2022 - Jan/Feb TFDA

celebrating 100 years!

Happy 100th Birthday, Today's FDA!

Skeptic Turned Supporter: Why I Now Accept the Non-patient Licensure Exam

FDA LCDs

Protect Your Profession Tallahassee 2022 FLA-MOM FAQs

Highly recommended!

Mr. Joe Perretti and the FDA in general have been really helpful in providing guidance and assistance with all my questions.

– Dr. Katia Gonzalez, Miramar

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CONTACT JOE perretti - SOUTH FLORIDA P: 305.665.0455 | E: joe.perretti@fdaservices.com fdaservices.com/insurance-programs | Follow us on

TABLE OF CONTENTS

JAN/FEB 2022 floridadental.org

community engagement issue 22 | Today’s FDA: Celebrating 100 Years!

25 | BOD Meets in Orlando 26 | Skeptic Turned Supporter: Why I Now Accept

the Non-patient Licensure Exam 31 | FDA LCDs Protect Your Profession 32 | Critical Relationships 34 | Attend DDOH to Bring About Change 38 | Advocacy: A Key Member Benefit 40 | Help Shed Light on the Dental Profession 42 | LDCs Bring the Passion to Close the Sale

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46 | Duty, Honor, Country, Profession 48 | The Evolution of Dentistry 50 | Tallahassee 2022 FLA-MOM FAQs 53 | Are Your Assistants Certified?

56 | FDC2022 Speaker Preview: Workplace Stress 60 | FDC2022 Speaker Preview: Erosive Tooth Wear

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62 | FDC2022 Speaker Preview: Focus on Successful

Treatment Outcomes of Adjunctive Clinical Homeopathy

IN EVERY ISSUE 2 Staff Roster

16 news@fda

4 Contributors

71 Diagnostic Discussion

7 President’s Message 10 Did You Know?

12 Legislative

76 Career Center

64 | FDC2022 Exhibit Hall

check out today’s fda online!

79 Advertising Index 80 Off The Cusp

14 Preventive Action

1 | TODAY'S FDA jan/feb 2022

545 John Knox Road, Ste. 200 • Tallahassee, FL 32303 • 800.877.9922 or 850.681.3629

EDITOR Dr. Hugh Wunderlich • Palm Harbor DIRECTOR OF PUBLICATIONS Jill Runyan

COMMUNICATIONS AND MEDIA COORDINATOR Jessica Lauria

GRAPHIC DESIGN COORDINATOR AJ Gillis

BOARD OF TRUSTEES PRESIDENT Dr. Dave Boden • Port St. Lucie

PRESIDENT-ELECT Dr. Gerald Bird • Cocoa

SECRETARY Dr. John Paul • Lakeland

FIRST VICE PRESIDENT Dr. Beatriz Terry • Miami

IMMEDIATE PAST PRESIDENT Dr. Andy Brown • Orange Park

SECOND VICE PRESIDENT Dr. Jeffrey Ottley • Milton

EXECUTIVE DIRECTOR Drew Eason, CAE • Tallahassee

Dr. Christopher Bulnes • Tampa | Dr. Bethany Douglas • Jacksonville | Dr. Dan Gesek • Jacksonville | Dr. Karen Glerum • Boynton Beach Dr. Reese Harrison • Lynn Haven | Dr. Bertram Hughes • Gainesvile | Dr. Bernard Kahn • Maitland | Dr. Gina Marcus • Coral Gables Dr. Irene Marron-Tarrazzi • Miami | Dr. Eddie Martin • Pensacola | Dr. Paul Palo • Winter Haven | Dr. Mike Starr • Wellington Dr. Don lIkka • speaker of the house, Leesburg | Dr Rodrigo Romano • treasurer, Miami

To contact an FDA board member, use the first letter of their first name, then their last name, followed by @bot.floridadental.org.

For example, to email Dr. Hugh Wunderlich, his email would be hwunderlich@bot.floridadental.org.

To call a specific staff member below, dial 850.350. followed by their extension.

EXECUTIVE OFFICE Drew Eason • chief executive officer/executive director Greg Gruber • chief operating officer/chief financial officer Casey Stoutamire • director of third party payer and professional affairs Judy Stone • leadership affairs manager Lianne Bell • leadership concierge

deason@floridadental.org • Ext. 7109 ggruber@floridadental.org • Ext. 7111 cstoutamire@floridadental.org • Ext. 7202 jstone@floridadental.org • Ext. 7123 lbell@floridadental.org • Ext. 7114

ACCOUNTING Breana Giblin • director of accounting Leona Boutwell • finance services coordinator Deanne Foy • finance services coordinator Jamie Idol • FDAS support services coordinator Mitzi Rye • fiscal services coordinator Stephanie Taylor • membership dues coordinator

bgiblin@floridadental.org • Ext. 7137 lboutwell@floridadental.org • Ext. 7138 dfoy@floridadental.org • Ext. 7165 jamie.idol@fdaservices.com • Ext. 7142 mrye@floridadental.org • Ext. 7139 staylor@floridadental.org • Ext. 7119

COMMUNICATIONS AND PUBLICATIONS Renee Thompson • director of communications and marketing Jill Runyan • director of publications AJ Gillis • graphic design coordinator Jessica Lauria • communications and media coordinator

rthompson@floridadental.org • Ext. 7118 jrunyan@floridadental.org • Ext. 7113 agillis@floridadental.org • Ext. 7112 jlauria@floridadental.org • Ext. 7115

FDA FOUNDATION R. Jai Gillum • director of foundation affairs Kristin Badeau • foundation coordinator

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rjaigillum@floridadental.org • Ext. 7117 kbadeau@floridadental.org • Ext. 7161

FLORIDA DENTAL CONVENTION AND CONTINUING EDUCATION Crissy Tallman • director of conventions and continuing education Mackenzie Johnson • FDC meeting assistant Brooke Martin • FDC marketing coordinator Deirdre Rhodes • FDC exhibits coordinator

ctallman@floridadental.org • Ext. 7105 mjohnson@floridadental.org • Ext. 7162 bmartin@floridadental.org • Ext. 7103 drhodes@floridadental.org • Ext. 7108

GOVERNMENTAL AFFAIRS Joe Anne Hart • chief legislative officer Alexandra Abboud • governmental affairs liaison Jamie Graves • legislative assistant

jahart@floridadental.org • Ext. 7205 aabboud@floridadental.org • Ext. 7204 jgraves@floridadental.org • Ext. 7203

INFORMATION SYSTEMS Larry Darnell • director of information systems Charles Vilardebo • computer support technician

ldarnell@floridadental.org • Ext. 7102 cvilardebo@floridadental.org • Ext. 7153

MEMBER RELATIONS Kerry Gómez-Ríos • director of member relations Megan Bakan • member access coordinator Joshua Braswell • membership coordinator Christine Trotto • membership concierge

krios@floridadental.org • Ext. 7121 mbakan@floridadental.org • Ext. 7100 jbraswell@floridadental.org • Ext. 7110 ctrotto@floridadental.org • Ext. 7136

FDA SERVICES 545 John Knox Road, Ste. 201 • Tallahassee, FL 32303 • 800.877.7597 or 850.681.2996

Scott Ruthstrom • chief operating officer Carrie Millar • director of insurance operations Carol Gaskins • commercial accounts manager Marcia Dutton • membership services assistant Porschie Biggins • Central FL membership commercial account advisor Maria Brooks • South FL membership commercial account advisor Kelly Dee • Atlantic Coast membership commercial account advisor Melissa Staggers • West Coast membership commercial account advisor Tessa Daniels • commercial account advisor Liz Rich • commercial account advisor Davis Perkins • commercial account advisor

scott.ruthstrom@fdaservices.com • Ext. 7146 carrie.millar@fdaservices.com • Ext. 7155 carol.gaskins@fdaservices.com • Ext. 7159 marcia.dutton@fdaservices.com • Ext. 7148 porschie.biggins@fdaservices.com • Ext. 7149 maria.brooks@fdaservices.com • Ext. 7144 kelly.dee@fdaservices.com • Ext. 7157 melissa.staggers@fdaservices.com • Ext. 7154 tessa.daniels@fdaservices.com • Ext. 7158 liz.rich@fdaservices.com • Ext. 7171 davis.perkins@fdaservices.com • Ext. 7145

Group & Individual Health • Medicare Supplement • Life Insurance • Disability Income • Long-term Care • Annuities • Professional Liability • Office Package • Workers’ Compensation • Auto • Boat

YOUR RISK EXPERTS Dan Zottoli, SBCS, DIF, LTCP director of sales • Atlantic Coast 561.791.7744 cell: 561.601.5363 dan.zottoli@fdaservices.com

Joseph Perretti, SBCS director of sales • South Florida 305.665.0455 cell: 305.721.9196 joe.perretti@fdaservices.com

Dennis Head, CIC director of sales • Central Florida 877.843.0921 cell: 407.927.5472 dennis.head@fdaservices.com

Rick D’Angelo, CIC director of sales • West Coast 813.475.6948 cell: 813.267.2572 rick.dangelo@fdaservices.com

Mike Trout director of sales • North Florida cell: 904.254.8927 mike.trout@fdaservices.com

3 | TODAY'S FDA jan/feb 2022

GUEST CONTRIBUTORS jan/feb 2022

JAMES ANTOON, DMD PERIODONTIST ROCKLEDGE, FL antoon1@gmail.com Page 32

JULIE M. BRIGHTWELL, BSN, JD, RN, CPHRM DIRECTOR, HEALTHCARE SYSTEMS PATIENT SAFETY

DIANA BRONSTEIN, DDS, M.S., M.S., M.S., DABP, DICOI, FICOI FDC2022 SPEAKER

THE DOCTORS COMPANY

brabins@msn.com

JBrightwell@thedoctors.com

Page 62

Page 14

SUSAN M. BYRNE, DMD

ALEX J. DELGADO, DDS, M.S.

JEN BUTLER JB PARTNERS CEO AND FOUNDER FDC2022 SPEAKER jen@jbpartners.com Page 56

MIKE EGGNATZ, DDS

LIZ GESENHUES, DDS

GENERAL DENTIST TALLAHASSEE, FL

FDC2022 SPEAKER

GENERAL DENTIST WESTON, FL

ORTHODONTIST ST. AUGUSTINE, FL

byrne1538@gmail.com

adelgado@dental.ufl.edu

dreggnatz@gmail.com

Page 34

drlizg9@gmail.com

Page 60

Page 38

Page 40

JOSHUA GOLDEN, DDS

STEVE HOCHFELDER, DMD

RICHARD C. MARIANI JR., DDS, M.S.

PAUL WERNER, DDS

GENERAL DENTIST LAKE MARY, FL

ORTHODONTIST SOUTH MIAMI, FL

shochfelder@gmail.com

DOGRM@atlanticbb.net

GENERAL DENTIST SUNRISE, FL jngoldendds@gmail.com Page 48

Page 46

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Page 53

PEDIATRIC DENTIST BOCA RATON, FL drpaul4kids@gmail.com Page 42

DAVE BODEN, DDS, M.S.

DONALD M. COHEN, DMD

oralpath@dental.ufl.edu

FDA PRESIDENT

oralpath@dental.ufl.edu

dboden@floridadental.org

Page 71

Page 71

850.681.3629 Pages 7 & 26

NADIM M. ISLAM, DDS

JOE ANNE HART

CASEY STOUTAMIRE, ESQ.

oralpath@dental.ufl.edu

FDA CHIEF LEGISLATIVE OFFICER

FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

Page 71

jahart@floridadental.org

cstoutamire@floridadental.org

850.350.7205

850.350.7202

Page 12

RENEE THOMPSON FDA DIRECTOR OF COMMUNICATIONS AND MARKETING rthompson@floridadental.org 850.350.7118 Page 22

Pages 10 & 25

HUGH WUNDERLICH, DDS, CDE FDA EDITOR hwunderlich@bot.floridadental.org 850.681.3629 Page 80

5 | TODAY'S FDA jan/feb 2022

CONTRIBUTORS jan/feb 2022

INDRANEEL BHATTACHARYYA, DDS

IT’S NOT YOUR AVERAGE DENTAL MEETING! COME FOR THE CE, STAY FOR THE FUN AT FDC2022 JUNE 23-25, 2022 GAYLORD PALMS RESORT & CONVENTION CENTER ORLANDO, FLORIDA

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LEARN MORE AT FLORIDADENTALCONVENTION.COM

in the sulcus

Are We There Yet?

By David F. Boden, DDS, M.S., FDA President

“Mommy, Daddy, are we there yet?” Those of you who are parents recognize this question all too well. We also know the quick standard responses, rotated as needed: “Five more minutes!” “Almost there!” “Just around the corner!” “You’ll have to hold it!” It is amazing how easily we lie to our kids.

It really doesn’t matter the age. As adults and grown, seasoned professionals, we still ask the same question: Are we there yet? Do we really expect a straight answer? Our profession and our country face many problems and issues, and many of us expect truthful adult answers. Unfortunately, today’s culture does not always reward honesty. Television, social media “influencers,” apparently everyone in Washington, even top brass in our military. We all sense how brazen the lying has become.

Is dishonesty beginning to creep into our profession? Is there more temptation to oversell treatment plans? Heaven knows financial pressures have ramped up considerably in the past 15 years with servicing loans for skyrocketing tuition as well as static or even decreasing reimbursements from even more intrusive insurance companies. Add to that the rapid ramping up of inflation effects to supplies and labor costs as an inevitable result of wildly out of control congressional spending, there is no doubt that dentists — and our physician colleagues — are certainly feeling a financial squeeze more than ever.

Dentistry and medicine may be businesses, and it is true that we are not exempted from the laws of economics, but we are special kinds of businesses. The Hippocratic Oath, while allowing to “thrive and prosper in my fortune and profession,” also admonishes that “my visit shall be for the convenience and advantage of the patient,” requiring to first and foremost to take care of our sick patients. As doctors, we feel this economic and ethical push and pull by which most competitive commercial businesses are not as tightly bound, and sometimes that can place us in an agonizing position.

Nevertheless, it is our professional duty to fiercely defend this conflict to all who challenge us. No one, especially an insurance company or a government entity, is as able to guard our patients’ health as the doctors bound by this oath, just as no one — not insurance companies, government entities, practice owners, or even patients demanding health care as a right — must be allowed to control doctors by manipulating the fiscal means by which patients are properly treated.

But, wait! There’s more! In the continuing Washington siren song that everything should be free, Congress was recently on the brink of imposing Medicare on dentistry. Since 1965, when Medicare first was born, there is a reason why physicians are so envious that dentistry managed to stay out of the Medicare quagmire. Our forefather dental leaders were very prescient and clearly understood how any federal program expands and exerts even more control as costs rise. Sometimes even our dental leadership does not see that as clearly as they t

7 | TODAY'S FDA jan/feb 2022

in the sulcus

”

OUr forefather dental leaders were very prescient and clearly understood how any federal program expands and exerts even more control as costs rise.

should. History is ignored, and the future is short sighted.

“Aw, but it will not affect me,” you say? “I just don’t have to participate in Medicare?” Perhaps. But ask your physician friends what happens. In medicine , Medicare takes over and private insurance disappears at age 65. The fees are fixed and there is no balance billing. Private insurance for earlier ages set their fee schedules using Medicare schedules as a strong guide and vice versa. Guess who comes out short in that little arrangement.

As parents, it is our obligation to be truthful to our children and set the example for when they are adults. As doctors and professionals, our patients trust us to be truthful in every way. Dentists are vested with high trust and respect in a sea of frank dishonesty. That is why our predecessors, and now you, are the great leaders our society, our patients and our children seek more than ever. Speak up, defend and practice your integrity. And don’t lie to your kids!

Your Colleague,

Don’t fall asleep on this, folks. We barely won this time. Trust me, this is not over. The political temptation is far too powerful. Nothing is for free. Proponents sell it as a “benefit.” But the dishonesty by omission is that it will be you who pays the bill, and you will not have a choice. Once in place, it will be like any other government program: far more costly and fraught with fraud than predicted, impossible to eliminate and nearly impossible to modify, all by design. You and your American Dental Association called out the deceit this time, but another push could be “just around the corner.”

9 | TODAY'S FDA jan/feb 2022

did you know?

Who Are You Going to Call ... an Emergency Medical Technician?

By Casey Stoutamire, FDA Director of Third Party Payer and Professional Affairs

Did you know that a dentist cannot bring an emergency medical technician (EMT) into the office to insert an IV or administer anesthesia? No matter what type of sedation permit he/she holds, a dentist cannot use an EMT to administer anesthesia in a dental office. Under Florida law, an EMT can only be supervised by a physician, not a dentist. Thus, if an EMT is working in a dental office he/she is functioning as a dental assistant and can only perform those remediable tasks that are delegable to assistants.

The rules on sedation and anesthesia in a dental office can be found at bit.ly/3xf8g4t. The list of tasks delegable to a dental assistant and the corresponding training needed for each task can be found at bit.ly/3FDNize.

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OPIOIDS information from the FDA

HEALTH CARE PROVIDER CHECKLIST: INFORM Non-opioid alternatives for pain treatment, which may include non-opioid medicinal drugs or drug products are available.

Non-opioid interventional procedures or treatments, which may include: acupuncture, chiropractic treatments, massage, physical or occupational therapy, or other appropriate therapy are available.

DISCUSS Advantages and disadvantages of non-opioid alternatives.

Patient’s risk or history of controlled substance abuse or misuse, and patient’s personal preferences.

DOCUMENT IN PATIENT’S RECORD Non-opioid alternatives considered.

SUMMARY: All health care providers must include non-opioid alternatives for pain and pain management electronically or in printed form in their discussions with patients before providing anesthesia, or prescribing, ordering, dispensing or administering a schedule II controlled substance for the treatment of pain.

Effective July 1, 2021.

PROVIDE “Alternatives to Opioids,” an educational information pamphlet created by the Florida Department of Health printed or in electronic format (required, available at bit.ly/2KXvZ2h). Also, a checklist and poster.

NON-OPIOID ALTERNATIVES r You FDA ve R lusi exc EMBE !

M EFIT BEN

LAW: FOR THE LATEST ON OPIOIDS, GO TO:

FLORIDADENTAL.ORG/NYK

GO TO bit.ly/2KXvZ2h

legislative

are you ready to run for office? be distracting and unproductive. Try to find someone who has experience in running campaigns. Talk with local elected officials for recommendations and make sure it’s someone with integrity whom you can trust.

By Joe Anne Hart, FDA Chief Legislative Officer

Running for a political office is something that should not be taken likely. It is especially important for you to consider many different aspects of how your life may change should you get elected.

But first, you need to evaluate your tolerance level, patience and fortitude to withstand and endure everything that comes with campaigning and running for office.

Will the Florida Dental Association (FDA) or FDA Political Action Committee (FDAPAC) be directly involved in my campaign?

Running for office isn’t pretty and can lead you down several winding roads that are unexpected and many times uncomfortable. You will need to have a strong support system in place to help balance out the stress and assist you through early morning meetings and late-night strategy sessions. And ultimately, if you are successful in getting elected to office, understand that no matter what anyone says, being an elected official is a FULL-TIME JOB!

No. The FDA and FDAPAC are not qualified entities to run campaigns. However, through FDAPAC, support can be provided through a PAC check contribution to your campaign, upon approval from the FDAPAC Board. Also, the FDAPAC includes a list of supported candidates for primary and general elections in Today’s FDA each election cycle.

How much money do I need to raise to run for office?

Here are some tips that may be helpful if you are ready to run for office. While this list is not comprehensive — there is so much more to running for office — this information can help get you started.

It all depends on where you are in the state and whether you are running for a House or Senate seat. Senate races require you to raise more than House races because you are campaigning in larger districts. It also depends on the media market where you live. It is very expensive to buy TV spots versus developing mail pieces. The amount of money you need to raise also depends on how competitive your race will be.

Do I need to hire a campaign manager?

Yes, you will need to hire a campaign manager to be the lead person on your campaign. Having a contact person for your campaign, other than yourself, provides you with a much-needed barrier away from many of the details of a campaign that would

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”

What is “opposition research?”

Should I be concerned about it?

Opposition research is the investigation into the dealings of political opponents, typically to discredit them publicly (that’s the textbook definition). This is typical in campaigns. Candidates try to find out everything about their opponents that may be contrary to a position they are taking on an issue or possibly some questionable behavior in their past. I would suggest that you do opposition research on yourself.

Again, this is just a small sample of information that is beneficial if you decide to run for office. For more information, contact Chief Legislative Officer Joe Anne Hart at jahart@floridadental.org or 850.224.1089.

Evaluate your tolerance level, patience and fortitude to withstand and endure everything that comes with campaigning and running for office.

ARE YOU A MEMBER OF FDAPAC CENTURY CLUB? Join now: floridadental.org/centuryclub

A portion of your required dues is transferred to the Florida Dental Association Political Action Committee (FDAPAC). FDAPAC provides campaign contributions to dental-friendly candidates.

FDAPAC Century Club members provide additional financial support of $150 or more for state campaigns. FDAPAC dues and contributions are not deductible for federal income-tax purposes.

Dr. Rudy Liddell FDAPAC Chair

“Your support of the PAC helps the FDA build relationships with leaders who will be making important decisions in Tallahassee that will impact our profession and our patients.”

— Dr. Rudy Liddell

13 | TODAY'S FDA jan/feb 2022

preventive action

Responding to Requests for Dental Records and the Consequences of Refusing

By Julie M. Brightwell, BSN, JD, RN, CPHRM

This case study involving a dentist who refused to provide a complete copy of a patient’s dental records demonstrates the value of knowing the rules concerning dental records and complying with state and federal laws. The discussion includes strategies to help dental professionals avoid complaints, investigations and sanctions.

The patient, a 34-year-old female, discussed a complex treatment plan with her dentist but did not agree with the dentist’s recommendations. She subsequently decided to consult with another dental provider for a second opinion. The patient requested a complete copy of her dental records from her original dentist to help expedite the consultation, but her dentist refused, stating that

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the patient had not paid the full amount of her dental fees and had an outstanding balance remaining on her account.

The patient filed a complaint with the state’s dental board. After receiving a letter of investigation, the dentist provided the patient with a copy of her dental records, but he did not include copies of her X-rays. The investigator suggested that the dentist consult an attorney. The attorney confirmed the requirement to provide copies of the patient’s complete dental record — including copies of the X-rays. The dentist complied.

Risk Management Discussion Many states have statutes or administrative code provisions governing the content of dental records, and those requirements include patient history; X-rays; dental

examinations; test results; drugs prescribed, dispensed or administered; relevant comorbidities; consultation reports; and any other documentation that the dentist relies on to treat the patient.

It is not appropriate for any health care provider to withhold requested records or portions of a record because a patient has an outstanding balance for services rendered, disputes the treatment provided or disagrees with fees that have been charged. With very few exceptions, patients are entitled to a complete record set maintained by the practice pursuant to federal and state law. It is important to know the rules concerning dental records in the jurisdiction in which you practice, including the requirements for their minimum content, retention, storage and release.

Additionally, dental offices that submit electronic claims, eligibility requests, claim status inquiries, and requests for authorization also are governed by HIPAA privacy, security and breach notification rules.

The following strategies can help dental professionals avoid patient complaints, governmental investigations, administrative sanctions and adverse social media postings when responding to record requests: n Contact your patient safety risk manager pr omptly if you receive one of the following types of record requests: a subpoena, a signed authorization presented by a third party or a court order. The Doctors Company will review the request to ensure it is valid and assist in identifying the nature and scope of the requested records.

n If you receive an oral request for dental records, either in person or by telephone (including from a law enforcement representative), respectfully and politely tell the individual that all requests for records must be submitted in writing (on official letterhead, if appropriate). Tell the individual that, once you receive the written request, it will be reviewed as soon as possible. n Do not unilaterally refuse to provide records to a properly authorized individual who presents an appropriate written request. Seek advice from your professional liability carrier, risk manager or corporate counsel. Withholding records can antagonize the patient and irreparably injure the patient-provider relationship. It also may result in a complaint to your state dental licensing board, state department of consumer affairs or even the federal Office of Civil Rights. n Respond promptly to requests for records. You are not expected to provide the material on short notice, but you are required to respond in a timely manner, as defined under applicable state law and in the HIPAA Privacy Rules.

The guidelines suggested here are not rules, do not constitute legal advice and do not ensure a successful outcome.

The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission by The Doctors Company. This article can be found at bit.ly/3J3FSYD.

For more strategies on patient record issues, read “The Defensible Medical Record,” which can be found at bit.ly/3E8Jx3G. For guidance and assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at 800.421.2368 or use the contact page at bit.ly/32hMjGy. 15 | TODAY'S FDA jan/feb 2022

news@fda The ADA has heard from its members about this challenge. In an effort to raise awareness of the various allied dental-related employment opportunities, the ADA has created two different recruitment flyers:

*PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.

Dr. Leonard Britten Memorial Fund to Support FLA-MOM

n Dental assistants and dental hygienists

Dr. Leonard Britten was active in political and legislative advocacy and encouraged his sons, Nick and Todd (who also practice in Florida), to do the same by bringing them with him to Dentists’ Day on the Hill. He is still supporting dentistry even after his passing in December 2021; his family is asking for donations be sent to the Florida Dental Association Foundation in his honor. Memorial gifts will support one of Dr. Britten’s favorite causes, Florida Mission of Mercy, a charitable annual event that provides free dental care to the underserved population that would otherwise go without care. Donations can be mailed to 545 John Knox Road, Ste. 200, Tallahassee, FL 32303 or made online at bit.ly/3zWwyS6.

n Dental assistants, dental hygienists, dental office managers and dental laboratory technicians The two flyers aim to recruit qualified people into dental team careers and may be used in several ways. Practice owners can post these flyers in their dental offices, use them if invited to present at a local career day or offer them for distribution at job fairs or other community events.

To add customized practice information, ADA members can download the member exclusive flyers. Access the flyers at bit.ly/3GUF2vX.

Make Plans to Attend the 2022 Florida Dental Convention

Resources to Recruit Your Dental Team Recruiting dental team members — such as dental assistants, dental hygienists, dental office managers and dental laboratory technicians — was a challenge for practice owners before the COVID-19 pandemic and it continues to be a challenge today.

Recent surveys by the American Dental Association (ADA) reveal that workforce issues were a pain point experienced by dentists in many states and indicated that looking for staff was extremely difficult. A perceived lack of awareness of the many dental profession career options, as well as the impression that the dental assisting field offered limited opportunities for career growth, are among the contributing factors to this reported challenge.

The 2022 Florida Dental Convention (FDC), “Dentistry & Systemic Health: Mouth, Mind & Body Connection,” will be held on June 23-25 at the Gaylord Palms Resort & Convention Center in Orlando. FDC will offer more than 130 courses and 300-plus exhibitors to enhance and refine skills for everyone on the dental team.

Course highlights include Pankey Essentials 1, pediatric tonguetie treatment, 3D printing, whole-body health and wellness, aerosol-free dentistry and much more. As a member benefit,

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FDA members receive FREE preregistration as well as a multitude of free courses to choose from! View the FDC2022 speaker and course listing at floridadentalconvention.com.

Don’t Forget to Make Your FDC2022 Hotel Reservation

in using caries risk assessment, disease prevention and early interventions to reduce tooth decay among children ages birth to 6 years. Tiny Smiles is sponsored by Colgate and CareCredit.

Information about the collaboration and instructions for how to access the course can be found at ADA.org/TinySmiles — just in time for Children’s Dental Health Month!

Welcome New FDA Members The following dentists recently joined the FDA. Their memberships allow them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry. Names listed in blue are members in dental residency.

FDC2022 offers two hotel options. Stay at the Gaylord Palms Resort & Convention Center to be in the middle of the action! Call 877.491.0442 or make your reservation online at bit.ly/3fyIccm for the discounted rate of $209 per night, including free self-parking.

Or stay just minutes from the Gaylord Palms at the Fairfield Inn & Suites for only $119 per night, including free self-parking and breakfast. Call 407.390.1532 or make your reservation online at bit.ly/3A9NnJg for the Fairfield Inn & Suites today.

ADA Tiny Smiles Promotes CDA’s CE Course on Care for Young Patients

Atlantic Coast District Dental Association Dr. Jordan Betel, Jensen Beach Dr. Julie Freedman, Delray Beach Dr. Carmen Goulet, Port St. Lucie Dr. Bryan Kuhlman, Vero Beach Dr. Katherine Lin, Boca Raton Dr. Michael Pinholster, Vero Beach Dr. David Posada, Lake Worth Dr. Tanmya Ravi, Wellington Dr. Sara Rosenberg, Boynton Beach Dr. Jennifer Schaumberg, Fort Lauderdale Dr. Beatriz Valerio Gil, Margate

Central Florida District Dental Association Dr. Saja Alramadhan, Gainesville Dr. Mark Angeloni, Winter Park Through a collaboration with the California Dental Association, the ADA Give Kids A Smile Tiny Smiles Program is able to offer the Treating Young Kids Everyday (TYKE) course for free, a $200 value, through February 2022. The TYKE course (two CE credits) is designed to increase dentists’ confidence to see babies and young children and inspire a commitment to decreasing the prevalence of dental caries in young children. The online course offers effective educational tools and training to support dental teams

Dr. Andrew Benfield, Merritt Island Dr. Cuong Dinh, Orlando Dr. Omar Elkhabbaz, Melbourne Dr. Franciele Floriani, Gainesville Dr. Yanfei Hu, Winter Park Dr. Reem Jaber, The Villages Dr. Gabrielle Kubas, Gainesville t

17 | TODAY'S FDA jan/feb 2022

news@fda Dr. Michael McLennon, Gainesville

Dr. Cassia Barros, Pompano Beach

Dr. Marnie Bauer, Tampa

Dr. Samantha Montoya, Gainesville

Dr. Noel Concepcion Paez, Miami

Dr. Michael Bettner, Sarasota

Dr. John Purpura, Groveland

Dr. Dayne Corcho Martell, Miami

Dr. Joan Blundell, Odessa

Dr. Nalini Ramlochan, Orlando

Dr. Veronica De Armas, Hallandale

Dr. Storm Briggs, Tampa

Dr. Zoany De la Rosa, South Miami

Dr. Ivo Bushati, Pinellas Park

Dr. Dunia Garcia Perez, Miami

Dr. Serban Cismarescu, Cape Coral

Dr. Cesar Gonzalez, Davie

Dr. Ravneet Dhillon, Plantation

Dr. Damilet Gregorich, Miami

Dr. Jorge Dovale Ricardo, Largo

Dr. Doris Gutierrez, Miami Gardens

Dr. Haifa El Zhawi, Sarasota

Dr. Natan Haramati, Bay Harbor Islands

Dr. Justin Elikofer, Bradenton

Dr. Isamary Herrera, Miami

Dr. Robert Fili, Lakewood Ranch

Dr. Haissel Iglesias, Sunrise

Dr. Camila Flach, Wesley Chapel

Dr. Anthony Lima, Hollywood

Dr. Garrett Folks, Bradenton

Dr. Mayte Martinez Cabrera, Miami

Dr. Christine Hernandez, Tampa

Dr. Daniela Martinez-Florez, Miami

Dr. Sydney Lundy, Lutz

Dr. Monica Ortiz-Velasquez, Doral

Dr. Seth Lutjemeyer, Tampa

Dr. Ailsa Pla Novo, South Miami

Dr. Jacobson Ma, St. Petersburg Dr. Andrew Minias, Tampa

Dr. Allen Benzenhafer, Freeport

Dr. Sundaralingam Premaraj, Fort Lauderdale

Dr. Raluca Nasta, Cape Coral

Dr. Hannah Farrar, Pensacola

Dr. Gisleda Ramos, Coral Springs

Dr. Carolyn Norton, Tampa

Dr. Marcus Joy, Tallahassee

Dr. Arelys Ruiz Jimenez, South Miami

Dr. Brian Sampayo, Valrico

Dr. Nisarg Parikh, Gulf Breeze

Dr. Darlenis Sanchez Licea, Zephyrhills

Dr. Michelle Thomas, Panama City

Dr. Gennys Russo De Romero, South Miami

Dr. Nehal Ali, Pompano Beach

Dr. Arthur Shinder, Fort Lauderdale

Northeast District Dental Association Dr. Elie Abboud, Jacksonville Dr. Noah Andone, Orange Park Dr. Adam Cohlmia, Jacksonville Dr. Ahmed Elbira, Jacksonville Dr. Dena Mizrahi, Orange Park Dr. Mahsa Rostami, Jacksonville Dr. Jasmine Shakya, Jacksonville Dr. Ritika Singh, Jacksonville Dr. Arthur Sollee III, Jacksonville

Northwest District Dental Association

South Florida District Dental Association

Dr. Ludmila Tesoro, Pembroke Pines

Dr. Michael Schaake, Fort Myers Dr. Denys Severchenko, North Port Dr. Inderpal Singh, Sarasota

Dr. Antonio Almaguer Martinez, Miami

West Coast District Dental Association

Dr. Jason Vanman, St. Petersburg

Dr. Astrid Alves Daporta, Coral Gables

Dr. Morgan Abraham, Naples

Dr. Yamile Villavicencio, Cape Coral

Dr. Oscar Arevalo, Miami

Dr. Nelson Andujar Ortiz, Wesley Chapel

Dr. Daniel Winokur, Bonita Springs

Dr. Gina Asturr izaga, Miami

Dr. Donald Antonson, Clearwater

18

Dr. Lora Soliman, Dunedin

In Memoriam The FDA honors the memory and passing of the following members: Dr. Leonard Britten Lutz Died: 12/28/2021 Age: 69 Dr. Frank Davis Kissimmee Died: 11/20/2021 Age: 76

FDA: Well-being program Tobacco Free Florida

19 | TODAY'S FDA jan/feb 2022

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happy birthday

celebrating 100 years!

Through wars, hurricanes, recessions and even a pandemic, the FDA’s journal delivers useful information to members.

Today’s FDA Fast Facts The first editor was Dr. A. B. Whitman, of Orlando. During his tenure, the editor was made a member of the state executive council.

Number of editors throughout the years: 16 More than 8,000 members receive Today’s FDA; approximately 16,000 Florida dentists (members and nonmembers) receive the Nov/Dec “Membership Issue.”

1924

1958

Average page count in 2020: 82.

The FDA’s publications staff produced more than 500 journal pages last year alone!

1932

The issue that travels the farthest is mailed more than 6,600 miles to Israel.

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9

1945

22

1974

By Renee Thompson, FDA Director of Communications and Marketing

The Florida Dental Association (FDA), established in 1884 as the Florida State Dental Society (FSDS), is one of the oldest associations in the state. This journal, which was initially distributed as a quarterly publication called Bulletin, began in 1922 and has now reached a major milestone: 100 years in print.

TFDA Timeline 1922: The FSDS established its Quarterly Bulletin.

1929: An appropriation of $100 was made for publication of the Bulletin and it was changed from a quarterly publication to a monthly journal.

While many of the subjects covered in articles have varied through the years and now focus on technology, practice management and emerging trends, there also are topics that have remained consistent. Regulatory challenges, diagnostic discussions, social events and association business have been perennial favorites.

1931: The Bulletin was renamed Florida Dental Journal and was considered the official organ of the FSDS. 1938: The journal name was changed again; this time to Journal of the Florida State Dental Society.

Through the years, there have been several changes — as would be expected. They include different names, altered publication schedules and growing distribution lists. Another example is that, for more than a decade, Today’s FDA also has included a digital edition with interactive links. However, it is important to note that it has been a printed journal for a centu-

1968: The society’s name was changed to the Florida Dental Association and the publication’s name was changed back to Florida Dental Journal.

1990: The journal got its present name, Today’s FDA.

ry. While the FDA has many methods for communicating with members, nonmembers, elected officials and the public, such as email distributions, social media posts and even phone calls, the journal has been a consistent print piece mailed to Florida dentists.

2010:

Designed to help members succeed, there has been a continual effort to use the publication to inform, connect and educate members. Another theme that has been consistent during the journal’s 100 years is evolution. Improvements in appearance, approach and an effort to provide valuable insight have occurred throughout the publication’s history and will surely continue in the future. For now, we are excited to present this redesigned 100th anniversary issue!

2021: Total circulation: 57,099

A change was made from monthly to bimonth- ly publication and distribution, with the Nov/Dec membership-focused issue distributed to all Florida-licensed dentists, even those who aren’t presently FDA members.

2021 1990

2012

1981 1981

23

2002

HELPING MEMBERS SUCCEED

RENEW YOUR MEMBERSHIP FOR 2022 We have your back. Always.

TODAY! Dr. ArNelle R. Wright 17th District Rep. , ADA New Dentist Committee New Dentist Member, ADA Council on Dental Practice Editor, Dental Society of Greater Orlando

THREE EASY WAYS TO PAY: Online: Visit floridadental.org/dues.

Mail: Return blue envelope with statement and payment.

Phone: Dial 850.681.3629 to speak to our friendly membership team.

PAYMENT PLAN: Choose from a variety of monthly installment plans.

AUTO-RENEWAL: Set it and forget it! Your membership will automatically renew each year with the credit card you put on file.

board of dentistry

BOD Meets in Orlando

By Casey Stoutamire, FDA Director of Third Party Payer and Professional Affairs

required so it is not left up to interpretation. The language will most likely define “sufficient amounts to address medical emergencies” for 15 minutes in the definition section of the anesthesia rules and the definition will be based on advanced cardiovascular life support protocols. The FDA will continue to monitor and update its members accordingly.

The Florida Board of Dentistry (BOD) met in Orlando on Friday, Nov. 19, at 7:30 a.m. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Joe Calderone and Director of Third Party Payer and Professional Affairs Casey Stoutamire.

Drs. Andy Brown, Dave Boden, Walter Colon and Steve Hochfelder also were in attendance.

The BOD members present included: Dr. Nick White, chair; Mr. Fabio Andrade (consumer member), vice chair; Drs. Christine Bojaxhi, Tom McCawley, Claudio Miro, Jose Mellado, Brad Cherry and T.J. Tejera; and hygiene members, Ms. Angela Johnson and Ms. Karyn Hill. There is one consumer position open on the board that the governor has not yet filled.

Ms. Hill gave the Council on Dental Hygiene report and presented the proposed rule language allowing hygienists to administer nitrous oxide under indirect supervision. Dr. Tejera informed the BOD that the Anesthesia Committee discussed the language and proposed adding special needs patients and previously sedated patients (including oral sedatives) to the American Society of Anesthesiologists (ASA) IV patients as those that must still be administered under direct supervision. The BOD unanimously approved language allowing a hygienist, with appropriate training, to administer nitrous oxide to ASA I-III patients under indirect supervision. Language also was approved that stated a hygienist, with appropriate training, can only administer nitrous oxide to ASA IV, special needs and previously sedated patients under direct supervision. This rule is not yet effective as it must still go through the administrative rulemaking process. The FDA will keep its members updated about this issue.

Mr. Lawrence Harris, BOD attorney, discussed antitrust issues again; however, this time he mentioned the Alabama BOD case and its settlement with the Federal Trade Commission. As a reminder, President Biden created the White House Competition Council, whose goal is to promote competition in the American economy. Specifically, the council will coordinate, promote and advance federal government efforts to address overconcentration, monopolization and unfair competition in or directly affected the American economy.

As a result, dental licensure and practice act issues will be scrutinized and all regulatory boards will increase anti-trust enforcement.

Finally, Dr. Tejera was elected chair and Mr. Andrade was elected vice chair for 2022. The FDA thanks Dr. White for his leadership as chair during the past year, and congratulates Dr. Tejera and Mr. Andrade on their elections. The FDA looks forward to working with them throughout the upcoming year.

There were five disciplinary cases, one informal hearing, one determination of waiver, two petitions for modification of final orders and two voluntary relinquishments dealing with failing to meet the minimum standard of care, ownership of a practice not entirely made up of licensed dentists and failing to keep adequate records. Peer Review could keep you from BOD disciplinary action. Only FDA members have the benefit of Peer Review. It is much better to be a spectator than a participant in BOD disciplinary cases.

Dr. Tejera reported the Anesthesia Committee had a productive meeting with inspectors to discuss the amount of various drugs sedation permit holders must have in the dental office. Right now, the rule is an “adequate amount.” This objective standard is causing some confusion and leading to different inspectors requiring dentists to have different amounts upon inspection. Dr. Tejera said the proposed language will be presented to the BOD in February about how to better define the quantities of drugs

The next BOD meeting is scheduled for Friday, Feb. 18 at 7:30 a.m. EDT in Gainesville.

25

licensure

Skeptic Turned Supporter: Why I Now Accept the Non-patient Licensure Exam

By David F. Boden, DDS, M.S., FDA President

The debate between patient-based and non-patient-based dental licensure exams has been one of the most controversial topics in dentistry. Many of you know that I do not avoid controversy when principles are involved, and I was right in the middle of this one. Nevertheless, as professionals we should be open to changing our minds when facts lead our way. Let me guide you down my path toward change with a little history.

What is the Purpose of a Licensure Exam?

The sole purpose of licensure by the state is to ensure grantees are as safe as possible to treat Floridians by: p being at least minimally competent. p having met certain didactic and clinical standards tested by standardized examination. p having no criminal record.

Does the Florida Clinical Examination Require a Patient?

For now, yes. The only examination accepted by Florida statute is the American Dental Licensing Examination (ADEX) as administered by the Commission on Dental Competency Assessments (CDCA).

The same statute requires certain clinical

procedures prescribing certain restorations and periodontal procedures be “on a live patient.” As a state law and not a rule, this is not amendable by the Florida Board of Dentistry (BOD).

Is this Going to Change?

Short answer, likely … probably this year. Again, this is not under control of the Florida Dental Association (FDA) or even the BOD, but each can make recommendations. Bills have been introduced into the Florida Legislature to change the statute to an examination developed by ADEX that does not require a “live patient.”

So, why the change?

History Dental licensure examination has been required since the enactment of the first Florida dental law by the state dental legislature in 1887 at the behest of the Florida State Dental Society. There has been a long history of legislation affecting the Dental Practice Act, but in general, the requirement of examination by the Board of Dental Examiners has continued.

In 2011, Things Changed The Florida examination, administered by the Northeast Regional Board (NERB) became nearly identical to the examination given by ADEX in other states. There was a potential lawsuit by a dentist in Illinois who had taken the ADEX exam in Illinois claiming unnecessary restraint of trade by Florida.

After much negotiation with the FDA, the BOD and the Florida Legislature, the statute was changed to today’s iteration. Florida joined the 46 states using ADEX, gained a seat on the ADEX

26

DLOSCE and CDCA Compedont™ were both offered to boards of dentistry throughout the country. DLOSCE, a very elegantly constructed examination, gained a handful of states. The CDCA’s OSCE and Compedont™ had the advantage of existing massive market penetration and rapidly gained large acceptance.

Board and the Florida examination became the ADEX exam.

Candidates could now take the ADEX anywhere it was offered, providing all the modules were included.

Worries regarding a flood of dentists relocating to Florida became unfounded, as only nine dentists reportedly took immediate advantage of the change.

In 2020, Everything Changed Due to the COVID-19 pandemic, the governor ordered practices and universities closed, eliminating the possibility of administering a patient-based examination.

A Crisis Answered

The race was already on to develop a non-patient-based exam due to a push from the American Dental Association (ADA) House of Delegates to eliminate patient-based exams since 2018.

Because the patient-based examination in Florida was required by statute, the only option was for the governor to proclaim an emergency order temporarily setting aside the words “live patient” in the statute and permitting the BOD to administer a non-patient-based examination. This was done with the FDA’s support. It was extended several times, permitting dental candidates to gain licenses during a health crisis.

Canada was using an Objective Structured Competency Examination (OSCE), which I observed, for many years. But they had less than a dozen schools with highly standardized national curricula, whereas the U.S. had, at that time, more than 60 schools with widely differing curricula, varied teaching methods and an accreditation standard that had to encompass all those variations.

The Florida BOD only accepted the CDCA Compedont™ model because they wanted a manikin module, and the statutes already required the ADEX examination as administered by the CDCA.

The ADA accelerated its own version of this type of exam, called the Dental Licensure Objective Structured Clinical Examination (DLOSCE) that did not require patients or mannikins.

I was able to observe parts of the development of the ADA DLOSCE while a member of the ADA Council on Dental Education and Licensure, but full observation of it was shrouded in secrecy and almost all permission for observation was denied.

The Case for a Change All dentists are surgeons, using mental, somatosensory and manual skills to a high degree to perform microsurgical procedures in a difficult environment. William J. Geis, considered the founder of modern dental education, wrote the famous landmark Geis Report for the ADA in 1926:

Meanwhile, the CDCA (the successor to the NERB) already had an OSCE examination and was concluding a three-year development of a mannikin operative dentistry tooth model, called Compedont™. I also was able to observe this and noted a very close resemblance to enamel, dentin and caries textures and hardness; there were several variations of the test lesions.

“… but even if he knew all about dentistry and yet were unable to do effectually its essential tasks, the award to him of a license, the board’s certificate of professional proficiency and acceptability as a practitioner, would be indefensible.”

The variations of Compedont™ caries force candidates to make clinical decisions more typical in practice, rather than minimal carious lesions sought in patients for examinations. t

27

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licensure

”

The CDCA’s OSCE and Compedont™ had the advantage of existing massive market penetration and rapidly gained large acceptance.

The non-patient-based CDCA Compedont™ exam has now been administered by ADEX several times by dental schools in Florida and throughout the country. The feedback by student candidates, some at the institution where I teach (Nova Southeastern University College of Dental Medicine), has been positive, but more telling are the comments from some of the candidates who have taken both the patient-based and this examination. In each case, the candidates said the new examination was significantly more challenging due to the tooth caries variations.

The actual patient-based examination itself has been studied and declared ethical several times by the ADA Council on Ethics, Bylaws and Judicial Affairs. As past chair, I oversaw one of these debates. However, the lack of patient contact eliminates the truly unethical temptations for pre-examination patient brokering by candidates as well as patient extortion of candidates.

My Change

It is with this knowledge that the FDA Board of Trustees and the FDA House of Delegates support the change to the non-patient-based examination for our state of Florida, and support the bills recently filed with the Florida Legislature.

Although you, our member readers, may not have seen this data, it is compelling, and it is my hope that you trust that your FDA delegates and officers have debated this decision at great length and reached a strong consensus. If you would like additional information, I am always happy to speak with you.

Or you can reach out to FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire. My email is dboden@ bot.floridadental.org and Ms. Stoutamire can be reached at cstoutamire@floridadental.org or 850.350.7202.

Let it be known that, once again, you can be proud Florida and the FDA lead the way.

Photos: Courtesy of CDCA-WREB

I was truly a vociferous skeptic to the end regarding the efficacy and validity of a non-patient examination. I had many debates. Early proponents were highly emotional but had few facts to back their arguments. However, we now have data from three iterations of this exam right here in Florida in addition to the exams given in other states and can make factbased decisions. The conclusion is that the ADEX/CDCA OSCE/ Compedont™ examination psychometrics demonstrated at the very least an equivalency to the current patient-based examination that could not be denied.

Sources: https://floridasdentistry.gov/licensing/dentist/#tab-statutes-rules https://floridasdentistry.gov/licensing/ High Fidelity Restorative Compedont™ Human Tooth Simulation, Clinical Performance and Psychometric Statistical Evaluation, A Non-Patient Alternative (Presentation by Dr. Guy Shampaine, CDCA, presented to the FDA House of Delegates Jan. 23, 2021) “One Hundred Years of Dentistry in Florida,” Dr. Robert Thoburn Private communications, ADA CDEL, ADA CEBJA, The National Dental Examining Board of Canada, and of course, Dr. James Antoon

29 | TODAY'S FDA jan/feb 2022

Dental Student Award Ms. Sophia Mohseni

Helping Members Succeed Team Impact Award Mr. Rick D’Angelo

Dental Team Member Award Ms. Teresa Wilcher

Leadership Awards Dr. Lee Anne Keough Dr. Angela McNeight

Public Service Awards Dr. Reza Iranmanesh Dr. Greg Scott 2021 FLA-MOM Hospitality Committee: Ms. Angie Brown, Ms. Stacy Gesek, Ms. Kathy Ilkka

New Dental Leader Dr. Mariana Velazquez

President’s Award Dr. David Boden Dentist Of The Year Dr. Dan Gesek J. Leon Schwartz Lifetime Achievement Award Dr. Howard Pranikoff

Special Recognition Award Dr. Yoshita Patel-Hosking

Join in the recognition of your colleagues.

Tickets are $45 each or $450 for a table of 10.

Purchase your tickets with your FDC2022 Registration.

30

FDA LCDs

Protect Your Profession Legislative contact dentists (LCDs) are the Florida Dental Association’s (FDA) grassroots advocates who take the initiative to get involved in helping protect their profession. These volunteers are a group of people who signed up to ensure dentists are the ones making changes to dentistry and not outside groups or organizations that may not have the same views or priorities as organized dentistry. Becoming an LCD enables you to effect meaningful changes at the state level; changes that could affect not only the health and well-being of your patients, but also the way you conduct business.

Currently, not all legislators in the state have an LCD and we need at least one for each legislator. As Florida’ s advocate for oral health, the FDA wants to ensure that each legislator is educated about the priorities of the dental profession — and we need your help to do it! Signing up to be an LCD is easy: Contact the FDA Governmental Affairs Office (GAO) at gao@floridadental.org or 850.224.1089. The GAO will tell you who your legislator is if you do not know, and how you can reach out to him/her to begin building your relationship with them as an LCD. If you think you don’t have to be involved because “someone else will do it,” you’re leaving that burden to your colleagues and the weight of that burden will eventually become too heavy for them to carry. If you wait to get involved in the legislative process, you may be too late to stop any unfavorable changes made to the dental profession. If FDA members themselves don’t care about how their own profession is governed, who is going to? So, don’t delay, sign up to become an LCD today!

31 | TODAY'S FDA jan/feb 2022

Critical Relationships We Must Protect the Dental Profession

By James Antoon, DMD

Attending Dentists’ Day on the Hill in 1988 (from l to r): Dr. Bob Downey, Mrs. Carol Nissen, Dr. Larry Nissen, Mrs. Jerilyn Bird, Dr. Jim Antoon, Dr. Curt Hill, Dr. Jerry Bird and Dr. Victor Apel.

Sometime after Christmas in 1998, Dr. Bob Downey invited me and three other local dentists, Drs. Jerry Bird, Larry Nissen and Curt Hill, to drive to Tallahassee with him and discuss the Florida Dental Association’s (FDA) legislative priorities with legislators. I met Bob when he was the mayor of Indian Harbour Beach, and I was in high school. He invited students to city hall to encourage us to consider careers in public service. Later, when I received my “white coat” at the University of Louisville, the dean shook my hand and told me he had spoken to Dr. Downey and would be watching me closely. Twelve years later, I was on

32

lcds a long road trip, learning why it was important to stay involved in organized dentistry and why relationships with decision-makers were critical to the future of our profession and the well-being our patients.

”

The following year, we learned that a Senate committee chair would not give our lobbyist an audience to discuss a priority scope of practice bill. Dr. Downey took us to the senator’s office.

The chief of staff, an old friend of his, gave him a warm welcome.

Within a few minutes we were sitting with Sen. Patsy Kurth. She told us that she was overwhelmed by other professions, pulling her in different directions but knew that Dr. Downey acted in his patients’ best interests. She then supported our issue in committee.

On another visit, the FDA was faced with losing our health insurance due to expenses and limits on premium hikes. We needed a waiver from the insurance commissioner to continue providing coverage to FDA members and their families and employees. The commissioner had opposed our request. Bob made a call and we assembled at Commissioner Bill Nelson’s office. We were warmly greeted, and the FDA president and Bob explained our situation.

We received the waiver.

There were many similar events in those first years. Neither the senator nor the commissioner belonged to the same political party as Dr. Downey, but both knew him personally and respected his dedication to dentistry and our (their) community. He was the perfect legislative contact dentist (LCD).

Dr. Bob Downey charged us with supporting local candidates and developing friendships with leaders in both parties.

On the way home one year, Bob told us he was retiring and that his health would prevent him from attending future events in Tallahassee. He charged us with supporting local candidates and developing friendships with leaders in both parties. Larry and Carol Nissen, Jerry and Jerilyn Bird, Curt and Dana Hill and I have attended nearly all the past 23 Dentists’ Day on the Hill events.

Jerry took up the task of scheduling with legislators. Larry led the FDA through difficult times and befriended many in the Legislature. Carol, Jerilyn, Dana and the Alliance of the FDA have raised money, secured lodging and food, and helped us gain access to legislators.

Bob died in 2010. His service to dentistry and our community continues through the work of those he mentored. He would be proud of our current and past LCDs and tell all of us to stay involved.

33 | TODAY'S FDA jan/feb 2022

Attend DDOH

to Bring About Change

By Susan M. Byrne, DMD

The first Dentists’ Day on the Hill (DDOH) I attended was as a dental student at the University of Florida. It was amazing to see dentists from all over Florida converging in Tallahassee to enact change and help preserve the way we practice dentistry. Attending this event and being a part of the local chapter of the American Student Dental Association was the start of my involvement in local and state government on behalf of dentistry.

After graduating, I became a member of the Florida Dental Association (FDA) and the American Dental Association (ADA) as a way of staying involved in my profession. I’ve tried to attend DDOH

every year that I can. I think it’s our responsibility as dentists to be aware of what is going on in our government, whether it’s locally, statewide or nationally, as it pertains to dentistry and how we treat our patients. The way I see it is, if you aren’t willing to help bring about change through attending or supporting events and causes related to dentistry, how can you complain when something goes wrong? Being involved with your community is the first step to enacting change.

If you haven’t been to DDOH, consider attending next year. You also can get involved by becoming a legislative contact dentist (LCD) in your area. By participating in these events, you can interact and learn from dentists you wouldn’t meet otherwise. This

34

lcds

”

The way I see it is, if you aren’t willing to help bring about change through attending or supporting events and causes related to dentistry, how can you complain when something goes wrong?

also is a fantastic way to make connections with dentists in the wider community and even make lifelong friends. Joe Anne Hart and Alexandra Abboud at the FDA’s Government Affairs Office are valuable assets and are always eager to answer any questions or help when needed.

I’ve been in practice for more than 20 years, and I’ve been fortunate enough to be able to service my fellow colleagues in so many areas, both locally and statewide. I’ve served as president of the Leon County Dental Association and the Northwest District Dental Association, as a delegate of the FDA House of Delegates and as an ADA alternate delegate. Now, I’m an alternate to the FDA Board of Trustees. I’ve stayed so involved because I love being a dentist and I love treating my patients the way I think they should be treated: with kindness and respect. I’m thankful I have the ability to relieve people from pain and give them back the ability to smile.

This year, I’m the co-chair of the 2022 Florida Mission of Mercy (FLA-MOM). It will be held in Tallahassee on March 11-12 at the Donald L. Tucker Civic Center. If you haven’t volunteered at a FLA-MOM event before, please consider doing so this year. It’s an honor and a privilege to help those who are desperately in need, especially over the last two years due to COVID-19. Go to flamom.org for more information and to register to volunteer. I hope to see you there!

Dr. Byrne is an NWDDA alternate trustee to the FDA Board of Trustees.

35 | TODAY'S FDA jan/feb 2022

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Advocacy: A Key Member Benefit

By Mike Eggnatz, DDS

Advocacy is consistently ranked as the one of the most valuable membership benefits by members of the American Dental Association (ADA). It is a comprehensive term that encompasses many facets of our relationship with legislators who determine the scope of our dental license and our profession.

There are national issues we advocate for through the American Dental Political Action Committee (ADPAC), and many more here in Florida through the Florida Dental Association Political

Action Committee (FDAPAC). National issues we have successfully advocated for are the repeal of the McCarran-Ferguson Act (a law that exempts insurance companies, including health insurance companies, from some of the antitrust laws) and an appropriate pathway for a dental benefit in Medicare if it were to be included in legislation.

At the FDA, you can be directly influential as a grassroots dentist by becoming a legislative contact dentist (LCD). You can have a direct and immediate impact on legislation that affects your

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dental license and your ability to practice your profession. It’s easy, local and personal with your local representative or senator, whom you may already know or even have as a patient in your practice.

You are the elected official’s constituent and a respected professional who can and should educate them with simple messaging on subjects you already know well, like the importance of fluoridation in community drinking water, funding for the Dental Student Loan Repayment Program and Donated Dental Services program, Florida Mission of Mercy and Reducing the Insurers’ Recovery of Overpayment to Providers and Liability for Health Care Providers. Educating your local legislators who represent you in Tallahassee is in your interest and it protects the profes-

sion that you have earned with your degree(s). Get involved and stay informed for everyone’s sake. All politics are local, and you can make a difference at home and at the state level. You are an important messenger, and the FDA can help you with the right messaging to educate your legislator(s). Contact the FDA’s Governmental Affairs Office at gao@floridadental.org or 850.224.1089 to become more involved. It truly takes little time and effort, but has a tremendous influence on all of us and our profession!

Dr. Eggnatz is a member of the FDA House of Delegates and a delegate to the 17th District Delegation to the ADA.

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You can be directly influential as a grassroots dentist by becoming a legislative contact dentist (LCD).

You can have a direct and immediate impact on legislation that affects your dental license and your ability to practice your profession.

39 | TODAY'S FDA jan/feb 2022

Help Shed Light on the Dental Profession

By Liz Gesenhues, DDS

Engaging in politics is not something I’ve ever wanted to pursue; I had zero respect for politicians, and it really bothered me to give my hard-earned money to the political action committees (PACs)!

However, my years in the Florida Dental Association (FDA) House of Delegates (HOD) made me painfully aware of how the political/ legislative process was being used to advance the special interests of others at the expense of dentists, their patients and the profession. The HOD also gave me the opportunity to see how hard our lobbyists worked for us. That realization resulted in Step 1: I loosened my wallet and became a PAC supporter.

Step 2 came when I decided to participate in Dentists’ Day on the Hill (DDOH) and marveled at how effectively our state, district and local leadership addressed our concerns with lawmakers. It demonstrated how tightly coordinated they work with FDA Chief

Legislative Officer Joe Anne Hart and her team. DDOH showed me how much pressure lawmakers come under from so many directions — everyone has a special need/interest they want addressed. Our legislators are no different than the rest of us; they have areas of expertise from their work and personal life, and just don’t know it all! They depend on input from trusted sources to shed light on areas they are not familiar with or an expert in, which helped me realize how important it was to be a legislative contact dentist (LCD). When the dental therapy bill was first presented, I was so riled up I marched to my legislator’s office to register my complaint. That resulted in Step 3: I became an LCD. I’ve heard every excuse under the sun about how people don’t have time to get involved politically and I get it. But it isn’t an option — if you don’t want a bureaucracy (insurance, legal, political) dictating your clinical practice, you’d better at least make the

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time to contact your legislators! It’s not that complicated: Find out who your state legislators are, bookmark their websites, have a form letter started with the most important info (the name and address of the legislator) on it and when a topic of interest comes up, insert your thoughts, opinions and recommendations and fire it off to every person who is representing you. If your legislator has an office reasonably close to you, drop in and introduce yourself. You’ll probably spend your time chatting with their assistants, but they are a wealth of information and can help you a lot, as they sure did for me!

If you love the profession you’re in, get involved with it.

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Our legislators are no different than the rest of us; they have areas of expertise from their work and personal life, and just don’t know it all!

41 | TODAY'S FDA jan/feb 2022

LCDs Bring the Passion

to Close the Sale Sale Closed

By Paul Werner, DDS

I’m just about retired, but I’ve made the decision to remain active in organized dentistry, including its relationship with the political process that impacts us all. I used to be a legislative contact dentist (LCD) for five or six legislators; as they’ve termed out, I’m now down to two: a congressman and a state representative.

In my 30-something years of involvement, I’ve seen and perhaps done a lot. Politics has become a lot more divided and angrier over time, but I still believe that if we set aside the hot-button,

red-meat, partisan issues, most politicians often want to do the right thing. The problem is they usually don’t know what the right thing is. Sometimes it’s preventing the wrong thing. Sometimes it’s a good thing for something unrelated to dentistry that has an unintended negative impact on our profession.

One of the jobs of our Governmental Affairs Office (GAO), with our assistance, is to help politicians distinguish between the good, the bad and the ugly. Politicians know little about what we, as dentists, do and how we do it. They often have no idea how their impact on us impacts the oral health of the public.

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Our professional staff does a great job in educating legislators on issues impacting us, but as wonderful as they are, they are not dentists. They can explain the nuts and bolts of an issue, and how it affects dentistry, but by using a dentist as a closer, it can be better explained how it affects an individual dentist, and his or her patients.

Governmental and insurance rules and regulations can place great stress on a dental practice that only the dentist and staff can feel, not just be aware of. For example, while our GAO pros can explain to a legislator the problems and unfairness of an insurance clawback, we are the ones who are being clawed. They bring the facts, but we are the ones who bring the passion, and who often can close the sale.

Being involved at this level is the big line of defense against abusive actions by the government and the insurance industry and the burdens they place on you and your practice. Without

the vigilance of the GAO with member support, you would have to hire a physician to be the medical director of your practice, as well as wear a name badge. These two things became close to becoming law in the past.

I believe the best way for you to become involved is to become an LCD for a legislator, or a few. I read in one of our publications that a good number of Florida legislators do not have an LCD. Is one of them a friend or acquaintance, a patient or your legislator?

Consider establishing a relationship with one. Do not let party difference be a deterrent, as when you meet, you represent the “Tooth Party” only. Most legislators would welcome your collaboration with them.

Get involved to protect the health of our patients, our practices and our profession.

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Being involved at this level is the big line of defense against abusive actions by the government and the insurance industry and the burdens they place on you and your practice.

43 | TODAY'S FDA jan/feb 2022

IT’S TIME TO RENEW YOUR LICENSE

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Duty, Honor, Country,

Profession

By Steve Hochfelder, DMD

This is the motto of the United States Military Academy at West Point, which is inscribed around the hallowed grounds of the premier leadership institution in the world. This motto is ingrained in all cadets during their 47-month experience at the academy.

These famous words were uttered by the iconic Gen. Douglas MacArthur, a West Point graduate and superintendent. I respectfully substitute profession for country and use this phrase to inspire and define my commitment to dentistry. Allow me to explain: Duty: In military terms, it is defined as doing that which is asked of you regardless of whether you agree. It is done because you are committed to a higher cause. As dentists, we have a duty to serve our patients and profession to the best of our ability and with our best effort.

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Honor: In military jargon, is an honor to serve your country. It is an honor to help others in need and be part of a revered profession.

Profession: Our noble and esteemed profession is one of service to our patients, staff and communities. It is a privilege to be part of.

The often-asked question to many leaders in organized dentistry is “What have the American Dental Association and Florida Dental Association (FDA) done for me?” I hear it all too often and as many have heard, I happily reply, “Just volunteer and get engaged in any leadership position or committee with your local dental society/community or the FDA. Join any of the many committees, attend Dentists’ Day on the Hill or become a legislative contact dentist. It will quickly become apparent and clear what organized dentistry does for YOU and ALL dentists.” Quite simply, organized dentistry advocates on our behalf, looks out for our best interests and works tirelessly behind the scenes to protect our profession against many outside influences. Get involved for a year and then come back and we can discuss that question.

However, there won’t be a discussion. You will never ask it again, I assure you. It becomes imminently clear.

Initially upon graduation from the University of Florida College of Dentistry in 1986, I was quite involved in organized dentistry for the first seven to 10 years, but then life got in the way. Five kids and a reset were in order. I still attended meetings and stayed engaged, but my priorities had to be realigned. Now with my youngest son off to college, I am back at what I was many years ago: A fully committed and reengaged dentist welcoming leadership opportunities and growing in knowledge to better serve and represent my fellow dentists. I am surrounded with many great fellow dentists and leaders whom I both learn from and admire.

I challenge and encourage all of you to do the same, especially the younger dentists and recent graduates. You will build lifelong friendships and enjoy good times and grow as a person and leader. A fulfilling career is one that is committed to excellence, and the FDA is defined by excellence. The staff and support for members are second to none, and they advocate for us with a passion and professionalism that is inspiring.

Dr. Hochfelder is a member of the FDA House of Delegates and the Governmental Action Committee.

Quite simply, organized dentistry advocates on our behalf, looks out for our best interests and works tirelessly behind the scenes to protect our profession against many outside influences.

47 | TODAY'S FDA jan/feb 2022

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The Evolution of Dentistry

By Joshua Golden, DDS

The field of dentistry is changing right before our eyes. In my opinion, the way we think, practice and care for patients has evolved over the last decade and impacted our journey from dental students to dental professionals. Essential topics such as representation for dental support organizations (DSOs) and diversity in dentistry are a few reasons why I attended the Florida Dental Association’s (FDA) Dentists’ Day on the Hill (DDOH) at the Capitol.

I remember being in dental school and feeling a “stigma” toward dentists who chose a DSO model for their practice. The DSO model often was seen as a threat to the “grassroots” ownership some associate with the dental field. As an owner dentist in a DSO, I can say that times have changed, and DSOs are being recognized more as a viable option for dental practice. Receiving my 2021 membership to the American Dental Association (ADA)

and the FDA through Pacific Dental Services showed me that organized dentistry is becoming more inclusive of DSOs, and I am excited for the opportunity to plug into the dental association, get involved and ensure all dentists are represented.

My starting point was with the Leaders Emerging Among Dentistry (LEAD) training program in October 2021. This program focused on current trends in dentistry, and I truly enjoyed Dr. Chelsea Fosse’s discussion of the improvements in dental technology, changes in the dental insurance landscape and the multiple shifting demographics as it pertains to the face of dentistry. As an African American dentist, I am still shocked that the distribution of Black dentists hasn’t grown in the past 20 years, and nationally we only represent 3.8% of the profession. Diversity in dentistry is a significant topic for me because I believe my community needs more representation in dental care. I want to be a part of the solution by serving Black and brown communities and em-

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Diversity in dentistry is a significant topic for me because I believe my community needs more representation in dental care. I want to be a part of the solution by serving Black and brown communities and emphasizing the importance of education and prevention through advocacy.

phasizing the importance of education and prevention through advocacy. Learning that FDA member dentists have traveled to Tallahassee for the past 25 years to proudly advocate on behalf of organized dentistry and the issues that impact the communities I serve highlighted a new way for me to share my voice and get more involved.

On Feb. 1, I eagerly joined my colleagues and attended DDOH in Tallahassee, where we spread the message that good oral hygiene works in preventing dental disease. I look forward to continuing to represent ALL dentists in the ever-evolving field of dentistry with the goal to motivate, educate and inspire!

FLORIDA DENTAL CHATTER This Facebook group is designed for dentists to interact with other members, receive the latest updates and information, and engage with FDA leaders and staff. This is the place to be in the know!

Join us at facebook.com/groups/floridadentalchatter.

49 | TODAY'S FDA jan/feb 2022

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Are Your Assistants Certified?

By Richard C. Mariani Jr., DDS, M.S.

Whether you are practicing orthodontics as a general dentist or as an orthodontist, what is the significance of your assistants being certified?

Did you know that the Florida Statutes specify that if an assistant is not certified and he or she is performing tasks only allowable by a certified assistant, the dentist may be liable to having his or her license suspended for a minimum of six months? Statute 466.028, Grounds for Disciplinary Action, Action by the Board states: 1. The following acts constitutes to ground for denial of a license or disciplinary action, as specified in s.456.072 (2: The board may enter and order denying licensure or imposing any of the penalties in s.456.072). (z) Delegate professional responsibilities to a person who is not qualified by training, experience, or licensure to perform them. There shall be a minimum six-month suspension of the license of a dentist who is convicted of a violation of paragraph (1)(z).

2. The board may enter and order denying licensing or imposing any of the penalties in s.456.072.

The Florida Association of Orthodontists (FAO) provides convenient access to the certifying process. The FAO certification test is given in 13 locations throughout the state every month of the year. Your assistant needs only six months of in-office training and experience to qualify to take the test. The fee is $125 per applicant.

Dr. Mariani Jr. is the FAO Expanded Duties Committee chair.

53 | TODAY'S FDA jan/feb 2022

Test Locations and Times For more information regarding test locations and times, visit the FAO website at faortho.org.

For any other questions or more information, please contact Dr. Richard Mariani Jr. at DOGRM@atlanticbb.net.

AMATEUR PHOTOGRAPHY IS GREAT FOR VACATIONS (JUST NOT GREAT FOR RADIOGRAPHY) If you’re doing radiography without the proper training, it’s really more like amateur photography. There’s no room for amateurs in dentistry and it violates Florida law. The Florida Dental Association (FDA) Online Radiography Training Program provides you the formal training you need, with the professional development you want. This training enriches your career path while contributing a vital service to your patients and dental team. It’s the most convenient and economical way to get the radiography training required by Florida law. No travel. No time away from work. Train online, at your own pace. It’s affordably priced, too — just $285 per student for FDA members!

FDC2022 | SPEAKER preview

workplace stress: facts and fictions nesses $450 billion a year at a minimum, a figure that would certainly be revised upward during crises like the Boeing 737 Max airplane failure or the pandemic.4 A Gallup poll found that 51% of stressed employees are disengaged;5 and a Colonial Life poll found that 41% are less productive.6 Stress compromises customer service, causes distractions that lead to costly errors, increases absenteeism and hurts the company image among future employees and customers.

By Jen Butler Heavy workloads, team conflicts, miscommunications, struggles to balance work and home, and job insecurity — it’s no wonder that we’ve come to believe that workplace stress is inevitable.

That first fiction, that workplace stress is inevitable, leads us to a second: Stress is something we simply have to live with. In fact, if we want to rise in our jobs, we want to learn how to handle stress like the CEOs do. Finally, if we don’t want to live with stress, countless enthusiasts insist they have the one true cure for stress — and if we don’t like that cure, we’re doomed.

The Truth about Stress With so many myths circulating about stress, it’s time to look at a few hard facts:

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Stress is not inevitable, but it is increasing. COVID-19 plunged us into fears around a new disease, unemployment and food insecurity. A study by the Centers for Disease Control and Prevention compared similar populations from June 2019 and June 2020 for symptoms of anxiety, depression and strain. Anxiety disorders rose from 8.1% in 2019 to 25.5% in 2020; depressive disorders tripled from 6.5% to 24.3%; and mental strain rose from 30.9% to 40.9%.1 Workplace stress is life-altering at all levels of an organization. According to a recent Yale School of Management study, high exposure to incredibly stressful situations reduced a CEO’s lifespan by at least 10 years.2 Moreover, 80% of second-level executives identify themselves as burned out.

Finally, a 2018 survey by Wrike found that in both small and large companies, the major contributor to employee stress was poor communication.3 Workplace stress is too costly to ignore. According to the American Psychological Association, stress causes U.S. busi-

The Individuality of Stress One size does not fit all. We are each susceptible to different triggers for stress. One person may shrug off a friend’s insensitive joke or the failure of a pet project or even a “happy” event like a promotion; another finds it intolerable. Our go-to responses to stress also vary wildly, through every stage from total withdrawal to anger and even violence.

Stress itself has three components. It may be psychological, the stress we put on ourselves by our way of thinking; physiological, those things we do to our body that are unhealthy (such as sitting at a desk for hours without a break); and situational, brought on by events, activities and situations in our daily life (such as interpersonal conflict). It may be triggered by any one or any combination of those components, or all three together.

The Options Available The same stress-reduction techniques may make perfect sense for some of us and only add to the stress of the rest. Many socalled team-building events have that effect — not everyone bonds happily over bungee jumping. Moreover, we all learn at a different pace and need time to absorb, practice and embrace new ways of responding to stress. The options for dealing with stress fall broadly into four categories:

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Mindfulness brings us back to the here and now and to appreciation and gratitude for what we have. It breaks the stress of always thinking about what might have been, what might happen and what we cannot have.

1. Health. When we exercise too much or too little, sleep too much or too little, and fail to take opportunities to rest and relax, we put stress upon our health. A failure to protect our health also may be a clue to underlying problems. For example, sleep apnea, restless leg syndrome, teeth grinding, arthritic pain and allergies may all interfere with sleep. By staying within healthy parameters, we give our bodies time to repair and rejuvenate and our minds a chance to make creative connections that fizzle out among the constant interruptions and challenges of daily life. Restoring health begins with a visit to a physician, followed by learning specific techniques to overcome physical and emotional challenges.

2. Habits. Self-medicating and self-soothing behaviors often emerge when we are stressed. Cigarettes, alcohol, drugs and sugar are among the items we turn to when we ignore stress or refuse to deal with it. The stress trigger becomes a cue (“I can’t think straight”), which leads to a routine (“I have to get away from here”) and provides the soothing reward (“I’ll go out for a smoke”). Habits may be broken and rebuilt when we understand that cue-routine-reward cycle and how to make the cycle work to our benefit.

3. Mindfulness. Our minds are tricky — they may constantly ruminate about the past, worry about the future or shut down to find temporary relief. They are seldom here, in the moment. Mindfulness brings us back to the here and now and to appreciation and gratitude for what we have. It breaks the stress of always thinking about what might have been, what might happen and what we cannot have. Among mindfulness activities are visualization, focused breathing, practices like

qigong and yoga, and distractions like counting your steps as you walk (rather than revisiting your anger once again, for example).

4. Skills. No one teaches us how to be a team member or leader at work, or a partner or parent at home. The skills that we need to communicate well, deal with conflict, avoid discriminatory behavior, foster productivity and engagement, and so on can be learned, and once learned they reduce our workplace stress considerably. Even mentor relationships benefit from professional advice on giving and receiving mentoring. “I know how to handle this” is a very satisfying feeling.

Overcoming Reluctance With all the various techniques, programs and experts at our disposal, why do we hesitate to deal with stress? In addition to the belief that stress is inevitable, ignoring it is laudable and bowing to it is a moral failure, we face the stigma associated with any referral to a doctor, mental health practitioner or coach.

That stigma may find its roots in a desire to be perfect, harnessed to a secret conviction that we are far from perfect and, therefore, need to hide anything we consider a weakness. It also may arise from a desire to transform ourselves into something we aren’t — thinner, smarter, more successful, more in command — leading us to try paths that compromise our physical, mental and emotional health. We also may simply be afraid. What part of ourselves will we lose during meditation? How much respect will we lose if anyone finds out we are addicted to stimulants? What if we are expected to do more and be better when we are already struggling? t

57 | TODAY'S FDA jan/feb 2022

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This reluctance is a source of stress. However, there are practitioners out there who will meet us where we are, offer a range of options, and provide the time, resources and skills needed to deal with stress. We do need to deal with it. The personal, organizational and social costs of stress are simply way too high.

Ms. Butler is the CEO and founder of JB Partners, and brings a Master of Education degree, board certification as a coach, a fresh perspective and more than 30 years of experience to business consulting. A Diplomat of the American Institute of Stress, she helps businesses across the U.S. and Canada get back to enjoying their work — and the financial and lifestyle benefits of success.

Ms. Butler will be speaking at the 2022 Florida Dental Convention and presenting four courses. On Thursday, June 23, “People Who Drive You Crazy: Difficult People Made Easy” will be at 9 a.m. and “From Functional to OPTIMAL: Facing Realities of Stress and Kicking its A**” will be at 2 p.m. On Friday, June 24, “From Chaos to Cohe-

siveness: Five Foundations for Predictable, Repeatable and Scalable Success” will be at 9 a.m. and “Team Synergy: The Science Behind the Success of High-performing Teams” will be at 2 p.m.

References: 1. Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020.

MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. dx.doi.org/10.15585/mmwr. mm6932a1 2. Borgschulte, Mark and Guenzel, Marius and Liu, Canyao and Malmendier, Ulrike, CEO Stress, Aging, and Death, June 2020. Available at SSRN: ssrn.com/ abstract=3638037 3. Hansen, Brianna. Crash and Burnout: Is Workplace Stress the New Normal?, September 6, 2018. wrike.com/blog/stress-epidemic-report-announcement/ 4. stress.org/workplace-stress 5. Harter, Jim. U.S. Employee Engagement Reverts Back to Pre-Covid-19 Levels, October 16, 2020. gallup.com/workplace/321965/employee-engagement-reverts-back-pre-covid-levels.aspx 6. Colonial Life, Stressed workers costing employers billions, March 14, 2019. coloniallife.com/about/newsroom/2019/march/stressed-workers-costing-employers-billions

Read, Learn and Earn!

Visit floridadental.org/online-ce for this FREE, MEMBERS-ONLY BENEFIT. You will be given the opportunity to review the “Diagnostic Discussion” and its accompanying photos. Answer five multiple choice questions to earn one hour of CE.

Contact FDC Marketing Coordinator Brooke Martin at bmartin@floridadental.org or 800.877.9922.

59 | TODAY'S FDA jan/feb 2022

FDC2022 | SPEAKER preview

erosive tooth wear:

Etiology, Diagnosis, Risk Factors and Management drinks have been shown to have erosive potential. The erosive potential of beverages is not only related to their pH value; beverage composition and the titratable acidity can be even more important. The consumption of these drinks has increased tremendously in the last decade.

By Alex J. Delgado, DDS, M.S. Dental erosion is the irreversible loss of tooth structure by a chemical process that does not involve bacteria.1 Diagnosis at an early stage may decrease the risk of wear reaching a pathological state, in which the wear requires restorative intervention.2 Enamel and root dentin begin to decalcify at pH values of 5.2-5.5 and 6.7. There are two types of dental erosive causes, intrinsic and extrinsic. The intrinsic type results from gastric acids entering the oral cavity, most often due to gastroesophageal reflux disease (GERD) or eating disorders. The extrinsic type is mainly due to the ingestion of acidic diet. A thorough medical history is essential to identify the causative factors, and treatment should never be initiated until the factors at play are under control.

Intrinsic Causes The intrinsic causes are mainly from gastric acids, which can reach a pH value of less than 1. The prevalence of GERD in the adult U.S. population has been found to be 6-10%.3 Clinical symptoms of GERD are heartburn, non-cardiac chest pain, chronic cough and hoarseness. Dental erosion is the primary oral clinical manifestation of patients who suffer from this condition.3 Systematic reviews have reported the prevalence of dental erosion among GERD-positive patients to be in the range of 32.5-48%.5 Eating disorders, such as anorexia nervosa (AN) and/or bulimia also may cause dental erosion. Excessive vomiting, in addition to eroding the teeth, leads to dehydration and low levels of salivary flow.4

Clinical Signs The three main clinical signs of erosion are cupping of cusps, restorations standing proud or alone, and the absence of anatomical features (Figs. 1-3). It is essential to determine the location of these clinical signs to understand the cause.

Prevention and Management of Dental Erosion When a patient is diagnosed with dental erosion, one needs to identify whether it is intrinsic, extrinsic or both. No matter what the eating disorder the patient is suffering from, open communication between the patient and dentist must be established, using a nonjudgmental approach.4 A multidisciplinary approach is crucial to treat these patients, and the role of the dentist is to assess the case and make the appropriate referral to a psychologist, nutritionist and physician. Keep in mind that dentists often are the first health provider to identify these situations.

In case of extrinsic erosion, a diet analysis should be made, including at least two weekdays and a weekend. The patient needs to be educated about the nature of the condition and encouraged to change his/her dietary habits to a less erosive pattern. Acidic consumption should be reduced with emphasis on reducing the frequency of acidic attacks. Acidic beverages should be substituted with water, or milk ideally, or the mouth at least rinsed with water, fluoride or bicarbonate after acidic drinks.

Extrinsic Causes Extrinsic erosion is due to acidic dietary habits. Several beverages such as citrus juices, carbonated drinks, teas, wine and designer

If the posterior teeth are affected by erosive tooth wear, the vertical occlusal relationship can be raised with either direct

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When a patient is diagnosed with dental erosion, one needs to identify whether it is intrinsic, extrinsic or both.

composite resin or bonded onlays on the affected teeth, thus gaining space to restore the anterior dentition adhesively.

Evidence is supporting the use of bonded ceramic onlays, which defy traditional retention and resistance form, a very favorable treatment modality for eroded teeth. Long-term clinical evidence on this treatment modality is still being established, but short- to medium-term studies and reports have shown very good results.

Numerous case reports have been published where cases of erosive tooth wear have been successfully treated using bonded ceramic onlays, palatal and facial veneers, and direct composite.6

Fig. 1: Cupping

For more severe cases, a full-coverage restoration may be the most reasonable treatment to offer. Still, our goal should always be to delay such invasive treatment for as long as possible, and whenever possible detect this condition early and employ preventive measures and minimally invasive treatment modalities to protect what is remaining.

Dr. Delgado is a clinical associate professor and director of dental continuing education at the University of Florida College of Dentistry. He will be speaking at the 2022 Florida Dental Convention and presenting two courses. On Saturday, June 25, “Conservative Approaches in the Aesthetic Zone” will be at 9 a.m. and “Erosive Tooth Wear: Etiology, Diagnosis, Risk Factors and Management” will be at 2 p.m.

Fig. 2: Restorations standing alone

References 1. Pindborg J. Pathology of Dental Hard Tissues. Copenhagen: Munksgaard; 1970.

2. Amaechi BT, Higham SM, Edgar WM. Influence of abrasion in clinical manifestation of human dental erosion. J Oral Rehabil 2003;30(4):407-13.

Fig. 3: Loss of anatomical features, such a cusp ridges, occlusal anatomy.

3. Barron RP, Carmichael RP, Marcon MA, Sandor GK. Dental erosion in gastroesophageal reflux disease. J Can Dent Assoc 2003;69(2):84-9.

5. Milosevic A. Gastro-oesophageal reflux and dental erosion. Evid Based Dent 2008;9(2):54.

4. Hellstrom I. Oral complications in anorexia nervosa. Scand J Dent Res 1977;85(1):71-86.

6. Dietschi D, Argente A. A comprehensive and conservative approach for the restoration of abrasion and erosion. Part I: concepts and clinical rationale for early intervention using adhesive techniques. Eur J Esthet Dent 2011;6(1):20-33.

61 | TODAY'S FDA jan/feb 2022

FDC2022 | SPEAKER preview

focus on successful treatment outcomes of adjunctive clinical homeopathy to ascertain resulting improvement for the patient and therefore for us. Dogmatism is a sign of inexperience.7

By Diana Bronstein, DDS, M.S., M.S., M.S., DABP, DICOI, FICOI In these unprecedented times, the challenges for dental practitioners mirror the need for implementation of new pathways to serve their patient population and all who depend on their leadership and work. Being successful with patient treatment is imperative for all practicing dentists. Treatment success is determined by the outcome for the patient who cares primarily for levels of morbidity and only then for aesthetics, function and cost.

Fear of pain during and after the procedure will deter a patient

Meta-analysis reviews hold the highest academic level of evidence, yet most conclude righteously with the statement that more research is needed, while expert opinion, clinical experience and case reports, for example, hold the lowest level of academic empirical evidence and are considered anecdotal. The dentist in the trenches will appreciate safe and reliable means to achieve clinical treatment success.

from seeking care until it is the pain that will force the patient to present as an emergency.1,2

Homeopathy has been used as a treatment modality since the 1800s and evidence of its safety and efficacy has been documented extensively,8 yet, it remains the most controversial treatment modality in the field of complementary medicine. The reasons for the polarized, at times hostile, controversy are rooted in fear of the unknown, which is the greatest fear of all,9 and lack of understanding of how a nanoconcentration can affect an organism inversely to its level of dilution. The higher the dilution, the lower the concentration, the stronger and deeper the effect. The ArndtSchulz law,10 while it is currently being applied to laser and phototherapy,11 seemingly contradicts the dosage-dependent rule of toxicity, which says the dose makes the poison. In fact, there is no contradiction, as toxicity has dose-dependent inhibiting effect on the organism. At the other side of the spectrum, the question arises how micromolecular dosage and Brownian motion energy can affect an organism at all.

Even before the opioid crisis, NSAIDs have been routinely used in indicated cases. Contraindications in general are GI, urogenital and nephrotic conditions, as well as allergies and sensitivities to these drugs. These cases leave little choices for postoperative moderate to severe pain management.3,4 Many patients are familiar with Arnica as an antiphlogistic and analgesic in herbal as well as homeopathic form. They often are better informed than their dentist. This can impact rapport and trust. Regardless of application and use, it behooves each provider to present to the patient upon request, rounded knowledge of pain management and treatment modalities.13 To differentiate and define alternative versus complementary versus integrative medicine and herbalism versus homeopathy, on the one hand, will demonstrate the provider’s competence and, therefore, increase patient’s trust. On the other hand, it can provide another tool in the dentist’s toolbox, which has a great cost-benefit ratio.5,6

In clinical practice, the most experienced and successful practitioners use, endorse, and promote pre- and postoperative intraoral topicals and ingestible preparations containing homeopathic dilutions of Arnica montana with great and reproducible success.14 Current and classic research is providing evidence-based grounds for clinical application.8,12-17

As credible professionals, we practice evidence-based dentistry, which is clinically applicable, ergo translational, as well as it being reliable and reproducible in its successful treatment outcome. Before implementing any procedure or change, we strive

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“

„

Homeopathy has been used as a treatment modality since the 1800s and evidence of its safety and efficacy has been documented extensively,8 yet, it remains the most controversial treatment modality in the field of complementary medicine.

What is holding back progress, innovation and reduced postoperative patient morbidity is lack of education in unfamiliar concepts. Even if the dentist does not change the way he practices after learning new modalities in a continuing education course,18 the next time a patient mentions dental homeopathy, the average patient will not know more about the subject matter than the dental provider, which the patient hopefully chose for his expertise in all oral-related questions.

Dr. Bronstein is a Diplomate of the American Board of Periodontology and a Diplomate and Fellow of the International Congress of Oral Implantology with a Master’s Degree in Oral Biology, Medical Education and Health Law. She is an adjunct clinical professor at Nova Southeastern University College of Dental Medicine and practices in the Tampa Bay area.

Dr. Bronstein will be speaking at the 2022 Florida Dental Convention and will be presenting her course, “Science of Evidence in Homeopathy and Applications in Dentistry,” on Thursday, June 23 at 9 a.m.

References: 1. Bürklein, S., Brodowski, C., Fliegel, E., Jöhren, H. P., & Enkling, N. (2021).

Recognizing and differentiating dental anxiety from dental phobia in adults: a systematic review based on the German guideline “Dental anxiety in adults.” Quintessence International, 52(4), 360–373. https://doi-org.ezproxylocal.library.nova. edu/10.3290/j.qi.a45603 2. Sambuco, N., Costa, V. D., Lang, P. J., & Bradley, M. M. (2020). Assessing the role of the amygdala in fear of pain: Neural activation under threat of shock. Journal of Affective Disorders, 276, 1142–1148. https://doi-org.ezproxylocal.library.nova. edu/10.1016/j.jad.2020.07.110 3. Sabounchi, S. S., Sabounchi, S. S., Cosler, L. E., & Atav, S. (2020). Opioid prescribing and misuse among dental patients in the US: a literature-based review.

Quintessence International, 51(1), 64–76. https://doi-org.ezproxylocal.library. nova.edu/10.3290/j.qi.a43697

5. Lennihan, B. (2017). Homeopathy for Pain Management. Alternative & Complementary Therapies, 23(5), 176–183. https://doi-org.ezproxylocal.library.nova. edu/10.1089/act.2017.29129.ble 6. Bronstein, D. (2017). The Role of HOMEOPATHY In Oral Health Care. Dimensions of Dental Hygiene, 15(8), 55–58.

7. Ciurczak FM, & Smith E. (1984). Dogmatism, age and change: a perspective of a nurse practitioner program. Journal of Nursing Education, 23(9), 374–379.

8. https://homeopathyusa.org/uploads/Homeopathy-Research-Evidence-Base-09-01-2021.pdf 9. Rusbatch V. (2000). Fear of the unknown. Vision (11749784), 6(10), 21.

10. Schulz, H. (1888) “Uber Hefegiste”, Pflügers Archiv Gesammte Physiologie, Vol. 42 pp.517 Zur Lehre von der Arzneiwirkung. (1887) [Virchows] Archiv für pathologische Anatomie und Physiologie und für klinische Medizin, Berlin,; 108: 423-445.

11. A. Michtchenko; M. Hernandez (2006) Photobiostimulation Effects Caused for Low Level Laser Radiation with 650 nm in the Growth Stimulus of Biological Systems. Electrical and Electronics Engineering, 2006 3rd International Conference, Sept. Page(s):1 – 4 12. Zhou P, Chrepa V, Karoussis I, Pikos MA and Kotsakis GA (2021) Cytocompatibility Properties of an Herbal Compound Solution Support In vitro Wound Healing.

Front. Physiol. 12:653661. doi: 10.3389/fphys.2021.653661 13. Tatch, W. (2019). Opioid prescribing can be reduced in oral and maxillofacial surgery practice. J. Oral Maxillofac Surg. 77, 1771–1775. doi: 10.1016/j. joms.2019.03.009 14. Muller, H. D., Eick, S., Moritz, A., Lussi, A., and Gruber, R. (2017). Cytotoxicity and antimicrobial activity of oral rinses in vitro. Biomed. Res. Int. 2017:40 19723.

15. Lee, H. S., Yoon, H. Y., Kim, I. H., and Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. Eur. Arch.

Otorhinolaryngol 274, 2685–2694. doi: 10.1007/s00405-017-4535-6 16. Lee, C. Y., and Suzuki, J. B. (2019). The efficacy of preemptive analgesia using a non-opioid alternative therapy regimen on postoperative analgesia following block bone graft surgery of the mandible: a prospective pilot study in pain management in response to the opioid epidemic. Clin. J. Pharmacol. Pharmacother.

1:1006.

17. Fujioka-Kobayashi, M., Schaller, B., Pikos, M. A., Sculean, A., and Miron, R. J. (2020). Cytotoxicity and gene expression changes of a novel homeopathic antiseptic oral rinse in comparison to chlorhexidine in gingival fibroblasts. Materials (Basel) 13:3190. doi: 10.3390/ma13143190 18. Bronstein, D. (2016). Modifying Behavior to IMPROVE OUTCOMES. Dimensions of Dental Hygiene, 14(10), 45–49.

4. Policy on Acute Pediatric Dental Pain Management. (2018). Pediatric Dentistry, 40(6), 101–103.

63 | TODAY'S FDA jan/feb 2022

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70

Read, Learn and Earn!

By Sumita Sam*, Neel Bhattacharyya, DDS; Donald M. Cohen, DMD; and Nadim M. Islam, DDS

A 38-year-old Black female patient was referred to an oral surgeon for a large mandibular lesion. The lesion was on MEMBERS-ONLY BENEFIT. You will be given the Visit floridadental.org/online-ce foridentified this FREE, a panoramic radiograph and the patient was asymptomatic. The opportunity to review the “Diagnostic Discussion” and its accompanying photos. Answer five patient’s medical history was non-contributory, and the duration multiple questions earnwere onenoted hour of CE. of the lesionchoice was unknown.

No clinicalto findings upon intraoral examination and the teeth were vital. Radiographic findings showed a large, expansile, multilocular radiolucency in the area of tooth No. 19 (Figs. 1-2). The clinician’s differential was florid cemento-osseous dysplasia versus an odontogenic cyst or tumor. An incisional biopsy was performed and submitContact Marketing Coordinator Martinfor ted to the FDC University of Florida Oral PathologyBrooke Biopsy Service a diagnosis. at bmartin@floridadental.org or 800.877.9922. t Fig. 1: Well-defined multilocular radiolucency involving teeth Nos. 18-20 of the left mandible.

Question: Based on the above history, clinical presentation and radiographic findings, what is the most likely diagnosis?

A. Lateral periodontal cyst B. Periapical cyst/granuloma C. Focal cemento-osseous dysplasia D. Ameloblastoma E. Traumatic bone cyst

Fig. 2: CBCT imaging shows a well-defined radiolucency with buccal and lingual expansion.

71 | TODAY'S FDA jan/feb 2022

quiz A. Lateral periodontal cyst Incorrect. A lateral periodontal cyst (LPC) is a developmental odontogenic cyst that occurs along the lateral root surface of a tooth. The cyst is thought to arise from the dental lamina, an epithelial remanent of the developing tooth bud. LPC is seen most frequently between the fifth and seventh decade, and there is no sex predilection. The vast majority of LPCs occur in the mandible, between the premolar and canine teeth. In the current case, the lesion occurs predominantly in the posterior mandible, which is an unusual site for an LPC. In addition, though the lesion involves multiple teeth, the radiographic features are not suggestive of LPC. LPC appears as a unilocular radiolucency between two teeth and is usually less than 1 cm in size. Large lesions that involve the entire length of the root have been reported, but multilocularity is not a standard feature of LPC. Key histologic features of LPC include a thin, epithelial-lined cyst with focal nodular thickening.

A cystic lining would be absent in the microscopic features of the present case. Treatment of LPC is complete enucleation and recurrence is rare.

B. Periapical cyst/granuloma Incorrect. A periapical cyst or granuloma, however, is an important entity to consider in the clinical and radiographic differential diagnosis of a multilocular lesion involving several teeth. A periapical lesion consists of granulation tissue that forms at the apex of a nonvital tooth. The granulation tissue represents an immune response response to the presence of a microbial infection within the root canal that spreads into the apical region. Most lesions are asymptomatic, but pain and sensitivity of the involved teeth can develop. The involved teeth are invariably nonvital and usually do not respond to pulp testing. In the present case, the teeth did not have an abnormal response upon pulp testing and appear to be vital radiographically, so periapical pathology should be ruled out. Most lesions are discovered on routine radiographic examination and often involve a radiolucency that encircles the affected tooth. Periapical lesions may demonstrate a variety of radiographic presentations, including multilocularity. Large lesions can be destructive, as loss of lamina dura, root resorption and expansion are sometimes identified. Though periapical cysts are indistinguishable from periapical granulomas radiograph-

ically, the lesions can be differentiated under the microscope.

The histologic features consist of inflamed granulation or fibrous connective tissue, and in the presence of a cyst, non-keratinized stratified squamous epithelium lining will be apparent. Treatment involves root canal therapy for viable teeth or extraction and complete removal of the periapical lesion for non-restorable teeth.

C. Focal cemento-osseous dysplasia Incorrect. Cemento-osseous dysplasia (COD) is a consideration, given the age, sex and race of the patient. COD is the most common benign fibro-osseous lesion encountered in clinical practice and the oral pathology laboratory. This lesion most commonly occurs in the posterior mandible, and patients are often asymptomatic. Focal COD lies in the spectrum between periapical and florid COD. Most cases of COD are seen in the third to sixth decade, and there is a predilection for Black women.

While the age, sex and race of the patient match the current case, the radiographic presentation does not support a diagnosis of focal COD. A characteristic mixed radiolucent/radiopaque lesion is usually seen, and the lesion does not display multilocularity.

In early stages, COD may be completely radiolucent, compared to later stages where the lesion develops more radiopacities and only a small radiolucent rim is evident. The lesion may occur in dentulous or edentulous areas. Upon surgical exploration, the tissue occupying the bone defect consists of gritty and fragmented tissue. Microscopically, these lesions exhibit variably sized and shaped trabeculae of cementum-like material and bone distributed in a loose, cellular fibrous stroma. Since COD often displays pathognomonic radiographic features, biopsy is not usually recommended, and the prognosis is good. The lesion often is hypovascular and prone to necrosis when irritated or exposed to the oral cavity. It is possible for a traumatic bone cyst to arise in the site of a degenerative COD, and in this circumstance, a biopsy would be necessary to render a diagnosis.

D. Ameloblastoma Incorrect. A good choice, as ameloblastoma should be in the differential for an expansile, multilocular radiolucency. An am-

72

eloblastoma is the most common clinically significant tumor of odontogenic origin and is considered benign but locally aggressive. Ameloblastomas are rare in young children and have an equal prevalence in the third to seventh decade of life. Though an ameloblastoma can occur anywhere in the maxilla and mandible, approximately 80% of ameloblastomas occur in the mandible with a predilection for the molar-ascending ramus region. As seen in our case, painless buccal and/or lingual expansion is frequently identified. Although ameloblastomas often result in significant destruction and root resorption, these features are absent in the present case. Radiographically, an ameloblastoma may appear unilocular but most often exhibit multilocularity with a characteristic “soap-bubble” appearance. Erosion through the cortex with extension into the soft tissue is common. These aggressive features are not evident in the current case. Though a variety of patterns are seen microscopically, islands of odontogenic epithelium with peripheral palisading cells and reverse polarity are characteristic of ameloblastomas. These features are distinct from the scarce microscopic features of the current lesion. Treatment for an ameloblastoma is aggressive and usually requires marginal resection to reduce the likelihood of recurrence. CBCT imaging is useful in the assessment of these tumors and assists in the mapping of cortical destruction. Curettage is not recommended for an ameloblastoma, as a 50-90% recurrence is noted for incomplete removal.

many cases have no known previous history as in the present case. TBC also is thought to arise from a previous tumor process, which undergoes degeneration and liquefaction resulting in minimal contents remaining.

Regardless of the etiopathogenesis, TBC is a benign lesion with a favorable prognosis. The lesion most often occurs in teenagers and young adults and is observed most frequently in the posterior mandible. Radiographic findings usually exhibit a unicystic radiolucency that often scallops between teeth. In the present case, the lesion is a well-defined multilocular lesion in the posterior mandible that involves the second molar to the second premolar.

CBCT imaging shows expansion of the buccal and lingual cortical plates (Fig. 2). Root resorption is rare and was not observed in the present case. Though the current features are unusual for t

E. Traumatic bone cyst Correct! This was a difficult case, as the age and radiographic presentation do not match the classic features of traumatic bone cyst (TBC). TBC, also known as a simple bone cyst, is an empty cavity in the alveolar bone and usually presents with minimal tissue upon surgical exploration. Though the lesion is referred to as a “cyst,” TBCs are not true cysts as the lesion is devoid of a cystic epithelial lining. While the etiology is uncertain, a likely theory involves a prior injury that leads to intraosseous bleeding.

The subsequent blood clot formed fails to organize and breaks down, leading to the formation of an empty cystic cavity. Though previous trauma to the affected area is occasionally discovered,

Fig. 3: Wispy mineralized bone (blue arrow) among small fragments of periosteal soft tissue and extravasated red blood cells.

73 | TODAY'S FDA jan/feb 2022

quiz

TBC, a strong presumptive diagnosis can be made upon biopsy. During surgery, a predominantly empty cavity is frequently identified. Blood or serosanguinous fluid may be present within the cavity. Upon histopathologic examination, fragments of periosteal bone and vascular connective tissue are usually identified (Fig. 3). The lesion seldom results in complications, and surgical exploration not only supports the diagnosis but often is curative.

The curettage performed during the procedure induces bleeding and promotes osseous regeneration; normal radiographic findings are usually observed after 12-17 months.

References: 1. Kerezoudis NP, Donta-Bakoyianni C, Siskos G. The lateral periodontal cyst: aetiology, clinical significance and diagnosis. Endod Dent Traumatol. 2000 Aug;16(4):144-50.

2. Neville BW, Damm DD, Allen CM, Chi AC. Oral and maxillofacial pathology. 2016. 4th edition. WB Sauders, Elsevier.

3. Surej Kumar LK, Kurien N, Thaha KA. Traumatic bone cyst of mandible.

J Maxillofac Oral Surg. 2015 Jun;14(2):466-9.

Diagnostic Discussion is contributed by University of Florida College of Dentistry professors, Drs. Indraneel Bhattacharyya, Don Cohen and Nadim Islam, who provide insight and feedback on common, important, new and challenging oral diseases.

The dental professors operate a large, multi-state biopsy service.

The column’s case studies originate from the more than 12,000 specimens the service receives every year from all over the United States.

Clinicians are invited to submit cases from their own practices.

Cases may be used in the “Diagnostic Discussion,” with credit given to the submitter.

Drs. Bhattacharyya, Cohen and Islam can be reached at oralpath@ dental.ufl.edu.

Conflict of Interest Disclosure: None reported for Drs. Bhattacharyya, Cohen and Islam.

The Florida Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/goto/cerp.

*Third-year resident in Oral and Maxillofacial Pathology University of Florida College of Dentistry.

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Career Center

The FDA’s online Career Center allows you to conveniently browse, place, modify and pay for your ads online, 24 hours a day. Our intent is to provide our advertisers with increased flexibility and enhanced options to personalize and draw attention to your online classified ads!

Post an ad on the FDA Career Center and it will be published in our journal, Today’s FDA, at no additional cost!

Today’s FDA is bimonthly; therefore, the basic text of all active ads will be extracted from the Career Center on roughly the 10th of every other month (e.g., Jan. 10 for the Jan/Feb issue, March 10 for the March/April issue, etc). Please note: Ads for the Nov/Dec issue must be placed no later than Nov. 1.

Please visit the FDA’s Career Center at careers.floridadental.org.

Greater Tampa, FL General Dental Practice for Sale. Tampa Bay is known as the heart of Florida’s Gulf coast. New to the market is a thriving general dental practice in the greater Tampa area.

The current doctor has practiced in the community for nearly thirty years. They are therefore interested in exploring all transition options, including partnership, buy-out or affiliation with the right group! Currently equipped with seven new operatories (six equipped) there is also an expansion opportunity into additional adjacent space.

Within thirty minutes of downtown Tampa, the practice is situated in a professional office park and the real estate is for sale as well. TO LEARN MORE ABOUT THIS GREATER TAMPA, FL GENERAL DENTAL PRACTICE FOR SALE, READ BELOW: 7 operatories; Expansion opportunity; Collections of $1.1 million; SDE over $500,000; 2025 active patients; Real estate opportunity.TO LEARN MORE ABOUT THIS TAMPA, FLORIDA GENERAL DENTAL PRACTICE FOR SALE, PLEASE CONTACT PROFESSIONAL TRANSITION STRATEGIES: SAM@PROFESSIONALTRANSITION.COM OR GIVE US A CALL: 719.694.8320. WE LOOK FORWARD TO SPEAKING WITH YOU! Visit bit.ly/3nwtgjB. Clinical Assistant/Associate Professor of Oral and Maxillofacial Surgery – University of Florida. [This is a shortened version of the classified ad.

Visit the website for the full text.] The University of Florida-College of Dentistry is seeking applications for a clinical track faculty position in the Department of Oral and Maxillofacial Surgery (OMFS) at the Assistant/Associate Professor rank.

The faculty member will be primarily responsible for teaching at the pre-doctoral (DMD) as well as advanced education (resident) levels, participating in Faculty Practice, service and scholarly activity. This position will also serve as the Oral and Maxillofacial Surgery pre-doctoral (DMD) Program Director. To apply, please go to jobs.ufl.

edu and search for requisition 519878. Applicants should attach curriculum vitae including a teaching and/or research statement, along with a cover letter describing their interest in the position, and a list of three references with their application for consideration. For more information about the University of Florida College of Dentistry, visit: dental.ufl.edu. The position requires a DDS, DMD, completion of OMFS residency from CODA accredited program and applicants must be board certified or board eligible in Oral and Maxillofacial Surgery. The ideal candidate would have experience in teaching, service and scholarly activity related to OMFS in an academic setting. Candidates should have clinical expertise in the full scope of OMFS. Salary commensurate with credentials and experience. Visit careers.floridadental.org/ jobs/16063894.

Experienced Dentist Wanted — Oviedo, FL. Looking to make your dental dreams come true?

Bright Now! Dental in sunny Oviedo, FL may be exactly what you are looking for. This fully established practice with an experienced staff and a location you can’t resist, what are you waiting for?

Not only does Smile Brands offer great benefits such as a health insurance and 401k, but you can choose from a robust list of CE to keep you learning and growing as a dentist. To learn more about this great opportunity, give Ashton Heeter a call at 816-589-7472 or email aheeter@midwest-dental. com. Let’s add your name to our list of successful General Dentist’s at Smile Brands!

Clinical Assistant/Associate Professor of General Dentistry – University of Florida. [This is a shortened version of the classified ad. Visit the website for the full text.] The University of Florida College of Dentistry is seeking applications for a full-time clinical track faculty position in the Department of Restorative Dental Sciences, Division

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of General Dentistry at the Assistant/Associate Professor rank. Responsibilities for this position will center on learner-centered pre-doctoral level didactic, pre-clinical and clinical instruction in general dentistry, including serving as a course director, participation in intramural faculty practice, distinction in academic pursuits and service, and include opportunities for participation in the development of departmental research and/or other scholarly activities. To apply, please go to jobs.ufl.edu/ and search for job number 519881.

Applicants should attach a curriculum vitae, a cover letter describing their interest containing a statement of academic objectives, and a contact list of three references with their application for consideration. For more information about the University of Florida College of Dentistry, visit: dental.ufl.edu. Applicants should possess the skills and knowledge to provide clinical coverage in all aspects of general dentistry. As well as being a strong clinician, applicants should be organized, open minded, dedicated to excellence in teaching students according to the guidelines set by the department, proficient with technology and the use of electronic health records, abreast of current evidence-based dentistry and possess excellent communication skills. The position’s requirements include a DDS, DMD or equivalent degree. Teaching and private practice experience are preferred. Salary and rank are commensurate with credentials and experience. Visit careers. floridadental.org/jobs/16063697.

Clinical Supervisor, Health Sciences – Dental Hygiene – Miami Dade College. Miami Dade College, Medical Campus is now accepting applications for the Clinical Supervisor, Health Sciences – Dental Hygiene position. This position is responsible for the management of clinical operations of the On-Campus Clinic. Duties and Responsibilities: Serves on campus and college

career center wide committees, during non-clinic hours; Participates in the development and implementation of college policies, procedures, and guidelines; Provides clinically related training for employees and supervises OSHA compliance; Identifies resources necessary for the successful operation of a Clinic; Examines and reviews records of all new and returning patients, and gives referrals when required; Manages clinical emergencies that may arise as result of treatment of patients in the clinic; Assists clinical instructors in the instruction and evaluation of students in all clinical courses; Consults with students and instructors regarding patients’ medical histories, examinations, and treatment; Reviews health histories of all students working in the clinic; Participates in the development and implementation of clinical curricula to meet accreditation standards; Reviews current literature for information on risk management; Supervises management of the clinic’s inventory and maintenance of the clinic equipment; Assists in the supervision of clinic staff and participates in faculty meetings; Assists in the Self-study for re-accreditation of the program and supervises students in the Dental Hygiene Clinic. Doctorate degree in General Dentistry and a current license to practice in the State of Florida, with a minimum of three (3) years prior clinical experience. Visit careers.floridadental.org/jobs/16056293.

Dentist — Multiple Locations. Seeking Full Time & PRN General Dentist. WH FL Dental, PLLC/ Walmart Health, the dental care provider to Walmart Health care centers is seeking Dentists to join a dynamic clinical services team! We have a unique opportunity to provide access to affordable healthcare to millions of people. Walmart Health needs passionate healthcare professionals to help us achieve our mission. Potential Sign On/ Relocation Bonus Available! Jacksonville, Middleburg, Kissimmee, Sanford & Wesley Chapel. Apply today: bit.ly/31f8DR2. For additional information please contact Charles Peterson at 725-4007519 or charles.peterson@walmart.com and Mary Moreno at 503-998-070 or mary.moreno@ walmart.com. Visit our careers site at careers. walmart.com/healthcare/walmart-health.

Associate Dentist — Hobe Sound. Great opportunity for full or part time Associate Dentist position. We are a successful, private practice providing all facets of dentistry, including implants.

Located in the beautiful and rapidly growing Treasure Coast area of Florida. Great location, experienced staff and great income opportunity.

Don’t miss out! Must be licensed in Florida. If interested, please email your C.V. at ccp1222@ bellsouth.net.

Excellent Opportunity for General Dentist — Boca Raton. Excellent Opportunity!! Seeking General Dentist Associate. Part time leading to full time in 27-year-old, well-established, high-quality, busy Boca Raton dental practice. Great opportunity to join our group and transition to ownership.

Visit careers.floridadental.org/jobs/16028925.

Associate Dentist — Fort Pierce. Associate Dentist Full Time in Private Practice, Fort Pierce.

Full- time Associate Dentist position available, 3 – 5 days, centrally located in the Florida beachside community of Fort Pierce in the heart of the beautiful Treasure Coast. Ideal candidate would be lifelong learner, interested in CE and mentorship opportunities in oral surgery, selective implant placement, some endo, Invisalign, children of all ages, Botox, dermal fillers and all phases of general dentistry. Offering $650 per day or 35% of collections whichever is greater, also applies during credentialing. This practice prefers a W-2 classification. Practice pays all lab bills. Long established prominent private practice with consistent growth and collections ranking in the top 1% nationally providing excellent potential for a candidate looking for more than just a job. The office is freestanding, in a professional neighborhood across the street from a regional HCA trauma capable hospital. A $1,000,000 complete renovation of the 3000 square foot office space was finished four years ago, to include 10 ops including a dedicated surgical suite, all Adec equipment, and two private doctor offices each with private bath.

The office is fully digital including Itero scanners, intraoral x-rays, cone beam, and EHRs. We are fully engaged with an active social media presence.

Work with a well-trained staff of 18, half of whom have been with the practice between 20 and 30 years. There are many longstanding patient relationships, providing wonderful opportunities for a rewarding work experience. Visit careers. floridadental.org/jobs/16025111.

Associate Dentist — Kissimmee. 25+ year, multi-doctor, privately owned family practice seeking a highly motivated General Dentist to help treat our great patients and work with a wonderful and experienced team. Join a successful practice and jump right into a strong schedule with over 100 new patients a month waiting for quality, comprehensive care. Enjoy a base salary with percentage-based incentive compensation.

Visit our website: kissimmeefamilydental.com Please forward CV to Holly Lance: holly@kissimmeefamilydental.com.

Dental Assistant — Tallahassee. Private dental office in Tallahassee has an immediate opening for an experienced and highly motivated dental assistant. We are looking for a team member who is hard working detail oriented, has strong communication abilities and interpersonal skills.

Salary and benefits based on experience. To apply, please email resume to drlumpp1867@ yahoo.com, Fax: 850-942-0867 or by mail: 1867 Professional Park Circle, Tallahassee, Florida 32308.

Tallahassee Associate Desired for Private Practice. We are in search of a hardworking, skilled associate to join our family practice. Our office has been open for over 35 years and currently has 4 doctors, 5 hygienists, and each doctor has two assistants. We are looking for either a full or part

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time associate to help care for our large patient base. New CBCT, Rotary endo, iTero scanners, and Invisalign are some of our office features. Visit smilesbybeck.com. Florida License, Friendly, Hard working.

General Dentist — Lake Mary. Lake Mary, fee for service, 5-star, high-end practice is looking for a part-time/full-time dentist. Applicant must have knowledge of or would be willing to learn holistic/ biological dentistry. We spend quality time with our patients and are not in a rush to treat them fast. We develop trusting relationships that are long lasting. In addition, we have up-to-date equipment to help provide quality dentistry! If you are interested in a great opportunity, please contact us at 407.333.1335 and provide us with a resume at timtiralosi@tiralosidental.com.

Associate Dentist — Ocala. Due to the high demand of patient care our practice currently has an opportunity to add an associate dentist. If you are seeking a practice that provides excellent patient care while working with a great team, we would love to hear from you! The ideal candidate for this position has experience with minor and complex dental procedures, proficient in performing periodic and comprehensive exams and has a thirst for growth. Visit careers.floridadental.org/ jobs/15894685.

Fort Lauderdale, FL Periodontal Practice for Sale. Fort Lauderdale is famous for its beaches, arts, culture and events. New to the market is a well-established periodontal practice in the Ft. Lauderdale area. The current doctor has practiced in the community for decades and has built an excellent patient base. With limited marketing, the practice sees 45 new patients per month.

Interested in retirement, the doctor is considering a straight buy-out or short-term affiliation with a group. FOR AN OVERVIEW OF THIS FORT LAUDERDALE, FL PERIODONTAL PRACTICE FOR SALE, READ BELOW: 7 operatories; Adjacent suites available for expansion; Collections of $1.1 million; SDE $377,000; 45 new patients per month; Over 2500 patients seen in the last 12 months; Growth opportunity with additional hours of operation.

TO LEARN MORE ABOUT THIS FORT LAUDERDALE PERIODONTAL PRACTICE, PLEASE CONTACT PROFESSIONAL TRANSITION STRATEGIES: SAM@ PROFESSIONALTRANSITION.COM OR GIVE US A CALL: 719.694.8320. WE LOOK FORWARD TO SPEAKING WITH YOU! Visit bit.ly/32aC1s1.

General Dentist — Pace, FL. We live our Mission: To Improve the Oral Health of All. Through education and with compassion, we strive to provide the best care possible for patients. We are committed to helping our communities be healthier, feel better, and smile with confidence. We have a great opportunity for a Dentist to join us in Pace, FL and lead the team in providing oral health care for patients. Not only do our providers find it rewarding to help their communities be healthier, but they also enjoy: Clinical Independence; In- t

career center dustry-Leading Comprehensive Benefits Package; Continuing Education; Malpractice Insurance; Tuition Reimbursement, Sign-On, and Relocation Bonuses – in specific situations. Primary Responsibilities: Diagnose and provide the appropriate treatment for patients while maintaining the highest standards care. Educate patients and guardians on the importance of maintaining proper oral health and outlining goals for both medical and dental health considerations. Develop a welcoming, supportive atmosphere for patients to help them feel comfortable with receiving treatment and encourage patient retention. Partner with all team members in fostering a collaborative environment. Qualifications: DDS or DMD. Hold a current or willing to obtain the Dentist licensure and certifications required by the state, with no negative claims. We provide the necessary support for Dentists to be successful. While you focus on patients, we provide the business aspects, including Clinical Development, Marketing, IT, HR, Operations Management, Compliance, Accounting & Finance, etc. An equal opportunity employer and an advocate for diversity and inclusion. Visit careers.floridadental.org/jobs/15876852.

bring their experience to the team. Not only do we offer a full benefits package, and malpractice coverage, but you will also have access to our booming CE program. If you are interested in learning more about this exciting opportunity, give Ashton Heeter a call at 816-589-7472 or email aheeter@midwest-dental.com.

General Dentist — Pinellas Park, FL. At Bright Now! Dental, we are looking for a high caliber Full Time Dentist who is dedicated to serving patients and providing quality dental care. If you are seeking clinical autonomy with the backing of a full support team and the latest technology, we have the ideal opportunity for you in Pinellas Park, FL. At Smile Brands we believe culture matters.

We believe that happier teams lead to happier patients, and we’ve got the happiest team in the dental industry. As an integral part of a hardworking dental team, we encourage you to give guidance and direction to your dental assistants, hygienists and other support personnel. And while you’ll have the support of the entire office, you’ll have full autonomy over your patients, a steady stream of patients to keep you busy and exposure to all types of procedures. We also offer top-of-the-line technology and safety equipment to help you give high quality, compassionate care.

Continuing education, wide range of benefits, 401K, malpractice insurance and Lead Dentist incentive plans are part of the competitive compensation package. If you are interested in learning more about this exciting opportunity, give Ashton Heeter a call at 816-589-7472 or email aheeter@ midwest-dental.com. We are looking forward to speaking with you!

Oral Surgeon — Pembroke Pines. Part-time Oral Surgeon wanted to join a multispecialty practice in Broward County. Equity position available.

Please contact us at 954-474-9660.

General Dentist — Oviedo, FL. What are you looking for in a practice? Is it working alongside a great staff? Or having clinical autonomy? What about the location? Lucky for you, Bright Now! Dental is hiring in beautiful Oviedo, FL and we can check all those boxes! We are looking for a full time General Dentist that is ready to jump in and

General Dentist — Tampa, FL. Bright Now! Dental is looking for an experienced full time Dentist who is ready to grow and expand their knowledge, within a great organization. Our beautiful Tampa practice is a single provider, fully established practice with an amazing front office staff. We are looking for an experienced Dentist who is ready to work with a great patient base, continue his or her education with our robust CE program, and practice with full clinical autonomy. PPO and Fee for service only. The full-time position also includes health insurance, 401k, and malpractice coverage! If you are interested in learning more about this exciting opportunity, please apply with your CV. We are looking forward to speaking with you! Visit careers.floridadental. org/jobs/15871867.

Fee-For-Service General Practice Belleview/ The Villages for Sale. 10-year Fee For Service/No Insurance Assignment General Dental Practice is centrally located among several 55+ communities including The Villages. Modern free-standing building has two equipped operatories and is plumbed for 3. There is plenty of room for expansion. Area is growing rapidly with new Publix, AdventHealth ER, and new homes in the immediate vicinity. Office has new Patterson Fuse cloud-based software and digital sensors.

This would be a great open slate for a mid-career practitioner looking for quality of life or for a young dentist wanting low overhead to develop into the dream practice. Please message for pics.

Due to family health issues, practice has been seeing 20-25 patients on 3-4 days/week with dentist doing hygiene and all new patients being referred out. 1000+ patients of record with over 300 scheduled for recare. Gross 2021 $160K with less than 30% overhead. Real estate including 1 acre of land could be available also. This would also be an excellent satellite office and great for Endo/Pros/Surgery. $150K sale price and start practicing right away! Visit careers.floridadental. org/jobs/13686503.

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Dental Assistant I — Miami. Provides access for patients and families with friendly interaction and communication. Works under the direct supervision of the Dentist in providing care to pediatric patients undergoing dental treatment, including prophylaxis (supra-gingival) cleaning. Responsible for preparing for procedures, providing supplies and instruments during procedures, and post-procedure clean-up. Performs the expanded duty functions as permitted by the Florida Board of Dentistry. Responsibilities: Applies knowledge of growth and development in patient interactions and treatment. Provides expertise with appropriate approaches to small children, children with autism, children confined to wheelchairs, and children with developmental delay. Ensures patient safety with papoose (when necessary) for patients unable to sit for procedures unassisted.

Assures clinic operatory supply levels are par and ensures appropriate staff are notified when master inventory levels drop to re-order status.

Checks all equipment for proper function and cleanliness. Notifies designated employee of any equipment not operating properly and needing repair. Executes clear & concise education information for parents/patients. Provides parents with post- treatment, sedation & OR verbal instructions as well as written information when indicated. Maintains and sterilizes dental instruments. Provides for patient safety, greets parents, and assists patients to operatory checking with parent, reading armband to identify scheduled patient before beginning any procedure. Reviews, maintains, and documents patient information in the computer thoroughly, accurately, and in a timely manner. Obtains consent from parents.

Takes x-rays to assure the highest degree of diagnostic information with the least amount of exposure. Follows hospital and departmental infection control policies. Works directly with the Pediatric Dental Attending, Residents, and other specialists in the dental clinic and operating room. Performs designated expanded duty functions permitted by the Florida Board of Dentistry. Provides assistance with behavior and monitors patient with nitrous oxide and never leaves them unattended.

Qualifications: Graduate of an accredited school of Dental Assisting or Expanded Duties Certified (EFDA). Expanded Duties Certification required within 12 months of hire. American Heart Association AED — Must maintain active and in good standing throughout employment. Apply here: bit.ly/3qCm8UE.

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ADVERTISING INFORMATION For display advertising information, contact: Deirdre Rhodes at rhodes@floridadental.org or 800.877.9922, Ext. 7108.

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PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly by the Florida Dental Association (FDA), 545 John Knox Road, Ste. 200, Tallahassee, FL 32303. FDA membership dues include a complimentary subscription to Today’s FDA. Nonmember subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, FL and additional entry offices. Copyright 2021 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication.

POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 545 John Knox Road, Ste. 200, Tallahassee, FL 32303.

EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the FDA endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the FDA.

EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. Hugh Wunderlich, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, FL 32303.

FDA office numbers: 800.877.9922, 850.681.3629; fax: 850.561.0504; email address: fda@floridadental.org; website address: floridadental.org.

Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.

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off the cusp

The Sounds of Science

By Hugh Wunderlich, DDS, CDE, FDA Editor

About 60 years ago, a relatively unknown songwriter penned a song that propelled Simon and Garfunkel into popularity that endures to this day. With apologies to Paul Simon, I borrow the lyrics and sprit of one of his greatest hits, “The Sounds of Silence.”

The song’s meaning is for the listener to decide, but for most, it is about the inability of people to communicate, so what you see is people unable to work with each other, but more importantly, to not remain stagnant. With all the electronic media sources available today, it is easy to be overwhelmed. Legislators are exposed to all kinds of information that may not be evidence-based science. The actions of just a few can affect the way you can practice. Dentists’ Day on the Hill and legislative contact dentists can be a source of enlightenment. Come be an activist, dig out your “Best of …” album, fire up the incense and in this spirit, I offer … people hearing without listening,

The Sounds of Science

legislators writing laws that we never shared,

Hello, access my old friend.

and no one cared

I’ve come to talk with you again.

to hear the sounds of science.

As some solutions have come creeping, growing roots while we were sleeping

“Wisdom,” said I, “you will never know,

and the vision with the laws that they explain

science like a cancer grows,

could remain

having ideas that I might teach you,

without the sounds of science.

take my plans that I might reach you.”

And my words like a torrent fell,

In listless dreams I stood alone,

and filled

stood by and watched a rolling

up the halls of science.

stone gather moss and control our lives.

We must be part of the molded clay

New providers look like it survives

in the foundation they might lay.

and when my feet were fixed in mud

And the change dashed out its warning,

by a will-less might

in the words that it was forging,

that split the fight,

And the change said, “The words

there were no sounds of science.

of the prophets are almost fading calls” And in a legislative light, we saw

in nomistic halls.

300 people, maybe more —

But will they listen to the sounds of science?

lawyers talking without speaking,

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