2019 Dentists’ Day on the Hill -FAQs March— 11-12, 2019 COVID-19 Vaccine Page 8 - Page 2
VOL. 33, NO. 1 • JANUARY/FEBRUARY • LEGISLATIVE ISSUE
A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION
2020-2022 Legislature BOD Discusses Human Trafficking CE Requirement
Trust Your Instincts Hope Panhandle The Land of the Free
Dr. Jerry Bird and Sen. Aaron Bean Photo taken during the 2020 Legislative Session
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We work for you.
My agent Mike is fast to respond, knowledgeable in a lot of fields and gets me answers to all my questions. Thankful to the FDA for helping with all my practice needs! – Dr. Nicholas Gregg
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HELPING MEMBERS SUCCEED VOL. 33, NO. 1 • January/February 2021
in every issue 3 Staff Roster 5 President's Message 12 Did You Know? 15 Info Bytes 16 news@fda 25 Legislative Corner 77 Diagnostic Discussion 82 Career Center 82 Advertising Index 84 Off the Cusp
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COVID-19 Vaccine FAQs
19
FDA Representatives on ADA Councils/Committees/Commissions
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BOD Discusses Human Trafficking CE Requirement
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A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION
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32
FDAPAC, GAC and LCD Members by District Dental Association
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FDC2021 Exhibit Hall
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Leading, Advocating and Mentoring
FDC2021 Speaker Preview: Modified Extraoral Landmarks
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58
Giving Back Through Mission Trips
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1 Dental Practice, 2 Military Veterans
FDC2021 Speaker Preview: The New COVID-19 Dental Practice
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44
FDC2021 Speaker Preview: The Prevention of Musculoskeletal Disorders in Dentistry
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The ADA Library & Archives
Trust Your Instincts
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Hope Panhandle Restored Community After Hurricane Michael
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49
Why Landlords Love Lease Renewals
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Communicate Conveniently and Compliantly in the Cloud
Dental Lifeline Heroes
The Land of the Free
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The 2020-2022 Legislature
TODAY'S FDA ONLINE: floridadental.org
American Sensor Tech
FLORIDA DENTAL ASSOCIATION JANUARY/FEBRUARY 2021 VOL. 33, NO. 1
EDITOR Dr. John Paul, Lakeland, editor
STAFF Jill Runyan, director of publications Jessica Lauria, communications and media coordinator Andrew Gillis, graphic design coordinator
BOARD OF TRUSTEES Dr. Andy Brown, Orange Park, president Dr. Dave Boden, Port St. Lucie, president-elect Dr. Gerald Bird, Cocoa, first vice president Dr. Beatriz Terry, Miami, second vice president Dr. Jeffrey Ottley, Milton, secretary Dr. Rudy Liddell, Brandon, immediate past president Drew Eason, CAE, Tallahassee, executive director Dr. Dan Gesek, Jacksonville • Dr. Karen Glerum, Boynton Beach Dr. Reese Harrison, Lynn Haven • Dr. Bernard Kahn, Maitland Dr. Gina Marcus, Coral Gables • Dr. Irene Marron-Tarrazzi, Miami Dr. Eddie Martin, Pensacola • Dr. Rick Mullens, Jacksonville Dr. Paul Palo, Winter Haven • Dr. Howard Pranikoff, Ormond Beach Dr. Mike Starr, Wellington • Dr. Stephen Zuknick, Brandon Dr. Don Ilkka, Leesburg, speaker of the house Dr. Rodrigo Romano, Miami, treasurer • Dr. John Paul, Lakeland, editor
PUBLISHING INFORMATION
Aftco
Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303 . FDA membership dues include a complimentary subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. 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, Fla. 32303.
EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association 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 Florida Dental Association.
EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303. FDA office numbers: 800.877.9922, 850.681.3629; fax 850.561.0504; email address, fda@floridadental.org; website address, floridadental.org.
ADVERTISING INFORMATION For display advertising information, contact: Deirdre Rhodes at rhodes@floridadental.org or 800.877.9922, Ext. 7108. For career center advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.877.9922, Ext. 7115.
Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.
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TODAY'S FDA JANUARY/FEBRUARY 2021
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CONTACT THE FDA OFFICE 800.877.9922 OR 850.681.3629 545 John Knox Road, Ste. 200 • Tallahassee, FL 32303
EXECUTIVE OFFICE DREW EASON, Chief Executive Officer/ Executive Director deason@floridadental.org 850.350.7109 GREG W. GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111 CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202 JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 LIANNE BELL, Leadership Concierge lbell@floridadental.org 850.350.7114
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CRISSY TALLMAN Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105
800.877.7597 or 850.681.2996 545 John Knox Road, Ste. 201 Tallahassee, FL 32303
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DEIRDRE RHODES, FDC Exhibits Coordinator drhodes@floridadental.org 850.350.7108 EMILY SHIRLEY, FDC Program Coordinator eshirley@floridadental.org 850.350.7106
GOVERNMENTAL AFFAIRS JOE ANNE HART Chief Legislative Officer jahart@floridadental.org 850.350.7205 ALEXANDRA ABBOUD Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204 TATIANA AHLBUM Legislative Assistant tahlbum@floridadental.org 850.350.7203
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SCOTT RUTHSTROM Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 CAROL GASKINS Commercial Accounts Manager carol.gaskins@fdaservices.com 850.350.7159 MARCIA DUTTON Membership Services Assistant marcia.dutton@fdaservices.com 850.350.7145 PORSCHIE BIGGINS Central Florida Membership Commercial Account Advisor pbiggins@fdaservices.com 850.350.7149 MARIA BROOKS South Florida Membership Commercial Account Advisor maria.brooks@fdaservices.com 850.350.7144 KELLY DEE Atlantic Coast Membership Commercial Account Advisor kelly.dee@fd3aservices.com 850.350.7157
MEMBER RELATIONS
MELISSA STAGGERS West Coast Membership Commercial Account Advisor melissa.staggers@fdaservices.com 850.350.7154
KERRY GÓMEZ-RÍOS Director of Member Relations krios@floridadental.org 850.350.7121
TESSA DANIELS Commercial Account Advisor tessa.daniels@fdaservices.com 850.350.7158
MEGAN BAKAN Member Access Coordinator mbakan@floridadental.org 850.350.7100
LIZ RICH Commercial Account Advisor liz.rich@fdaservices.com 850.350.7171
JOSHUA BRASWELL Membership Coordinator jbraswell@floridadental.org 850.350.7110
RYAN WHITE Insurance Advisor ryan.white@fdaservices.com 850.350.7151
CARRIE MILLAR Director of Insurance Operations carrie.millar@fdaservices.com 850.350.7155
YOUR RISK EXPERTS DAN ZOTTOLI, SBCS, DIF, LTCP Director of Sales — Atlantic Coast 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com DENNIS HEAD, CIC Director of Sales — Central Florida 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com MIKE TROUT Director of Sales — North Florida Cell: 904.254.8927 mike.trout@fdaservices.com
JOSEPH PERRETTI, SBCS Director of Sales — South Florida 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com RICK D’ANGELO, CIC Director of Sales — West Coast 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com
CHRISTINE TROTTO Membership Concierge ctrotto@floridadental.org 850.350.7136
R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117 KRISTIN BADEAU, Foundation Coordinator kbadeau@floridadental.org 850.350.7161
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The last four digits of the telephone number are the extension for that staff member.
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, Dr. John Paul: jpaul@bot.floridadental.org.
TODAY'S FDA JANUARY/FEBRUARY 2021
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PEOPLE.
PURPOSE.
PASSION.
PATHWAYS TO SUCCESS THE OFFICIAL MEETING OF THE FDA
leadership
START 2021 WITH ADVOCACY! Advocacy has long been the priority hallmark of any survey for the dental profession’s biggest need from organized dentistry, and has particularly taken center stage this last year with the COVID crisis still in our midst. I cannot tell you how proud I am with everything our American Dental Association (ADA) and Florida Dental Association (FDA) staff have done to help all our members move through this unrelenting pandemic at every national and statewide level. I see it every day as FDA president. It’s certainly proven why membership is more important than ever with last year’s work and the hurdles we have faced — and the challenges still to come! The long COVID-19 winter stretches into 2021 now, and dentists continue to maneuver the landscape keeping our patients, dental teams and communities safe and healthy in the process. We continue to provide essential services for our patients with our attention to the enhanced protocols we’ve all embraced. Presumably, the universal availability of the vaccine will change the landscape soon, despite the stubborn fits and starts to the rollout of the same. Our advocacy continues daily for making those vaccines available for our universally recognized tier 1A dentists and staff. The state’s counties are each going through their own processes to get us all included, and we are in their ear every day! The hospitals and Department of Health have FLORIDADENTAL.ORG
been tasked with the vaccination process, and we will continue collaborating with them as opportunities are presented. With our next legislative session soon upon us, we need to turn up the advocacy within our local levels and help support our staff in Tallahassee with boots on the ground. This Today’s FDA issue is dedicated to the planning and resources we bring to the table with every legislative session. Meeting legislators during session will be much more restrictive with the new parameters in place within the legislative arena. Even more reason we need to engage our legislators preemptively in our local areas and bring the messaging for any dental questions that may arise. Please help our staff and our profession with your commitment to being a legislative contact dentist (LCD). Strive to be THE resource for your local legislators so we can get them the correct information about ways different initiatives may affect our profession before other groups’ lobbyists with their own agendas are the only discussions they hear.
PRESIDENT’S MESSAGE ANDY BROWN, DDS, MS FDA PRESIDENT
Dr. Brown can be reached at abrown@bot.floridadental.org.
We will be celebrating the 25th anniversary of our legislative initiatives with a virtual Dentists’ Day on the Hill on Tuesday, March 16 … how fitting! The good news is that it gives a fantastic opportunity for new dentists to have a chance to see the process without leaving their offices, realize that it’s not difSEE PAGE 7 TODAY'S FDA JANUARY/FEBRUARY 2021
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2021 2021 AWARD RECIPIENTS AWARDS LUNCHEON PRESIDENT’S AWARD Dr. Andy Brown
NEW DENTAL LEADER Dr. Jenna Pascoli
DENTIST OF THE YEAR Dr. Rudy Liddell
DENTAL STUDENT AWARD Ms. Ashley Maus
J. LEON SCHWARTZ LIFETIME ACHIEVEMENT AWARD Dr. Cesar Sabates
PUBLIC SERVICE AWARD Dr. Al Warren Dr. Ken Owens
LEADERSHIP AWARD Dr. Rebecca Warnken
HELPING MEMBERS SUCCEED TEAM IMPACT AWARD Ms. Rachel Stys
JUNE 25, 2021 | 11:30 AM-1 PM
GAYLORD PALMS RESORT AWARDS LUNCHEON & CONVENTION CENTER JOIN IN THE RECOGNITION OF YOUR COLLEAGUES FRIDAY, JUNE 25, 2021
11:30 AM-1 PM
GAYLORD PALMS RESORT & CONVENTION CENTER ORLANDO, FL TICKETS ARE $45 EACH OR PURCHASE A TABLE OF 6 FOR $270. AVAILABLE SPRING 2021.
leadership
FROM PAGE 5
ficult and plan to participate more in the future. Sometimes, it’s just that little mentoring step (this year is easy and virtual!) to engage a new generation of LCDs moving into the fray as future local advocates. I’ve done this for a long time, and most have no idea how your profession can change in an instant with one or two initiatives that may pass. I’ve seen it happen. We need more help with our elected officials who subsequently vote on these potential changes. Every dentist needs to do his or her part! The “COVID winter” is still with us, and we’ll be going through significant further challenges to our profession on many fronts as we continue navigating to the end of this pandemic. The true health of our communities, dental teams, patients and practices is of utmost concern, and I challenge you to continue the excellent job we’ve all done so far! Advocacy at every level is ongoing daily — locally and nationally. Know that Team FDA in Tallahassee is working tirelessly for us, providing resources about how best to maneuver the issues and opportunities presented, and I could not be prouder of them. We all still have your back!
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Meeting legislators during session will be much more restrictive with the new parameters in place within the legislative arena. Even more reason we need to engage our legislators preemptively in our local areas and bring the messaging for any dental questions that may arise.
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Tips on Meeting with a Legislator in Your District n Call the legislator’s office to schedule the meeting in their district office. The meeting does not have to be in person. Meeting a legislator via Zoom or even a conference call are both viable options. n If you do have an in-person meeting, be sure to ask the legislator’s office whether they are wearing masks or abiding by social distancing guidelines.
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Some are and some are not. It is important to ask their preference regarding this before your meeting. If they choose not to, that is okay. If you personally wish to wear a mask and abide by social distancing guidelines, it is perfectly fine for you to do so even if they do not.
Go to bit.ly/2LPBaVB to read all the tips! TODAY'S FDA
JANUARY/FEBRUARY 2021
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human relations
COVID-19 VACCINE FAQS 1. Can I require or mandate that employees get the COVID-19 vaccine?
DEBORAH S. MINNIS
Ms. Minnis practices labor and employment law at Ausley McMullen, and she also represents various local government bodies. She can be reached at dminnis@ausley.com. This article is for informational purposes only and is not intended to be a substitute for professional legal advice. If you have a specific concern or need legal advice regarding your dental practice, you should contact a qualified attorney.
a. If you are an employer with fewer than 15 employees, the answer is yes. There are generally no prohibitions or qualifications for mandating that employees get the vaccine. However, each employer should consult with its workers’ compensation provider to determine the carrier’s position in relation to vaccination requirements. b. For employers with 15 or more employees who are, therefore, covered by the Americans with Disabilities Act (AwDA), there are several things to remember in requiring employees to get the vaccination. See question 7. c. The Centers for Disease Control and Prevention (CDC) recommends prescreening questions be asked before the vaccine is administered. For AwDA-covered employers, even though requiring the vaccination is not prohibited under the AwDA, the prescreening questions are covered under the AwDA’s medical inquiry provision and certain requirements must be met by the employer in order to ask the questions. d. For AwDA-covered employers, accommodations must be made for individuals with disabilities that may prevent them from being able to take the vaccination. See question 8. e. In addition to the AwDA accommodations, employers with 15 or more employees must allow for religious accommodations under Title VII. See question 9.
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TODAY'S FDA JANUARY/FEBRUARY 2021
2. What entities can administer the vaccine? a. An employer can administer the vaccination itself, contract with a third-party vendor to administer the vaccination on its behalf or allow employees to use a third party with no contract or relationship with the employer.
i. Please note: In Florida, dentists are not currently allowed to administer the vaccine, as it is not included in their scope of practice as defined by Florida law.
b. If an AwDA-covered employer administers the vaccinations itself or contracts with a third-party vendor to administer the vaccinations, they must comply with the AwDA provisions applicable to medical inquires in relation to the prescreening questions.
i.
Because the prescreening questions could disclose an individual’s disability or genetic information, they are covered by the AwDA provisions relating to medical inquiries by employers and Title II of the Genetic Information Nondis- crimination Act (GINA).
ii.
Under the AwDA, an employer can- not make medical inquiries unless the employer can show that the inquiry is job related and consistent with business necessity. To satisfy this requirement, the employer must show that it has “a reasonable belief based on objective evidence that the employee who does not answer FLORIDADENTAL.ORG
the questions and, therefore, does not receive a vaccination will pose a direct threat to the health or safety of herself or himself or others.” (EEOC Technical Assistance Questions and Answers, Dec. 16, 2020, question-k-2)
iii. Under the GINA, employers cannot acquire genetic informa tion except in limited cir- cumstances, cannot use genetic information to make decisions about the terms and conditions of employ ment and cannot disclose genetic information except in limited circumstance. An example of genetic information would be questions relating to an employee’s family medical history.
c. If an independent third party with whom the employer does not have a
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contract or relationship (i.e., pharmacies, the employee’s health care provider, etc.) administers the vaccination, these entities do not have to comply with the AwDA medical inquiry provisions.
You also should consult with your workers’ compensation provider to determine its position on offering the vaccination and the prescreening questions.
3. If my practice administers the vaccination or contracts with a third-party vendor to administer the vaccination on its behalf, am I required to ask the prescreen- ing questions? a. The CDC recommends, but has not at this time mandated, that the prescreening questions be asked to determine if medical conditions exist that would prevent the individual from taking the vaccine. b. Though the prescreening questions are recommended but not required by the CDC, the Florida Dental Association recommends asking the questions for purposes of potential liability due to reactions to the vaccine.
d. Any medical information obtained by asking the prescreening questions should be kept confidential and should not be used for any other purpose. You should treat this information the same as other HIPAAprotected information. 4. If my practice requires employ- ees to get vaccinated but allows them to use an outside vendor (i.e., pharmacy, their individual health care provider, etc.), can I ask for proof of vaccination? a. For employers with less than 15 employees and who are not covered by the AwDA, the answer is simply yes. b. For employers with 15 or more employees and who are thus covered SEE PAGE 10
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referenced in question 2bii and show that answering the questions and receiving the vaccination is job related or consistent with business necessity if the decision is made to discipline or terminate the employee for failing to answer the questions.
human relations FROM PAGE 9
by the AwDA, you can request proof of vaccination. You should simply obtain documentation that the employee was vaccinated. You should not request or receive any medical information or responses to the prescreening questions. If the third party indicates that the employee was refused vaccination, you cannot ask the reason for the refusal. Such inquiry would likely be an impermissible medical inquiry under the AwDA. Absent a showing that having this information is job related or consistent with business necessity, it could be a violation of the AwDA.
7.
If I am an AwDA-covered em- ployer, what requirements must I meet to be able to require an employee to get vaccinated if he or she has identified as hav- ing a disability that would pro- hibit vaccination?
As an AwDA-covered employer, you can require an employee be vaccinated as a qualification standard for employment. However, having this standard cannot have the effect of improperly screening out an individual with disabilities. Therefore, you must be able to document with objective evidence that an unvaccinated employee would “pose a direct threat due to a significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by a reasonable accommodation.” An individual analysis must be conducted, and the following factors considered:
5. Can employers make getting the vaccination voluntary?
Yes. Employers can make the decision on whether to get the vaccination voluntary. In that instance, the employee’s decision to answer or not answer the prescreening questions also must be voluntary.
6. What do I do if I allow voluntary vaccinations and the employee has agreed to be vaccinated but refuses to answer the pre- screening questions? a. Independent third-party entities will follow their established protocols. If the practice or its contracted vendor is administrating the vaccination, you can decline to administer the vaccine to the employee. b. However, AwDA-covered employers cannot retaliate against, intimidate or threaten employees who refuse to answer the prescreening questions.
If, after considering the factors set out in question 7, it is determined that the employee would pose a direct threat, you must then consider if there is a reasonable accommodation (e.g., working from home) that would eliminate or reduce the risk. If an accommodation that reduces the risk is not available without causing undue hardship, the employer can exclude the employee from the workplace but cannot automatically terminate.
Before terminating the employee, the employer must engage in a flexible, interactive process to identify any workplace accommodation options that would not cause an undue hardship. For example, to determine potential undue hardship, the employer should consider the number of workplace employees who have already been vaccinated, how much contact the unvaccinated employee will have with other workers or patients, if continuing to use personal protective equipment will be appropriate, etc. Caution should be used in deciding to terminate an employee under these conditions. In addition to ensuring compliance with the AwDA, a review should be conducted to ensure that the termination will not violate other anti-discrimination laws.
a. duration of the risk. b. the nature and severity of the potential harm. c. the likelihood that that the potential harm will occur. d. the imminence of the harm. 8. Can I terminate an employee who refuses to be vaccinated because of a disability?
c. An AwDA-covered employer would likely have to meet the standard
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For employers with fewer than 15 employees, the answer is yes. For employers with 15 or more employees, additional steps must be taken.
9. Can I terminate an employee who refuses be vaccinated due to religious beliefs?
For employers with fewer than 15 employees, the answer is yes. For employers with 15 or more employees, additional steps must be taken before the employee can be terminated.
Employers with 15 or more employees are required under the provision FLORIDADENTAL.ORG
of Title VII, a federal law, to provide accommodations for employees’ sincerely held religious beliefs. These terms are defined very broadly. Why the person believes or whether it is considered a reasonable belief is not relevant.
If the employee identifies as having religious beliefs that would prohibit or based upon which he/she refuses to be vaccinated, the employer must engage in an interactive process to determine if it can offer the employee a reasonable accommodation. The process is like that discussed in question 8 above. As with accommodations for persons with disabilities, the employer may be able to exclude the employee from the workplace if there is no reasonable accommodation available. However, caution should be exercised before terminating an employee who has asked for an exemption based on religion. In addition to ensuring compliance with the AwDA, a review should be conducted to ensure that the termination will not violate other antidiscrimination laws.
10. Can I terminate an employee who refuses to be vaccinated but does not raise either reli- gion or disability as the basis for the refusal?
For employers with less than 15 employees, the answer is generally yes. For employers with 15 or more employees, termination may be possible but should not be automatic. Each situation should be reviewed individually and collectively to ensure other anti-discrimination laws are not being violated. For example, automatic termination may result in a disparate adverse effect on one group
FLORIDADENTAL.ORG
of employees (i.e., based on race, age, etc.), when viewed as a whole. 11. If I decide to terminate an employee, what documenta- tion should I maintain?
Regardless of whether you have 15 employees or less than 15 employees, the recommendation is that you should have the following documentation:
a. A memo to all employees notifying them that you are requiring mandatory vaccination. b. If an employee refuses, request that they put the refusal in writing.
h. If you are not able to offer an accommodation or the employee refuses your accommodations and the accommodation he/she requested would cause an undue hardship, you should provide the employee with a written response explaining this fact.
c. A response to the refusal reiterating your reasoning for mandating vaccinations and an opportunity to reconsider.
g. You should provide the employee with a written response to his/her request for an accommodation. You are not required to give them the accommodation they want but should consider if there are other “reasonable” accommodations you can offer.
For employers with less than 15 employees, having this documentation may assist in responding to unemployment compensation filings by terminated employees. For employers with 15 or more employees, the following additional documents should be maintained for purposes of the AwDA:
d. If the employee requests an exemption from vaccination based on a disability, you should request that in writing. e. You also can request that they provide you with information from their health care provider about their disability and what accommodation is being requested. f. You should document your interactive process with the employee, i.e., note the date and time of any discussions and the general nature of the discussion.
For employers with 15 or more employees who receive a request for exemption for religious reasons:
i. It is not wise to get into a debate with the employee about the reasonableness of his/her religious belief. j. You should move to the interactive process and ask the employee to put the requested accommodation in writing. k. You should then proceed as set out in d-h above.
Because these issues can be highly legally charged, it would be wise to consult with a professional before terminating employees.
12. Can I have employees who refuse to get a vaccination sign a release and liability waiver?
Based on Florida law, you should consult with your workers’ compensation carrier before requesting or requiring an employee to sign a release or liability waiver.
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BOD
UNLICENSED ACTIVITY
x
DR. JOE CALDERONE FDA LIAISON TO THE FLORIDA BOARD OF DENTISTRY
CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS
If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@floridadental.org or 850.350.7202, or FDA Liaison to the Florida Board of Dentistry Dr. Joe Calderon at drcalderone@gmail. com or 407.509.1493.
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Did you know that if you want to report unlicensed activity in the state of Florida, you do not report it to the Board of Dentistry? Instead, you report it to the Unlicensed Activity and Fraud unit (ULA) at the Department of Health. This unit protects Florida residents and visitors from the potentially serious and dangerous consequences of receiving medical and health care services from an unlicensed person. It investigates and refers for prosecution all unlicensed health care activity complaints and allegations. The ULA unit works in conjunction with law enforcement and the state attorney’s office to prosecute individuals practicing without a license. In many instances, unlicensed activity is a felony level criminal offense. For more information about unlicensed activity in Florida and to report unlicensed activity, visit FLHealthSource.gov/ULA.
TODAY'S FDA JANUARY/FEBRUARY 2021
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FDA Online Radiography Training Program
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Your
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E-VAC Inc.
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IT’S ALL ABOUT THE DATA … OR IS IT? If you’re like me, then you’re a data hoarder. Do you want the first email I sent when I installed an email system at the Florida Dental Association in 1996? I have that. It’s also likely I have many of the emails I’ve sent since then. What that means is that I have at least 25 years’ worth of data files. This recently came to light in a personal way to me, too. I’m an amateur photographer and I realized I’ve taken more than a quarter of a million photos in the digital age. Yikes! That is a lot of photos. Where I struggle may be where you struggle as well: organization. It’s not a matter of do I have it, but can I find it? I feel like I need a Marie Kondo makeover for my hard drives. Usually, I just buy a bigger, faster hard drive and keep the data heap growing. Unfortunately, I now have a landfillsized data heap of files some with names like “document9.doc.” In the last few years, I’ve pushed that humongous data heap into cloud storage, such as Dropbox or Google Drive. Same problem with a different place to keep the files, and I still can’t find what I want all the time. Today is the day to change that. I know I’ve said that before, like the 25 pounds that will never come off. The new year needs to bring a new way of doing things. A great option is to create an organizational system for the data files you are using — start there and work backward until every file falls into that system. We may be here a while, so pack a lunch. Decide where you ultimately want to keep your files, how often you back them up and how often you need to access them. Then begin deciding which files you want to keep and which ones you want to discard. I recently started this process with the massive photo library I have across 20+ hard drives. This will likely be a yearlong process, but I’m organizing any new photos I take right away. This works for emails, texts — you name it. If it’s data, you should probably be doing a better job of organizing it than you do. It really does me no good if I can recreate what I am looking for before I can ever find it.
LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS
Mr. Darnell can be reached at ldarnell@floridadental.org.
By the way, when is the last time you went back and looked at your web browser’s bookmarks/ favorites? That’s what I thought. I have hundreds, most of which I will NEVER use again. So, to summarize: Look at your data/files/photos (whatever it is). Decide on a place to organize your files. A hard drive or cloud options both have advantages but choose one and create your organizational system. It needs to make sense to you five years from now, so keep that in mind. Then start chipping away at that mountain of data files a little bit each day. I had to refrain from reminiscing too much looking at old photos in order to stay focused and on task. It feels good to get started, but the ultimate jubilation comes when you finish the job — stick with it no matter how hard it seems today. The 2026 you will remember what you did today.
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updates for members *PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.
Request Your PPE Delivery from the ADA Recently, the American Dental Association (ADA) was allocated an allotment of personal protective equipment (PPE) from the FEMA national office. As the PPE comes in, the ADA will be distributing it as quickly as possible to dentists. Since they expect to receive the PPE in periodic allotments, the ADA will be providing it as it’s received. To request your allotment please complete your registration at bit.ly/2Lh9DvZ. You will first identify yourself with your ADA number and last name, confirm you want your allotment, and finally pay the fee to cover processing, shipping, handling and credit card fees. The ADA is NOT charging for the PPE as it is provided by FEMA at no cost. The ADA is NOT profiting on this PPE — charging only to recoup actual costs to receive, repackage, ship via UPS through their fulfillment partner PBD and credit card/ processing fees. We strongly encourage you to complete your request ASAP as supplies are limited. Requests will be processed in the order they are received from each group of prioritized states. Once you complete your online request and pay the reimbursement fee, you will receive a confirmation email. Please allow up to 15-20 BUSINESS days to receive your allotment.
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If inventory is not available when you complete your request, you will be placed on a “waiting list” (back order) and informed of such. The ADA will then send your allotment if and when they receive more product from FEMA. If additional inventory from FEMA is not received, your fee will be reversed accordingly.
2021 Annual Call for Volunteers The Florida Dental Association (FDA) Leadership Development Committee (LDC) works to engage new and emerging leaders in the dental profession. One of the ways we do that is by asking if you are interested in serving in a leadership capacity in any aspect of the national, state or local dental organizations that you belong to as an FDA member. We’ll take your information and provide it to those charged with finding qualified candidates for leadership positions so they will know of your interest. There is no guarantee of a position, but it’s the start of what could be a mutually beneficial leadership role within the ADA, FDA or your local district. Visit bit.ly/3nsao2m to indicate your interest.
FDA Services Reminder: New Year, Time to Review Now is the time to review your life and disability insurance with one of the FDA Services’ directors. Call or text 850.681.2996 today.
TODAY'S FDA JANUARY/FEBRUARY 2021
Make Plans to Attend FDC2021 Make plans to attend the 2021 Florida Dental Convention (FDC), “People. Purpose. Passion: Pathways to Success,” June 24-26 in person at the Gaylord Palms Resort & Convention Center in Orlando. FDC will offer 130+ courses to enhance and refine skills for everyone on the dental team. Course highlights include Dawson Seminar 2, Botox, in-office clear aligner therapy, infection control, cannabis and pain management, head and neck cancer symposium, homeopathic trends and much more. You can earn up to 20 continuing education hours at FDC. As a member benefit, FDA members receive FREE preregistration as well as a multitude of FREE courses to choose from! Visit floridadental.org/convention-ce/ convention/attend/education/ to view the courses and speakers today. FDC is excited to be back at the Gaylord Palms Resort & Convention Center June 24-26, 2021. Make your hotel reservation today for the discounted rate of $205 per night, including free self-parking. The FDC room block sells out quickly, so visit floridadental.org/ convention-ce/convention/hotel to reserve your room today! As always, if your plans change you can cancel your reservation up to 72 hours prior to check-in.
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Accepting Nominations for the Next FDA Editor The FDA LDC is excited to be accepting nominations for the next FDA editor! The position will begin in June 2021 and all the information regarding the position can be found at bit.ly/3mrKUBV. FDA members are welcome to self-nominate or can be nominated by colleagues. Thank you for encouraging those you see fit to apply, including your own editor! The committee will collect the nominations and make recommendation(s) to the Board of Trustees for selection at their May 2021 meeting. If you have any questions about the position or nomination process, please contact LDC Chair Dr. Angela McNeight at angela.mcneight@ gmail.com. Candidates are encouraged to submit their applications to their respective districts for review and forwarding to the LDC. Candidates also may submit their applications and writing samples directly to the LDC. The deadline for submitting nomination forms is Feb. 28, 2021. The mailing address of the LDC: Leadership Development Committee, Florida Dental Association, 545 John Knox Rd., Ste. 200, Tallahassee, FL 32303. Nomination forms also may be faxed to 850.561.0504 or emailed to ldarnell@floridadental.org. The committee looks forward to receiving your nominations!
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.
Dr. Mehreen Sulaiman, West Palm Beach
Dr. Marlys Cabrera, Jacksonville
Dr. Lesley Tenn, Parkland
Dr. Samantha Evans, Neptune Beach
Dr. Lorraine Clark, Jacksonville Dr. Tyler Holley, Jacksonville
Central Florida District Dental Association
Dr. Sagar Kumar, Jacksonville Dr. Anthony Massaro, Fernandina Beach
Dr. Omeir Ansari, Kissimmee Dr. Leonard Badger, Orlando
Dr. Joseph Schiels, Elmsford
Atlantic Coast District Dental Association
Dr. Catherine Bridges, Dunnellon
Dr. Jorge Alvarez, West Palm Beach
Dr. Matthew Green, Winter Park
Dr. Stephanie Alvarez, Englewood
Dr. Snigdha Kalvakolanu, Gainesville
Northwest District Dental Association
Dr. Craig Brown, Boca Raton
Dr. Kerry Leonard, Daytona Beach
Dr. Samavia Ahmed, Tallahassee
Dr. Scott Brown, Boca Raton
Dr. Sarah Menias, Orlando
Dr. Phillip Bell, Pensacola
Dr. Dave Burke, Stuart
Dr. Monica Minjares, Apopka
Dr. Emeline Calligaris, Sunrise
Dr. Arelys Ruiz, Orlando
Dr. Christin Carter-Mobley, Tallahassee
Dr. Renatta Griffith, Tamarac
Dr. Diorgis Sarmiento, Melbourne
Dr. Monica Collazos, Sopchoppy
Dr. Shakeel Khan, Fort Lauderdale
Dr. Micah Sourlis, Orlando
Dr. Johana Kutrolli, Tallahassee
Dr. Richard Kitt, Boca Raton
Dr. Natalia Thillet, Orlando
Dr. Wai Hang Kwong, Tallahassee
Dr. Maria Nord, Fort Lauderdale
Dr. Cam Tran Nguyen, Orlando
Dr. Kishen Patel, Gulf Breeze
Dr. Amanda Nunez, Coral Springs
Dr. Crisalida Ulloa, St. Cloud
Dr. Chandler Pritchett, Gulf Breeze
Dr. Hayley Rodgers, Stuart
Dr. Samuel Wakim, Winter Garden
Dr. Christian Silva Silveira, Gulf Breeze
Dr. Santiago Roldan, Pompano Beach Dr. Aria Sharma, Boca Raton Dr. Aarya Shenoi, West Palm Beach
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Dr. Victoria Shirley, Jacksonville
Dr. Andrew Corsaro, Gainesville
Northeast District Dental Association Dr. Carl Amaral, Jacksonville
Dr. Julie Tran, Choctaw Beach Dr. Lauren Weir, Tallahassee SEE PAGE 18 TODAY'S FDA JANUARY/FEBRUARY 2021
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Dr. Fadi Mdanat, Davie
Dr. Robert Ferguson, St. Petersburg
Dr. Nicole Pena, Coral Gables
Dr. James Gardner III, Tampa
Dr. Carla Rodriguez, Hialeah
Dr. Jonathan Journo, Naples
Dr. Kelly Salgado, Miami
Dr. Bartlomiej Ladzinski, Tampa
Dr. Justin Sedaghat, Miami
Dr. Jae Hyun Lee, Fort Myers
Dr. Andre Smith, Hollywood
Dr. Pat Little, Land O’ Lakes Dr. Bianca Lopez-Isa, Tampa
Dr. Sasha Acloque, Miramar
Dr. Noemi Tisminesky Cardier, Aventura
Dr. Michael O’Donnell, Sarasota
Dr. Marianne Cardenas, Miami
Dr. Belen Vimo, Miami Springs
Dr. Keenan Osman, Temple Terrace
updates for members FROM PAGE 17
South Florida District Dental Association
Dr. Rene Cedeno, Miami
West Coast District Dental Association
Dr. Coralie Ciceron, Miami Dr. Elise de Latour, Miami
Dr. Moyosoreoluwa Oyebolu, Tampa Dr. Akash Patel, Tampa Dr. Alba Pena, Plant City
Dr. Elizabeth Elmaleh, Miami
Dr. Jeffrey Anderson, Bradenton
Dr. Stephan Pietro, Fort Myers
Dr. Jimena Frost, Aventura
Dr. Dwayne Bacchus, Lakewood Ranch
Dr. Rebecca Renelus, Winter Haven
Dr. Rene Gacives Vega, Weston
Dr. Natalie Bentivegna, Tampa
Dr. Geoffrey Rintel, Lakeland
Dr. Ana Garrido, Miami
Dr. Eduardo Rodriguez, Fort Myers
Dr. Christopher Golden, Leesburg
Dr. Toniann Burrus Conte, Bonita Springs
Dr. Camila Guiribitey, Pinecrest
Dr. Katia Consuegra, Bonita Springs Dr. Paula De Oliveira, Lehigh Acres
Dr. Robert Uhle, Palm Harbor
Dr. Mariano Gutierrez, Hialeah Dr. Christina Hanna, Miami
Dr. Omar Luis Delgado, Bradenton
Dr. Christian Jimenez, Miami
Dr. Robin Ellis, Fort Myers
Dr. Michelle Luis, North Miami
Dr. Jennifer Engelhardt, Fort Myers
Dr. Irina Toma, Naples Dr. Ricardo Ullrich, St. Petersburg Dr. Jenny White, Sarasota
Tobacco Free Florida
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TODAY'S FDA JANUARY/FEBRUARY 2021
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ada
FDA REPRESENTATIVES ON
COUNCILS/COMMITTEES/ COMMISSIONS Year indicates term limit
Council on Advocacy for Access and Prevention Dr. Steve Cochran – 2024
Council on Communications Dr. Mark Limosani – 2024
Council on Dental Benefit Programs Dr. Jessica Stilley-Mallah – 2023
Council on Dental Practice
Council on Member Insurance and Retired Programs Dr. Richard Huot – 2022
Council on Membership Dr. Mike Eggnatz – 2022
Committee on the New Dentist Dr. Arnelle Wright – 2024
National Commission on Recognition of Dental Specialties and Certifying Boards Dr. Alan E. Friedel – 2022, vice chair
Dr. Jeff Ottley – 2024
Council on Ethics Bylaws and Judicial Affairs CEBJA
Council on Scientific Affairs Dr. Ana Karena Mascarenhas – 2022, vice chair Dr. Marcelle M. Nascimento – 2024
Dr. Jay “Drew” Johnson – 2022
Council on Governmental Affairs Dr. Dan Gesek – 2024
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American Dental Political Action Committee Dr. Terry Buckenheimer – 2024 Drew Eason (representing state executive directors)
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DISABILITY INSURANCE YOU WORK HARD, NOW PROTECT YOUR HARD WORK FDAS: Disability What would happen if you became disabled? Your ability to earn an income is your most valuable asset and it should be protected! Disability insurance replaces a part of your regular income if you are sick or injured and can’t work. This coverage will put your mind at ease and help protect you and your family in the event of a disability. FDA Services offers the best policies from the best providers available on the market today. Be sure to ask about available discounts. Discounts are available to students in dental school or up to 60 days after graduation.
Just over 1 in 4 of today’s 20-year-olds will become disabled before they retire. SOURCE: The Guardian Life Insurance Company of America
SO, WHAT ARE YOUR GOALS? Do you want to buy a house, a car, start your own pracrice? Your
income and ability to make money are the foundation for all your goals.
You need to protect that foundation. You insure your house and your vehicles, don’t you? Then why wouldn’t you protect against the very thing that affords you these same items — your ability to produce an income?
BULDING BLOCKS OF YOUR FINANCIAL LIFE: FDAS: Disability
INVESTMENTS BUSINESS INTERESTS
EDUCATION
HOME
CARS
PERSONAL ASSETS
INCOME SOURCE: The Guardian Life Insurance Company of America
CALL OR TEXT US AT 850.681.2996 FOR A DISABILITY INSURANCE QUOTE.
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FLORIDA BOARD OF DENTISTRY DISCUSSES HUMAN TRAFFICKING CE REQUIREMENT The Florida Board of Dentistry (BOD) met via conference call on Friday, Nov. 13, 2020 at 8 a.m. The BOD cancelled its in-person meeting due to the COVID-19 pandemic; however, it still met to conduct the necessary business of the board. 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. Other FDA members present on the call included Drs. Jim Antoon, Andy Brown and Jessica Stilley.
CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS
If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@floridadental.org or 850.350.7202.
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BOD members present included: Dr. Naved Fatmi, chair; Dr. Nick White, vice chair; Drs. Matt Freedman, Claudio Miro and T.J. Tejera; hygiene members, Ms. Cathy Cabanzon and Ms. Karyn Hill; and, consumer member, Mr. Fabio Andrade. Dr. Nick Kavouklis was absent. There is one dentist position and one consumer member position open on the board that the governor has not yet filled. Ms. Jessica Sapp, BOD executive director, informed the board that many dentists still had not completed the mandatory human trafficking continuing education (CE), which must be completed by Jan. 1, 2021. The FDA obtained a list of dentists who had not yet completed the course to date and sent reminder emails to members to complete the CE requirement before the deadline. Please note that if you received your initial license in 2020, you still must have completed this course by Jan. 1, 2021. As a reminder, the mandatory Human Trafficking course is a one-time only CE requirement for dentists and hygienists, and the one hour is included in the total number of CE hours required for license renewal. The course must address both sex and labor trafficking, how to identify individuals who may be victims of human trafficking, how to report cases on human trafficking and resources available to victims.
TODAY'S FDA JANUARY/FEBRUARY 2021
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The next BOD meeting is scheduled for Friday, Feb. 19 at 7:30 a.m. EDT via conference call. The Council on Dental Hygiene put forth its revised proposal to allow hygienists to use a laser while performing their remediable tasks. After much discussion, the proposal died on a 4-4 tied vote. The BOD members who voted against the proposal argued the efficacy of using a laser as an adjunct to scaling and root planing for bacterial reduction has not yet sufficiently been proven. There were three disciplinary cases and two voluntary relinquishments dealing with failing to meet the minimum standard of care and failing to keep adequate records. There also were five motions to vacate final orders that were granted. The final orders in those cases were for failure to pay student
FLORIDADENTAL.ORG
loans; however, due to legislation passed during the 2020 Legislative Session, failure to pay student loans is no longer a disciplinary violation and those orders were vacated. It is much better to be a spectator than a participant in BOD disciplinary cases. Finally, Dr. White was elected BOD chair and Dr. Fatmi was elected vice chair for next year. The FDA thanks Dr. Fatmi for his leadership as chair during the unpredictable 2020 term. The FDA also congratulates Dr. White on his election as chair and looks forward to working with him during the upcoming year.
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Celebrating 25 years of advocacy and beyond!
2021 DENTISTS’ DAY ON THE HILL is going VIRTUAL! TUESDAY, MARCH 16, 2021 DDOH will start at 8 a.m. EDT
REGISTER AT: floridadental.org/virtualddoh
SPONSORED BY
legislative corner
ADVOCACY DURING A PANDEMIC As the Florida Legislature prepares for the 2021 Legislative Session, things will be a lot different in Tallahassee. The incoming House and Senate leadership are outlining strategies that will allow for engagement from the public but will limit the traffic at the Capitol to ensure that legislators are safe doing their jobs. Because the virus is invisible and a person could be infected without showing any symptoms, it is paramount that we strive to follow the recommended guidelines and rules that will be enacted during session to help reduce the spread of COVID-19. As vaccines are being approved for distribution, eventually things will get better, but for now — let’s play it safe and follow the rules! The Florida Dental Association (FDA) has been instrumental in advocacy efforts for many years and was prepared to celebrate 25 years of advocacy in March during the annual Dentists’ Day on the Hill (DDOH) event, but because of the coronavirus and the limitations placed on large crowds at the Capitol, the in-person event had to be cancelled. Despite this minor setback, a celebration will still take place on March 16 and will now be a virtual event! The silver lining to a virtual event is that it allows many dentists who have never experienced DDOH to do so from the comfort of their offices! You don’t want to miss it — be sure to register at floridadental. org/virtualddoh and participate.
Dental Student Loan Repayment Program and the Donated Dental Services program. These programs were passed into law in 2019 but were not funded by the Legislature. For a small investment of $773,000 by the state, people who live in rural and underserved communities will have access to routine dental care. Additionally, the FDA will be supporting funding for community water fluoridation at $200,000. These funds would be administered through the Department of Health to help provide local governments with resources to support fluoridation in their communities.
JOE ANNE HART FDA CHIEF LEGISLATIVE OFFICER
For additional information on legislative issues, you can reach Joe Anne Hart at jahart@floridadental.org or 850.350.7205.
Dentists have been successful in treating patients safely during this national pandemic by implementing strict protocols and safeguards to protect themselves and their patients from COVID-19. Even still, there are individuals who look for opportunities like this to take advantage of businesses by falsely claiming they were infected while at that establishment. The FDA will be supporting efforts this session to create uniform standards to help protect health care providers and businesses from frivolous lawsuits. Liability protection legislation will attempt to curtail these types of lawsuits that seek to blame someone else or a business entity when an individual tests positive for COVID-19. For the past three years, the FDA successfully defeated legislation to create a new
During this year’s session, the FDA will seek to secure funding from the state for the
SEE PAGE 27
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now you know INFORMATION FROM THE FDA GO TO SUMMARY All health care providers must include non-opioid alternatives for pain and pain management 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, 2019.
OPIOIDS
Non-opioid Alternatives Law bit.ly/2KXvZ2h
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.
Your
BACKSTAGE
PROVIDE
“Alternatives to Opioids,” an educational
ALL ACCESS
ur FDA YoEXCLUSIVE
information pamphlet created by the Florida Department of Health (required, available at bit.ly/2KXvZ2h). Also, a checklist and poster.
MEMBER BENEFIT
For the latest on opioids, go to: floridadental.org/nyk
GO TO
legislative corner
FROM PAGE 25
licensed dental provider called a dental therapist. A dental therapist could be a high school graduate with three years of dental therapy training, who would be authorized to perform extractions, partial root canals and administer local anesthesia. Proponents of dental therapy claim that this new provider will solve the access-to-care issues in the state. The FDA does not support dental therapy as a solution for Florida. Lowering the standard of care for the most vulnerable populations does not make sense and could potentially create more problems for people who haven’t received routine dental care and may present with severe medical issues. Florida’s robust workforce is sufficient enough to help address these concerns and could be implemented within months if and when the Legislature funds the Dental Student Loan Repayment Program. These individuals will need comprehensive dental care from highly trained dentists.
The 2021 Legislative Session will be challenging as the Legislature tries to navigate through priority issues that will most likely include implementing significant budget cuts or limitations on new spending because of the impact of COVID-19. The FDA will be monitoring the budget process and several other issues that will consume legislators during the 60-day session. To keep up to date on legislative issues impacting dentistry during session, be sure to read the weekly Capital Report digital newsletter sent to members. For more information, contact the Governmental Affairs Office at gao@floridadental. org or visit at dentalhealthfl.org.
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. Gerald Bird FDAPAC Chair FLORIDADENTAL.ORG
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PNC Bank legislature
The
2020-2022 Legislature
Below is a list of senators and representatives who will serve in the 2020-2022 Florida Legislature. These legislators were officially sworn in on Nov. 17 during Organizational Session. Legislators elected to the Senate during this election cycle will serve four-year terms, while the House members will serve two-year terms.
Senate President Sen. Wilton Simpson
House Speaker Rep. Chris Sprowls
House Democratic Leader Rep. Bobby DuBose
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Senate Democratic Leader Sen. Gary Famer
House Democratic Leader Rep. Evan Jenne
FLORIDADENTAL.ORG
Senate District 1: Sen. Doug Broxson (R) Pensacola District 2: Sen. George B. Gainer (R) Panama City
District 37: Sen. Ileana Garcia (R) Miami District 38: Sen. Jason Pizzo (D) Miami District 39: Sen. Ana Maria Rodriguez (R) Miami District 40: Sen. Annette Taddeo (D) Miami
District 3: Sen. Loranne Ausley (D) Tallahassee District 4: Sen. Aaron Bean (R) Jacksonville
House of Representatives
District 5: Sen. Jennifer Bradley (R) Fleming Island District 6: Sen. Audrey Gibson (D) Jacksonville
District 1: Rep. Michelle Salzman (R) Pensacola
District 7: Sen. Travis Hutson (R) Palm Coast
District 2: Rep. Alex Andrade (R) Pensacola
District 8: Sen. Keith Perry (R) Gainesville
District 3: Rep. Jayer Williamson (R) Pace
District 9: Sen. Jason Brodeur (R) Sanford
District 4: Rep. Patt Maney (R) Shalimar
District 10: Sen. Wilton Simpson (R) Spring Hill
District 5: Rep. Brad Drake (R) DeFuniak Springs
District 11: Sen. Randolph Bracy (D) Orlando
District 6: Rep. Jay Trumbull (R) Panama City
District 12: Sen. Dennis Baxley (R) Lady Lake
District 7: Rep. Jason Shoaf (R) Perry
District 13: Sen. Linda Stewart (D) Orlando
District 8: Rep. Ramon Alexander (D) Tallahassee
District 14: Sen. Tom A. Wright (R) Port Orange
District 9: Rep. Allison Tant (D) Tallahassee
District 15: Sen. Victor M. Torres (D) Kissimmee
District 10: Rep. Chuck Brannan (R) Lake City
District 16: Sen. Ed Hooper (R) Palm Harbor
District 11: Rep. Cord Byrd (R) Jacksonville Beach
District 17: Sen. Debbie Mayfield (R) Melbourne
District 12: Rep. Clay Yarborough (R) Jacksonville
District 18: Sen. Janet Cruz (D) Tampa
District 13: Rep. Tracie Davis (D) Jacksonville
District 19: Sen. Darryl Rouson (D) St. Petersburg
District 14: Rep. Angie Nixon (D) Jacksonville
District 20: Sen. Danny Burgess (R) Zephyrhills
District 15: Rep. Wyman Duggan (R) Jacksonville
District 21: Sen. Jim Boyd (R) Bradenton
District 16: Rep. Jason Fischer (R) Jacksonville
District 22: Sen. Kelli Stargel (R) Lakeland
District 17: Rep. Cyndi Stevenson (R) St. Augustine
District 23: Sen. Joe Gruters (R) Sarasota
District 18: Rep. Sam Garrison (R) Orange Park
District 24: Sen. Jeff Brandes (R) St. Petersburg
District 19: Rep. Bobby Payne (R) Palatka
District 25: Sen. Gayle Harrell (R) Stuart
District 20: Rep. Yvonne Hayes Hinson (D) Gainesville
District 26: Sen. Ben Albritton (R) Bartow
District 21: Rep. Chuck Clemons (R) Jonesville
District 27: Sen. Ray Rodrigues (R) Estero
District 22: Rep. Joe Harding (R) Ocala
District 28: Sen. Kathleen Passidomo (R) Naples
District 23: Rep. Stan McClain (R) Ocala
District 29: Sen. Tina Polsky (D) Boca Raton
District 24: Rep. Paul Renner (R) Palm Coast
District 30: Sen. Bobby Powell (D) West Palm Beach
District 25: Rep. Tom Leek (R) Daytona Beach
District 31: Sen. Lori Berman(D) Boynton Beach
District 26: Rep. Elizabeth Fetterhoff (R) DeLand
District 32: Sen. Lauren Book (D) Plantation
District 27: Rep. Webster Barnaby (R) Deltona
District 33: Sen. Perry E. Thurston (D) Fort Lauderdale
District 28: Rep. David Smith (R) Winter Springs
District 34: Sen. Gary Farmer (D) Fort Lauderdale
District 29: Rep. Scott Plakon (R) Longwood
District 35: Sen. Shevrin Jones (D) Hollywood
District 30: Rep. Joy Goff-Marcil (D) Maitland
District 36: Sen. Manny Diaz (R) Hialeah Gardens FLORIDADENTAL.ORG
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District 62: Rep. Susan Valdes (D) Tampa
legislature
District 63: Rep. Fentrice Driskell (D) Tampa District 64: Rep. Traci Koster (R) Tampa
FROM PAGE 29
District 31: Rep. Keith Truenow (R) Tavares District 32: Rep. Anthony Sabatini (R) Clermont District 33: Rep. Brett Hage (R) The Villages District 34: Rep. Ralph Massullo (R) Beverly Hills District 35: Rep. Blaise Ingoglia (R) Spring Hill District 36: Rep. Amber Mariano (R) Hudson District 37: Rep. Ardian Zika (R) Land O’Lakes District 38: Rep. Randy Maggard (R) Zephyrhills District 39: Rep. Josie Tomkow (R) Auburndale District 40: Rep. Colleen Burton (R) Lakeland District 41: Rep. Sam Killebrew (R) Winter Haven District 42: Rep. Fred Hawkins (R) St. Cloud District 43: Rep. Kristen Arrington (D) Kissimmee District 44: Rep. Geraldine Thompson (D) Orlando District 45: Rep. Kamia Brown (D) Orlando District 46: Rep. Travaris L. McCurdy (D) Orlando District 47: Rep. Anna Eskamani (D) Orlando District 48: Rep. Daisy Morales (D) Orlando District 49: Rep. Carlos Guillermo Smith (D) Winter Park District 50: Rep. Rene Plasencia (R) Titusville District 51: Rep. Tyler Sirois (R) Merritt Island District 52: Rep. Thad Altman (R) Indian Harbour Beach District 53: Rep. Randy Fine (R) Palm Bay District 54: Rep. Erin Grall (R) Vero Beach District 55: Rep. Kaylee Tuck (R) Sebring District 56: Rep. Melony Bell (R) Fort Meade District 57: Rep. Mike Beltran (R) Valrico District 58: Rep. Lawrence McClure (R) Plant City District 59: Rep. Andrew Learned (D) Brandon District 60: Rep. Jackie Toledo (R) Tampa District 61: Rep. Dianne Hart (D) Tampa
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District 65: Rep. Chris Sprowls (R) Clearwater District 66: Rep. Nick DiCeglie (R) Largo District 67: Rep. Chris Latvala (R) Clearwater District 68: Rep. Ben Diamond (D) St. Petersburg District 69: Rep. Linda Chaney (R) St. Petersburg District 70: Rep. Michele K. Rayner (D) St. Petersburg District 71: Rep. Will Robinson (R) Bradenton District 72: Rep. Fiona McFarland (R) Sarasota District 73: Rep. Tommy Gregory (R) Bradenton District 74: Rep. James Buchanan (R) North Port District 75: Rep. Michael Grant (R) Port Charlotte District 76: Rep. Adam Botana (R) Fort Myers District 77: Rep. Mike Giallombardo (R) Cape Coral District 78: Rep. Jenna Persons-Mulicka (R) Fort Myers District 79: Rep. Spencer Roach (R) North Fort Myers District 80: Rep. Lauren Melo (R) Naples District 81: Rep. Kelly Skidmore (D) Boca Raton District 82: Rep. John Snyder (R) Palm City District 83: Rep. Toby Overdorf (R) Stuart District 84: Rep. Dana Trabulsy (R) Fort Pierce District 85: Rep. Rick Roth (R) Palm Beach Gardens District 86: Rep. Matt Willhite (D) Royal Palm Beach District 87: Rep. David Silvers (D) West Palm Beach District 88: Rep. Omari Hardy (D) Lake Worth Beach District 89: Rep. Mike Caruso (R) Boca Raton District 90: Rep. Joseph Casello (D) Boynton Beach District 91: Rep. Emily Slosberg (D) Delray Beach District 92: Rep. Patricia H. Williams (D) Fort Lauderdale District 93: Rep. Chip LaMarca (R) Lighthouse Point District 94: Rep. Bobby DuBose (D) Fort Lauderdale District 95: Rep. Anika Omphroy (D) Sunrise District 96: Rep. Christine Hunschofsky (D) Parkland
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District 97: Rep. Dan Daley (D) Coral Springs District 98: Rep. Michael Gottlieb (D) Plantation District 99: Rep. Evan Jenne (D) Hollywood
U.S. House of Representatives Congressional District 1: Rep. Matt Gaetz (R)
District 100: Rep. Joe Geller (D) Dania Beach
Congressional District 2: Rep. Neal Dunn (R)
District 101: Rep. Marie Woodson (D) Hollywood
Congressional District 3: Rep. Kat Cammack (R)
District 102: Rep. Felicia Simone Robinson (D) Miami Gardens
Congressional District 4: Rep. John Rutherford (R)
District 103: Rep. Tom Fabricio (R) Miramar
Congressional District 5: Rep. Al Lawson (D)
District 104: Rep. Robin Bartleman (D) Weston
Congressional District 6: Rep. Mike Waltz (R)
District 105: Rep. David Borrero (R) Miami
Congressional District 7: Rep. Stephanie Murphy (D)
District 106: Rep. Bob Rommel (R) Naples District 107: Rep. Christopher Benjamin (D) Miami District 108: Rep. Dotie Joseph (D) Miami
Congressional District 8: Rep. Bill Posey (R) Congressional District 9: Rep. Darren Soto (D)
District 109: Rep. James Bush (D) Opa Locka
Congressional District 10: Rep. Val Demings (D)
District 110: Rep. Alex Rizo (R) Hialeah
Congressional District 11: Rep. Daniel Webster (R)
District 111: Rep. Bryan Avila (R) Hialeah District 112: Rep. Nicholas Duran (D) Miami District 113: Rep. Michael Grieco (D) North Bay Village
Congressional District 12: Rep. Gus Bilirakis (R) Congressional District 13: Rep. Charlie Crist (D)
District 114: Rep. Demi Busatta Cabrera (R) Miami
Congressional District 14: Rep. Kathy Castor (D)
District 115: Rep. Vance Aloupis (R) Miami
Congressional District 15: Rep. Scott Franklin (R)
District 116: Rep. Daniel Perez (R) Miami District 117: Rep. Kevin Chambliss (D) Dade District 118: Rep. Anthony Rodriguez (R) Miami
Congressional District 16: Rep. Vern Buchanan (R) Congressional District 17: Rep. Greg Steube (R)
District 119: Rep. Juan Fernandez-Barquin (R) Miami
Congressional District 18: Rep. Brian Mast (R)
District 120: Rep. Jim Mooney (R) Islamorada
Congressional District 19: Rep. Byron Donalds (R) Congressional District 20: Rep. Alcee Hastings (D)
Florida Congressional Members U.S. Senate Sen. Marco Rubio (R)
Congressional District 21: Rep. Lois Frankel (D) Congressional District 22: Rep. Ted Deutch (D) Congressional District 23: Rep. Debbie Wasserman Schultz (D) Congressional District 24: Rep. Frederica Wilson (D) Congressional District 26: Rep. Carlos Gimenez (R) Congressional District 27: Rep. Maria Elvira Salazar (R)
Sen. Rick Scott (R)
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TODAY'S FDA JANUARY/FEBRUARY 2021
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grassroots
FDAPAC, GAC and LCD Members by District Dental Association Dr. Joseph Dermody, LCD
Dr. Russell Stoch, LCD
Dr. Shawn Engebretsen, LCD
Dr. Craig Stranigan, LCD
Dr. David Boden, FDAPAC consultant, GAC member, LCD
Dr. Donovan Essen, LCD
Dr. James Strawn, LCD
Dr. George Kolos, FDAPAC member, LCD
Dr. Mark Fedele, LCD
Dr. Paul Werner, LCD
Dr. Jeffrey Ganeles, LCD
Dr. Clifford Yanover, LCD
Atlantic Coast
Dr. Jenna Schwibner, GAC consultant Dr. Jay Singer, GAC member Dr. Ralph Attanasi, LCD Dr. William Balanoff, LCD Dr. Susan Berlin, LCD Dr. Christopher Dermody, LCD
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Dr. Laurence Grayhills, LCD Dr. Rick Huot, LCD Dr. Brian Jacobus Jr., LCD Dr. Thomas Lane, LCD Dr. Robert Bruce McDonald, LCD Dr. Ethan Pansick, LCD Dr. Emmanuel Platis, LCD Dr. Douglas Starkey, LCD
TODAY'S FDA JANUARY/FEBRUARY 2021
Central Florida Dr. Gerald Bird, FDAPAC chair, GAC consultant, LCD Dr. Jerilyn Bird, FDAPAC member Dr. Joe Calderone, GAC BOD liaison Dr. Steve Hochfelder, GAC member, LCD
FLORIDADENTAL.ORG
Dr. Brenna Kever, FDAPAC consultant
Dr. Claude Owens, LCD
Dr. Scott McCauley, FDAPAC member
Dr. Curt Standish, LCD
Dr. Donald Thomas, FDAPAC member
Dr. John Verville, LCD
West Coast Dr. Doug Jungman, GAC member, LCD
Dr. Rick Stevenson, LCD
Dr. Zack Kalarickal, FDAPAC consultant, GAC consultant, LCD
Dr. George Weeks, LCD Dr. Cecil White, LCD
Dr. Rudy Liddell, GAC member, LCD
Dr. Daryl Askeland, LCD Dr. Brian Coleman, LCD Dr. Dan Crofton, LCD
Dr. Brent Mayer, FDAPAC member, LCD
Northwest
Dr. Paul Palo, FDAPAC member, LCD
Dr. Bert Hughes, LCD
Dr. Reese Harrison, FDAPAC consultant, LCD
Dr. Don Ilkka, LCD
Dr. Jeff Ottley, GAC member, LCD
Dr. Eva Ackley, LCD
Dr. Bernard Kahn, LCD
Dr. Daniel Melzer, FDAPAC member, LCD
Dr. Rodney Ackley, LCD
Dr. Curtis Hill Jr., LCD
Dr. Raymond Kenzik, LCD Dr. Lee Anne Keough, LCD Dr. Jason Larkin, LCD Dr. Oscar Morejon, LCD Dr. Larry Nissen, LCD Dr. Elizabeth Nixon, LCD Dr. Naghman Qureshi, LCD Dr. Sundeep Rawal, LCD Dr. Jeff Sevor, LCD Dr. Kevin Snyder, LCD
Dr. Nolan Allen, LCD Dr. Richard Bastien, LCD
Dr. Leonard Britten, LCD
Dr. Walter Colon, LCD
Dr. Terry Buckenheimer, LCD
Dr. Howard Fisher, LCD
Dr. Natalie Carr-Bustillo, LCD
Dr. Chinara Garraway, LCD
Dr. Lynne Cataldo, LCD
Dr. Tricia Hess, LCD
Dr. David Clary, LCD
Dr. Frank May, LCD
Dr. Irene Hurst, LCD
Dr. Jolene Paramore, LCD
Dr. Bradley Jergins, LCD
Dr. Robert Payne, LCD
Dr. Gregg Langston, LCD Dr. Patrick Lepeak, LCD
Dr. Suzi Thiems-Heflin, LCD Dr. Wade Winker, LCD Dr. Anthony Wong, LCD
Northeast Dr. Andy Brown, FDA president, GAC chair, FDAPAC member, LCD Dr. Dan Gesek, FDAPAC member, GAC member, LCD Dr.Stephen Beckett, LCD Dr. Stephen Cochran, LCD Dr. Ron Dixon, LCD Dr. Elizabeth Gesenhues, LCD Dr. CJ Henley, LCD Dr. Thomas Klechak, LCD Dr. Jackie Miller, LCD Dr. Orrin Mitchell, LCD
Dr. Henry Acosta, LCD
South Florida
Dr. Charles Llano, LCD Dr. Mariela Lung, LCD
Dr. Tim Franklin, FDAPC member, LCD
Dr. Andrew Martineau, LCD
Dr. Irene Marron-Tarrazzi, GAC member, LCD
Dr. Paul Miller, LCD
Dr. Rachel Perez, GAC consultant Dr. Beatriz Terry, FDAPAC consultant, GAC consultant, LCD Dr. Andres de Cardenas, LCD Dr. Alan Friedel, LCD Dr. Harvey Gordon, LCD Dr. Laurie Gordon-Brown, LCD Dr. Ernesto Perez, LCD Dr. Evan Rubensteen, LCD
Dr. Oscar Menendez, LCD Dr. John Paul, LCD Dr. Robert Payne, LCD Dr. Queanh Phan, LCD Dr. Michael Reynolds, LCD Dr. Rodrigo Romano, LCD Dr. Carol Stevens, LCD Dr. Tina Thomas, LCD Dr. Roger Triftshauser, LCD Dr. Andrew Varga, LCD Dr. Dewitt Wilkerson, LCD
Dr. Cesar Sabates, LCD Dr. Carlos Sanchez, LCD
Dr. Gary Myers, LCD Dr. Merlin Ohmer, LCD
FLORIDADENTAL.ORG
TODAY'S FDA JANUARY/FEBRUARY 2021
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heroes
LEADING, ADVOCATING AND MENTORING Dr. Jerry Bird is a longtime and active member of the Florida Dental Association (FDA), who hasn’t been afraid to get involved in many different roles of leadership. He currently serves as the FDA first vice president and chair of the FDA Political Action Committee (FDAPAC). He serves on the Governmental Action Committee and the DR. JERRY BIRD 17th Delegation to the American Dental Association (ADA). Dr. Bird also is a past chair of the ADA Political Action Committee (ADPAC). Dr. Bird is one who doesn’t shy away from hard work and has constantly volunteered his time to lead the charge for legislative and political advocacy for organized dentistry. He participates as a legislative contact dentist (LCD) for several Florida state legislators, as well as an action team leader for congressional members. Dr. Bird understands the value of relationship building and how it benefits the dental profession. That’s why he works tirelessly to encourage his dental colleagues to get involved. And let’s not forget his biggest supporter — his wife, Mrs. Jerilyn Bird. This dynamic duo is relentless in their
support of the FDA and the FDAPAC. They both consistently contribute to FDAPAC Century Club and Capital Hill Club, which are commitments to give contributions above and beyond regular PAC dues. They also contribute at the highest ADPAC level which is the Diamond Level. In addition to his state and federal level involvement, Dr. Bird has previously served in leadership roles at the local level with the Brevard County Dental Society (BCDS) and the Central Florida District Dental Association (CFDDA); he served as president of both organizations. In 2019, Dr. Bird received the most prestigious recognition within the FDA as Dentist of the Year. He also was the elective chairman of leadership of the Department of all Surgery at the Rockledge Regional Medical Center. Oral and maxillofacial surgeons have the unique opportunity to get involved in other surgeries more than the dental profession in their assignment positions. Dr. Bird is a triathlete and health enthusiast who loves to run, bike, swim and work out. He enjoys competing in triathlons and road races ranging from two miles to marathons. Dr. Bird also enjoys family time with his wife, Jerilyn; his children, Stephanie and Kevin; daughter-in-law, Taylor; and, his favorite grandson, Carter!
“
Dr. Bird is many things to many people. To the dentists of Brevard County and I, he embodies the true meaning of a mentor. From the moment you meet Dr. Bird, his energy and passion are captivating. Not only does he always share the importance of advocating for the dental profession at each and every turn, but he selflessly gives his time and effort to guide members through the legislative process himself. He leads by example in every aspect, always striving to include his colleagues by finding their passions and strengths and helping determine how they can best put those into action. I first met Dr. Bird at Dentists’ Day on the Hill (DDOH) when I was a resident at the University of Florida, and he encouraged me to speak in front of a group of legislators and fellow dentists about student debt and my thoughts on programs that could help. The confidence he showed in me then on the first day we met and many times since exemplify his unabated attitude that teamwork towards our common goal is what was most important to protect our profession.
— Dr. Angie McNeight
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”
FLORIDADENTAL.ORG
In His words ... Why is being an LCD so important and vital to legislative advocacy? It’s extremely important to be an LCD in these rapidly changing times. Everything we’re allowed to do as a dentist is decided by the Legislature or by the Florida Board of Dentistry. There’ll be continued pressure at the legislative level to alter what we’re able to do in our practices on a day-to-day basis. We face threats from the dental therapist issue, third-party payers, increased regulation, do-it-yourself dentistry, and increasing political and social pressures to find ways to care for the underserved in Florida. Becoming an LCD allows you to have personal influence when your legislator comes to you for answers about our profession in which you are the expert.
what made you want to become involved in the FDA’s Grassroots/political advocacy? As I ascended to leadership positions both in the BCDS and the CFDDA, I realized the importance of the political process. At the FDA’s first DDOH back in the 90s, a local Brevard County dentist, Dr. Bob Downey, took me and Drs. Larry Nissen and Jim Antoon to Tallahassee. The first three years of the program, Bob guided us through the halls of the Capitol and taught us how to interact with our legislators and discuss our legislative issues. More importantly, we visited both Republicans and Democrats, and he introduced us to the concept of the Tooth Party long before it became popular. He was instrumental in teaching us how important it was to be involved with a political process to influence legislation that affected our patients and our profession.
(L to R) Drs. Jerry Bird and Rick Andolina, and Mrs. Jerilyn Bird attend the 2018 ADA Dentist and Student Lobby Day in Washington, D.C.
Heartland Triathlon in Sebring, Fla.: (L to R) Anthony Stamm (Stephanie’s boyfriend), daughter, Stephanie, Jerilyn and Dr. Bird.
Dr. Bird has been making amazing progress in his recovery since his bike accident in August. He’s participated in virtual board meetings and council meetings, and is enjoying getting back to being involved.
ADPAC friends showing off Tooth Party socks at the 2018 ADA Dentist and Student Lobby Day: (L to R) Drs. Rick Andolina, Tommy Harrison, Steve Ortego, Jerry Bird, David Watson, Bruce Hutchison, Loren Feldner and Frank Graham.
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heroes
GIVING BACK THROUGH MISSION TRIPS Early in my career, I was blessed with the opportunity to travel to some underserved areas in Central America to deliver dental care. After completing seven trips to parts of Honduras and Guatemala, I can honestly say that it’s one of the most rewarding things you can do as a dentist. The remarkable thing about going on trips like these is despite the Dr. Byrnes is a general poor living conditions you may dentist in Winter Park, Fla. and can be reached at endure (hard mattresses, no air dentistwp@gmail.com conditioning, poor lighting and no or 407.645.4645. suction) there is a certain energy you feel that makes those things seem insignificant. DR. DREW BYRNES
Perhaps it’s the recognition that while these conditions are only temporary for us, they are permanent for those we’re helping. Perhaps it’s the gratitude expressed by every person we get to serve. Or maybe, it’s just the simple joy that comes from doing something good. Whatever it is, it makes you feel energized and excited to work when you should be exhausted and ready to quit. One day giving back can be just as exhausting as a day in the office, but the difference is that it can renew your passion for dentistry. It can be a great way to help prevent burnout. After returning from my last visit to Guatemala several years ago, I shared my experience with some local dental colleagues. I told them about the people we helped and how the poor working conditions didn’t seem to matter. They all seemed genuinely interested and a few of them responded with similar experiences from their own trips. However, there was one response that really made me think.
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TODAY'S FDA JANUARY/FEBRUARY 2021
“I’ve always wanted to do that.” I heard this same response from a few dentists. It made me think that many dentists probably feel this same way. After all, the reason that most of us got into dentistry in the first place is that we wanted to help people. If anyone is on the fence about giving back through a service trip, my advice is simple: “Just go do it!” There is always an excuse not to go. I’ve used plenty of them myself. But if you don’t make it a priority, it’ll never happen. Don’t let yourself get to the end of your career and regret having not answered a call to serve those in need. If you think that you’d like to give back by going somewhere like Guatemala to serve those without dental care, I say go for it! You worked hard to become a dentist. You have a valuable set of skills that everyone needs, but many do not have access to. Don’t let your schedule hold you back. Your patients will understand and appreciate that you give back. If you want to go but you don’t know where to start, try contacting local churches. They likely have service trips all the time and dentists are in high demand in these areas. You also could try asking other dentists if they’ve been on a trip. They might offer to take you with them. I went with the Christian Dental Society from the University of Florida. Finally, while trips like these are great, don’t forget about the free dental clinic in your own town or the FDA Foundation’s annual Florida Mission of Mercy. It’s a gift to serve those less fortunate, whether across the globe or just down the street. We will be hosting our first Free Dental Day at Park Smiles Dentistry in Winter Park this year. If you would like to volunteer your time, please contact our office. We would love to have you.
FLORIDADENTAL.ORG
The Christian Dental Society from the University of Florida travels to Guatemala once a year to help those in need. They are always accepting donations of dental supplies and financial support.
Dr. Byrnes educating children on dental hygiene in Guatemala.
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heroes
DENTAL PRACTICE
MILITARY VETERANS
FLORIDADENTAL.ORG
TODAY'S FDA
JANUARY/FEBRUARY 2021
39
heroes A dental career in the military will change your life — trust me. I know it certainly changed mine! In 1988, I graduated from the Indiana University School of Dentistry with no real direction for my life and my career. Associate? Startup? Buy-in? Buy-out? GPR? Specialty? Military? God had a plan for me — I just needed to trust him and follow the open doors! After much research and prayer, my decision was made. I would be commissioned as a lieutenant in the United States Navy. This would allow me to accomplish several goals:
DR. LAWRENCE E. WEAVER
Dr. Weaver is a general dentist in Tallahassee and can be reached at leweaverdds@yahoo.com or 850.385.2003.
Serve my country. Hone my skills and determine if a specialty school was right for me. Travel to other areas of the country to see where I wanted to practice. Prepare and pass other state dental boards. On Jan. 1, 1989, I was commissioned and traveled to Newport, R.I. for six weeks of Officer Indoctrination School where I learned naval history and what was expected of me becoming a naval officer. My only regret was I had to complete the school in winter and not during the summer!
Officer Indoctrination School, Newport, R.I.
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TODAY'S FDA
After graduating, I was stationed at Camp Lejeune in Jacksonville, N.C. to work with the Marines. As I found out, all medical personnel for the Marine Corps comes from the U.S. Navy. This meant I would practice on Marines, wearing camouflage uniforms and combat boots to work. Working with Marines allowed me to do other things besides dentistry — throwing grenades, shooting rifles and pistols, humping 15 miles with full packs and driving a tank are just a few! I was selected to join the 22nd Marine Expedition-
JANUARY/FEBRUARY 2021
ary Unit and be deployed on the USS Saipan, living on a ship for six months. Before deploying, I worked six-week specialty training segments in periodontics, endodontics and oral surgery to improve my skills and prepare me for most dental emergencies that I would see while stationed on the ship. The deployment was set to travel within the Mediterranean Sea and stop at multiple countries along the way. I was able to visit Spain, Italy, France and Mallorca before we were called to Operation Sharp Edge. This was a humanitarian mission to help Liberians escape from Monrovia, Liberia during their country’s civil war. I was assigned more than 1,600 Marines to care for while stationed on the USS Saipan. I found there is no better way to practice your dental skills than working in a dental treatment room while on a ship during rough seas! Upon my return to Camp Lejeune, our facility helped train Coastal Carolina Dental Hygiene students and I met my future wife, Gina Whitehurst, through this program. My two-year commitment to Camp Lejeune was now over and I accepted a transfer to Kings Bay Naval Base in St. Mary’s, Ga. Kings Bay is a submarine community that had seven other dentists working to service the sailors stationed at Kings Bay. Gina and I were married and lived on Amelia Island in Florida while stationed there for three years. Gina worked at a private practice on the island and thanks to my training at Camp Lejeune, I started the oral surgery department at our dental clinic. This allowed me to do most minor surgical procedures and remove even complicated wisdom teeth. All this while living in a beautiful spot of Northeast Coastal Florida.
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My time in the Navy allowed me to accomplish my original goals — serve my country, hone my skills, travel, prepare and decide my next career move. We decided to move to Tallahassee, Fla. and buy out a retiring general dentist, Dr. Joe R. Hughes, and take over his practice. Dr. Hughes was a former Navy dentist, so we had a connection, and he and his wife Peggy became great mentors for my wife and me. Even now, after five years of naval service and more than 25 years of owning my general dental practice in Tallahassee, God continues to open doors for me, my wife and my family. My new partner, Dr. Alan Dransfield, is a former Navy dentist, too. I’m grateful for the additional dental training and experience the military provided me. I’m proud to be a Navy veteran and am thankful for such a memorable opportunity to serve our country.
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Photos: 1. Naval Submarine Base, Kings Bay, Ga. 2. Field dentistry outside Quantico, Va. 3. Onboard USS Saipan sailing by Rock of Gibraltar.
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4. Field Ops in Sardinia, Italy. 5. Onboard USS Saipan alongside a Harrier Aircraft.
United States Navy Logo featured on page 39: By United States Navy This vector image includes elements that have been taken or adapted from this file: Emblem of the United States Navy.png., Public Domain, commons.wikimedia.org/w/index.php?curid=66890252.
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DR. ALAN D. DRANSFIELD
Dr. Dransfield is a general dentist in Tallahassee and can be reached at adransfield@comcast.net or 850.385.2003.
Lt. Dransfield honorably served in the U.S. Navy Dental Corps from 2012-2016, 2D Dental Battalion, Camp Lejuene, NC.
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My adventure in military service began at the end of my first year in dental school at the University of Florida College of Dentistry (UFCD). I was enlisted in the United States Navy in May 2009 under the Health Services Collegiate Program. Although technically considered to be on active duty, my mission was to successfully complete dental school and obtain a license to practice so I could fulfill my commitment to the Navy. I had to remain in frequent contact with the local recruiter’s office, pass the physical readiness tests and submit to random drug tests. Other than that, they left me alone. I was a dental student. In return, the Navy helped reduce my student loan debt and took away the stress of finding that first job. I suppose I even had some extra incentive to work hard and maintain good grades because if for any reason I dropped out or flunked out of school, my contract would have sent me to boot camp to fulfill my commitment as an enlisted sailor doing whatever the needs of the Navy deemed necessary. Thankfully, I graduated from UFCD in May 2012. Shortly after, I received a direct commission as a lieutenant in the United States Navy Dental Corps. Following six weeks of Officer Development School in Newport, R.I., my wife, 3-year-old daughter, and 3-month-old son relocated with me to Camp Lejeune in North Carolina. I spent the next four years as a dental officer assigned to the United States Marines. During my first year, I completed an Advanced Education in General Dentistry as one of six residents. The training, study and practice were rigorous, but helped me feel more confident in my practice.
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Dentistry was not the only rigorous part of my job. In the military, a dental officer is always an officer first and a dentist second. As such, I had several opportunities to participate in the military side of things. Annually, I would qualify with a 9 mm pistol and learn to trust my gas mask in the gas chamber. I also took a ride in the back of a helicopter and drove an amphibious assault vehicle through the mud trails. I camped out with the Marines on several training exercises, usually for several days or a week at a time. The longest one was a month spent at Fort Bragg for Operation Rolling Thunder. Not only did I get to do a lot of dentistry in tents or even just out in the open using mobile units, but I also got to fire a Howitzer cannon during a nighttime training operation. An intense training exercise was at Fort Sam Houston, Texas, for Combat Casualty Care Course (or C4, for short). During this exercise, I was prepared to fill my role as a triage doctor in the event of a wartime mass casualty scenario. I’m so thankful that I never had to fill that role. For some, the military is a full-time, lifelong career. For me, it was the start of my career. I left active duty in 2016. I’m grateful for the time served in uniform, the training opportunities and the team approach. But in the end, I preferred to settle down in one place and enjoy more independence in life. As I was seeking a practice opportunity outside of the military, I was introduced to Dr. Lawrence Weaver by a mutual friend in my hometown of Tallahassee, Fla. And as fate would have it, he was a Navy dentist, too and even spent time in Camp Lejeune. There
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seemed to be an immediate connection that has continued as we have become business partners and practiced together now for more than four years. I think our common background helps us have similar practice philosophies, which makes a huge difference in how partnerships can work out. I’m honored to have served in the United States military, serving those who serve us, who literally put their lives on the line to protect our nation’s freedoms. I hope the small part that I played made a difference for some of those brave men and women in uniform.
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Photos: 1. Gotta love tent dentistry — don't mind the mud. 2. Caravanning in an amphibious assault vehicle. 3. Digital X-rays in the middle of nowhere. 4. That's right — I'm kind of a bad @$$.
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TRUST YOUR INSTINCTS Occasionally, patients remind us why we matter in ways bigger than we can imagine. I don’t have to tell anyone that 2020 was a challenging year as a dentist and practice owner. We all know that. In the middle of the summer, when COVID-19 cancellations were still very much a challenge in our practices and shortly after the World Health Organization had released a statement saying that routine dental care should be postponed, was one such time.
DR. BECKY WARNKEN
Dr. Warnken is a general dentist in Wesley Chapel , Fla. and can be reached at rwarnkendds@ gmail.com or 813.991.9893.
During this period, I saw a 69-year-old female patient for a routine hygiene exam. I begin each exam by palpating for lymphadenopathy. Immediately, my gut told me something wasn’t right when I discovered her right sublingual lymph node was firm, rigid and markedly abnormal from the left side. The patient had a history of cancer years before. I didn’t want to panic the patient, but I didn’t want her to take this lightly or ignore it either. I finished my exam and then sat her up. I showed her the lymph node and had her palpate it herself. We discussed her history and I stressed that this needed further evaluation. I wrote down exactly what description she needed to give her primary care physician (PCP) of the lymph node when she called to make an appointment. She stated that it hadn’t been more than six months since she had seen her PCP, and that nothing had come back abnormal at her last regular appointment. I assured her that we would just rather be safe than sorry, and she agreed. She called her PCP immediately upon leaving my office. Two weeks later, my office received a phone call from this patient. She told Sandy at my front desk, “I don’t want to bother Dr. Becky, she is busy. But I need you to thank her for me. I need you to thank her for catching my cancer. I am entering Moffitt now for a workup and I don’t have a lot of time either, but please just tell her thank you.” She started crying. Sandy started crying. When Sandy told me, I started crying. I was devastated that my patient was facing a cancer diagnosis. I was simultaneously so thrilled that she had come in for her routine exam and that I hadn’t ignored my instincts. She’s undergoing treatment and, at our last update, her prognosis was good. The physician assistant students I teach at the University of Tampa always ask how you know something is abnormal, or when you should insist something has a further evaluation. My answer is always the same: If you aren’t sure, insist that they return in two weeks. If the abnormal spot or lymph node hasn’t changed, then you know it is worth further
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investigation. However, sometimes you just know something isn’t right and you can usually help the patient realize the same and guide them to further care. Trust your instincts. This is the one time when a patient will be truly grateful your instincts were wrong if it is nothing, and even more grateful you followed them if you are correct. It is my daily mission to stress to my patients and my peers the importance of our role as essential health care providers. Even in our day-to-day routine, what seems like a mundane exam can save lives. We can change lives with a smile, and we can save lives with a routine exam. As oral health care providers, we are essential and should not be undervalued. You matter to your patients. I pray you never forget it!
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Trust your instincts. This is the one time when a patient will be truly grateful your instincts were wrong if it is nothing, and even more grateful you followed them if you are correct.
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HOPE PANHANDLE RESTORED COMMUNITY AFTER HURRICANE MICHAEL
DR. REESE HARRISON
Dr. Harrison is a general dentist in Lynn Haven, Fla. and can be reached at ReeseH@aol.com or 850.265.9593.
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As dentists, we’re able to help people in some ways each day in our offices. Over the 20+ years of practicing general dentistry in my hometown, Lynn Haven, I’ve sometimes taken that privilege for granted. In 2017, I watched my middle daughter, Evelyn, initiate a relief project to help fill basic needs following Hurricane Maria. She saw all the pallets of water bottles being donated to send to Puerto Rico and thought it would be better to use water filters we had helped distribute in the Dominican Republic that connect to any bucket and filter all water into clean, drinkable water. She posted a video documenting her idea to help and raised $40,000 — enough funds to send 850 filters in four weeks. We all helped package the filters for delivery, but she added an inspirational quote or Bible verse handwritten in Spanish into each filter packet. Witnessing her heart for those in need at that moment caused both my wife and me to pause. The following year, on Oct. 10, 2018, Hurricane Michael made landfall just east of Panama City, Fla. as a Category 5 hurricane. It was predicted to strike further west the day before but had a change of course eastward and unexpectedly strengthened from a Category 3 to a Category 5 right at landfall. Our family has lived in the area for four generations and dealt with many
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Dental office destroyed by Hurricane Michael.
storms, but this was different in many ways. We decided to evacuate our immediate family (myself, my wife and our three daughters) the day before it was expected to hit. We live 30 miles to the west of my office in a community known as 30A and that, at the time, was the center of the cone 24 hours before landfall. The turn to the east allowed our home area to be spared but put my office and our extended families’ communities in the crosshairs. As the hurricane path turned eastward, we started back home. This allowed us to enter the destruction the next morning and see the extent of the damage and how we could help. As we crossed over the Bay Bridge into Lynn Haven, where my office is located just north of Panama City, it truly looked like a war zone. The trees were either upended completely or broken off halfway up the trunks. Power lines were down across each other and all over the ground. Streets were unrecognizable due to debris and fallen oaks. Once we arrived at my office, the first thing we saw was the roof peeled back and multiple windows gone. The same was true for most of the surrounding homes and businesses. There were people wandering around not knowing what to do and in total shock. We had brought some chainsaws, waters, supplies and a few 5-gallon gas tanks. When I saw the city manager, a
Photo of same street before Hurricane Michael and after.
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At the end of the day, it’s nice to know that our world still relies on neighbors helping neighbors in a time of need. “Evelyn” moments are around us all, we just need to recognize them and step up to take action.
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patient for years, sitting on a fold-out chair in the back parking lot of our destroyed city hall building, it became clear there was such immediate need, it was our “Evelyn” moment to jump into action. He asked me to do whatever we could, and they would assist, but their priority had to lie on the infrastructure of the city as all utilities, cell service, bandwidth and access to even getting down the roads was nonexistent. When we drove the 30 miles back to our home community, cell service kicked back on about 5 miles from home. We began to contact all our friends throughout our 30A community and asked them to return with supplies in hand when they got back home from evacuation. Within days, a website with signups for everything that would help those in Lynn Haven was circulated to churches and schools with our daily coordinated plans, including multiple gas runs twice a day, casseroles being
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cooked each night for us to pick up on our way into the damaged area early each morning, every supply we listed each day times 10, chainsaws and crews to work them and a GoFundMe account that allowed it all to happen. Hope Panhandle was born. The outpouring of volunteers to help in all facets of the relief effort, still to this day gets me choked up even to think back to those weeks following the hurricane. We used the parking lot behind my office as our “hub” for cooking, and we had meal lines on one side and supplies drop-off and organized distribution through lines on the opposite side of the lot. Our busiest day at the hub allowed us to serve 15,000 meals and distribute an estimated $150,000 in supplies — all donated daily. Hope Panhandle and our generous donors were able to provide 175,000 meals, $800,000 in donated supplies and 550 gallons of gas in those first six weeks post-Hurricane Michael. We were incredibly lucky to have our house spared by the hurricane, and our relationships within the community of Lynn Haven allowed us the opportunity to immediately provide aid wherever needed. It was inspirational to see the entire local community stand by us to unite and turn the focus towards rebuilding our community. These same individuals continued to help as we transitioned the focus of Hope Panhandle from providing immediate needs toward rebuilding homes through our partnership with the St. Bernard Project. Through these efforts, Hope Panhandle assisted in hundreds of repairs to homes and to fully rebuild 62 homes to date. Hope Panhandle has continued to help other communities following hurricane damage around the Gulf Coast and plans to continue the rebuilding efforts as a result of Hurricane Michael until it is not needed. Our family and community will always be grateful for the outpouring of support we received and, despite this terrible natural disaster in our area, we all have a better respect for helping others when that opportunity presents itself. We witnessed firsthand that local communities can help themselves faster and more efficiently than any state or national government agency. At the end of the day, it’s nice to know that our world still relies on neighbors helping neighbors in a time of need. “Evelyn” moments are around us all, we just need to recognize them and step up to take action. To learn more about Hope Panhandle’s efforts, visit hopepanhandle.org/hope-videos.html and bit.ly/3mqUZ1K.
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heroes
LIFELINE HEROES HELPING PEOPLE THROUGH DLN’S DONATED DENTAL SERVICES PROGRAM DENTAL LIFELINE NETWORK • FLORIDA
More than 500 Florida Dental Association (FDA) members volunteer for Dental Lifeline Network’s (DLN) Donated Dental Services (DDS) program, helping to change and save the lives of more than 2,000 adults with special needs. These members, together with 226 local labs, have donated more than $9.7 million worth of comprehensive donated treatment. DLN • Florida appreciates the generosity of all the DDS volunteers, and is proud to call these dentists and labs our Lifeline Heroes! FDA past president Dr. Michael Eggnatz, a longtime volunteer with DLN, has provided nearly $75,000 in donated treatment over the past 23 years he has participated. Currently, he serves as DLN • FL president, and is an example of the many heroes having helped veterans like David, a Florida DDS patient. David is a 64-year-old Army veteran who served in the early 1970s. After being discharged, he went on to work as an executive chef. He’d suffered a service-related injury and had ongoing orthopedic issues that forced him to go on disability insurance. He had no way to pay for the dental care he desperately needed. Fortunately, David was referred to the DDS program, where he was matched with Dr. Eggnatz.
(L to R): Dr. Michael Eggnatz with DDS patient David.
than $490 million worth of comprehensive donated dental care for more than 165,000 people across the country through a network of over 15,000 volunteer dentists and 3,400 volunteer laboratories!
David had several missing teeth and those that remained were loose and broken at the gum line. He was fitted for dentures, which were generously donated by Rebour Dental Lab and Valdez Dental Lab. David was extremely grateful for the help. “Dr. E is awesome and I am so thankful for the help,” said David.
“My staff has had the opportunity to share the joy of providing care to our DDS patients. They see, feel and hear the appreciation of these patients. Volunteering brings our entire staff together for a great cause and our office is better for it,” said Dr. Eggnatz. “I believe if other dentists experienced the joy of the sincere appreciation these patients express after treatment, then more dentists would volunteer their services more often.”
DLN is a nonprofit organization that has been transforming lives by providing comprehensive dentistry for adults with special needs across the U.S. for more than 40 years through its flagship DDS program. DDS volunteers have donated more
You can learn more at dentallifeline.org and follow @dentallifeline on social media: Facebook, Instagram, Twitter and LinkedIn.
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The Land of the Free
I was born in Canada of Moroccan descent and am an avid world traveler. At a young age, my family moved to Florida and I had the privilege of visiting many places in the United States. I’ve grown to love this country for its history and resilience. I pledged to always give back to those who made the country the land of the free. Our heroes, the United States armed forces, have kept our nation safe for generations by laying their lives on the line to secure the future of this great country. Since government-funded dental care is limited and accessible to few veterans, I felt my services could be a useful addition.
DR. JASON WATTS
Dr. Watts is a general dentist in Lithia, Fla. and can be reached at 813.737.7370.
Since 2018, Dr. Casey Lynn and I have partnered practices to give thanks for the bravery and service of our veterans by dedicating a day of free dentistry, focusing on veterans with financial hardships. Whether it was to provide preventive or emergency dental care, Watts Dental and our volunteers have completed more than $175,000 in dental services in one day. Treatments include exams, counseling, cleanings, fillings, extractions and root canals. Every year, I recruit more general providers as well as oral surgeons, periodontists and endodontists to comprehensively treat even more of our beloved veterans. To ensure the accessibility to the public, these annual events are held on a Saturday, so no veteran has to sacrifice work in exchange for his or her care. As my practice begins to expand to more locations, Watts Dental and our volunteers are on an upward trajectory to surpass previous donations and aim to increase care to more veterans. The long-term goal is to encourage other dental practices to open their doors to a day of free dental care for veterans. Through the support of the Florida Dental Association and West Coast District Dental Association, we hope sharing our story and inspirations will encourage others to help this cause.
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Volunteers from the community dedicate their time to making sure veterans receive the best possible care.
Dentists and specialists from around the community dedicate their time, skills and supplies to helping provide as much dental care as possible for our veterans.
Dr. Casey Lynn is a pediatric dentist in Apollo Beach, Fla. While his day-to-day operations are focused on children, he offers his office and staff to help support our mission to provide dental care to veterans in need.
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2021
The 2021 Florida Dental Convention (FDC) presents industry leading exhibitors with the latest products, services and technologies. Stop by the booths of your current suppliers and connect with new ones for exclusive convention-only deals and to thank them for their support of FDC. Support the companies that support the Florida Dental Convention!
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FDA SERVICES INC. IS A MAJOR SPONSOR OF THE FLORIDA DENTAL CONVENTION.
IAAbyde ACTEON North America ADA Practice Transitions A-dec Inc. Advantage Technologies Air Techniques Argen Refining ARKRAY USA Aseptico, Inc. Aspen Dental Atlanta Dental Supply Atlantic Dental Solutions | Brewer
B Bank of America Practice Solutions BARKSDALE DENTAL LAB Benco Dental Beutlich Pharmaceuticals BIOLASE Bisco Brasseler USA
Elevate Oral Care Florida Combined Life Florida Dental Association (FDA) FDA Foundation FDA Services Inc. Florida Medical Advisors Fotona, LLC. Four Quadrants Advisory
Porter Instrument PostcardMania Practice Alpha Predictable Surgical Technologies Professional Services Plans Pulpdent Corporation
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Q-Optics & Quality Aspirators Radiation Dectection Company RGP Dental Inc. Ritter Dental USA Royal Dental Group
Garfield Refining Garrison Dental Solutions General Scientific/SurgiTel Systems Getsee & DeMeola, LLC Glidewell Dental Gracey-Backer/Fortress Insurance Company GradFin
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Hawaiian Moon Henry Schein Professional Practice Transitions Hiossen
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Carr Classic Craft Dental Lab Coast Dental Colgate COLTENE CreditBench Powered by First Home Bank
iDental Credential IMPLADENT LTD Implant Educators Academy Kettenbach KOMET USA Kuraray America Legally Mine Liberty Dental
D DDSMatch South Dental Dynamic Staffing Dental Equipment Liquidators, Inc. Dental Tribune America DentaQuest Designs for Vision, Inc. Digital Doc LLC Digital Resource DigitalHealthcareProfessionals Doctor Multimedia Doctor's Choice DoctorsInternet Doral Refining Corp. DPC Technology
E-F Econologics Financial Advisors
M M.A.R.S Bio Med Processes Inc. MCNA Dental Plans MediLoupes Microcopy Midmark Corporation Myofunctional Research Co.
N-P NichePractice Noris Medical NSK America Corp. Patterson Dental Perio Protect Peter J. Freuler Jr., PA, CPA Philips North America LLC Planmeca
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EXHIBITORS IN BLUE ARE FDAS CROWN SAVINGS MERCHANTS.
S Salvin Dental Specialities SciCan Inc. / Coltene SDI (North America) Inc. Shamrock Dental Company Inc. Shatkin F.I.R.S.T., LLC Shofu Dental Corporation Snap On Optics Sodium Dental Southern Implants of North America Steszewski Medina, P.A. Streamhealth Group Suncoast Credit Union Superior Dental Designs & Upholstery
T-U The Doctors Company The Solutions Team, Inc. The Transitions Group, LLC Ultimate 3D Printing Store Ultradent Products Inc. Ultralight Optics Inc. Unified Smiles
THURSDAY JUNE 24 FRIDAY JUNE 25 SATURDAY JUNE 26
FREE EXHIBIT HALL PASSES AVAILABLE! REGISTRATION OPENS MARCH 1!
V-Z Vatech America, Inc. Video Dental Concepts Virtus Financial Partner Water Pik Inc. Wells Fargo Practice Finance White Towel Services Inc. YAPI
EXHIBITORS AS OF JANUARY 11, 2021
NEW! EXHIBIT HALL EVENTS THURSDAY, JUNE 24 | 4-6 PM COCKTAIL RECEPTION FRIDAY, JUNE 25 | 4-6 PM SWEET TOOTH BREAK
FDC2021 Speaker Preview Modified Extraoral Landmarks for the Gow-Gates Mandibular Division Nerve Block Anesthesia Injection Technique Introduction
ALAN W. BUDENZ, MS, DDS, MBA
Dr. Budenz is a professor in the Department of Biomedical Sciences and vice chair of the Department of Diagnostic Sciences at the University of the Pacific, Arthur A. Dugoni School of Dentistry. He can be reached at abudenz@pacific.edu. Dr. Budenz is an FDC2021 speaker and will be presenting two courses on Saturday, June 26. “X Marks the Spot: Hands-on Technique Simulation Workshop for Local Anesthesia” is scheduled for Saturday morning and “Wait, I Still Feel That! Problem-solving the Delivery of Local Anesthesia” is scheduled for that afternoon.
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The Gow-Gates mandibular division nerve block injection technique is considered by many researchers and dental practitioners to be the most successful, consistent and efficient method for obtaining mandibular quadrant anesthesia for dental procedures.1-3 The Gow-Gates technique also has the lowest incidence of reported side effects or complications. Yet many practitioners find the technique difficult to understand and master, primarily due to the use of extraoral landmarks. The extraoral landmark modifications for the Gow-Gates injection technique introduced in this article have been taught at the University of the Pacific, Arthur A. Dugoni School of Dentistry for several years, and were found to be easily learned and used by dental students, as well as practicing dentists and dental hygienists who attended hands-on technique training courses. These modifications build upon both the original description of the technique by Dr. George Gow-Gates4 and later modified descriptions by other authors, but incorporate what we at Pacific Dugoni have found to be a simpler method for determining the correct target point and the proper angulation of the syringe in the medial-lateral orientation.
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Modified Extraoral Landmarks for the Gow-Gates Injection Technique Step 1: Our modified technique begins by observing and extraorally palpating the head of the condyle as the patient opens and closes their jaw. With jaw movement, the clinician can see the bulge of the cheek created by the head of the condyle during opening and closing, and can feel the condyle as it slides anterior-posteriorly over the articular eminence of the temporal bone.
Step 2: After first palpating the bulging condylar head extraorally, the clinician then slides their index finger inferiorly below the head of the condyle, and then posteriorly behind the neck of the condyle.
Step 3: With the finger kept in this position and the mouth wide open, the clinician next palpates the anterior border of the mandibular ramus intraorally, either at or slightly above the depth of the coronoid notch. Step 4: With the mucosa pulled taut anteriorly, the clinician then inserts the needle at the intra-oral penetration site and aims the needle directly toward their finger. We teach a penetration site at a level just below the distobuccal cusp of the maxillary second
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Fig. 1
molar or just distal to this tooth. Because the extraoral finger is held posterolateral to the targeted neck of the condyle, it is directly behind the injection target. As long as the needle is aimed directly toward the finger/condylar neck from the penetration site, failure to contact bone is unlikely. Alignment of the injection path with the extraoral and intraoral landmarks is easily assessed both when applying topical anesthetic before and during the injection. This is done by simply “leaning back” from the oral cavity and visually checking that the needle pathway intraorally is directed toward the fingertip behind the condylar neck extraorally, and correcting the needle angulation if necessary (Fig. 1).
Note: The patient’s mouth must be fully open throughout all phases of the Gow-Gates injection. The condyle then assumes an anterior position over the articular eminence of the temporal bone that is immediately lateral to the trigeminal mandibular division nerve trunk as it emerges through the foramen ovale of the cranial base into the infratemporal fossa. SEE PAGE 56 FLORIDADENTAL.ORG
It is in large part because of this similarity of visualization skills that both inexperienced dental students and seasoned practitioners can more quickly master consistent success with this modified Gow-Gates injection technique.
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FROM PAGE 55
There Are Many Advantages of This Modified Approach 1. Familiar landmarks: With palpation of the anterior border of the mandibular ramus intraorally and the posterior border of the ramus extraorally, although at a higher level, the landmarks used are similar enough to the familiar conventional inferior alveolar nerve block landmarks that practitioners are immediately confident with them. With the clinician then aiming for their extraoral finger directly behind the desired target, the condylar neck of the mandible, the injection pathway is more readily understood. Use of these familiar and definitive mandibular landmarks anteriorly and posteriorly also enables use of the same mind visualization skills that are used with the conventional inferior alveolar injection technique. However, instead of visualizing a “bisection” point for bony contact between the two landmarks, we are visualizing a path aimed directly at the posterior landmark. It is in large
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part because of this similarity of visualization skills that both inexperienced dental students and seasoned practitioners can more quickly master consistent success with this modified Gow-Gates injection technique. This is certainly a simpler visualization concept than the rather abstract visualization of the imaginary alpha and beta planes described by Dr. GowGates and where they intersect. It’s also our experience that palpation of the neck of the condyle relative to the anterior border of the ramus provides a more individual, and therefore more accurate, assessment of the degree of lateral flaring of the posterior ramus rather than relying on the soft-tissue variability of the angulation of the tragus of the ear away from the face (Fig. 2).
2. High success rate: As with all variations of the Gow-Gates technique, the greatest advantage is the high success rate for anesthesia of all the sensory branches of the mandibular division of the trigeminal nerve with a single injection.
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3. Safety: The high success rate is coupled with an extremely low incidence of complications, such as positive aspirations, hematoma, trismus or nerve injury. a). Positive aspiration at the injection site is very low with the
Gow-Gates technique with a reported incidence of less than 2%.1,2,5,6 This is due to the needle passing through a region of relatively avascular, loose, fatty areolar tissue on its course to the anterolateral neck of the condyle7. b). The incidence of trismus also is extremely low due to the
passage of the needle below the insertion of the inferior head of the lateral pterygoid muscle and superiolateral to the position of the medial pterygoid muscle.1,2,4,7 c). Nerve injuries, such as paresthesia, are rarely observed
with the Gow-Gates technique. At the bony contact site, the needle is 10-20 mm lateral to V3 so direct contact with this large neurovascular bundle is avoided, and the deposition site is far enough away from the bundle that theoretical chemical injury to the nerves by high concentration local anesthetics also is minimized.3,7
References 1. Malamed SF. Handbook of local anesthesia. 5th ed. St. Louis, Elsevier Mosby; 2004, Chapter 14: Techniques of Mandibular Anesthesia, pp. 227-242. 2. Haas DA, Alternative mandibular nerve block techniques: A review of the Gow-Gates and Akinosi-Vazirani closed-mouth mandibular nerve block techniques, JADA, 142(9 suppl):85-125, 2011. 3. Malamed SF, The Gow-Gates mandibular block: Evaluation after 4,275 cases. Oral Surg Oral Med Oral Path, 51(5):463-467, 1981. 4. Gow-Gates GAE, Mandibular conduction anesthesia: A new technique using extraoral landmarks. Oral Surg Oral Med Oral Pathol, 36(3):321-328, 1973. 5. Clark S, Reader A, Beck M, Meyers W, Anesthetic efficacy of the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block. Oral Sur Oral Med Oral Path, 87(5):557-63, 1999. 6. Meechan JG, Practical Dental Local Anesthesia. London, Quintessence Publishing Co. Ltd.; 2002, pp. 65-66. 7. Gow-Gates GAE, Watson J, The Gow-Gates mandibular block: Further understanding. Anesth. Prog. 25(6): 183-189, 1977. 8. Hung P-C, Chang H-H, Yang P-J, Kuo Y-S, Lan W-H, Lin C-P, Comparison of the Gow-Gates mandibular block and inferior alveolar nerve block using a standardized protocol, J Formos Med Assoc 105(2): 139-146, 2006.
Conclusion This modified approach provides a reliable and quickly learned technique for the everyday clinician to use for successful mandibular division nerve block anesthesia because the landmarks are familiar and are determined individually for each patient.
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FDC2021 Speaker Preview
The New COVID-19 Dental Practice: It's All About PERSPECTIVE
MS. CHRISTINE TAXIN
Ms. Taxin is the founder and president of Links 2 Success and the Dental Medical Billing University. She can be reached at ctaxin@links2success.biz. Ms. Taxin is an FDC2021 speaker and will be presenting two courses on Friday, June 25. “Are You Driving Through Red Lights or Green Lights — What is Your Compliance Risk?” is scheduled for Friday morning and “Dental to Medical Billing Workshop” is scheduled for the afternoon.
What are your patients going to be looking for at your practice? Now is the perfect time to pivot your messaging to help your patients understand that we’ve been at the front of infection control for years. Ask them about the last time (prior to the pandemic) they went to a medical practice, if everyone was wearing masks or if the room was sterilized after you left it, besides putting clean paper on the table? We are not dentists who fix teeth, we are oral providers who connect the dots to active infection and transmission of the infection not just to their entire body, but also to others they are close with. In the last three years, the American Dental Association (ADA) announced several new codes that are taking our industry into the medical world. If you haven’t considered this before COVID-19, now is the time to make the changes. Three new codes were added: D0412 – Blood glucose level test — inoffice using a glucose meter D0604 – Antigen testing for a public health-related pathogen, including coronavirus D0605 – Antibody testing for a public health-related pathogen, including coronavirus
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In fact, in March 2020, the ADA announced oral medicine as the 11th specialty, which is described as taking care of patients with systemic issues and diseases that affect them. Now is the time to change perspective from having treatment due to pain to prevention of infection and transmission. We are in a unique time and people are more aware of the transmission of infection just by touch. We can show patients that a family that has periodontal infection or caries are transmitting infection without even understanding the effects that has on our entire systemic conditions. Take the time to talk to your patients about sharing a fork with cake, sharing a drink, or absentmindedly touching food before eating. Do not just simply lecture or talk to them about the connection with words they are not hearing. Show them pictures of why the oral cavity is so important in their ability to stay healthy. After showing your patients the pictures of the digestive system and notating their responses, go over their medical history and discuss how some medical conditions, such as diabetes, Alzheimer’s, cardiac or
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Now is the time to change perspective from having treatment due to pain to prevention of infection and transmission.
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other conditions puts them at risk when they have an infection in the oral cavity. After the last year of hearing about COVID-19 and as we continue to move forward, patients are more motivated than ever before. Today, patients will understand the connection and want to do something about it. Join me and learn the coding and information you will need to earn more benefits and the diagnostic codes that are part of billing dental and/or medical benefits.
a). Digestion of food begins in the mouth. b). Food is masticated by teeth and moistened by saliva secreted from the salivary gland. Enzymes in the saliva begin to digest starches and fats. With the help of the tongue, the resulting bolus is moved into the esophagus. (Credit: modification of work by Mariana Ruiz Villareal).
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FDC2021 Speaker Preview
The Prevention of Musculoskeletal Disorders in Dentistry
RICHARD WILLIAMSON, BS, ACE, CPT
Mr. Williamson is a certified personal trainer and nationally recognized certified Pilates practitioner for rehabilitation. He developed the Body Praxis system after successfully rehabilitating numerous dentists and hygienists from the pain associated with musculoskeletal disorders and common complaints experienced by dental professionals. He can be reached at bodypraxis@aol. com. Mr. Williamson is an FDC2021 speaker and will be presenting his course, “Body Praxis: Physical Rehabilitation Program for Dental Professionals: The Prevention and Reversal of Musculoskeletal Disorders in Dentistry� on Thursday, June 24 in the afternoon.
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More than 80% of dental professionals suffer from pain associated with musculoskeletal disorders caused by the demands of their profession. Years of hunching over patients, reaching and stretching in awkward positions, fighting with equipment, and coping with the physical redundancy of the occupation leaves the professional with daily pain and chronic discomfort. Dentists commonly suffer from tingling and numbness in fingers and hands, and deal with shoulder, back, neck and hip pain. These regularly occurring conditions, if ignored, can cause cumulative physiological damage that may lead to a career-ending injury. Like a professional athlete, the dental professional needs to understand how rigorous physical strains and repetitive movements lead to muscle imbalances, postural dysfunction and compensatory movement patterns. Overused muscles fatigue while underused muscles fail to properly support the spine and extremities. Fortunately, the pain and discomfort of dentistry is avoidable. Like an athlete, the dental professional needs to physically train to prevent and reduce pain. Unfortunately, if muscle imbalances and compensatory movement patterns already exist, general exercises can be detrimental.
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They tend to only reinforce faulty movements and imbalances. Without focused and specific movement reeducation, the strong and overused muscles and systems will be further strengthened while the neglected musculature will remain weak. Biomechanical reeducation must be introduced and consider the occupational, recreational and daily activities. Oppositional movement patterns must be created to counteract imbalances and common repetitive positions. The importance of muscle recruitment, balance, spine segmental mobility, stabilization, and breathing techniques need to be properly learned to restore function and alleviate pain. We advocate the introduction of these specific programs as early as dental school. A strong emphasis on a daily commitment to the program will provide career sustainability and contribute to overall wellness. One specific concept that is valuable to many dental professionals is the concept of engagedisengage. This is a concept that anyone can easily incorporate into the workday. Often, procedural work places the dental professional into a postural position of forward flexion and rotation of the spine and hips in
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one direction. This creates imbalances that the engage-disengage technique can address. The dental professional needs to learn to break out of the habitual posture any time they are not engaged with the patient. They need to learn to come into a neutral postural position to retrain the body to know where proper alignment is. They learn to incorporate it throughout the day and even outside of the office in other activities, reducing the cumulative trauma of repetitive faulty positions. Another common problem is hip and pelvic pain. Sitting in the dental stool forces the pelvic bones into a rotation, which is held for long periods of time. Over time, the cumulative effect can lead to a fixed rotation of the pelvis, causing misalignment and pain. A common movement or exercise used to reeducate pelvic alignment is pelvic rolls on a stability ball. While seated on a stability ball, movement is initiated by the coccyx (tail bone) as the pelvis is rolled forward and back. This creates a nutation and counternutation of the pelvis, which reeducates and realigns the pelvis to eliminate pain. These techniques will be demonstrated and further explored in my “Body Praxis” seminar at the 2021 Florida Dental Convention.
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The dental professional needs to learn to break out of the habitual posture any time they are not engaged with the patient.
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Doctor's Choice
Henry Schein Professional Practice Transitions
ada library and archives
The ADA Library & Archives: The Right Information Anytime, Anywhere journals and e-books from your dorm room or a coffee shop off campus. Once you entered practice, you may have found yourself at an institution that provided continued access to dental journals and textbooks, but for many of you, free access to evidence-based, up-to-date information ended the day you graduated.
HEIDI NICKISCH DUGGAN MA, MS ADA LIBRARY & ARCHIVES DIRECTOR
KELLY K. O’BRIEN, MLIS ADA LIBRARY & ARCHIVES INFORMATIONIST
Take a moment to reflect on the health sciences library you used in dental school. It was perhaps where you went to read all the books you needed for class or to check out the latest research in the dental journals. You likely used it as a study space, spending more than one late night at the group study tables or in a quiet carrel cramming for an important exam. In recent years, you probably used the library’s website to access
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One of the benefits of American Dental Association (ADA) membership is 24/7 online access to the ADA Library & Archives — thousands of full-text journals and e-books, clinical information resources, clinical calculators and drug information, systematic reviews and clinical guidelines, health care management resources and patient information. You can answer your clinical questions using DynaMed, Cochrane Library, MEDLINE and more, directly from your home or office, and you’ll enjoy direct full-text article linking from PubMed. gov. The ADA Library & Archives provide extensive expert search assistance and education, reference services, data and information referrals, and electronic document delivery, all as part of ADA membership and at no additional cost to you.
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DynaMed, mentioned earlier, is a clinician-focused tool designed to facilitate efficient and evidence-based patient care. Initially built for medicine, its rigorous and daily review of medical literature provides timely and objective analysis and synthesis frequently of use to dentists and other members of the clinical care team. DynaMed includes drug information, drug interaction notes, dosing and conversion calculators, and more. Notably, ADA members can now generate AMA PRA Category 1 Credit™ when using DynaMed to answer clinical questions. This process is accomplished entirely on the DynaMed site once the ADA member authenticates through the ADA.org/library website and creates a personal account on the DynaMed site. Contact the professional staff at the ADA Library for more information. The ADA Archives, a division of the ADA Library & Archives, provides quality reference and research assistance to ADA staff, members and other dental organizations and institutions searching for information on ADA history, the history of dentistry and biographical information about individuals involved
in the profession. Interested in the history of toothbrushes and toothbrush design? Want to know more about pioneering women in dentistry? Interested in the links between golf and dentistry (yes, pun intended)? Want to know the history of the ADA’s involvement in water fluoridation science and advocacy? Want to identify the outcome of a House of Delegates resolution? The ADA Archives is a treasure trove of information and the certified archivist on staff is a historical detective extraordinaire. We invite you to tour the ADA headquarters and visit the physical library at the ADA headquarters the next time you’re in Chicago. While we have converted most of our collection to electronic resources, visiting members can still enjoy the monograph and journal stacks, impressive rare book collection, ADA archives and exhibits on dental history. Members also benefit from the library staff ’s expert knowledge of information sources and research. Whether you are visiting the
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Cardconnect
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ADA, or calling or emailing from your office, reference and research consultations are part of the perk. We help members with a wide variety of needs from finding guidelines for a specific case or high-level evidence about materials, tools or conditions. We also help members with more in-depth research needs. You might need assistance formulating a research question for a manuscript, locating citation metrics or deciding which type of publication to pursue for your project. Whatever your need, we are here to help. You can access all these resources at ADA.org/library and by logging into the website with your ADA credentials. Prefer to interact with a human being? Email us at library@ada.org or call us at 800.621.8099. While libraries constantly evolve to leverage new technologies, the mission remains to support their users’ information and research needs. We hope the ADA Library & Archives will become your source for lifelong learning, and we look forward to serving you soon.
iCoreConnect
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ada library and archives
Once you entered practice, you may have found yourself at an institution that provided continued access to dental journals and textbooks, but for many of you, free access to evidence-based, up-to-date information ended the day you graduated.
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real estate
WHY LANDLORDS LOVE LEASE RENEWALS
MIKE RUSO, CARR
Mr. Ruso can be reached at 407.443.9193 or mike.ruso@carr.us.
Commercial real estate landlords operate his or her buildings like any savvy business owner operates his or her company — with a focus on maximizing their profitability. One of the top ways they maintain and increase profitability is through lease renewal negotiations. A landlord’s goal during renewal negotiations is to maintain annual escalations of 2.5%-3%, prevent any vacancy, provide the least amount of concessions and increase the lease rate. To accomplish this, landlords use specific tactics to keep tenants in the dark, uneducated and often, backed into a corner.
most scenarios, this represents a six-figure loss spread out over 12-24 months of vacancy.
Renewals are rich deals for property owners and present an opportunity they work hard to capitalize on. It’s when landlords make the most margin on a tenant, and it’s the most common opportunity for renewal rates to be above market. Landlords often fight the hardest on lease renewals too, because when lease rates go down, so does their building’s value. However, the typical concessions offered to tenants in lease renewal scenarios often are a mere fraction of the profits realized by the landlord — further highlighting why most landlords love renewals.
Below Market Value
When a tenant vacates, there are substantial costs a landlord realizes to backfill the space. The landlord must market the space, cover all the operating expenses while the space is vacant, and typically invest in updating the space or fund the next tenant’s build-out. In
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It’s crucial to understand this dynamic during renewal negotiation and hire a tenant’s broker to represent you and execute a strategy to competitively procure your renewal option. Together, this will ensure you’re getting the best possible terms on your lease renewal and tip the scales back in your favor. It’s also critical regardless of whether you are currently paying above or below the fair market value of your space. Let’s review both scenarios.
If you’re paying below market rent at the time of your renewal, you can expect the landlord will try to raise rates at least to a market rate. They may even try to raise rent beyond a market rate to make up for lost time. This could impact your practice’s bottom-line profits by six to seven figures over the next 10 years, so creating the maximum negotiation leverage is both paramount and urgent.
Above Market Value If you’re already paying above market for your lease, the landlord will still probably push to increase your rate. They’re relying on the assumption that you don’t know the market lease rate for your space and won’t take the time to hire someone to represent and educate you. They’re also relying on the fact that it
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usually takes a compelling reason for a health care practice to move out of its current space and will assume you aren’t willing to relocate. The secret is knowing what’s in a renewal (or a vacancy) for the landlord and leveraging this information to your advantage. When you’re overpaying on your lease, a landlord will have a much harder time getting a new tenant to pay the same rate you currently pay. This gives you even more leverage to get a better deal.
Timing is Everything You may not need to move or even have the desire, so it’s understandable that even the process of discussing and exploring relocations can feel disruptive. The question becomes, “Why take a shot in the arm if you’re not even sick?” However, this “side effect” is more tolerable than a financial blow to your profits and is a needed step in the process to create a true posture that you have other viable options. FLORIDADENTAL.ORG
To avoid the greater consequence of a significant increase to your real estate expenses, remaining committed to the plan your agent puts forth allows you to rattle the landlord’s confidence that they have complete control. Additionally, by negotiating legitimately better economic terms for at least one other location, even if only as a backup, will allow you to hold the building owner accountable to the fair market competition. These alternative options are only realistic and believable to your landlord if you have the correct lead time and position to negotiate. The minute the landlord knows you’re staying, the opportunity for receiving any additional or substantial economic concessions is lost. A typical lease negotiation timeline is: Negotiations: 60-90 days Legal review: 30-45 days Design, permitting, build out: 120-180 days
Peace of Mind and Your Best Possible Terms The goal in a renewal negotiation is to achieve the best possible terms and walk away with the peace of mind that you capitalized on the opportunity. The best deal often isn’t the cheapest one. By conducting a competitive procurement process, your health care real estate expert will help you discover your value as a tenant in your market and obtain the context needed for evaluating an offer from your current landlord versus your other top property options. This process will account for your unique circumstances, needs and offerings.
Strategy and Next Steps The timeline mentioned is designed to position you to achieve the best terms possible. Starting too soon or too late can jeopardize the terms or concessions SEE PAGE 71
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The Doctors Company
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The goal in a renewal negotiation is to achieve the best possible terms and walk away with the peace of mind that you capitalized on the opportunity.
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you could receive. Space planning, negotiations with the landlord and subsequent legal review could easily take three to five months. To maintain the best negotiation posture, which is that you “could” elect to move, it’s critical to conclude renewal negotiations before your landlord knows you’re nearly out of time. In addition to losing leverage for your best possible terms, delaying the renewal process could be costly because your current lease may have a holdover clause requiring you to pay as much as double your base lease rate for any occupancy after the term’s expiration. Time is of the essence. A lease renewal represents one of only a few events in the life of your practice where profits can be realized or lost by six to seven figures. Prior to negotiating terms, your agent should be able to help you decide how much space is needed for future years by making introductions to architects and general contractors to provide help with space planning and to test-fit options for best using the available space.
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An expert health care real estate agent is uniquely qualified to navigate every nuance of each scenario and consideration. He or she will save you a significant amount of time and money while providing you peace of mind during this process.
CARR is the nation’s leading provider of commercial real estate services for health care tenants and buyers. Every year, thousands of health care practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with startups, lease renewals, expansions, relocations, additional offices, purchases and practice transitions. Health care practices choose CARR to save them a substantial amount of time and money, while ensuring their interests are always first. Visit CARR.US to learn more and find an expert agent representing health care practices in your area.
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Call 888.810.7706 or visit fdaservices.com/icore-exchange to learn more!
Abyde
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FLORIDADENTAL.ORG
hipaa
COMMUNICATE CONVENIENTLY AND COMPLIANTLY IN THE CLOUD
ROBERT MCDERMOTT PRESIDENT AND CEO, ICORECONNECT
There are real benefits of choosing a cloud-based, fully HIPAAcompliant email service. The cloud means all your data is backed up with every keystroke and stored in extremely secure centers, not on a vulnerable server in your office. The cloud also means speed, freedom and flexibility in the way you work. Here are three ways cloudbased, HIPAA-compliant email improves business.
First, it gets your work done faster. Cloud-based, compliant email can streamline your workflow with one interface for both your compliant and regular messages. One interface means one login to send and receive protected health information (PHI) and check your Gmail, Hotmail, Yahoo, etc. without forcing you to log in and out of different windows. Second, send any PHI — even large imaging files — from anywhere. The cloud gives you freedom to send and receive compliant email no matter where you are. Often, patient
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care doesn’t begin and end at the time of the appointment. If records need to be transferred to a specialist or information is requested, you can send quickly and easily from any device and any location. Third, protect your patients and your practice. When you are sending PHI through the cloud, that data often is stored in a secure data center. These centers provide stringent access controls and 24/7 monitoring to prevent hacking or other attacks on PHI. This is a big differentiator from storing your data on a server in your office or through common cloud-services hosted on the public internet, which is far less secure. Now is an excellent time to look at your business services with fresh eyes. Protect your practice by keeping patient data safe from cybercriminals and work smarter and faster through the cloud.
iCoreExchange cloud-based, HIPAA-compliant email is an FDA Crown Savings merchant. Visit iCoreConnect.com/FDA or call 888.810.7706 for special pricing and a free iCoreExchange demo.
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The Paragon Program
PSC Group, Inc.
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DRS. SHANKAR VENKAT*, NEEL BHATTACHARYYA, DONALD M. COHEN AND NADIM M. ISLAM
A 73-year-old male patient was referred to Dr. Michael Semidey, a maxillofacial surgeon at Tampa Bay Jaw and Facial Surgery. The patient’s chief complaint included swelling in the upper right maxillary region that started after extraction of tooth No. 3. The swelling was persistent for the past month. The patient also complained of continuous pain and maxillary sinus congestion. Extraoral examination revealed mild right-midfacial edema, with the swelling gradually increasing in size. Previous antibiotic therapy did not provide any significant relief. Intraoral examination showed slightly fluctuant swelling and exhibited a bluish-red hue (Fig. 1). A cone beam computed tomography (CBCT) revealed a hazy radiopacity with complete destruction of the posterolateral and medial wall of the right maxillary sinus with a soft-tissue mass occupying most of the antrum (Fig. 2). Two incisional biopsies were performed by Dr. Semidey and submitted to the University of Florida Oral Pathology Laboratory biopsy service for histopathologic evaluation.
Fig. 1: Clinical picture showing a mass involving right maxillary alveolar ridge.
Question: Based on the above history, clinical presentation and radiographic findings, what is the most likely diagnosis? A. Ameloblastoma B. Mucoepidermoid carcinoma C. Adenoid cystic carcinoma D. Oral malignant melanoma E. Non-Hodgkin lymphoma
Fig. 2: CBCT showing destruction of the posterolateral wall/floor (red arrow) and medial wall (yellow arrow) of the maxillary sinus with soft-tissue mass occupying portions of the right maxillary sinus (green arrow) in coronal view (A) axial view (B) and arch view (C). SEE PAGE 78 FLORIDADENTAL.ORG
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diagnostics FROM PAGE 77
Diagnostic Discussion A. Ameloblastoma Incorrect. Good consideration; ameloblastomas occur mostly in the third to seventh decades of life. These are benign, locally infiltrative and clinically persistent. More than 80-85% of ameloblastomas are prevalent in the mandible with the remaining 15% common in the maxilla. Clinically, ameloblastomas in the maxilla appear as smaller lesions that are slow-growing, painless, asymptomatic and display expansion over a long period of time. Although the characteristic features of swelling, clinical persistence and age have close similarities to this case, the presence of continuous pain with mild expansion and sinus congestion are not generally associated with ameloblastomas. Radiographically, ameloblastomas are significantly different from our case. They appear as multilocular radiolucent lesions and are described as presenting with a “soap bubble” or “honeycomb” appearance. Buccal and lingual cortical expansion along with root resorption of the adjacent teeth are frequently noted on radiographs. Histologically, ameloblastic lesions show varying combinations of cystic and solid features, demonstrate multiple histological variants with fascicles of neoplastic cells, central stellate reticulum-like cells, and columnar cells with reverse polarity and “apical vacuolization” at the periphery. These histological features are not consistent with the current case. Patients with conventional solid or multicystic intraosseous ameloblastomas have been treated by simple enucleation and curettage to en-bloc resection.
B. Mucoepidermoid carcinoma Incorrect. Excellent guess and a good differential diagnosis to add in this case. Mucoepidermoid carcinoma (MEC) is a malignant salivary gland tumor that is encountered in both major and minor salivary glands. The major ones are commonly seen in the parotid gland. The minor ones are predominantly found in palate as slow-growing, fluctuant red or blue mass that depicts close similarity to a mucocele. Although, the MECs occurring in minor salivary gland have close similarity in clinical location and appearance, large infiltrative lesions
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may invade the maxillary sinus and destroy bone. On rare occasions, high-grade tumors in this location can cause pain and facial palsy. Further, these tumors are prevalent within a wide age range seen between the second to seventh decades of life. Although this tumor is rarely seen in the first decade, this remains the most common salivary gland malignancy in children. Histologically, MECs are completely different from our case. They are composed of a mixture of mucus-producing cells and squamous (epidermoid) cells. The mucous cells contain abundant foamy cytoplasm that stains positively with mucin stains. The epidermoid cells demonstrate a polygonal shape, intercellular bridges and keratinization. Intermediate cells also are present as a group of highly prolific, small, basaloid cells with scant, pale eosinophilic cytoplasm. Histologically, mucoepidermoid carcinomas are categorized into three histopathologic grades: high grade, intermediate grade and low grade. Mucoepidermoid carcinomas occurring in minor glands have a relatively better prognosis and assured surgical excision remains the treatment of choice.
C. Adenoid cystic carcinoma Incorrect, but a good guess! This salivary gland malignancy is not uncommon on the palate. Adenoid cystic carcinoma (ACC) clinically presents as a slow-growing mass with lowgrade pain, which gradually increases in intensity. Although these clinical findings can make them difficult to interpret and distinguish from our case, clinical and histological disparities remain. Approximately 40-45% of ACCs develop within the minor salivary glands. The remaining tumors can develop in the parotid, submandibular and sublingual glands. ACCs in the palate tend to manifest as a firm swelling with an ulcerated or smooth surface, rather than appearing as a fluctuant swelling. It does not exhibit a bluish-red hue as seen in this case. Further, these tumors are most commonly seen among middle-aged adults with marked female predilection. Radiographically, ACCs may exhibit bone destruction like our case. Tumors arising in the palate often exhibit obliteration of the maxillary sinus. Histologically, ACCs are notably different from our case. They are mainly composed of a mixture of myoepithelial cells and ductal cells arranged in cribriform, tubular and solid patterns. Perineural invasion is a highly characteristic feature of this tumor. ACCs have a high recurrence potential with tendency towards distant metastasis. If
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left untreated, tumors of the palate or maxillary sinus, may invade the base of the brain. Due to the aggressive nature of these lesions, surgical resection with adjuvant radiation therapy remains the treatment of choice.
D. Oral (mucosal) malignant melanoma Incorrect. This is a good thought to have in the differential diagnosis, as these tumors tend to grow in the palate or maxillary alveolus in 80% of the cases. Oral malignant melanoma is a malignant neoplasm of epidermal melanocytes occurring in the oral cavity. It develops as a brown-black irregular macule and transforms to a nodular growth. The dark bluish color of the lesion, tendency for male predilection and occurrence in older age groups are some of the common features to consider in the present case. However, there are some clinical, histopathologic and radiographic features that are distinguishable. Oral melanomas are generally soft in consistency and painless. They may present with irregular “moth-eaten” appearance on radiographs with the evidence of cervical lymph node metastasis. Histologically, oral melanomas are composed of atypical melanocytes that are seen at the epithelial and connective tissue junction or in the deeper stroma. These atypical cells are enlarged, with nuclear pleomorphism and hyperchromatism. They demonstrate a pagetoid (i.e., single-tumor cell infiltrating into the upper layers of the surface epithelium), radicular and vertical growth phase patterns. None of the above-mentioned histopathologic presentation was noted in our case. The prognosis of oral melanomas remains poor due to the tendency toward early distant metastasis. Therefore, the treatment of choice involves surgical excision with jaw resection and lymph node dissection.
for the presentation of NHL is over 50 years. Soft-tissue lesions appear as non-tender, diffuse swellings with boggy consistency. The lesion appears red or purplish in color, grows rapidly within weeks to months and ulcerates causing vague pain or discomfort. All these characteristics are seen in the current case. Radiographically, NHL appears to have an ill-defined or ragged radiolucency. Long-standing cases cause expansion of the bone, perforation of the cortical plate and leads to a soft tissue swelling. In this case, the CBCT scans reveal the destruction of the medial and posterolateral walls of the maxillary sinus with the appearance of a mass within the antrum. Histologically, NHL is characterized by a proliferation of lymphocytic-appearing cells. Low-grade lesions consist of well-differentiated small lymphocytes. High-grade lesions tend to be composed of less differentiated cells. A histological section of NHL can appear as nodular or diffuse. In the nodular pattern, the neoplastic cells form clusters of cells whereas the diffuse pattern is characterized by a monotonous distribution of cells (Fig. 3). In the current case, a diffuse proliferation of lymphocytes was observed with no evidence of germinal center formation. Most patients with NHL respond to treatment based on disease staging and grading of the lymphoma. A mortality rate of 60% at five years after diagnosis and treatment is common. In an aggressive high-grade lesion such as ours, management includes radiation with multiagent chemotherapy.
E. Non-Hodgkin lymphoma Correct! The Non-Hodgkin lymphoma (NHL) is the variant of lymphoma seen commonly in extranodal locations of head and neck, particularly in the oral cavity. The most common intraoral locations of NHL include the buccal vestibule, posterior hard palate, alveolar bone and the gingiva. It is in accordance with the present case, as the swelling was noted involving the alveolus with buccal and palatal extension. There are two types of malignant lymphomas: Hodgkin’s disease and non-Hodgkin’s lymphoma. The current case demonstrates a proliferative swelling characteristic of NHL. The median age
20X Fig. 3a: Low power magnification shows showing diffuse proliferation of lymphocytes
SEE PAGE 80 FLORIDADENTAL.ORG
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Diagnostic Discussion is contributed by UFCD professors, Drs. Indraneel Bhattacharyya, Don Cohen and Nadim Islam who provide insight and feedback on common, important, new and challenging oral diseases.
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The dental professors operate a large, DR. BHATTACHARYYA 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.
40X Fig. 3b: High power magnification shows a monotonous proliferation of malignant poorly differentiated lymphocytes
References: Dhanuthai K, Chantarangsu S, Rojanawatsirivej S, et al: Ameloblastoma: a multicentric study, Oral Surg Oral Med Oral Pathol Oral Radiol 113:782– 788, 2012. Milman T, Ying GS, Pan W, LiVolsi V. Ameloblastoma: 25 Year Experience at a Single Institution. Head Neck Pathol. 2016;10(4):513-520. doi:10.1007/s12105-016-0734-5. Schwarz S, Stiegler C, Müller M, et al: Salivary gland mucoepi- dermoid carcinoma is a clinically, morphologically and genetically heterogeneous entity: a clinicopathological study of 40 cases with emphasis on grading, histological variants and pres- ence of the t(11;19) translocation, Histopathology 58:557–570, 2011. Chae YK, Chung SY, Davis AA, et al. Adenoid cystic carcinoma: current therapy and potential therapeutic advances based on genomic profiling. Oncotarget. 2015;6(35):37117-37134. doi:10.18632/oncotarget.5076. Smith MH, Bhattacharyya I, Cohen DM, et al. Melanoma of the Oral Cavity: an Analysis of 46 New Cases with Emphasis on Clinical and Histopathologic Characteristics. Head Neck Pathol. 2016;10(3):298-305. doi:10.1007/s12105-016-0693-x.
DR. COHEN
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 AsDR. ISLAM sociation 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. *Resident in oral and maxillofacial pathology at the University of Florida College of Dentistry.
Singh R, Shaik S, Negi BS, et al. Non-Hodgkin’s lymphoma: A review. J Family Med Prim Care. 2020;9(4):1834-1840. Published 2020 Apr 30. doi:10.4103/jfmpc.jfmpc_1037_19 Scherfler S, Freier K, Seeberger R, et al: Cranio-maxillofacial non- Hodgkin’s lymphoma: clinical and histological presentation, J Craniomaxillofac Surg 40:e211–e213, 2012.
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JOHN PAUL, DMD FDA EDITOR
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Dr. Paul can be reached at jpaul@bot.floridadental.org.
I was wearing a long face and being generally disgruntled by all the goings on in this great country when I walked into the room with one of my favorite patients and longtime advisors, Ima Mae Gruntbuns, a great American. Not being one to let me rest on my laurels or rain on any parade she is enjoying, she questioned my lack of enthusiasm for being alive one more day. I complained that people just seem to being sliding back into the slime. Folks I know and like are being nasty to one another. Others think they can run amok, spouting hate and destroying things that don’t belong to them. When one side behaves badly, the other side tries to top them and then the “news” tells you about the worst of us every hour on the hour in gory detail with plenty of video from every angle. Mrs. Gruntbuns pulled me up short. She said, “Son, you are looking in the wrong place for inspiration. Just because you get elected or you are famous or someone points a camera your way, doesn’t make you a leader or a hero. All those pictures on your Marvel comics scrub top are fiction.” That was a little disheartening because my wife thinks I look like Thor now that I wear a beard, but Mrs. Gruntbuns wasn’t slowing down.
“Yes, Doc — but you did it. You came in and got him out of pain. He carries that bone around in his wallet and he’s still telling people about it. “Who grabs people’s tongues with a piece of cotton, pulls it out past their nose and stares at that hangy-down thing and whatever else is in the back of our mouths to make sure we don’t have cancer, or at least catch it early so we can cure it?” “Well, we dentists do, Mrs. Gruntbuns, but it’s just what we were taught to do in school and it’s the right thing to do,” I responded. She went on. “Have you counted up the lives you’ve saved, the suffering you prevented? There is a hero or two in every dental office. Every once in a while, an ‘Atta-girl/boy’ and a pat on the back goes a long way, but you don’t need the satellite truck and the pretty newsreader to verify what you do. Just keep doing it for all of us regular folks who may not be famous either but deserve your best effort every day.” It’s hard to argue with someone who is so right.
“Turn off the TV and put down the phone. Last April when no one knew who had or who might die from the coronavirus, who opened his office and removed that fish bone stuck between Mr. Gruntbuns’ teeth?” she continued. I replied, “Well, I did Mrs. Gruntbuns, but he’s a friend and I was just doing what I know how to do with the tools I have on hand …”
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