, about 7.5 million individuals are medically appropriate to receive implants, yet only 12 percent of that group actually receives treatment with implants, despite their proven long-term superiority over other solutions.

Every dentist must be conscious of our patient’s financial situation, but we should also be mindful of the long-term ramifications that can result from choosing a lower quality and perhaps less expensive solution—be it foregoing dental implants as an option altogether, or choosing a less expensive dental implant provider. While implants may initially be more expensive than alternative treatments, with today’s advancements it is often the superior solution for better long-term satisfaction, and results in fewer follow-up appointments and procedures. Dentists should be encouraged to not assume that a patient or their insurance won’t pay for the more expensive implant.

At a minimum, implants should be discussed as an option with the patient when appropriate.

Choosing an Implant Partner The same theory holds true when choosing an implant platform. A myriad of providers are making the most of today’s economy by promising lower-cost alternatives to name-brand implants. However, this is another case where the less expensive option may not be in the best interest of the patient over the long term. When faced with selecting a dental implant

platform, general dentists should consider several criteria in order to make an informed decision.

One of the primary factors in choosing a platform should be ease of use of the system. Dentists and their staff must be able to quickly and easily become comfortable using the platform, streamlining introduction into the practice. It is important that the system of choice does not come with many tools but instead supports the simplicity and success of implant restoration. For example, some systems offer a single surgical kit, as compared to platforms that have multiple surgical kits for each type of implant offered. This enables the dentist to be trained on one kit, to quickly and easily fit many different restorations. Additionally, having options for both bone-level and tissue-level implantation saves time and increases productivity in more simple cases. An easy-touse system helps reduce the need for complications that can lead to additional follow-up procedures and office visits which frustrate the patient and practitioner alike.

Identifying an ideal partner company should also be a factor in selecting a dental implant platform. What makes a good dental implant partner? It is crucial that the vendor is an established company with a demonstrated track record that will be around for years to come. The best vendors offer a warranty on their dental implants, adequate training to support its products, and local technical support when needed.

Dentists should be aware that a vendor’s warranty can be voided if

864 Texas Dental Journal l www.tda.org l October 2015

generic or mismatched components are placed on a premium implant because of the very real risk of failure when implant components are used on platforms for which they weren’t designed. While the up-front savings may be attractive, the cost to a practice in terms of replacement, lost time and dissatisfied patients will be far greater than a $40 or $50 discount over the long term.

Having a designated local company representative often proves invaluable for dentists, especially those new to restoring implants. They may find themselves in a situation where one-on-one training is necessary, or personal support during a particularly difficult case is needed. A wellestablished company can provide such support, while dentists working with smaller vendors need to rely heavily on written materials to successfully restore implants, often compromising patient outcomes.

In summary, while dentists take cost into consideration when choosing a dental implant partner, it is something that they will need to look past in order to ensure a long-term and positive relationship that is not only beneficial to their patients but also to their practice. Though it seems counterintuitive, choosing a premium provider in a tough economy may work in the dentist’s favor. Having worked with a large and well-regarded dental implant partner for many years now, I see the benefits that come with this type of partner and recommend making the investment in your practice and your patients.

CALENDAR OF EVENTS OCTOBER2015

JANUARY2016

30–31 The TDA Smiles Foundation will hold a 40-chair,

21–23 Greater Houston Dental Society will host its

2-day Texas Mission of Mercy in Abilene, TX. For more information, please contact Missions Coordinator Sara Harney at TDASF, 1946 S IH 35 Ste 300, Austin, TX 78704; Phone: 512-448-2441; Email: sara@tda.org.

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; Email: cbolls@ghds.org; Web: starofthesouth.org

NOVEMBER2015 5–10

The American Dental Association will host its 156th Annual Session in Washington D.C. For more information, please contact ADA Conference and Meetings Services, ADA, 211 East Chicago Ave, Chicago, IL 60611-2678. Email: annualmeeting@ ada.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 October 2015 865

Oral and Maxillofacial Pathology Diagnosis and Management

Plasminogen Deficiency (Ligneous Periodontitis) Oral and Maxillofacial Pathology Case of the Month (from page 800)

Discussion

function, proliferation, adhesion and migration. Fibrinolysis also produces fibrin degradation products that are biologically active. Therefore, in patients with plasminogen deficiency, wound-healing is greatly disrupted, halting at the granulation tissue stage with the accumulation of excess fibrin deposits.

Inherited plasminogen deficiency (PD) is a rare genetic disorder that leads to the development of fibrin pseudomembranes on mucosal surfaces with associated inflammation, tissue destruction and delayed healing (1-14). PD occurs in approximately 0.3% in the population.

(2) Plasminogen is the precursor to plasmin, a serine protease enzyme involved in hemostasis. It is produced in the liver and is present in the circulating blood. Plasminogen may also be found in interstitial fluid and extracellular matrix. It is converted into plasmin by plasminogen activators that are released from vascular endothelium and a variety of other cell types. Activated plasmin degrades blood clots by fibrinolysis, thus re-establishing and maintaining vascular patency. Plasmin activity and fibrinolysis are inhibited by plasminogen activator inhibitor-1, alpha-2-antiplasmin, antithrombin, and thrombin activatable fibrinolysis inhibitor.

PD is caused by autosomal recessive mutations involving the gene for plasminogen, which is located on chromosome 6. Most cases are sporadic, but familial cases have been reported. The mutations result in decreased plasminogen production (Type I plasminogen deficiency/ hypoplasminogenemia). With some mutations there is production of a dysfunctional plasminogen molecule (Type II plasminogen deficiency/ dysplasminogenemia). However, these patients rarely develop pseudomembranous lesions.

Acquired plasminogen deficiency can be seen with liver disease, secondary to medications and following plasmapheresis.

Plasmin also plays a role in woundhealing by degrading fibrin and matrix glycoproteins present in damaged tissue. It also activates other enzymes such as metalloproteinases and transforming growth factorbeta that are also involved in soft tissue remodeling. Activating plasmin bound to its receptor on cell surfaces can influence cell

Lesions associated with PD develop most often at mucosal sites that are associated with persistent minor trauma, infection and/or inflammation. The conjunctiva (ligneous conjunctivitis—80%) and oral mucosal/gingiva (34%) represent the most commonly involved anatomic sites. The sinonasal tract, pharynx, larynx, tracheobronchial

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tree, middle ear, genitourinary tract, skin, lymph nodes, and central nervous system may also be involved.

Airway obstruction can occur with formation of fibrin casts. Reduced or absent plasminogen would, logically, lead to accumulation of fibrin.

This occurs at the sites of injury or inflammation as described above.

One would also expect an increased risk for venous or arterial thrombosis.

Interestingly, for reasons that are not yet understood, patients with Type I plasminogen deficiency rarely have complications related to intravascular thrombosis. The onset of symptoms is usually in childhood but may develop at any age. There is a female gender preponderance ranging from 1.3:1 to 2:1 (2). Oral lesions associated with PD most often involve the gingiva with the development of erosive/ ulcerative erythematous hyperplastic plaques and nodules exhibiting thick yellow-tan creamy to firm (ligneous = wood-like) surface deposits of fibrin. The lesions may superficially involve the gingiva (ligneous gingivitis), but may show progressive periodontal attachment loss and bone destruction (ligneous periodontitis or destructive membranous periodontal disease). The gingival lesions may be localized, multifocal or diffuse. The clinical presentation can be similar to other oral immune mediated vesiculoulcerative diseases such as erosive lichen planus, mucosal pemphigoid, pemphigus vulgaris, lupus erythematosus, contact

hypersensitivity, drug reaction, sarcoidosis, and granulomatosis with polyangiitis (Wegener’s). However, unlike many of the above conditions, most patients with ligneous gingivitis/ periodontitis do not have significant discomfort associated with their lesions. The lesions have a tendency to wax and wane in severity over time and there can be significant variation in disease severity from patient to patient. Progressive periodontal destruction and bone loss may develop and eventually require tooth extraction.

Biopsies of involved tissue often show inflamed mucosa with erosion, ulceration, granulation tissue and thick fibrinous pseudomembranes.

Pink hyaline deposits of fibrin also develop within the connective tissue and histologically can resemble amyloid or other proteinaceous material. The fibrin should stain positively with a Fraser-Lendrum PTAH stain and negative with a Congo red stain for amyloid. The histologic features may appear nonspecific and the diagnosis could be easily missed without the appropriate clinical context. Direct immunofluorescence will show staining for fibrinogen and may also be positive for immunoglobulins entrapped within the fibrin deposits.

The management of PD can be problematic. A number of different treatment strategies have been tried and have produced variable results.

Systemic and topical preparations of plasminogen concentrate have been utilized with success but unfortunately, are not currently widely available. Trauma to the affected tissues should be minimized.

Surgery can be used to reduce larger lesions, but is frequently followed by regrowth of the fibrin membranes.

For ligneous gingivitis/periodontitis, conservative periodontal therapy, meticulous plaque control, use of

a soft toothbrush, gentle brushing technique, and topical chlorhexidine will help reduce local gingival inflammation. Medical therapies including topical heparin, topical and systemic steroids, systemic doxycycline, and systemic warfarin have been utilized. The use of other medications such as azathioprine, cyclosporine, alpha-chymotrypsin, hyaluronidase and oral contraceptives has also been reported. Lesions related to PD can regress spontaneously. However, for gingival lesions, this usually occurs only after extraction of the involved teeth. In the future, plasminogen replacement therapy and gene therapy may become available.

4.

5.

6.

7.

8.

The prognosis for PD is generally good, with most patients having a normal life span. However, significant morbidity including blindness, deafness, tooth loss, infertility in women, respiratory failure, obstructive hydrocephalus and Dandy-Walker malformation of the central nervous system can occur.

Unfortunately, some patients may die secondary to the pulmonary and central nervous system complications of this serious systemic disease.

It is important that dentists be aware of this rare condition and consider plasminogen deficiency/ ligneous gingivitis/periodontitis in the differential diagnosis of erosive/ ulcerative conditions of the oral cavity.

References 1.

2.

3.

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10.

11.

12.

13.

Neville BW, Damm DD, Allen CM, Chi AC. Oral and Maxillofacial Pathology, 4rd Ed. Saunders/Elsevier, St. Louis, 2016: 536-537.

Destructive membranous periodontal disease (ligneous gingivitis): a literature review. Sivolella S; De Biagi M; Sartori MT; Berengo M; Bressan E. Journal of Periodontology. 83(4):465-76, 2012 Apr. Extensive fibrin accumulation and accompanying epithelial changes in the pathogenesis of ligneous mucosal disease (ligneous periodontitis). Gunhan O; Avci A; Dereci O; Akgun S; Celasun B.

14.

American Journal of Dermatopathology.

34(1):35-40, 2012 Feb. Successful treatment of ligneous gingivitis with warfarin. Fine G; Bauer K; Al-Mohaya M; Woo SB.Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 107(1):77-80, 2009.

Plasminogen deficiency as a rare cause of conjunctivitis and lymphadenopathy.

Yohe SL; Reyes M; Johnson DA; Fry CL; Scribbick FW; Kinney MC. American Journal of Surgical Pathology. 33(2):3139, 2009 Feb. Plasminogen deficiency. Mehta R; Shapiro AD. Haemophilia. 14(6):1261-8, 2008 Nov. Hypoplasminogenaemia, gingival swelling and ulceration. Scully C; Gokbuget A; Kurtulus I. Oral Diseases.

13(6):515-8, 2007 Nov. A ligneous periodontitis and conjunctival lesions in a patient with plasminogen deficiency. Toker H; Toker MI; Goze F; Turgut M; Yilmaz A. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics.

103(6):e35-8, 2007 Jun. Hypoplasminogenemia with ligneous periodontitis: a failed local therapeutic approach. Kurtulus I; Gokbuget A; Efeoglu A; Cintan S; Tefs K; Schuster V; Scully C. Journal of Periodontology.

78(6):1164-75, 2007 Jun. Clinical manifestations due to severe plasminogen deficiency: a case report.

Silva GB; Bariani C; Mendonca EF; Batista AC. Journal of Dentistry for Children (Chicago, Ill.). 73(3):179-82, 2006 Sep-Dec. Destructive membranous periodontal disease (ligneous periodontitis): a case report and 3 years follow-up. Baykul T; Bozkurt Y. British Dental Journal.

197(8):467-8, 2004 Oct 23.

Recurrent recalcitrant gingival hyperplasia and plasminogen deficiency: a case report. Suresh L; Aguirre A; Kumar V; Solomon LW; Sielski EA; Neiders ME. Journal of Periodontology. 74(10):1508-13, 2003 Oct. Otolaryngological manifestations of ligneous conjunctivitis. Chai F; Coates H. International Journal of Pediatric Otorhinolaryngology. 67(2):189-94, 2003 Feb. Oral lesions indicative of plasminogen deficiency (hypoplasminogenemia).

Scully C; Gokbuget AY; Allen C; Bagan JV; Efeoglu A; Erseven G; Flaitz C; Cintan S; Hodgson T; Porter SR; Speight P. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics.

91(3):334-7, 2001 Mar.

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ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS AREA: 2 general dentistry practices available (1 practice in Dallas and 1 practice in Richardson); NORTH TEXAS: 1 general dentistry practice available. HOUSTON AREA: 2 general dentistry practice available (1 northeast of Houston and 1 southeast of Houston and 1 in Pearland); CORPUS CHRISTI AREA: 2 general dentistry practices available. EAST TEXAS AREA: 1 general dentistry practice available. WEST TEXAS AREA: 1 general practice available. BRYAN/COLLEGE STATION AREA: 1 general dentistry practice available; SAN ANTONIO AREA: 1 general practice available; SOUTH TEXAS: 1 general dentistry practice available; SANTA FE, NEW MEXICO 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: Practice for sale. Dentist wants to slow down and work a day or 2 days a week if purchaser desires for him to do so. Excellent operating profits.

ADVERTISING BRIEF INFORMATION SUBMISSION AND CANCELLATION DEADLINE: 20th, 2 months prior to publication (eg, November 20th for January issue).

MONTHLY RATES: First 30 words = $60 for ADA members; each additional word = $0.10.

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. Advertisements must be not quote revenues or gross or net incomes; only generic language referencing income will be accepted.

Hygiene scheduling is good. Call Gary Clinton 972317-9756.

AMARILLO: We are looking for a motivated, eager dental associate who can learn from experienced and innovative doctors and together grow personally and professionally. We will offer a sign on incentive to help pay for moving expenses! We offer medical/vision, malpractice during the term, and 1k in CE/year, and a generous compensation average salary for a new associate can be well in the 6 figures! If you’re interested in paying off school loans, let Smile Workshop customize a partnership to help pay off debt, contact us at 214-757-4500.

ARGYLE: Dental practices for sale in Dallas, Richardson. Austin, Houston, San Antonio, Waco, Corpus Christi, College Station, East and West Texas.

For more information, call 888-429-5531 or visit ADSTexas.com.

AUSTIN (MOPAC AREA): DDR Dental general practice, excellent reputation updated equipment and facility. Six-figure gross collections and 6-figure net income. Six operatories and 2 more plumbed, digital X-ray and paperless charts, 2,600 sq ft in retail center. Contact Chrissy Dunn at 800-930-8017 or Chrissy @DDRDental.com.

AUSTIN, SAN ANTONIO & CORPUS CHRISTI AREA PRACTICE OPPORTUNITIES MCLERRAN & ASSOCIATES: AUSTIN (ID #T258): This is a rare opportunity to purchase an established orthodontic practice. Excellent location in a free-standing building situated directly on a busy thoroughfare.

The office space encompasses 2,400 sq ft and has 6 treatment chairs. The seller is available for a

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ADVERTISING BRIEFS transition. You can purchase this practice for less than it would cost to start a practice from scratch!

AUSTIN (ID #T260): This established oral surgery practice is located in the Austin area and features a large referral base and annual revenue of over 7 figures. The seller is available for a transition. Please request information for more details! AUSTIN (ID # T271): If you are a specialist who is thinking about starting a practice or opening a satellite office in the Austin area, this opportunity is a must see! This turn-key dental office is located in a highly desirable area of Austin known as Westlake Hills. The facility is located in a high-end, professional condominium complex and features 3 fully equipped operatories with 2 additional operatories available for expansion, high end finishes, computers throughout the office, and digital radiography. This is an excellent opportunity for a specialist to start a practice or establish a satellite office for a fraction of the cost of doing a scratch start-up. AUSTIN (ID #T272): This general family practice is located in an affluent and desirable area of Austin. The practice serves a predominately fee-for-service/PPO, middle class patient base and has solid upside potential as the practice currently refers out a good amount of specialty procedures and does limited marketing.

This is an excellent opportunity to acquire an existing, cash flowing practice with an established patient base, and a quality build-out and equipment for less than the cost of a comparable start-up. This would be an ideal satellite or stand-alone practice.

AUSTIN (ID #T278): This is a unique opportunity to purchase a practice located in a busy retail center in Austin. The practice is ideal for a doctor or company looking for a large facility to establish a multiple doctor and hygienist office for less than the cost of building out a shell space and equipping a startup.

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The practice has a total of 18 plumbed operatories with 6 operatories currently equipped. Serious inquiries only as this is a unique opportunity; not suited for most solo practitioners looking to acquire a practice. HILL COUNTRY WEST OF AUSTIN (ID #T236): This predominately fee-for-service general family practice is located in a desirable community in the heart of the Texas hill country. It boasts a great reputation and has been in its current location since 1980. The office has 3 fully equipped operatories, with the ability to add an additional operatory. There is a strong opportunity for growth, as the owner is not actively marketing the practice, does not participate in any PPOs and is referring out a fair amount of specialty procedures. The practice has a strong foundation of active patients with a good amount of upside potential. This is an excellent opportunity for someone who enjoys the beautiful hill county and wants to get away from the big city. NEW BRAUNFELS (ID #T279): This is an opportunity to start a dental practice, for less than 50% of the normal cost, in a highly visible location.

Located within a busy HEB shopping center in the rapidly growing town of New Braunfels. The facility has an attractive build-out with 4 fully equipped operatories, consultation room, private office, sterilization area, and lab. The office space housed a successful dental practice for years until the seller recently merged her two offices into a single location over 15 miles from her New Braunfels office (providing the new owner with the opportunity to potentially retain a substantial amount of the sellerís patients). If you are looking to start a practice in the New Braunfels area, this opportunity is a must see! HILL COUNTRY NORTH OF SAN ANTONIO (ID #T277): This established pediatric dental practice is located in a highly

ADVERTISING BRIEFS desirable hill country town located just 30 minutes north of San Antonio. The practice features a large patient base that is primarily PPO and Medicaid, consistent annual revenue, exceptional cash flow, and solid new patient flow. The office is located in a beautiful, free-standing building encompassing 5,400 sq ft with 8 fully-equipped operatories and room to expand. This opportunity won’t last long!

HILL COUNTRY NORTH OF SAN ANTONIO (ID #T263): This established general dentistry practice is located in a beautiful hill country town approximately an hour northwest of San Antonio. It is located in an attractive free-standing office building on a busy thoroughfare. This practice has three fully equipped operatories, a predominately

fee-for-service patient base, very strong hygiene recall, and has seen consistent revenue of approx. mid-6 figures per year for the last 3 years. The practice is only in network with one insurance plan, the owner does not externally market the practice, and a good amount of specialty work is being referred out. Therefore, this practice has a lot of upside potential and a new owner has plenty of areas to grow the practice. Both the practice and real estate are being offered for sale. SAN ANTONIO (ID #T239): A thriving multi-office pediatrics practice in the San Antonio area is seeking a full time associate to work between both locations.

Both facilities are state-of-the-art, featuring 12 treatment areas and the latest amenities, including

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ADVERTISING BRIEFS a movie theater, arcade, ceiling mounted televisions, and toddler play areas. Both offices are designed for high volume patient flow, as they see an average of over 100 patients each day. The patient base reflects the local blue-collar and educational communities. There is a mix of insurance, self-pay and state funded patients. The offices provide a full range of pediatric dental services and have very active sedation general anesthesia schedules. The associate doctor must be a graduate of a US dental school and hold a US pediatric dental training certificate. Spanish speaking is highly desired but not required. To learn more about this associate opportunity, please contact us at 512-900-7989 or texas@dental-sales. com. Please also send a current CV. SAN ANTONIO (ID #T244): This established, general family practice is located in a newly built-out facility located in a vibrant, high traffic retail location in a desirable area of San Antonio. The practice caters to a middle to upper middle income, fee-for-service/PPO patient base and boasts a strong new monthly patient count as a result of strong patient referrals, online marketing, and a highly visible location. This truly is a one of a kind location in a great area of San Antonio. SAN ANTONIO (ID #T276): This general family practice is located in a professional/medical office building off of a high-traffic major thoroughfare on San Antonio’s north central side of town. The practice has 4 fully equipped operatories with room to expand and boasts a middle income, fee-for-service/PPO patient base, strong net cash flow and a turn-key facility. There is solid upside potential, as the owner is currently working only 3 days per week. The owner has recently made significant upgrades to the facility and equipment/ technology including new floors, digital X-ray, digital panorex, and computers in all of the operatories.

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This is an excellent opportunity to acquire a turnkey practice with solid cash flow, a newly remodeled office, and current technology for less than a comparable start up. WEST OF SAN ANTONIO (ID #T262): This established, general dentistry practice is located in a quaint town near San Antonio and features a large fee-for-service/PPO patient base, solid hygiene production, 4 fully equipped operatories, digital X-ray sensors, computers throughout, and paperless patient records. This practice has tremendous upside potential, as there is limited competition in the local area and the seller currently does no external marketing. SOUTH OF SAN ANTONIO (ID #T235): This established general dentistry practice is located on a main thoroughfare in a quaint, rural town located approximately 90 miles southeast of San Antonio. This practice is in a high growth, low competition area in the Eagle Ford Formation. The practice has realized consistent annual revenue of 6 figures the past 2 years while maintaining low overhead, strong profitability of 50%, and solid new patient flow (currently averaging 27 new patients per month). The office space of the practice encompasses 1,200 sq ft and has 3 fully equipped operatories with digital X-ray units and computers (one additional plumbed operatory for expansion).

The building is also being offered for sale. SOUTH OF SAN ANTONIO (ID #T267): This is an opportunity to purchase a 50% ownership interest in an established, fee-for-service practice located in a growing community just 35 miles south of San Antonio. The practice has very strong cash flow and a beautiful, state-of-the-art facility with 10 fully equipped operatories. CORPUS CHRISTI AREA (ID #T269): This established, general dentistry practice is situated on a busy street in northwest Corpus Christi and features 5 fully equipped operatories, a

ADVERTISING BRIEFS large fee-for-service patient base, consistent annual revenue of mid-6 figures, solid net cash flow, and strong hygiene production. The practice has tremendous upside potential through increasing doctor days, enhancing marketing efforts, and retaining services that are currently being referred to specialists. The owner and staff are available for a transition. Contact McLerran & Associates: David McLerran, Brannon Moncrief or Kristyn Wilkerson in Austin 512-900-7989 or San Antonio 210-737-0100.

Practice appraisals, practice sales, transition consulting, partnership structuring, and lease negotiations. To request more information on our listings, please register at www.dental-sales.com or contact us via email at Texas@dental-sales.com AUSTIN/SAN ANTONIO: Oral surgery practice for sale in outlying community. Great place to raise a family. Very successful well-established practice.

High net on 4 days. Outright sale or transition (optional). Basic routine treatment. All staff are R.N.’s. Expandable to extensive oral surgery care.

Possible associateship with complete buy-out at any time; no partnership as doctor is close to retirement age. This is a golden opportunity. Whether a buyer or a seller, trust your life’s work to the most experienced senior appraiser/broker. For over 42 years, you have seen the name, Gary Clinton.

Buyers, avoid over-payment for a practice and sellers, avoid selling below market value with a socalled “free appraisal.” Knowledgeable buyers are willing to pay the fair market value. My extensive certified appraisals use market comparables from practices sold and located all over Texas.

Professional Certified Practice Appraisers, LLC. IBA/ NAVCA. Call Gary Clinton confidentially 972-3179756.

AUSTIN (ROUND ROCK, TX): General dentist position PT-FT to work 3-4 days per week. Our office is centered around patient wellness and team work.

The clinic has a beautiful modern décor, digital imaging and tranquil happy feel. Dentist must have great bedside manners and experience. Please contact, austindentalopportunity@gmail.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 state-of-the art technology and a highly trained support staff. We are looking for the right fit for our practice. Ideally, someone who is looking for a long-term opportunity. New grads are welcome to apply. Please email resume to tal@ austinchildrensdentistry.com.

AUSTIN: My Kid’s Dentist has an excellent opportunity for a pediatric dentist to work 10 days a month in our Austin offices. Contact Ed at 949842-7936 or email CV to looname@pacden.com for more information.

AUSTIN: Orthodontist needed for new startup venture. Start at half-day bi-weekly and then going to one day per week. Please call Dr Gershonowicz at 248-425-8444.

AUSTIN: Pediatric dentist. Progressive pediatric dental practice in Austin is looking for an energetic pediatric dentist to join our team. We offer a comprehensive compensation package. New grads welcome to apply. Please email CV to dentalresume27@yahoo.com.

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ADVERTISING BRIEFS BAY CITY (WHARTON AREA): DDR Dental general practice, country lifestyle but a quick drive to Houston. A fee-for-service practice providing comprehensive traditional restorative dentistry.

Three fully-equipped operatories. A 6 figure gross a year working 3 days a week. Lots of growth potential. Contact Chrissy Dunn at 800-930-8017 or visit www.DDRDental.com.

BIG SPRING: Dr David L. Ward is currently seeking an associate to join our growing, unique, state-ofthe-art general dental practice of over 30 years.

We are a comprehensive, fee-for-service, patientcentered, general practice that offers excellence in restorative, cosmetic and implant dentistry, as well as orthodontics. Technology includes PlanScan I-CAT and PerioLase. This is an exceptional opportunity to learn and expand oneself and receive a competitive compensation package. Personality traits desired in applicant are: ethical, ambitious, friendly, and teamoriented. Although experience is preferred, it is not required. Big Spring is a scenic, friendly, small city at the crossroads of west Texas between Midland, Abilene, Lubbock and San Angelo. Please contact us at, dlw@davidwarddds.com or 432-267-1677.

BROWNSVILLE: Pediatric and general dentists, south Texas-area Rodeo Dental is expanding!

A dynamic, high-energy, multi-specialty group practice, Rodeo is 100% dentist-owned and operated. Aggressive compensation packages are tailored to individual situations with an emphasis on promoting financial and professional growth. For more info, visit our website at www. rodeodentaltexas.com To speak directly to the owner call 214-600-5898 or email your CV to doctorcareers@rodeodental.com.

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BRYAN/COLLEGE STATION: Relationship based practice in Bryan/College Station area seeks part time associate. Experience in occlusion and prosthodontics is desired. Email resume to dentalpath2013@gmail.com.

CENTRAL TEXAS (WEST): Orthodontic practice for sale. Excellent location. Well-established successful practice. High visibility; gorgeous building to lease or purchase. Mid-size community; airport not far away. Retiring orthodontist is willing to transition PRN. Very nice office. Whether a buyer or a seller, trust your life’s work to the most experienced senior appraiser/broker. For over 42 years, you have seen the name, Gary Clinton. Buyers, avoid over-payment for a practice and sellers, avoid selling below market value with a so-called “free appraisal.” Knowledgeable buyers are willing to pay the fair market value. My extensive certified appraisals use market comparables from practices sold and located all over Texas. Professional Certified Practice Appraisers, LLC. IBA/ NAVCA. Call Gary Clinton confidentially 972-317-9756.

CENTRAL TEXAS: I35 corridor. Restorative feefor-service general dentistry practice available for qualified purchase candidate. 6 operatories equipped. Long term staff. Seller is seeking a clinically and financially qualified dentist who desires a single location traditional private practice.

Seller will gladly provide a long term phase out transition for the right successor. Please send inquiry and CV to info@lewishealth.com or call 972437-1180.

CORPUS CHRISTI: DDR Dental general practice, feefor-service practice with 6 figure gross collections

ADVERTISING BRIEFS and 6 figure net income. Well established with 3 operatories and a great patient base. Fully equipped with great growth potential. Contact Chrissy Dunn at 800-930-8017 or visit www.

DDRDental.com.

CORPUS CHRISTI: Pediatric dentist needed for multi-discipline group practice. Nice environment, minimal responsibilities, high earning potential.

Contact Dr Paul Kennedy 361-992-9500 office, or 361-960-6484 cell, or email pakjr68@gmail.com DALLAS: Oral surgery practice in well established 4 operatory practice in healthcare professional building available for purchase. Transition to be provided based on needs on successor. One surgical suite. Kodak digital. Mixed FFS and PPO. Implant and oral surgey blend. Contact Lewis Health Profession for more information. Info@lewishealth. com or 972-437-1180.

EAST TEXAS: Would you like to practice dentistry without the headaches of management or overhead fees? Maybe you just want to practice the way your grandfather used to practice in a more laid back and family-type atmosphere. Well you have found it. Thriving general dental practice in a beautiful east Texas country setting seeking motivated associate dentist. Eight operatories with 7 figure production and extremely high profit margin. Digital charting and radiology. Office expanding into surrounding east Texas towns. This is not a corporate business. Our flagship office is located in Center, Texas, and is privately owned by a local general dentist who has had a dental presence here for almost 30 years. We attend local athletic events, civic functions, and family gatherings, and are a part of our patient’s everyday lives. If you want to earn a very lucrative income and be a part of this relaxed family atmosphere, call Stephanie or Taylor at (936) 427-9070, or email centersmiles@ centersmiles.com.

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 email to jennifer@smileworkshop. com or call our office at 214-757-4500.

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 email at falcondentistry@gmail.com.

EAST TEXAS: Opportunity for endodontist 2 days/ week. Previous endodontist moved after 14 years.

Would share space with periodontist and would be the only endodontist in this part of east Texas. Call 713-376-9525.

EL PASO: Great dentist to work with kids. Good opportunity for someone who likes children. Busy practice. Great personality. Competent dentist not afraid to work. Great pay. Sedation taught. Send resume ASAP to Carol Erickson, info@txkidsdental. com, 9411 Alameda Avenue Ste P, El Paso, TX 79907. 602-309-2180 Texas Dental Journal l www.tda.org l August 2015

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ADVERTISING BRIEFS FORT WORTH: Practice for sale in the fast growing Southwest area. Average gross; 6 operatories; Excellent lease. Seller is relocating. Need to move quickly on this one. DFW 214-503-9696. WATS 800583-7765.

FORT WORTH: Practice for sale. Doctor is retiring; high growth potential; excellent opportunity; dental office facility available for purchase. Whether a buyer or a seller, trust your life’s work to the most experienced senior appraiser/broker. For over 42 years, you have seen the name, Gary Clinton.

Buyers, avoid over-payment for a practice and sellers, avoid selling below market value with a socalled “free appraisal.” Knowledgeable buyers are willing to pay the fair market value. My extensive certified appraisals use market comparables from practices sold and located all over Texas.

Professional Certified Practice Appraisers, LLC. IBA/ NAVCA. Call Gary Clinton confidentially 972-3179756.

FRISCO/PLANO: Oral surgery practice for sale.

Very high growth area. State-of-the-art digital well established practice; digital cone beam. Doctor is relocating to be near family. Whether a buyer or a seller, trust your life’s work to the most experienced senior appraiser/broker. For over 42 years, you have seen the name, Gary Clinton. Buyers, avoid over-payment for a practice and sellers, avoid selling below market value with a so-called “free appraisal.” Knowledgeable buyers are willing to pay the fair market value. My extensive certified appraisals use market comparables from practices sold and located all over Texas. Professional Certified Practice Appraisers, LLC. IBA/ NAVCA. Call Gary Clinton confidentially 972-317-9756.

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GARLAND: Equipped dental office for lease.

Downtown Garland, TX. Dental office, 4 ops, chairs, pano, digital scanner, x-ray unit, etc. Available for immediate release. Please call 214-415-9096.

GUN BARREL CITY: East Texas 2-operatory, standalone dental office; 1,200 sq ft remodeled home. All removable prosthetic practice. All fee-forservice. Mid-6 figure income. 12 hours per week schedule. Growth potential for general dentistry and implants. Doctor wants to retire and travel.

Contact 903-432-9414 in the evenings.

HOUSTON: MCLERRAN & ASSOCIATES: HOUSTON (EAST): New—general practice with a productive 100% fee-for-service, state-of-the-art with high 6 figure revenues in highly visible retail location. (#H295) HOUSTON (SOUTHEAST): Excellent opportunity, very nice general practice in highly visible retail center equipped with state-of-the-art dental equipment, digital xrays and computers throughout.

Flexible owner financing is available. (#H304) HOUSTON (GULF FREEWAY): Lucrative opportunity for a general practice. Fee-for-service; 9 operatories, 5 fully equipped for general dentistry and 4 for orthodontic care. Low overhead. (#H272) HOUSTON (SOUTH): Growing general practice with increasing revenues over the past year due to location in expanding petrochemical industry area, 4 equipped operatories, real estate is also available for this listing. (#H296) HOUSTON: Elegant, established and very productive general practice located in prestigious part of Houston. Recently built-out all digital with 7 operatories. (#H284)

ADVERTISING BRIEFS HOUSTON (SOUTHWEST): General practice located on major thoroughfare, 5 of 8 operatories are fully equipped, healthy new patient flow, DMO income plays major factor in the high 6 figure revenue. (#H274) HOUSTON (NORTHWEST): New — established prosthodontic practice seeking experience, qualified associate with possibility of buy-in and future purchase (#H308). Go to www.dental-sales. com for up to date listings. Contact McLerran & Associates in Houston: (866)756-7412 or (281)3621707, houstoneasttx@dental-sales.com.

seeking to share space with a part or full time periodontist, oral surgeon or orthodontist in a state of the art dental office. Four operatories fully equipped with digital X-rays and microscope. For more information, contact 713-932-1913.

HOUSTON AREA PRACTICE: Jeff Jones, DDS, HS Professional Practice Transitions. Excellent opportunity to capitalize on a fully digital high tech practice. Highly visible location with a great lease.

Beautiful finish out includes 5 chairs with room for expansion. Impressive new patient flow with strong hygiene revenue and gross receipts in high 6 figures. Owner willing to stay on as associate needed. To learn more, contact: Jeff Jones, DDS, with HS Professional Practice Transitions 830- 8325522, or dr.jeff.jones@henryschein.com.

HUMBLE: Carus Dental, established in 1983 in Austin, has always been committed to the traditional doctor-patient relationship and to the highest quality in dental care and service. We currently have 55 doctors on staff across our 21 practices in Austin, Houston and central Texas.

We offer dental services in general dentistry, oral surgery, orthodontics, pediatric dentistry, endodontics, and periodontics in some or all of our practices. We are seeking Part-Time Endodontist for our Humble, TX, practice, three days every other week. To learn more about American Dental Partners and Carus Dental please visit us at www.amdpi.com and www.carusdental.com.

If interested, please send CV and cover letter to kateanderson@amdpi.com.

HOUSTON: Practice for sale in Memorial area.

Established 3-operatory fee-for-service practice near the expanding city center. Annual gross in excess of 6-figures, on a 3 and half day week.

Exceptionally low rent and overhead. Dentist/owner leaving to take a teaching position at UT. Will also consider transferring patient records to an existing practice. If interested leave message at jacksbyte@ sbcglobal.net.

HOUSTON: Great opportunity for specialist. An endodontic practice in southwest Houston is

HOUSTON: Space available for pediatric dentist in established orthodontist office. Upscale and growing area of Houston. New construction everywhere. Modern facility w/easy access.

Great start-up or satellite. Send CV and photo to: tomash2o@hotmail.com.

KILLEEN: Endodontist, full time. Carus Dental, established in 1983 in Austin, has always been committed to the traditional doctor-patient relationship and to the highest quality in dental care and service. We currently have approximately 48 doctors on staff across our 21 practices in Austin, Houston and central Texas. We offer Texas Dental Journal l www.tda.org l August 2015

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ADVERTISING BRIEFS dental services in general dentistry, oral surgery, orthodontics, pediatric dentistry, endodontics, periododontics and prosthodontics in some or all of our practices. Carus Dental has been accredited by the Accreditation Association of Ambulatory Health Care since 2000. We offer a competitive salary and excellent benefit package including a 401k, health insurance and a professional work environment.

To learn more about American Dental Partners and Carus Dental please visit us at www.amdpi.com and www.carusdental.com. If interested, please send CV and cover letter to kateanderson@amdpi.com.

MANSFIELD: Award winning pediatric dental office is searching for a wonderful pediatric dentist to join our team. We are a state of the art facility that has experienced fast growth due to our over the top guest service and care. If children are number one in your heart, then iKids Pediatric Dentistry & Orthodontics will be a great fit. Join the team where only being good is not enough and terrific guest service is a key to success. iKids Pediatric Dentistry & Orthodontics has been featured on American Health Front on CBS, Fox 4 News, and Radio Disney Talk Radio. We are searching for passionate/ enthusiastic individuals who approach every task with pride and energy, inspire others to go above and beyond and, utilize creativity. All associates are encouraged to voice their opinion or innovations on ways to WOW our guests. We want each parent and child given a memorable, personable experience.

Potential buy in opportunities available. Please send CV to heather@ikidsdental.com or call 817466-8554.

MIDLAND: Kid’s Dentistree. We are looking for a general dentist to work in our pediatric practice. If

878 Texas Dental Journal l www.tda.org l August 2015

you love working with kids, you will love our culture and atmosphere. If you are seeking an opportunity where you can focus on the patient without administrative headaches give us a call. Benefits include: Stock ownership, high earning potential, 401K, profit sharing, CE reimbursement, Health insurance, Paid Malpractice. Due to growth, we are currently searching for a few dentists to join our team in Midland. Please call Dr Britt Bostick, 806438-5745 or email at bbost35821@aol.com.

MONTGOMERY COUNTY: Unbelieveable opportunity for an associate position available with an established fee-for-service practice. Looking for a dentist with 2+ years’ experience, preferably I.V. sedation certified, who is able to provide a wide array of dental services including placement and restoration of implants, molar endo, Invisalign and wisdom tooth extractions. The practice has 12 operatories with sedation equipment, catscan machine, iTero, Cerec and is digital and paperless.

The right person should make 6-figures their first year. Please email your resume and a brief bio to tim@consolidated.net.

NORTHWEST/CENTRAL TEXAS: Abbeville Dentistry.

Associate with partnership opportunities within a year. We are a doctor-run and doctor-lead group practice with over 12 practices. We provide amazing patient experience, excellent benefits and tremendous doctor-patient autonomy. If you are seeking an opportunity where you can focus on the patient without administrative headaches give us a call. Benefits include: stock ownership, high earning potential, 401K, profit sharing, CE reimbursement, health insurance, paid malpractice. due to growth, we are currently searching for a few dentists to join

ADVERTISING BRIEFS our team in Abilene, Brownwood, Odessa, Lubbock and Amarillo. We have a large patient base. Enjoy the instant patient flow, amazing facilities and technology. Please call Dr Britt Bostick, 806-4385745 or email him at bbost35821@aol.com. Weíd love you to see our facilities and speak with our doctors.

ODESSA: DDR Dental general/cosmetic practice in small town atmosphere with country club living.

High-6 figure gross collections. Very high net income. Excellent recall program and stable patient base. Over 2,000 sq ft using four operatories (2 dental and 2 hygiene), well maintained with latest equipment, digitalX-ray and paperless charts.

Contact Chrissy Dunn at 800-930-8017 or visit www.

DDRDental.com.

OPPORTUNITY TO TRANSITION into a busy oral surgery practice within a multi-disciplined practice. Present oral surgeon is retiring. Practice is private fee-for-service. New i-CAT (3D) in office.

For information contact Paul Kennedy, DDS at pkennedy@gte.net or 361-960-6484.

PRACTICE OPPORTUNITY: We are a Texas-based family group dental practice serving patients of all ages. With a busy workload and high traffic, our needs extend to general dentists, orthodontists, pediatric dentists, and endodontists. Qualified, compassionate and motivated doctors interested in opportunities to provide high quality care in communities in Texas may contact us. Our offices provide: State-of-the-art, high-tech facility; in-house digital X-rays; paperless charting; 3-D models; digital tracing and imaging. Work alongside in-house board certified pediatric dentists, oral surgeons,

endodontists and general dentists, allowing one to provide the absolute best care possible to even the most challenging cases. To join our team, please forward your CV to tx.dentistrygroup@gmail.com.

SAN AGUSTINE: Startup dental practice. Fall 2015. Accepting résumés for associate DDS, RDH, receptionist, office manager, and chairside dental assistant. Email résumés to idodentistry@yahoo. com.

SAN ANGELO: Extremely busy 100% fee-for-service general dental office in beautiful west Texas looking for an associate with buy in opportunity.

This well established modern practice has a great reputation for quality comprehensive care. With six- operatories, experienced well trained staff and tested systems in place, this practice regularly collects 7 figures working 4 days per week. Contact: info@shellystromboe.com.

SAN ANTONIO (NORTH): General dentistry practice for sale—located off of TPC Parkway.

Established 3 yrs ago; 2,200 sq ft with 3 operatories built out and plumbed for 5 total. Amazing demographic location and beautiful buildout with top of the line equipment. Patient base is over 1,200. Seller is relocating out of the country due to military orders. Asking $375K . Please contact: 210705-9297.

SAN ANTONIO NORTH WEST: Associate needed.

Established general dental practice seeking quality oriented associate. New graduate and experienced dentists welcome. GPR, AEGD preferred. Please contact Dr Henry Chu at 210-684-8033 or versed0101@yahoo.com.

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ADVERTISING BRIEFS SAN ANTONIO: Practice for sale. Well-established practice; high-tech with excellent recall; doctor will transition. Whether a buyer or a seller, trust your life’s work to the most experienced senior appraiser/broker. For over 42 years, you have seen the name, Gary Clinton. Buyers, avoid over-payment for a practice and sellers, avoid selling below market value with a so-called “free appraisal.” Knowledgeable buyers are willing to pay the fair market value. My extensive certified appraisals use arket comparables from practices sold and located all over Texas. Professional Certified Practice Appraisers, LLC. IBA/ NAVCA. Call Gary Clinton confidentially 972-317-9756.

EL PASO: East side; large practice; full fee patient base. EL PASO: West side; medium sized practice; mostly PPO patient base. BEAUMONT: Medium sized PPO practice; very nice free standing building, 5 ops. SAN ANTONIO: Very large, high-tech, implant focused, full fee restorative practice with 7 equipped treatment rooms in a highly visible free standing building with digital x-rays, a cone beam X-ray and a digital impression scanner. Long term staff and 10 days of hygiene per week. The doctor desires to sell half the practice now and the other half in 5 years prior to retirement. DALLAS SUBURB: Medium sized PPO practice, 5 treatment rooms, digital X-rays. Highly visible retail location.

SAN ANTONIO: A general practice (FFS/PPO) having gross receipts in mid 6 figures while practicing only 3.5 days per week with no marketing. This is an exceptional opportunity to profit from day one in a newly remodeled office equipped with 3 chairs for a fraction of the cost of a new start up. Tremendous potential to grow practice rapidly as current dentist refers out majority of endo, ortho, perio, pedo, and oral surgery cases. To learn more about this practice contact: Dr Jeff Jones, 830-832-5522 / dr.jeff. jones@henryschein.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 two other dentists and top notch staff. Please contact Dr Johnson at 435-2372339 or email at johnson.2978@gmail.com.

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. NORTH OF HOUSTON: Medium sized full fee patient base; digital X-rays; Free standing building; long term staff; 4 days of hygiene per week. EAST TEXAS: Medium sized PPO patient base. Free standing. VICTORIA: Medium sized practice; PPO patient base; free standing building, long term staff; doctor refers out lots of dentistry.

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WACO: Well established general practice looking for a caring and motivated associate. Our team provides patients with a full range of general dentistry in a relaxed, friendly, family atmosphere.

Interested candidates should call 254-7721827 and/or send an email to wwinarick@ dentalstationwaco.com

OFFICE SPACE LUBBOCK: 1,365 sq ft dental office for sale. 4 treatment rooms, lab/sterilization combination, small private office and private restroom. Condo situation with 3 other dentists that share reception area, patient restrooms and employee break room.

ADVERTISING BRIEFS Basement for storage. Close to medical district.

Contact: Scott Womack/Coldwell Banker (806) 7843265.

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.

FOR SALE: Cerec Omnican, Ivoclar Oven, and Milling Unit. Equipment purchased 6 months ago, but it is simply too costly for my small 2-chair practice. Looking for someone to assume payments. Currently owe $140k but will accept any reasonable offer. This is an excellent tool for a large multi-doctor practice. Will train doctor on use and transport to San Antonio, Dallas or Houston.

Cerec club membership through Patterson is $300/ mo additional optional expense. Includes blocks, glazing and staining materials, manuals, etc. Please email for pictures. rebeccagabrieldds@yahoo.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.

MISCELLANEOUS HANDS ON EXTRACTION CLASSES: Learn advanced extraction techniques, elevating flaps, suturing,

third molar removal, sinus perforation closure, using instruments properly and how to handle large abscesses and bleeding. Classes combine lecture and participation on live patients. Website: www. weteachextractions.com Phone: 843-488-4357 Email: drtommymurph@yahoo.com.

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.

PLACE A CLASSIFIED AD IN THE

TEXAS DENTAL JOURNAL It’s a member benefit!

Reach more than 9,000 of your dental colleagues.

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PRINT: $60 for the first 30 words for ADA members. 10 cents per word after that.

ONLINE: $10 a month (no word limit). $60 one-time additional fee to post online immediately.

CONTACT

For more information, please visit tda.org or contact Hannah Atteberry at 512-443-3675 ext 124 or by email: hannah@tda.org.

Texas Dental Journal l www.tda.org l August 2015

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YOUR PATIENTS TRUST YOU.

WHO CAN YOU TRUST?

ADVERTISERS ADS Watson Brown & Associates.......................796 Anesthesia Education & Safety...........................857 Clinton, Gary..........................................................795 Coastwide Networks.............................................798 DDR Dental Trust...................................................871 Dental Credentialing Specialists of Texas..........803 Dental Handpiece Repair Guy..............................808 Dental Post.............................................................806 Dental Systems......................................................797

If you or a dental colleague are experiencing impairment due to substance use or mental illness, The Professional Recovery Network is here

E-Vac, Inc...............................................................808 Greater Houston Dental Society..........................805 Hanna, Mark — Attn. at Law.................................806 Henry Schein Financial Services.........................804 JKJ Pathology.......................................................861 Kennedy, Thomas John, DDS, PLLC...................861 Mudlick Mail...........................................................803 OSHA Manual.........................................................798

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Phase II Associates...............................................868 Practice Growth Coach.........................................803 Professional Recovery Network...................794/882 Professional Solutions Insurance.......................809 Shepherd, Boyd Wilson........................................804 Sherri L. Henderson & Associates.......................791 TDA Financial Services Insurance Program..........................................798/Back Cover TDA Perks Program.....................Inside Front Cover The Hindley Group................................................807 University of Texas School of Dentistry..............809

PRN Helpline (800) 727-5152

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882 Texas Dental Journal l www.tda.org l October 2015

UTHSCSA / South Texas Pathology Lab.............807 Waller, Joe..............................................................807 Warschaw Learning Institute................................797

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Vol. 132, Issue 10

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