2020 - July/August TFDA

2019 Dentists’ Day on the Candidates Hill - March 11-12, 2019Page - Page12 2 FDAPAC-supported - See

VOL. 32, NO. 5 • JULY/AUGUST • CAREERS ISSUE

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

SO, YOU WANT TO SELL/BUY A PRACTICE Changing the Shape of Your Career

A Career in Military Dentistry Forensic Odontology

Steps to Success

We work for you.

Dr. Jenna Pascoli As a new dentist, I am constantly striving to build a strong foundation for my future, professionally and personally.

Through my coverage with The Doctors Company, I am achieving both of these.

As a covered member, my career is being protected by the largest doctorowned malpractice carrier in the nation.

The Doctors Company is the only

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carrier endorsed by the FDA in Florida for professional liability.

Having the FDA community support me on my choice for malpractice coverage is a benefit unrivaled.

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All new dental school graduates who become FDA members and practice in Florida will have their first year of professional liability coverage from The Doctors Company completely reimbursed by their FDA colleagues!

Call or text FDAS at 850.681.2996 to learn more!

HELPING MEMBERS SUCCEED VOL. 32, NO. 5 • July/August 2020

in every issue 3 Staff Roster 5 President's Message 8 Did You Know?

10 Info Bytes 14 news@fda 61 Diagnostic Discussion 66 Career Center 67 Advertising Index 68 Off the Cusp

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So, You Want to Sell/Buy a Practice?

12

FDAPAC-supported Candidates

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

20

Changing the Shape of Your Career

26

Forensic Odontology

The Journey from Dental School to Oral and Maxillofacial Pathology

48

Empathy: The Role of a Lifetime

30

Collaborating to Protect Workers and Patients

54

A Dentist and an Entrepreneur ... A Lofty Goal!

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A Career in Military Dentistry

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44

56

Steps to Success

The Formative Years: Where Does the New General Dentist Continue Learing

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The Unexpected Vowels of Leadership

TODAY'S FDA ONLINE: floridadental.org

Paragon Dental Practice Transitions

FLORIDA DENTAL ASSOCIATION JULY/AUGUST 2020 VOL. 32, NO. 5

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

American Sensor Tech

PUBLISHING INFORMATION 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 2020 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 JULY/AUGUST 2020

FLORIDADENTAL.ORG

CONTACT THE FDA OFFICE 800.877.9922 OR 850.681.3629 545 John Knox Road, Ste. 200 • Tallahassee, FL 32303

EXECUTIVE OFFICE DREW EASON, Executive Director deason@floridadental.org 850.350.7109 GREG 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

FLORIDA DENTAL CONVENTION (FDC) CRISSY TALLMAN Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103 DEIRDRE RHODES, FDC Exhibits Coordinator drhodes@floridadental.org 850.350.7108 EMILY SHIRLEY, FDC Program Coordinator eshirley@floridadental.org 850.350.7106

LEONA BOUTWELL, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 STEPHANIE TAYLOR, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

COMMUNICATIONS AND PUBLICATIONS RENEE THOMPSON Director of Communications and Marketing rthompson@floridadental.org 850.350.7118 JILL RUNYAN, Director of Publications jrunyan@floridadental.org 850.350.7113 AJ GILLIS, Graphic Design Coordinator agillis@floridadental.org 850.350.7112 JESSICA LAURIA Communications and Media Coordinator jlauria@floridadental.org 850.350.7115

FLORIDA DENTAL ASSOCIATION FOUNDATION (FDAF)

800.877.7597 or 850.681.2996 545 John Knox Road, Ste. 201 Tallahassee, FL 32303 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat

SCOTT RUTHSTROM Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146

EMILY SOMERSET, FDC Meeting Assistant esomerset@floridadental.org 850.350.7162

CAROL GASKINS Commercial Accounts Manager carol.gaskins@fdaservices.com 850.350.7159

GOVERNMENTAL AFFAIRS

MARCIA DUTTON Membership Services Assistant marcia.dutton@fdaservices.com 850.350.7145

ACCOUNTING BREANA GIBLIN, Director of Accounting bgiblin@floridadental.org 850.350.7137

FDA SERVICES

JOE ANNE HART Chief Legislative Officer jahart@floridadental.org 850.350.7205 ALEXANDRA ABBOUD Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204

INFORMATION SYSTEMS LARRY DARNELL Director of Information Systems ldarnell@floridadental.org 850.350.7102 RACHEL STYS, Systems Administrator rstys@floridadental.org 850.350.7153

MEMBER RELATIONS KERRY GÓMEZ-RÍOS Director of Member Relations krios@floridadental.org 850.350.7121 MEGAN BAKAN Member Access Coordinator mbakan@floridadental.org 850.350.7100 JOSHUA BRASWELL Membership Coordinator jbraswell@floridadental.org 850.350.7110 CHRISTINE TROTTO Membership Concierge ctrotto@floridadental.org 850.350.7136

PORSCHIE BIGGINS Central Florida Membership Commercial Account Advisor pbiggins@fdaservices.com 850-350-7149

KELLY DEE Atlantic Coast Membership Commercial Account Advisor kelly.dee@fdaservices.com 850.350.7157

DAN ZOTTOLI, SBCS Director of Sales — Atlantic Coast

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 904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com

MARRISA LEE North Florida Membership Commercial Account Advisor marrisa.lee@fdaservices.com 850.350.7122 MELISSA STAGGERS West Coast Membership Commercial Account Advisor melissa.staggers@fdaservices.com 850.350.7154

LIZ RICH Commercial Account Advisor liz.rich@fdaservices.com 850.350.7171

YOUR RISK EXPERTS

561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

MARIA BROOKS South Florida Membership Commercial Account Advisor maria.brooks@fdaservices.com 850.350.7144

TESSA DANIELS Commercial Account Advisor tessa.daniels@fdaservices.com 850.350.7158

CARRIE MILLAR Director of Insurance Operations carrie.millar@fdaservices.com 850.350.7155

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

ARIEL WORD Commercial Account Advisor a.word@fdaservices.com 850.350.7151

R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117 KRISTIN BADEAU, Foundation Coordinator kbadeau@floridadental.org 850.350.7161

FLORIDADENTAL.ORG

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 JULY/AUGUST 2020

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THE PLAYBOOK FOR OUR TIMES In June, the Florida Dental Association (FDA) maneuvered through its first virtual House of Delegates meeting. It’s been several months since many of us last met face to face, and the biggest thing we had on our plates was a governance issue at that time.

Our lives, families, businesses, communities — indeed, the whole world — have been affected by the current pandemic as it courses through the world’s population with no definitive end in sight. Florida’s COVID-19 positivity rate is rapidly increasing. Currently, the focus is on social justice, social inequities and reform, and is literally taking things to the streets in our communities.

Our always hardworking FDA staff, certainly my predecessor Dr. Rudy Liddell, and our tripartite resources have been instrumental and proactive, both statewide and nationally.

They’ve provided a wealth of comprehensive information, including: how to apply for and maneuver the Paycheck Protection Program and Economic Injury Disaster loans available, and how to best implement them; working to fill the personal protective equipment supply chain for eventual opening of our offices in May; and now, continuing the updates, webinars and resources for our ongoing practice efficiencies that are the “new normal” ... at least for the time being. If looking back the last several months and you cannot realize the significant value of your membership in our FDA to our profession and your practice, I just don’t know what I can say. No one could have provided more important material and methods — and remember, they did it all from home!

leadership

building at many levels of government was instrumental in bringing dentistry back into the Florida fold and clarifying our recognition as an “essential service” at all levels. As such, we were accommodated by the Federal Emergency Management Agency, allowing distribution of critical supplies for our practices to be able to work effectively and safely.

Our practices are up and running, rebounding and successfully reinstituting the full range of oral health care procedures for our communities. Building onto their existing infection control measures, dentists are able to protect patients and dental team members with what we have learned from years past, and certainly during the recent “free time” on our hands from the information aggregated, distilled and summarized by our wonderful FDA staff.

PRESIDENT’S MESSAGE ANDY BROWN, DDS, MS FDA PRESIDENT

Dr. Brown can be reached at abrown@bot.floridadental.org.

Please do not be naïve in thinking this is the end of our COVID-19 journey! Resources are already in place for the eventualities that we will find practices, employees and patients testing positive in the near term. How to maneuver those waters with your office, staff, patients, local media ... the playbook is already written. There are still more twists to be added to the story, to be sure.

As your newly minted FDA president, I stand up and congratulate you, our FDA member doctors, for adapting so quickly and so well to yet another challenge to our profession.

As our president-elect, Dr. Dave Boden exclaims, “The FDA has your back, doc!” We are here to help all members succeed!

What are the takeaways for the short term?

Advocacy is paramount, and relationshipFLORIDADENTAL.ORG

TODAY'S FDA JULY/AUGUST 2020

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human relations

SO, YOU WANT TO SELL/BUY A PRACTICE? Selling or buying a business is a complicated process, and no one article can provide all the information needed to navigate these waters successfully. This article is intended only to provide a general checklist of major issues that should be considered and addressed and is not intended to be all-inclusive.

What is Being Sold 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.

1.

Sales can be identified as either asset purchases or entity (stock) purchases. In an asset purchase, the buyer only purchases the equipment, fixtures, goodwill, licenses, trade secrets, trade name, telephone number and inventory of the business, and the seller retains the long-term debts and liabilities. In an entity (stock) purchase, the buyer purchases both the assets and liabilities, which means that any future lawsuits, environmental issues and OSHA issues become the responsibility of the buyer. Most buyers prefer an asset purchase over an entity purchase. The type of sale can affect the sale/purchase price.

Assignability of Agreements Another area to consider is whether agreements can be assigned and, if so, what requirements must be met to effectuate the assignment. For example, if employees are going to be transferred as part of the sale, are covenants not to compete assignable to the new employer? Or, would agreements/ accounts with insurance providers for submitting claims be assignable, or will new

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agreements/accounts need to be signed or established?

Licensure Issues and Requirements During the sale process, a review should be undertaken to determine what licenses are currently held by the practice and the status of those licenses, and whether they can be transferred to the buyer. If so, what notice, if any, must be provided to the licensing agency? Will there be a time delay between the purchase/sale and the ability to set up the new account or receive authorization to use the license?

Patient Issues Consideration should be given to providing notice of the sale to patients during and immediately after the sale, including: n How the notice will be provided. n How much time would be allowed for the patient to choose to remain with the new practice or leave. n Who is responsible for processing the request to leave the practice after the sale (i.e., returning the file to the patient or forwarding it to the new caregiver). n What procedures are taken for maintaining the confidentiality of patient information and files and complying with all HIPAA requirements.

FLORIDADENTAL.ORG

Employment Issues

Getting Assistance

What will happen with the employees of the existing practice? Are all employees transferring to the new entity with continuation of employment to be determined by the buyer? Will all employees be terminated by the seller but have an opportunity to apply for employment with the buyer? This decision can affect which entity may be charged under unemployment laws. If employees are on leave or have accommodations under the Americans with Disabilities Act, these matters will need to be disclosed and discussed. In addition, because successor employer liability is recognized in discrimination claims, pending discrimination litigation should be disclosed and issues as to handling such matters should be resolved.

It’s common, and generally suggested, that the buyer or seller (or both) retain a practice broker to help put the deal together. However, adding an attorney to the team can be a wise decision.

The broker’s major responsibility is to put the deal together and make sure it proceeds to completion with all required documents executed and filed with the appropriate agencies.

On the other hand, the attorney’s responsibility is to review and evaluate the legal nuances of the language of the documents, to ensure the parties understand the deal and to manage the risk of post-closing challenges. Because no two practices are identical, no two purchases

or sales are exactly alike. Though buying and selling a practice can be somewhat routine, it’s unwise to think that the process and, indeed, the paperwork can be one-size-fits-all.

Conclusion The sale of a business is not just a matter of signing documents. Each sale transaction presents its own problems and concerns and should be carefully evaluated on a case-by-case basis, and selling a dental practice adds additional complications. It’s wise to always consult with someone experienced in selling medical practices before venturing into those murky waters.

D L

O S FLORIDADENTAL.ORG

TODAY'S FDA JULY/AUGUST 2020

7

BOD

DR. JOE CALDERONE FDA LIAISON TO THE FLORIDA BOARD OF DENTISTRY

ARE YOU INTERESTED IN BECOMING A BOD MEMBER?

CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

Did you know there currently are two open positions on the Florida Board of Dentistry (BOD)? A dentist position and a consumer position are both vacant. The BOD is responsible for licensure, monitoring and ensuring the safe practice of dentists and dental hygienists in their service to the people of the state. The BOD consists of 11 members appointed by the governor and confirmed by the Senate. Seven members must be licensed dentists actively engaged in clinical practice; two members must be actively practicing dental hygienists; and two members must be consumers employed in a field or occupation that is not related to the dental profession. The BOD meets four times a year at various locations around the state and the various committees and councils meet via conference call in between those meetings.

If you are interested in becoming a board member or you know of someone who would be a good consumer member, flhealthsource.gov/board-members contains material that provides insight into the duties and responsibilities of the role.

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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If you are interested in applying to become a BOD member or have further questions, please contact the FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire at 850.350.7202 or cstoutamire@floridadental.org.

As Dr. Don Ilkka will now be taking over as the FDA’s Speaker of the House, he will be stepping down as the BOD liaison. Please join us in thanking him for all his hard work and service representing the FDA in front of the BOD. And please welcome Dr. Joe Calderone as the FDA’s new BOD liaison!

TODAY'S FDA JULY/AUGUST 2020

FLORIDADENTAL.ORG

now you know

FDA Online Radiography Training Program INFORMATION FROM THE FDA

 OPIOIDS

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.

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 9

info bytes

WHEN DID “DEFAULT” BECOME A BAD WORD? When I was in high school and college, I played competitive tennis. I was a pretty good player back in the day. If an opponent did not show up for a match, for any reason, it was called winning by default. I liked defaults back then. You got the benefit of winning without any of the effort it required.

LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS

Mr. Darnell can be reached at ldarnell@floridadental.org.

Fast forward to now and my role with technology. Suddenly, defaults are not such a good thing. Especially when it comes to cybersecurity. Let me elaborate. Almost every home has a type of technology called a router. Many times, this is issued by your service provider; mine is Comcast and I get my internet service from them. They also provide a cable modem/router that came with it (for a fee).

You might be surprised to learn that most of those internet provider routers (that are in use in many of our homes) are still set to use the default admin user/password combination. There are many other people that use internet routers from Netgear, Linksys, Belkin and Asus. A staggering number of those also are set to — you guessed it — factory defaults for security. Unfortunately, those factory defaults are also well-known and easily discoverable. You also might be surprised to learn that many businesses also use technology that’s set to the factory defaults. Defaults are bad!

If you are like me, I suddenly felt concerned about what people can do with the technology in my house. Doorbell cam? Factory

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defaults. Security system? Factory defaults.

Smart TV? Factory defaults! I’ve even grown to loathe the factories that made these things.

Some of those devices may not even have passwords and security enabled! In some of these devices, there’s also what we admins like to call a “back door.” Once again, to access these back doors, they are well-known and well-documented. The saddest thing is that the people responsible for this problem are you and me. It’s like having a spare key to your house and putting it under the welcome mat (or that obviously out-of-place rock) by your front door. That’s not secure at all.

As I write this from my house, I realize that I have more than 30 internet-capable devices at my house … each one with the potential to have the default admin usernames and passwords. Think about everything that can connect to the internet at your house. And you thought Alexa and Siri listening to us was bad! Here are some things to do now.

Go through and identify all your devices that connect to the internet: routers, modems, smart gadgets like TVs, Roku, Chromecast, Apple TV, printers, etc. Even my washer and dryer connect to the internet now!

Now that you have a list, systematically check the username and passwords for those devices. Some you may not even know or remember. Most will give you the option of resetting that password using “forgot password” options. I know this is time-consuming, but cybersecurity is no joke. Worst case, many

FLORIDADENTAL.ORG

of those devices will let you reset things to … factory defaults!

After doing that, change it.

If you have anything (including your routers and TVs) that can have a password but does not, put in a username/password combination and do not use the same thing for everything.

“Admin” and “Password” is not a good combination.

Check your office technology, too. If you have someone responsible to handle this, make sure they are doing it.

“

This isn’t designed to scare you, but it should. It might, at least, awaken you to the reality of the cybersecurity holes you have at your home or office. If they are left unattended, you’re putting your security and information at great risk. If someone gains access to your home or office router, they can see everything that you do on the internet. Banking information, credit card data and other personal information you would not want to fall into the wrong hands. Those three pages of security and privacy information that you just click “I Agree” to says it’s your responsibility to take care of this.

Unfortunately, this is one problem that won’t fix itself by default.

Your

You might be surprised to learn that most of those internet provider routers (that are in use in many of our homes) are still set to use the default admin user/ password combination.

”

Please see the Diagnostic Discussion on page 61.

BACKSTAGE

ALL ACCESS

FLORIDADENTAL.ORG

TODAY'S FDA JULY/AUGUST 2020

11

elections

FDAPAC-SUPPORTED CANDIDATES PRIMARY ELECTION: TUESDAY, AUG. 18 Thanks to your Florida Dental Association Political Action Committee (FDAPAC) membership and support, the FDAPAC has already contributed to many candidates’ campaigns for the 2020 Primary Election. Without the membership of FDAPAC, FDAPAC Century Club and FDAPAC Capital Hill Club, organized dentistry would not be as effective during the legislative session. Below is a list of FDAPAC-supported House and Senate candidates for the 2020 Primary Election.

ATLANTIC COAST DISTRICT

CENTRAL FLORIDA DISTRICT

Erin Grall, R-Vero Beach

H-54

Chuck Clemons, R-Jonesville

H-21

Kelly Skidmore, D-Boca Raton

H-81

Paul Renner, R-Palm Coast

H-24

Toby Overdorf, R-Stuart

H-83

Tom Leek, R-Daytona Beach

H-25

Delores Hogan Johnson, D-Fort Pierce

H-84

Elizabeth Fetterhoff, R-DeLand

H-26

David Silvers, D-West Palm Beach

H-87

David Smith, R-Winter Springs

H-28

Michael Caruso, R-Boca Raton

H-89

Scott Plakon, R-Longwood

H-29

Emily Slosberg, D-Delray Beach

H-91

Joy Goff-Marcil, D-Maitland

H-30

Patricia Williams, D-Fort Lauderdale

H-92

Geraldine Thompson, D-Orlando

H-44

Chip LaMarca, R-Lighthouse Point

H-93

Kamia Brown, D-Orlando

H-45

Bobby DuBose, D-Fort Lauderdale

H-94

Carlos Guillermo Smith, D-Orlando

H-49

Dan Daley, D-Sunrise

H-97

Tyler Sirois, R-Merritt Island

H-51

Mike Gottlieb, D-Plantation

H-98

Thad Altman, R-Indian Harbour Beach

H-52

Evan Jenne, D-Hollywood

H-99

Randy Fine, R-Palm Bay

H-53

Debbie Mayfield, R-Melbourne

S-17

Travis Hutson, R-Palm Coast

S-7

Gayle Harrell, R-Stuart

S-25

Jason Brodeur, R-Sanford

S-9

Tina Polsky, D-Boca Raton

S-29

Randolph Bracy, D-Orlando

S-11

Lori Berman, D-Boynton Beach

S-31

Victor Torres, D-Kissimmee

S-15

Perry Thurston, D-Fort Lauderdale

S-33

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TODAY'S FDA JULY/AUGUST 2020

FLORIDADENTAL.ORG

NORTHEAST DISTRICT

WEST COAST DISTRICT

Clay Yarborough, R-Jacksonville

H-12

Ralph Massullo, R-Beverly Hills

H-34

Tracie Davis, D-Jacksonville

H-13

Blaise Ingoglia, R-Spring Hill

H-35

Wyman Duggan, R-Jacksonville

H-15

Ardian Zika, R-Land O’Lakes

H-37

Jason Fischer, R-Jacksonville

H-16

Josie Tomkow, R-Auburndale

H-39

Cyndi Stevenson, R-St. Augustine

H-17

Colleen Burton, R-Lakeland

H-40

Sam Garrison, R-Orange Park

H-18

Sam Killebrew, R-Winter Haven

H-41

Bobby Payne, R-Palatka

H-19

Melony Bell, R-Fort Meade

H-56

Jennifer Bradley, R-Orange Park

S-5

Mike Beltran, R-Valrico

H-57

Jackie Toledo, R-Tampa

H-60

Dianne Hart, D-Tampa

H-61

Susan Valdes, D-Tampa

H-62

Fentrice Driskell, D-Tampa

H-63

James Grant, R-Tampa

H-64

Chris Sprowls, R-Clearwater

H-65

Nick DiCeglie, R-Largo

H-66

Chris Latvala, R-Clearwater

H-67

Ben Diamond, D-St. Petersburg

H-68

Will Robinson, R-Bradenton

H-71

Tommy Gregory, R-Bradenton

H-73

James Buchanan, R-North Port

H-74

Michael Grant, R-Port Charlotte

H-75

Spencer Roach, R-North Fort Myers

H-79

Bob Rommel, R-Naples

H-106

Darryl Rouson, D-St. Petersburg

S-19

Jim Boyd, R-Bradenton

S-21

Joe Gruters, R-Sarasota

S-23

Ray Rodrigues, R-Estero

S-27

NORTHWEST DISTRICT Alex Andrade, R-Pensacola

H-2

Jayer Williamson, R-Pace

H-3

Jonathan Tallman, R-Niceville

H-4

Brad Drake, R-DeFuniak Springs

H-5

Jay Trumbull, R-Panama City

H-6

Ramon Alexander, D-Tallahassee

H-8

Allison Tant, D-Tallahassee

H-9

Doug Broxson, R-Pensacola

S-1

Loranne Ausley, D-Tallahassee

S-3

SOUTH FLORIDA DISTRICT Joe Geller, D-Dania Beach

H-100

Cindy Polo, D-Hialeah

H-103

Bibiana Potestad, R-Coral Gables

H-105

Dotie Joseph, D-Miami

H-108

Bryan Avila, R-Hialeah

H-111

Nick Duran, D-Miami

H-112

Michael Grieco, D-North Bay Village

H-113

Demi Busatta-Cabrera, R-Coral Gables

H-114

Vance Aloupis, R-Miami

H-115

Shevrin Jones, D-Miami Gardens

S-35

Jose Javier Rodriguez, D-Miami

S-37

Ana Maria Rodriguez, R-Miami

S-39

FLORIDADENTAL.ORG

Please note: Those listed in purple are FDAPACsupported candidates who were elected to office without opposition after the June 12 qualifying deadline.

Their names will not appear on the election ballot.

For additional information on FDAPAC-supported candidates, contact the FDA Governmental Affairs Office at 850.224.1089 or gao@floridadental.org.

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

ADA FDC Annual Meeting 2020 — Putting the Well-being of Our Attendees First

New COVID-19 Exposure Toolkit

The ADA and FDA made the difficult decision not to move forward with ADA FDC 2020 as an in-person meeting, originally scheduled for Oct. 15-18 in Orlando. Instead, the ADA and FDA will hold the ADA FDC Virtual Connect Conference Oct. 15–17, a live and on-demand event created to inspire you and energize your practice. Expect thought-provoking keynote sessions, community-building events, wellness activities, flexible continuing education course selection, live workshops, a Virtual Exhibit Hall and more! Registration opens Aug. 12 at ADA.org/meeting. Enjoy Early Bird discounts through Aug. 31.

The Florida Dental Association (FDA) identified a potential member need and then worked to address it. With rising numbers of COVID-19 cases in Florida, the likelihood of possible exposure to a dental practice — through a patient or a staff member — also was increasing. So, the FDA developed a COVID-19 Exposure Toolkit that answers the question, “What should I do if a staff member or recent patient has tested positive for COVID-19?” This new toolkit resource can be found on the Practice Resources & Forms page of the COVID-19 section of the FDA’s website at floridadental.org/coronavirus/ covid-19-toolkit and includes: n Suggested language and techniques for communicating with staff members n Talking points for communicating with patients n Wording for an office closure email n Draft text for social media posts n Script for office voicemail message n The American Dental Association’s (ADA) Return to Work Interim Guidance Toolkit n The ADA's Protocols to Follow if a Staff or Household Member is COVID-19 Positive n The ADA's Steps to Take if a Patient Reports COVID-19 Exposure After Treatment n The ADA’s COVID-19 Hazard Assessment and Hazard Assessment Checklist n The Centers for Disease Control and Prevention’s FAQs about Suspected or Confirmed Cases of COVID-19 in the Workplace n The FDA’s 10-point checklist for What to Do When a Crisis Happens

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Is Your Hurricane Season Plan in Place?

Prepare and Protect Your Practice!

We’re in the middle of the 2020 Atlantic Hurricane Season — if you haven’t already, now is the time to review your home and practice storm readiness plans and ensure you have the right coverages in place to protect your practice! Flood policies, for example, have a 30-day waiting period before they become effective, so waiting could cost you. FDA Services (FDAS) can help you find any gaps in your existing office insurance coverage as well. Creating an airtight plan now will give you the peace of mind to focus your attention on other challenges your dental practice may face in the coming months. Make sure you check out the 2020 FDA Hurricane Readiness Guide at bit.ly/2W0Na8F, which is full of helpful resources that will help you prepare for this year’s hurricane season with plenty of time to spare. Contact FDAS at 800.877.7597 or insurance@fdaservices.com.

Rescheduled FLA-MOM The FDA Foundation is happy to announce the rescheduled date for the next Florida Mission of Mercy (FLA-MOM). Mark your calendar for April 9-10, 2021 for this volunteer event that provides dental care to more than 2,000 patients at no cost.

This two-day event will be held in Jacksonville at the Prime

FLORIDADENTAL.ORG

F. Osborn III Convention Center. Visit vimeo.com/348615786 to watch the FLA-MOM promo video to see the positive impact the FDA Foundation and its volunteers have on improving the oral health of Floridians. Volunteer registration opens Oct. 1.

2021 Dentists’ Day on the Hill Registration Open!

Next year marks the 25th anniversary of Dentists’ Day on the Hill (DDOH).

For 25 years, FDA member dentists have traveled to Tallahassee to proudly advocate on behalf of organized dentistry. The 2021 DDOH will take place on Tuesday, March 16 with a legislative briefing on Monday, March 15 at 6 p.m. at Hotel Duval. Go to floridadental.org/ ddoh to register.

To celebrate this momentous milestone, the FDA will host a buffet dinner with entertainment at Hotel Duval after the legislative briefing on March 15. If you plan on attending the briefing and dinner, please add both items during your registration.

The FDA has a room block at Hotel Duval of $229 a night. To book your room, please call 850.224.6000 and reference the “Florida Dentists’ Day on the Hill,” or go to bit.ly/3fqS46h. Rooms for this event fill up quickly — so reserve your room today! Please note: Room reservations should only be made for yourself/ parties staying in the same room. Multiple rooms reserved under one name for any affiliate or district may be subject to cancellation by the FDA. Thank you for your cooperation.

Information regarding DDOH will be sent periodically to registrants throughout the year and up until the event.

Register as soon as possible to receive timely information! If you have any questions, please contact Governmental Affairs Liaison Alexandra Abboud at 850.224.1089 or aabboud@floridadental. org.

Today's FDA Reception Room Issue Online According to the ADA and CDC’s infection control guidelines, magazines and other materials should be removed from dental lobbies and waiting rooms. As a result, the FDA is offering our annual “Reception Room” issue of Today’s FDA as an online-only resource. We encourage you to download and share this issue on your website, social media and newsletters, so patients can access this valuable resource from their FDA member dentist. Visit bit.ly/3foJ1ms to access this issue.

Welcome New FDA Members These dentists recently joined the FDA. Their membership allows them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry.

Atlantic Coast District Dental Association Dr. Chad Brown, Stuart Dr. Ilon Choai, Vero Beach Dr. Lakshay Goyal, Fort Lauderdale Dr. Dennis Hart, Port St. Lucie Dr. Rozana Karim, Margate Dr. Christopher Kuhns, Stuart Dr. Mary Kuhns, Stuart Dr. Andrew Nickel, Vero Beach Dr. Aditi Patel, Royal Palm Beach Dr. Krunal Patel, Royal Palm Beach

Central Florida District Dental Association Dr. Caroline Basta, Orlando

Northeast District Dental Association Dr. Taras Kulynych, Jacksonville Dr. Erin Standish, Orange Park

Northwest District Dental Association Dr. Roy Moshe, Pensacola

South Florida District Dental Association Dr. M Nadim Alzain, North Miami Beach SEE PAGE 16

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updates for members FROM PAGE 15

Dr. Carlos Boada, Miami Dr. Dashiel Carr Hodson, Miami Dr. Alejandra Cartagena, North Miami Beach Dr. Dominick Dolecki, Hallandale Beach Dr. Veronica Pereira Nava, Doral

West Coast District Dental Association Dr. Ziad Al Adham, Palm Harbor Dr. Hiba Alqasemi, Palm Harbor Dr. Nima Iranmanesh, Tampa Dr. Tina Jose, Tampa Dr. Natoya McLean, Haines City Dr. Sanket Rathod, Bartow Dr. Sara Safdari-Sadaloo, Tampa Dr. Aareet Sandhu, Venice Dr. Mary Shehata, Tampa Dr. Danielle Williams, Tampa

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FLORIDADENTAL.ORG

Florida Health: Tobacco Free Florida

FDA Services welcomes our new 2020-2021 Student Advisors!

Thank you for volunteering to provide the insights and perspective we need to serve the next generation of Florida dentists.

ASHLEY RYNAR

VRINDA SHAH

ASHLEY MAUS

Nova Southeastern University College of Dental Medicine

University of Florida College of Dentistry

LECOM School of Dental Medicine

Visit fdaservices.com to learn more about our products and services.

FLORIDADENTAL.ORG

TODAY'S FDA JULY/AUGUST 2020

17

FDAS: Dental Offic

FDAS: Dental Offic

DENTAL OFFICE INSURANCE SPECIALISTS Getting your dental office package through FDAS gets you access to the strength of the best carriers in the industry along with the unparalled customer service provided by your FDAS dental office specialists. We’ll work with you to find the best coverage at the best price for your practice.

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TODAY'S FDA

JULY/AUGUST 2020

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Dr. Bryan Griffith FDAS Customer Since 2000

“FDA Services has provided me coverage for my entire 18 years of practice. Great customer service with people who care about my practice and personal well-being. Thank you, Rick for your dedication to dentistry.”

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Dr. Richard Mullens FDAS Customer Since 2017

TODAY'S FDA

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TODAY'S FDA JULY/AUGUST 2020

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Changing the Shape of your career?

MARKET TO COLLEAGUES. Our aging population will need more restorative and cosmetic procedures than ever before. The growth of new technologies, the paperless office and electronic health records will create a strong demand for new equipment, supplies and software. As a dental professional, you can provide your colleagues with products in a knowledgeable manner based on practice and education.

It’s also helpful to have sales and marketing experience, a research background and advanced dental education when pursuing a transition into the dental products field. Some dentists also thrive in the pharmaceutical industry, including clinical research, sales, marketing and management.

Companies that manufacture these products that have received the ADA Seal of Acceptance may have opportunities in sales, marketing or research and development.

TAKE YOUR ACT ON THE ROAD. CONSULTING: Your dental degree and practice experience are a good start, but you also may need additional expertise in the dental care industry. Most dental consultants function independently or form companies to spread out expenses. Practice management fulfills a great need in the dental community as very little, if any, education in dental school involves business management. Many people who provide dental consulting services also conduct seminars and other speaking engagements.

Most dental practices seek assistance with areas such as:  financial management and strategic planning.  leadership skills for dentists.  team building.  practice startups and appraisals.  practice transitions.  internal and external marketing.  treatment planning and case presentation.  human resources and employee management.  regulatory issues.  equipment and technology.

In the corporate arena, a dental consultant may coordinate with a company’s human resources department and its dental insurance plan provider. Dental consultants also adjudicate claims for dental insurance companies.

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TODAY'S FDA JULY/AUGUST 2020

FLORIDADENTAL.ORG

ORGANIZE AND DEFEND YOUR PROFESSION. ORGANIZED DENTISTRY: Your local, state and national associations combine efforts to contribute to the dental profession. Association staff represent many diverse occupations and perspectives and work closely with other dental associations, specialty organizations, ethnic dental associations and student organizations. They advance important dental issues that serve the profession and protect patients’ health and safety.

These associations employ a number of dentists in administrative, policy, research and product evaluation positions. Other dental-related health organizations that generally function as nonprofit organizations employ dentists in a variety of capacities.

WORK FOR UNCLE SAM. Almost 5,000 DENTISTS work for the U.S. Public Health Service, the Department of Veterans’ Affairs or the military.

The U.S. Public Health Service Commissioned Corps are uniformed dental officers, serving in the Indian Health Service, U.S. Coast Guard, Federal Bureau of Prisons and the National Health Service Corps. They work for the U.S. Department of Health and Human Services, overseen by the surgeon general. These officers may respond to man-made and natural disasters. Find more information on these opportunities:  U.S. Army Dental Corps.  U.S. Navy Dental Corps  U.S. Air Force  U.S. Department of Veteran’s Affairs  USA Jobs (search keywords: dental, medical, public health)  U.S. Public Health Service  Health Resources and Services Administration (HRSA)  Indian Health Service  National Institutes of Health (NIH)  U.S. Coast Guard  Association of State and Territorial Dental Directors FLORIDADENTAL.ORG

TODAY'S FDA JULY/AUGUST 2020

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Changing the Shape of your career?

ZOOM WITH YOUR PATIENTS & COLLEAGUES. Do you need to move away from face-to-face patient care or consult with patients remotely? TELEDENTISTRY encompasses all those digital techniques that allow you to communicate with your patients, consult with specialists and instruct your dental team.

With teledentistry, your practice can:  reach patients in rural areas, or those without access to a dental provider.  communicate with dental hygienists providing off-site preventive care or screenings. Video chat, send data digitally to you on-site for diagnosis and necessary follow-up care protocols.  streamline interactions with specialists for more seamless referrals and follow-up appointments.  gather your new patients’ health histories from their pediatricians, physicians or skilled nursing facilities.  exchange information and administrative services with DSOs. Also, many websites that provide medical services or patient consultations employ professionals for live chat sessions with patients. These positions offer flexible hours and, frequently, the opportunity to work from home.

IDENTIFY VICTIMS & SOLVE CRIMES. FORENSIC DENTISTS, also called forensic odontologists, are specially trained dentists who use their expertise to help identify unknown remains and trace bite marks to a specific individual. You may be called in by police officers, the medical examiner and must be ready to work long hours, day or night, on holidays and on weekends.

After writing a detailed report, you must be prepared to testify in court. After earning your DDS or DMD, extensive additional training is required in the techniques and methods of forensic odontology, along with hands-on experience, often by shadowing a more senior professional. Typically, as a forensic dentist, you would:  identify human remains that cannot be identified using face recognition, fingerprints or other means.  identify bodies in mass fatalities, such as plane crashes or natural disasters.  identify source of bite mark injuries in cases of assault or suspected abuse.  estimate the age of skeletal remains.  testify in cases of dental malpractice.

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DrFirst

The

Journey

from Dental School to Oral and Maxillofacial Pathology 26

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pathology My experience as an oral and maxillofacial pathology (OMP) resident has been challenging but rewarding. I started my second year at the University of Florida Oral and Maxillofacial Pathology Residency in July — time flies!

I was a first-year dental student when oral pathology first sparked my interest. I’d never heard of this specialty before, but the opportunity to diagnose diseases using a microscope fascinated me. In undergrad, one of my favorite courses was histology, which allowed me to observe various tissues of the human body under a microscope. The vibrant colors and shapes that defined organs provided a distinctive perspective — one that I’d never encountered before. In my later years of dental school, I took an oral pathology course that affirmed my desire to pursue this field as a career. The course was an introduction into head and neck pathology, and I learned how to develop a differential diagnosis. In clinic, I learned the importance of a thorough head and neck exam to identify diseases that might otherwise go unnoticed. These early experiences were a foundation of what was yet to come.

I worked as a general dentist for nearly two years prior to starting my residency training.

Experience as a general dentist (and tackling my dental school loan!) was important to me. Occasionally, routine clinical encounters revealed incidental pathological findings.

These opportunities heightened my curiosity and passion for oral pathology. While I chose dentistry to serve others, oral pathology allowed me to channel that desire in an unconventional approach to save lives.

self-motivation and dedication beyond daily responsibilities. First-, second- and thirdyear residents attend seminar together where we review daily cases submitted to our biopsy service. Initially, it was daunting; I felt inadequate during the first few weeks of training.

There was so much to learn! What appeared as minor details under the microscope made considerable distinctions in the diagnoses.

Pathology is like a mosaic: To make a robust diagnosis, the patient’s history, clinical photos, and radiographs are essential. On particularly difficult cases, ancillary tests are needed as well. In addition to biopsies, we see patients on a weekly basis to provide diagnoses and treatment. Consultations to dental providers within the university allow us to apply our knowledge clinically as well. This upcoming year, I will rotate in the medical pathology specialties for six months. This is valuable as there is frequent overlap between OMP and other specialties, especially dermatopathology and ENT pathology. Research also is an important aspect of the program, and all residents participate in respective projects.

I am thankful for the opportunity to become an oral and maxillofacial pathologist. In the future, I hope to share the knowledge I’ve learned with other dental providers to improve patient outcomes. Though pathology is considered as a “behind-the-scenes” career, it’s pivotal in the future of treatment for a patient. Every biopsy is remarkably unique.

Through the lens, the pervasive nature of malignancy is elucidated. The bizarre architecture cancer creates is almost as jarring as the diagnosis itself. Shades of blue and pink can tell us a story — isn’t that remarkable?

DR. SUMITA SAM

Dr. Sam is a second-year resident at the University of Florida Oral and Maxillofacial Pathology Residency Program and can be reached at SSam@dental.ufl.edu.

“

Pathology is like a mosaic: To make a robust diagnosis, the patient’s history, clinical photos and radiographs are essential.

”

As a current resident, OMP residency is far different from any other training I’ve received. The program requires significant

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FDA: Radiography

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Card Connect

29

infection control

COLLABORATING TO PROTECT WORKERS AND PATIENTS The dental practice and the dental laboratory collaborate on many aspects that can affect the safety of the dental staff, dental technicians and the patient. Communication is critical not only for safety, but also for the quality of the product manufactured by the dental laboratory.

Neither the dentist nor the dental laboratory should presume what the other is doing when it comes to decontamination of impressions and other items that are shipped by the dental practice to the lab. Sharing information regarding the chemicals and procedures used for decontaminating impressions benefits both facilities.

The following are recommended steps for disinfecting impressions and other items produced by the dentist and sent to the dental lab:

MARY A. BARTLETT

Mary A. Bartlett is president and co-founder of Safelink Consulting Inc., an internationally recognized regulatory compliance consulting firm specializing in the dental industry.

1.

Rinse all items that have been in the patient’s mouth. Remove blood, cotton rolls and retraction cords prior to disinfection. When these items are removed from the impression in the dental lab, the impression may be damaged, which could require the recall of the patient to take another impression. If these items are not easily removed, then place them in an enzyme cleaner in the ultrasonic. If further removal of blood or other bioburdent is needed, use a brush and a stone mixture. Disinfectants typically state that they must be used on a clean surface, so this step is important to ensure proper disinfection.

2.

Disinfect the impression and other items that have been in a patient’s mouth. This step is important in the dental office as well as in the dental laboratory prior to pouring a model. This protects the staff and/or technicians who will be grinding or die trimming the model. Research has been published that indicates that living viruses can be found in models when the impressions have not been disinfected prior to pouring the model.

3.

4.

Rinse the items to remove the disinfectant.

The final step in the dental office is to remove gloves and wash hands, write the prescription, and then place the item in a shipping container that meets OSHA and Department of Transportation requirements for transport of potentially infectious items.

There are other tasks that can expose blood and saliva inside the impression. For instance, in the dental lab, the model room tech may have to remove overextended borders on impressions prior to pouring the model. The photo shown here is evidence of blood being exposed during this procedure. The impression would need to be rinsed, disinfected and rinsed again prior to pouring the model. Technicians have reported that blood has spewed out of the impression during this procedure onto their face and body. Anyone performing this task must wear

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Fig. 1

“

DENTISTS AND DENTAL LAB OWNERS MUST COLLABORATE ON THIS PART OF THE RESTORATION PROCESS TO ENSURE SAFETY OF STAFF, TECHNICIANS AND ULTIMATELY, THE PATIENT.

FLORIDADENTAL.ORG

”

SEE PAGE 33 TODAY'S FDA JULY/AUGUST 2020

31

PNC Bank

infection control

Fig. 2: Trimming back overextended border is the task where the dental lab can expose blood as shown in Fig. 1, which is an impression that has been trimmed back. If a technician gets cut while trimming back the impression, this is an exposure event that is regulated by OSHA and requires offering the employee medical evaluation among other requirements.

FROM PAGE 31

a mask, gown, gloves and safety eyewear to protect the entry routes (i.e., eyes, nose, mouth and skin).

Implant components also can present further disinfection requirements in the dental laboratory. Often, blood is exposed during the manufacturing process. Here again, further disinfection is required in order to decontaminate these items and make them safe for handling by the dental technicians.

The Centers for Disease Control and Prevention guidelines for infection control in dentistry state that the disinfectant to be used in the dental practice and the dental laboratory should be a hospital disinfectant with a tuberculocidal claim registered with the Environmental Protection Agency. It’s also important for the chemical to be compatible with the impression material to avoid distortion.

FLORIDADENTAL.ORG

Fig. 3: Bloody impression with cotton rolls intact.

Disinfection of the finished appliance The dental board in each state mandates this responsibility.

The Florida Board of Dentistry does not require the lab to disinfect the finished case prior to packaging for shipment to the dental client. If the lab indicates that the case has been disinfected, the dental practice should ensure that these items are decontaminated prior to placement in the patient’s mouth.

Even if the dental lab has disinfected the finished appliance, the dental practice would be held liable should a patient be harmed by the appliance.

Dentists and dental lab owners must collaborate on this part of the restoration process to ensure safety of staff, technicians and ultimately, the patient.

TODAY'S FDA JULY/AUGUST 2020

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military dentist

A CAREER IN

MILITARY DENTISTRY

“ ”

Each graduate, upon commissioning, will enter a GPR program and serve out the remainder of the commitment at an AFB location that is chosen from a list at the end of the residency program.

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Most dentists who served as a military dental officer will most likely tell you that it wasn’t really a career path they readily sought, but a series of events during dental school that made it a viable option. And almost every one of them will tell you that it was some of the best times in their professional career — whether it was an original three-year active duty commitment such as I had, or a long and interesting career path that I also experienced as a 27-year Air Force reservist, which ended with my retirement in 2012.

In the summer of my junior year in dental school, as I headed to Colorado to do a three-month externship near Boulder, the prime interest rate hit a record 20.5% in July. Given that business loans for dentists would be higher than that, I started thinkDR. RICK HUOT ing about alternative pathways other than establishing a practice in my hometown in Maine after graduation. My faculty advisor that summer had started his dental career in the Air Force and encouraged me to start the application process. The recruiting process has changed considerably since then, but the program was competitive (and still is today), as few military dentists were separating and starting practices of their own due to the economic times.

After applying to a few private general practice residency (GPR) programs, the Air Force accepted me in March of my senior year and I went in directly after graduation, with a three-week stop for medical basic training in Texas, and on to Korea at Osan Air Base, one hour south of Seoul. Since North and South Korea have never officially signed a Korean War Truce, the assignment was considered “remote,” but the conditions were far from being considered harsh. The base optometrist and I were both unmarried, and we took advantage of the many USO trip opportunities all over Asia and traveled to every corner of the Korean Peninsula.

As a result of accepting that one-year assignment, I had numerous assignment choices for my next two years, and I chose an undergraduate pilot training base in southeast Phoenix called Williams Air Force Base (AFB). Like the Osan clinic I worked at, this clinic had about six dentists (with no specialists), so I was able to do a lot of specialty SEE PAGE 37

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military dentist

Dr. Huot's wife, Joanne, and their son, Patrick, join Dr. Huot for his 90-day summer deployment to Germany in 2009.

Capt Huot at his first assignment in Korea.

Col. Lewis Neace, incoming 920 ASTS commander, congratulates Dr. Huot during his retirement ceremony in April 2012. Dr. Huot also is joined by his wife, Joanne, and son, Patrick.

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Military Health Professions Scholarship Programs • Air Force: bit.ly/2UTvc7A • Army: bit.ly/2AKCvHF • Navy: bit.ly/2AOepvw

Pentagon assignment with AF Reserves – Medical.

The United State Public Health Service also is a commissioned corps similar to the military, and has a variety of career opportunities, including working with the Indian Health Service and the U.S. Coast Guard.

More information can be found at usphs. gov/professions/dentist.

FROM PAGE 35

work all three years in active duty, and attended many advanced clinical courses stateside taught by Air Force specialists.

Prior to my separation from active duty, I was given the opportunity to apply to specialty programs if I considered extending my time, but I made the decision to separate and stay in the Air Force Reserves, with an assignment at Pease AFB near the Maine/New Hampshire border.

Many of my colleagues from those three early years eventually worked with me in Washington, D.C. after 9/11, and I also had assignments in Texas and the Pentagon, and in the final two years, came back to Patrick AFB in Cocoa Beach, Fla. as the medical commander of the 920 Aeromedical Staging Squadron. This 240-member group consisting of every medical discipline, including dentists, deployed to six continents and three Areas of Responsibility (combat zones) in Iraq and Afghanistan, as well as combat hospitals in Germany.

Today, a student accepted into dental school has the opportunity to apply for the three- or four-year Health Professions Scholarship Program (HPSP) in the Air Force, as that is the only way to gain entry after graduation from dental school.

Each graduate, upon commissioning, will enter a GPR program and serve out the remainder of the commitment at an AFB location that is chosen from a list at the end of the residency program.

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residency

THE FORMATIVE YEARS: WHERE DOES THE NEW GENERAL DENTIST CONTINUE LEARNING?

DR. COLT CANEPA

Dr. Canepa is a general dentist in West Palm Beach and can be reached at coltcanepadmd@ gmail.com.

40

Now that dental school is over and a new phase begins, where does a soon-to-be general dentist turn for continued development? This is a common dilemma faced by many approaching graduation, and dental school seems to progress so rapidly that it can be difficult to study all the options. In medicine, most states require a graduate to have additional training after medical school, usually in the form of a residency, before autonomous practice. But in dentistry, this isn’t the case. However, a dentist must know a great deal of medicine, pharmacology and dentistry to safely preform procedures. In this regard, a safe climate of fostering continued improvement can be significant when starting out. Many choices available include private practice, large dental practice networks, public health dentistry, or a residency in the form of an Advanced Education in General Dentistry (AEGD) or a General Practice Residency (GPR) program through the civilian or military sector. For some, it may encompass several of these aspects; for others, it may be a calling to one.

procedural, administrative and economic manners requires as much from learning as it does experience, and confidence in these aspects is imperative. Balancing these needs can leave little room or energy for additional education, especially early in a career when it is needed most. For these reasons, such a job position can be outside many new dentists’ qualifications and may impact their chances for practicing in the community at a future time. As an alternative, many consider large practice entities as a form of obtaining additional experience during their initial years of practice.

For dental students who struggled little in school, this may be a viable option — mentorship may be offered, procedures limited to a safe margin and risk potentially low.

Employment is common, alongside the potential for partial ownership. Both settings, however, usually aren’t environments that condone mistakes. While it is admirable that a need for learning is recognized, the demand for competency to allow a practice to remain solvent can challenge even the most experienced new dentists.

To many, the option of private practice can represent the ultimate accomplishment of a dental career. Characterized by high expectations and a tolerance for learning that is substantially smaller, this can be a challenging end goal, and an especially difficult first goal. Readiness to act in both

Considering alternatives to immediate independent practice, a new dentist can pursue alternative forms where progressive and safe development can still be ensured, such as a residency or employment in a public health setting for new dentists. In gross comparison, there are many similari-

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ties and differences: A residency might pay less but afford greater elective and advanced procedures than a community health care setting. Meanwhile, community health practice offers higher income, greater employee benefits, potential loan repayment and the provision of fundamental dental care in large volume with challenging cases. The ability for collaboration is present with colleagues, and a new dentist is supervised directly or indirectly. Both routes, ultimately, lead to increasing self-sufficiency for a lifetime career. What more, the adjusted income and intangible benefits from both residencies and community health care work can compete with salaries otherwise offered to a dentist in their first year.

An example of these scenarios coming into play is the continuously evolving subject of dental implants. It’s a matter of academic reality that most new dentists will probably not know enough to include an advanced surgical regimen in their initial array of techniques. The exception would apply to training conducted under the authority of an experienced clinician in a formal program, such as a residency or a prolonged continuing education course. But incorporating implantology while attempting to learn the boundaries of conservative techniques can be incredibly onerous. It’s an example of the “if you chase two rabbits you will catch neither” fallacy — except in dentistry, you are chasing a thousand rabbits, while striving to catch all of them!

Regarding the two forms of residencies, AEGDs and GPRs can be found within hospitals, outside institutions and the military. Both can entail one- or two-year terms, and offer faculty representing various dental specialties for a new dentist to learn under. Hospital-based residencies will likely make their graduates extremely adept in pharmacology, medically compromised cases, emergencies, essential and elective general procedures, with additional experience in specialty work. They often will cover larger elements of medicine through hospital rotations under physician guidance. These residents will likely have treated many dental emergencies during standard clinic hours or while on call and may be eligible for hospital privileges after graduation. Non-hospital-based residencies will usually have a healthier patient population, variation in the selection of assigned home literature, fewer high-risk or invasive procedures due to the outpatient nature of the facility, and deliver an emphasis of skillsets pertaining to family practice.

Incorporating education for general dentists, the military conducts one-year residencies to accepted graduates, accompanied by an active tour of duty in military clinical practice. Differences in this type of work include providing care under military authority with apportioned benefits and loan repayment programs. Duties also may include location changes, transfer to medical units where personnel are needed, and providing dental treatment based on protocols designed to prepare troops for war. Providers are soldiers, decorated by rank, and standards are typically governed internally by the United States military and its respective branches. Excluding these differences, both GPRs and AEGDs have advantages

“

Even if choosing to provide the most basic, fundamental dental care, one may still consider a formative year.

”

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41

The Doctors Company

residency

FROM PAGE 41

dependent on the source of the program and subject to the director’s preferences. If attending a second year, a participant may earn the title of “chief resident,” alongside potentially treating more advanced cases. Should one consider a career in education, the completion of a residency is an additional qualifying factor. When selecting between the options, it’s important to understand the identity one wishes to occupy in future practice, as this will allow for identifying programs with mutually shared interests.

Dentists can swear by the title of doctor and be able to practice without a residency. Multiple states now are requiring dentists to complete some form of a structured curriculum after dental school prior to independent practice. With the increased involvement of pharmacology, elderly and medically compromised patients, and advances in general dental techniques,

fulfilling additional academic requirements prior to independent practice may be a prudent decision. It’s unfortunate when a novice experiences a complication or an accident, but it can be ameliorated by taking place in a permissible environment. Even if choosing to provide the most basic, fundamental dental care, one may still consider a formative year. Those who do so not only have the chance of struggling less, but also have better qualifications to offer in employment or ownership. We all must learn but being knowledgeable beyond one’s years has true capability in the right environment. A bad habit can have years’ worth of consequences, and sometimes not surface for great lengths of time after the initial formation. Practicing in a setting with conditional independence, monitoring and collaboration can catch these early on. Dental school may not need a fifth year, but most students certainly could be benefitted by five years’ worth of learning before proceeding out on their own.

Aftco

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Forensic Odontology

forensic

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To dispel the rumors, the bodies were

coming British invasion, he was a prac-

found and exhumed. Finally, the remains

ticing dentist. During the American Revo-

of a bridge in Hitler’s jaw was matched

lution in 1775, his friend Dr. David Warren

with the records of his dentist, Dr. Hugo

was killed in the war and his body was

Blasche, and the death of Hitler was

tossed into a mass grave. Following the

confirmed.

departure of the British forces, in March 1776, Paul Revere went to the burial site

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to warn the people of Boston about the

and identified the body of his friend by the partial denture he had placed in Dr. WILLIAM E. SILVER, DDS, DABFO

Warren’s mouth.

All these techniques of dental identification are totally dependent upon accurate antemortem records to compare with similar postmortem records of photographs, radiographs and charts. Whether

Teeth and the various items constructed

it is the identification of one person

and placed in the mouth are perhaps the

or multiple bodies in a mass disaster

In the beginning, the first bitemark ever

most indestructible parts of the human

— such as from the great Chicago fire

made was on an apple. Eve allegedly ate

body. These parts withstand the test of

in 1903 when 602 died to the World

the apple from the Tree of Knowledge

time and temperature. Treatment by a

Trade Center on 9/11 with more than

of Good and Evil, or was it Adam or the

dentist is the greatest contribution to the

3,000 bodies to be identified — forensic

serpent? Unfortunately, there were few

unique character of an individual.

odontologists are constantly involved

forensic odontologists available at the

The oral cavity, its additions and nature

time and even though there were only

also may become critical as evidence

a limited number of suspects, no iden-

within the halls of justice as well. In

tification was made, and Adam and Eve

November 1849, Dr. George Parkman, a

were sent out of the Garden of Eden.

real estate speculator and money lender,

Dental identification has a long history

failed to return from dinner. Suspicion fell

that began in 66 A.D. when a woman

upon John Webster, a laboratory em-

named Agrippina married Claudius, the

ployee at Harvard Medical College who

Emperor of Rome. She feared that a rich

had borrowed a great deal of money

woman named Lollia Pauline might

from Parkman. When his laboratory was

If you want to learn more about this field

be her rival. So, Agrippina planned the

searched, the remains of a human body

of endeavor, including bitemarks, facial

murder of Lollia Pauline and instructed

was found dismembered and burned.

reconstruction, lip prints, rugae and age

one of her soldiers to commit the vile

The body was identified as Parkman’s by

estimation, you can join the American

act and bring back the head as evidence.

his dentist, Dr. Nathen Keep, by means

Society of Forensic Odontology with no

When Agrippina checked the front teeth,

of a lower denture he had constructed.

more credentials than an interest in fo-

she found the same discolored teeth that

Subsequently, John Webster was con-

rensic odontology. Visit asfo.org for more

Paulina had; thus, initiating the first use

victed and executed. This was the first

information.

of forensic odontology to identify human

case of a dentist giving testimony in the

remains.

courts of the United States.

The first person in the United States to

More recently, at the end of World War

cal Examiner Department and can be

employ forensic odontology was Paul

II, rumors suggested that Adolf Hitler

reached at billsilver@comcast.net.

Revere. In addition to his famous ride

had escaped with his wife, Eve Braun.

FLORIDADENTAL.ORG

in this process and are dependent upon the accurate antemortem records provided by the dentist. It is for this reason that records must be maintained for an extended period according to the law.

Although the dentist is the legal owner of the dental record, he/she must surrender that record to law enforcement upon request.

Dr. Silver is the deputy chief of forensic odontology at the Miami Dade Medi-

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Docor's Choie

two careers

Empathy: The

Role of a

Lifetime The Connection Between Two Careers

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I’m an actor and an orthodontist. I said actor first, not just because it’s in alphabetical order, but also because I’ve been doing it longer. Honestly though, they’re both just as important to me, and I feel that both my careers have benefitted from each other.

My father was an orthodontist and started the practice I run today in 1958. My mother was Miss Florida USA in 1957 and went on to have her own local children’s television show for WESH in Daytona Beach and did the weather for their local newscasts. So, you can see both careers are in my blood. I double majored in biology and theatre and was accepted into Northwestern University Dental School after my junior year. I went on to do my orthodontic residency at Northwestern and graduated in 1996.

I truly learned how to study in dental school. I’d always been pretty good at studying and memorizing lines for plays, but dental school drove home that attention to detail and the goal of perfection — especially in those preclinical years.

Then something happened in dental school where my theatre training seemed to help the clinical years. I was treating patients and not just teeth. The main ingredient to be a good actor also happens to be the same main ingredient to be a good clinician. That ingredient? Empathy.

Too often, I hear acting being described as the chance to become another person. That’s an exaggeration, no one becomes another person. What an actor does is understand another person. Memorizing lines? Pshh. I’m always amused when a dental colleague asks me, “How did you memorize all those lines?” My reply, “How did you memorize the Kreb’s Cycle in biochemistry? At least the dialogue makes sense!” Once the lines are memorized, then comes the real work: understanding the character’s motivations and feelings. It’s just like showing up to the office every day. I’m not thinking about arch-wire progressions or bracket placement

“

The main ingredient to be a good actor also happens to be the same main ingredient to be a good clinician. That ingredient?

Empathy.

”

SEE PAGE 50 FLORIDADENTAL.ORG

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two careers

FROM PAGE 49

or biomechanics — those are all memorized. What I’m thinking about are the patients I’m seeing that day.

I think as doctors in these times of the pandemic, political divisiveness and social change, our ability to empathize makes us role models in our community … and it also gets me roles. Thank you, Mom, Dad and dentistry!

This year, the Florida Dental Association (FDA) held its June House of Delegates’ meeting via Zoom. To commemorate this new experience (and knowing Dr. Lowe’s talented background), the FDA reached out to him to sing the national anthem for the attendees. He enthusiastically accepted and gave a beautiful performance. The FDA appreciates his contribution to making the virtual event special during the pandemic.

Dr. Lowe is an orthodontist in Port Orange, Fla. and can be reached at drdlowe@mac.com.

Photo captions: 1. Playing Rev. Crisparkle in “The Mystery of Edwin Drood” at The Mad Cow Theatre in Orlando.

2. Performing as Sweeney Todd at Central Florida Community Arts Theatre in Orlando.

3. Playing King Henry II in “The Lion in Winter” at Central Florida Community Arts Theatre in Orlando.

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Dr.David Lowe and staff.

Playing Don Quixote in “Man of La Mancha” at the Ice House Theatre in Mount Dora.

Playing Col. Nathan Jessep in “A Few Good Men” at Central Florida Community Arts Theatre in Orlando.

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software company

A DENTIST AND AN ENTREPRENEUR ...

A LOFTY GOAL!

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FLORIDADENTAL.ORG

I’ve been a general dentist since 1972, and now I’m the founder of a medical records software company. The company’s goal is to revolutionize the way your medical information is handled and who controls that information. A lofty goal, don’t you think? As a dentist, I’ve always wanted to help people and that desire continues to this day.

The evolution is that now my team and I have created a simple to use, affordable, secure and HIPAA-compliant software system that allows everyone to be in control of their medical information.

Medically related companies and associations support the concept of having your emergency medical information with you at all times. In May 2019, the federal government came out with a statement for individuals to take more control of their medical information. With COVID-19, preventable medical errors, and now a more active and severe hurricane season predicted, it has never been more important for people to take control of their medical information. This was evident in 2017, when Hurricane Irma came up the center of Florida and caused 6 million Floridians to evacuate and again in 2018 when Hurricane Michael devastated the Florida Panhandle. Almost no one had their medical information with them and couldn’t get the information because medical offices and hospitals were either closed or destroyed. We need to be prepared now.

DR. JAMES F. WALTON III, FOUNDER AND CHAIRMAN OF EMTELINK

Dr. Walton is a general dentist in Tallahassee and can be reached at jwalton409@aol.com.

For more information go to emtelink.com/control/mkt/index. html.

This all came about eight years ago when I became frustrated with my patients not knowing what medications they were taking and why. I’m certain many of you have had that same frustration. My IT guru and I began to explore options that would allow people to always have their emergency medical information on them. Then in May 2016, the Centers for Disease Control and Prevention and Johns Hopkins declared preventable medical errors as the third leading cause of death in the U.S. behind heart disease and cancer with as many as 440,000 deaths a year. This ranking still stands today. In addition, studies showed that the loss in economic productivity from preventable medical errors was more than $1 trillion. Thus, it became our company goal to save lives and reduce preventable medical errors through technology.

As a small company, it’s taken us a while to work through and beta test several solutions. Heck, it took Facebook five years before it made a dime. Security has always been the number one concern. Today, our system uses FBI and military grade AES 256-Bit encryption and designated servers in Microsoft Azure, making it at least as secure — and probably more so — than hospital and medical office portals. We believe that the patient’s information belongs to the patient even though the physical record may belong to a doctor’s office. The patient should be able to send that information to whomever they want whenever they want and not have to wait for a doctor’s office to do so.

Accept and approve the process. Sometimes I feel like Don Quixote. But I know the quest is worthwhile and reachable. It’s a matter of educating the public and having them break free from the bondage that the mega companies have placed on us. It’s my hope that many of my colleagues will take control of their medical information. It’s too important and time is of the essence.

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Steps

”

Success

“

When you live long enough and stay active in dentistry, you’ll be able to join me and many other excellent dentists as lifelong members of the American Dental Association and Florida Dental Association.

to

career

FLORIDADENTAL.ORG

Recommendations The following are my recommendations to my fellow dental colleagues, both young and old.

Be a Good Steward

DR. CARLTON SCHWARTZ

I’ve been blessed with a rewarding and diverse dental career that has spanned more than 50 years, and each phase has been just as thrilling and enlightening as the previous one. I’m humbly sharing my experience so that other members can understand how I got started and what I’ve learned.

I was born and raised in Ohio, but happily moved to Lakeland, Fla. when I received a basketball scholarship to attend Florida Southern College in 1961.

I played basketball for four years and received my bachelor’s degree in chemistry. After graduation, I was hired as a chemist at Wellman-Lord Engineering.

I wanted to be a doctor, but not in the field of chemistry. I realized that dentistry had all the attributes I liked: you helped people, it required mental and digital skills, it had prestige, business ownership, limited emergency calls and the ability to earn a good living. In 1968, Florida didn’t have a dental school, so I attended the Medical College of Virginia (now VCU) and graduated in 1971 with a dental degree.

After graduation, I was immediately inducted into the U.S. Air Force as a captain and served in the Dental Corps during the Vietnam War from 19711973. I was fortunate to be stationed at Tyndall Air Force Base in Panama City, Fla. When the war ended in 1973, I was living in the small town of Lynn Haven, which didn’t have a dentist. It was an excellent opportunity to open my first private dental practice. The practice was successful and grew exponentially from 1973-2000, and I had the privilege to employ and mentor five different dental associates and several outstanding dental auxiliaries throughout the years. My finances became secure and an opportunity arose to sell and finance the Lynn Haven practice in 2000. I decided to keep the commercial building and lease it out as a medical/dental professional center.

Another passion of mine is real estate.

Nearby, Panama City Beach was rapidly growing, and a real estate development opportunity presented itself. Since I already had my Florida real estate license, it seemed natural for me to help form a development corporation, which eventually became the Dolphin Bay Subdivision. Our corporation was successful in selling all the developed property within a three-year period. Fortunately, the restrictive covenant from the Lynn Haven practice allowed me to open a new practice in Panama City Beach in 2000, which I owned and operated until the outstanding dental assistant who

a During your time on this planet, you do not own anything. A supreme power (God) owns everything and you are here to take care of His possessions to the best of your ability.

Do not let possessions own you.

Develop a Good Attitude a Attitude is 10% of what happens to you in life and 90% how you react to it.

Live a Fulfilled Life a You are a physical, mental and spiritual person.

Have a proper diet and exercise regularly. Think positively and continue to learn. Pray one on one with your maker. Enjoy your family!

Don’t Put All Your Eggs in One Basket a Develop a financial plan and team of advisors. a Diversify your resources:

a Green dollar: earned income, such as dental and other earnings.

a Blue dollar: unearned income, such as investments, stocks, bonds, real estate.

a Orange dollar: retirement plans, IRA, etc.

a Budget! Make more than you spend and spend less than you make.

a Be in control of your assets and expenditures.

Be the Best Dentist You Can Be a Take continuing education to go above and beyond. a Become an expert in practice and patient management. a Strive for dental excellence.

Be Flexible a When the going gets tough, the tough get going! a Expect the unexpected with a positive attitude.

We have overcome disasters like Hurricane Michael and we will overcome COVID-19 and social injustices.

Be Prepared for Change!

SEE PAGE 58 FLORIDADENTAL.ORG

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career

FROM PAGE 57

worked for me in Lynn Haven advanced on to dental school and graduated.

She became my associate in 2004 and bought the practice in 2006.

I soon received another incredible opportunity to help start a dental clinic in Panama City and serve as the dental director of PanCare Dental Clinic, which would be federally funded and open to all patients for treatment, but would cater mainly to Medicaid and financially compromised patients on a sliding scale. It took approximately three years to get the clinic fully operational.

It was around this same time that I became fully vested in their pension plan, so it was another opportunity for me to retire — again! Today, PanCare Inc. has several successful medical and dental clinics all over northwest Florida and I’m honored to have been a part of it.

At that time, the historic area in Panama City, St. Andrews, was beginning to reemerge. I ventured back into real estate development for a few years before opening my third dental practice in 2010 in the new Harbour Village Execu-

58

TODAY'S FDA JULY/AUGUST 2020

tive Center my group developed. Many patients at this practice had special needs who needed to be treated under general anesthesia in the operating rooms at Gulf Coast and Bay Medical Centers, where I still maintain my staff privileges. In 2013, I merged the St. Andrews practice with the larger Panama City Smiles practice. That ended the “private dental practice” phase of my career. Currently, I represent Doctor’s Choice Companies in northwest Florida where we consult, appraise, evaluate, buy and sell dental practices. It’s been a blessing to be able to meet and help many of my fellow dentists buy or sell their practices.

There’s another aspect to my career I have yet to mention: teaching. The archaic definition of the word doctor is a “teacher or a learned person.” So, deep down in most doctors’ hearts is the desire to teach others about their professional experiences and to be a mentor. I taught at Gulf Coast State College Dental Clinic as an adjunct faculty member for several years while maintaining my private practices. In 1987, Gulf Coast

Community College (as it was then named) had a dental assisting program but lacked a dental hygiene program.

As a past president of the Bay County Dental Society, I helped raise money to start the dental hygiene program. Today, we have both a top-notch, leading-edge dental assisting program and a dental hygiene program. At age 76, I’m still actively teaching as an adjunct faculty member in the dental assisting and dental hygiene clinics. Each year, my family awards the Michael Scott Schwartz Endowment Scholarship to a deserving dental or nursing student in honor of my son, who died at an early age.

When you live long enough and stay active in dentistry, you’ll be able to join me and many other excellent dentists as lifelong members of the American Dental Association and Florida Dental Association.

Dr. Schwartz can be reached at csschwartz@knology.net.

FLORIDADENTAL.ORG

leadership

THE UNEXPECTED VOWELS OF LEADERSHIP

There are countless courses, books and seminars on leadership skills and traits, and how to discover and develop them. What you’ll see below isn’t commonly found in these courses, but they’re critical to your success as a leader.

Admit you don’t have LARRY DARNELL, MBA, CAE

all the answers.

This is one of the hardest things for me to do. In this age of Google, the answers are out there, and I shall have them (or so I think). It’s rather humbling to realize there are smarter people in the room than you. There’s something refreshing in saying, “I don’t know.” However, you can’t ignore the unknown. Find out, find someone who does know and learn from the experience.

Empower others to be better than you.

There’s a certain fear in empowering others. You may feel they’ll replace you. Honestly, that could happen. The greatest leaders in history have helped others go further than they could have alone. A better skilled and educated team shines positively on the leader and who knows, it may challenge you to improve as a leader, too.

Invite diverse people, opinions, thoughts

and strategies.

It’s a fact: Most leaders gravitate toward people who think like them, act like them and look like them. If you only surround

FLORIDADENTAL.ORG

yourself with others just like you, you’ll never grow past groupthink and a host of “yes” people. Diversity provides a full spectrum of perspectives, solutions and experiences that can expand your mindset.

Own your failures fully.

Failure is a part of life. Some of my most memorable experiences have been failures. However, when we encounter failure, we tend to deny it, blame others, throw people under the bus or completely ignore it. Failure has many lessons you’ll never learn until you own it, admit your part, embrace the consequences and learn from the experience. The “not me” narrative didn’t work when we were children, and it won’t work as leaders, either.

Understand when to pivot.

One of my most memorable experiences watching TV was a “Friends” episode where they’re trying to move a couch. The entire episode focused on the challenges of moving the couch upstairs. The “aha” moment occurs when Ross says, “Pivot!” I didn’t think much of it at the time, but it’s now an iconic moment in TV trivia. Willingness to pivot means understanding when to try something different. As they say, continuing to do something the same way and expecting a different result is the definition of insanity. Yet, this scenario plays itself out repeatedly every day. That way may not work — it’s time for you to pivot.

Mr. Darnell is the FDA Director of Information Systems and staff support for the FDA Leadership Committee. He can be reached at ldarnell@floridadental.org.

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PSC Group, Inc.

DRS. SHANKER VENKAT*, NEEL BHATTACHARYYA, DONALD M. COHEN AND NADIM M. ISLAM

An 8-year-old Black male was referred to Dr. Vanessa Watts, an oral and maxillofacial surgeon at the Tampa Bay Jaw and Facial surgery in for a dental evaluation. No significant medical history was reported. The patient presented with a bilateral swelling that was increasing in size for more than one year. A panoramic radiograph was taken at Dr. Watt’s office and upon radiographic evaluation, multilocular radiolucencies were noted bilaterally (Fig. 1). The radiolucencies were expansile and well-demarcated, extending along the posterior mandible towards the coronoid process. An incisional biopsy was performed by Dr. Watts and submitted to the University of Florida Oral Pathology Laboratory biopsy service for histopathologic evaluation. Upon histological assessment, variable numbers of multinucleated giant cells with vascular fibrous tissues were noted.

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

A. Brown tumor of hyperparathyroidism B. Nevoid Basal cell carcinoma syndrome C. Langerhans cell disease D. Central giant cell granuloma E. Cherubism

SEE PAGE 62

Fig. 1: Well-demarcated multilocular radiolucency noted bilaterally (yellow arrows). The radiolucent lesions are expansile and extend along the angle, rami and coronoid process.

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diagnostics FROM PAGE 61

Diagnostic Discussion A. Brown tumor of hyperparathyroidism Incorrect, but a good consideration. Although brown tumor of hyperparathyroidism consists of multiple radiolucent lesions and can affect the jaws, patients with hyperparathyroidism most often have associated kidney disease coupled with errors in calcium metabolism. Since the patient’s medical history was completely unremarkable, this diagnosis cannot be supported. Though primary hyperparathyroidism is remotely possible where a tumor (typically adenoma) of the parathyroid gland causes excess parathyroid hormone (PTH) production.

Hyperparathyroidism is categorized into primary and secondary hyperparathyroidism. Primary hyperparathyroidism is a rare condition and typically occurs due to a benign tumor (parathyroid adenoma) followed by parathyroid hyperplasia.

In exceedingly rare cases, primary hyperparathyroidism also can be associated with parathyroid carcinoma. Secondary hyperparathyroidism is far more common. It results from continuous production of PTH in response to low levels of serum calcium in a setting of chronic renal disease. In normal physiology, the kidney processes active vitamin D that is necessary for calcium absorption from the gut. In chronic renal disease, there is decreased intestinal calcium absorption, renal tubular reabsorption of calcium and increased release of serum phosphate. Usually, hyperparathyroidism does not cause expansile and bilateral radiolucent involvement of the jaw. Hyperparathyroidism has been known to produce the classic triad of “stones, groans, bones” and psychological condition called moans. The triad indicates renal stones, decreased bone density (because of the decrease in trabecular density), abdominal pain related to peptic ulcers and moans related to psychologic depression and neurologic symptoms.

As the disease progresses, osseous lesions such as brown tumor of hyperparathyroidism develop. Most patients with hyperparathyroidism associated with a brown tumor are older than 60 years of age, and our patient is not in this age group.

This tumor got its name for its characteristic dark red-brown color arising from the presence of abundant hemorrhage and hemosiderin deposits within the tumor. In addition, this tumor is histologically identical to central giant cell granuloma

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of the jaws, which usually affects teenagers and younger adults.

Both lesions show prominent cellular fibroblastic and vascular stroma with increased multinucleated giant cells. Typically, other osseous lesions are observed if a brown tumor is present.

These lesions can manifest in the form of severe skeletal bone disorder called osteitis fibrosa cystica. This condition develops from the central degeneration and fibrosis of previous longstanding brown tumor. Radiographically, the lesion appears as well-demarcated, unilocular or multilocular radiolucencies that can affect any part of the mandible and may even involve the entire jaw. Cortical expansion can be seen in long-standing lesions. This radiographic presentation is significantly different from our case, other than the obvious lack of supporting clinical and medical history.

B. Nevoid basal cell carcinoma syndrome Incorrect. Good consideration, especially given the multiple odontogenic keratocysts (OKC) presenting as radiolucent lesions of the jaw. However, patients with nevoid basal cell carcinoma syndrome (NBCCS) have other signs and symptoms of the syndrome, which weren’t reported in this case. Patients with NBCCS have multiple cysts consistent with OKCs of the jaws, which is the most common feature of this syndrome, as they are present in 90% of the patients. Syndromic OKCs usually arise in significantly younger patients and usually are clinically evident in the teen years. These lesions should not be confused with isolated (non-syndromic) OKCs, as the latter can occur in patients during the third and fourth decades of life. OKCs are most commonly located along the posterior body of the mandible. Radiographically, the cysts in patients with NBCCS do not differ significantly from isolated OKCs, as they commonly represent as unilocular or multilocular radiolucencies along the posterior ramus of mandible. However, histologically, syndromic OKCs present with features different from typical OKCs. These include increased number of satellite cysts, solid islands and odontogenic epithelial cell rests within the fibrous capsule. In some cases, foci of calcifications also are noted. Both syndromic and non-syndromic OKCs exhibit a brisk recurrence rate with a locally destructive clinical behavior. Although the destructive nature of OKCs causes facial swelling, they typically do not produce symmetrically or bilaterally expansions, as seen in this case. Multiple basal cell carcinomas (BCC) lesions of the skin are a less common feature of NBCCS. Typically, these BCC may vary from flesh-colored papules to ulcerating papules that often appear in non-sun exposed areas of the skin. These tumors most commonly develop in unusually young individuals, often during FLORIDADENTAL.ORG

the second and third decades of life. Furthermore, skeletal abnormalities, such as rib anomalies and spina bifida occulta (split spine) of cervical and thoracic vertebrae, are present in 60-75% of the patients. Other syndromic features include palmar and plantar pitting; early calcification of falx cerebri; and, characteristic facial features, such as frontal bossing, hypertelorism and microcephaly, are seen in greater frequency among these patients. NBCCS is an autosomal dominant inherited condition caused by mutation in a tumor suppressor gene known as patched gene. In the African American population, this syndrome has a less frequent tendency to develop BCC when compared to the white population (40% versus 90%). This could be due to the protective skin pigmentation present in Black patients.

C. Langerhans cell disease Incorrect. This is a good consideration in a differential diagnosis for radiolucent lesions of the jaw, especially since Langerhans cell histiocytosis (LCH) is seen in young patients, often children. Even though multiple jaw lesions are seen in LCH, the radiographic and histological features are significantly different from our case. Typically, LCH is characterized by dull pain and tenderness. In addition, a characteristic “scooped out” appearance may be evident in LCH, which results from bone destruction and loosening of teeth, mimicking severe periodontitis. Furthermore, the extensive alveolar involvement causes the teeth to appear as if they are “floating in air.” Clinically, the appearance of ulcerative or proliferative gingival masses may develop as a result of bone destructions.

These above features were not reported in our patient. LCH is characterized by proliferation of histiocytic-like cells known as Langerhans cells. LCH has been associated with BRAF mutations on several cases. In addition, LCH may be solitary or multiple bone lesions. They’ve been classified into chronic disseminated histiocytosis (Hand-Schuller disease) or acute disseminated histiocytosis (Letterer-Siwe disease) and most commonly, the isolated LCH. Both former conditions have common clinical features, such as the involvement of bone, skin and viscera, depending on the severity of the disease.

Although, these clinical spectrums are specific, many patients have one or more overlapping clinical features. The Histiocyte Society has proposed a classification based on single-organ and multi-organ involvement to better define the prognostic categories. Radiographically, osseous lesions appear as sharply punched-out radiolucencies without a cortical rim. Histologically, our case is different from LCH, as the latter consists of the presence of varying numbers of eosinophils that are typiFLORIDADENTAL.ORG

cally interspersed among the histiocytic cells. These histiocytes appear as large, pale-staining mononuclear cells. Additionally, plasma cells, lymphocytes, multinucleated giant cells and areas of necrosis and hemorrhage may be present.

D. Central giant cell granuloma Incorrect. Excellent guess — a good differential diagnosis to include for our case! Central giant cell granuloma (CGCG) can present as single or multifocal lesions in the jaw with histological features identical to our case. These findings can make them difficult to interpret and distinguish from our case.

Yet, the radiographic and clinical characteristics of CGCG are significantly different from the present case. CGCG often represents as a single intraosseous lesion. These lesions often are associated with an etiopathogenesis of trauma-induced hemorrhage. These osseous lesions also are predominantly seen in females in the anterior mandible, frequently (70%) crossing the midline. Besides, other syndromic variants of central giant cell lesions, including Noonan-like/multiple giant cell lesion syndrome, Ramon syndrome, Jaffe-Campanacci syndrome and neurofibromatosis type I are rarely associated with multifocal presentation in the jaws. CGCG is clinically divided into nonaggressive and aggressive types. Nonaggressive CGCGs are relatively small, slow-growing and do not perforate cortical bone or cause root resorption. Aggressive types are characterized by pain, rapid growth, cortical perforation, root resorption with ulceration of the overlying mucosa and extension into the soft tissue. Radiographically, CGCGs are significantly different from our case. They typically exhibit variations in the size of the lesion and appear as multilocular radiolucent lesions with well-delineated and non-corticated borders. Histologically, CGCG demonstrates numerous multinucleated giant cells distributed in a stroma consisting of loosely arranged collagen with increased ovoid to spindle-shaped endothelial cell proliferation and numerous capillaries. Although multinucleated giant cells are an important diagnostic feature in our case, the giant cells seen in CGCG are larger and numerous.

The background stroma also is subtly less cellular in our case compared to CGCG.

E. Cherubism Correct! The presentation of bilateral symmetrical expansion of the face with bilateral mandibular multilocular radiolucencies perfectly matches our case. In addition, the histological features also are consistent with our case. Cherubism is a rare developmental jaw condition that is inherited as an autosomal SEE PAGE 64 TODAY'S FDA JULY/AUGUST 2020

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' '

' 10X

'

Fig. 2a: Sparse multinucleated giant cells (yellow arrow) that are slightly angular and scattered within a fibromyxoid stroma.

'

dominant trait. Most cases are caused by gain-of-function mutations in the SH3BP2 gene. As a result of this gene mutation, there’s an increase in the osteoclastogenesis, which results in the production of lytic bone lesions. The name cherubism was assigned to this condition because the facial appearance is like that of plump-cheeked little angels (cherubs) depicted in Renaissance paintings. This condition usually becomes evident around 2-5 years of age. In mild cases, the diagnosis may not be made until 10-12 years. The plump, cherub-like cheeks results from the bilateral symmetrical expansion of the posterior mandible. In severe cases, involvement of the orbital walls may tilt the eyeball upwards and retract the lower eyelid, exposing the sclera. This gives an “eyes turned up to heaven” appearance. Unless there is strong familial history, cherubism rarely occurs unilaterally. In the mandible, the lesions most commonly involve the angles, ascending ramus and coronoid process. Involvement of the maxilla is seldom seen. Extensive jaw involvement causes marked widening and distortion of the alveolar ridges. In addition, tooth displacement, failure of tooth eruption and speech difficulties may be noted. In severe cases, upper airway obstruction has been reported. Biochemically, patients with cherubism typically are the same as those without. Radiographically, all cases show bilateral, multilocular, expansile radiolucencies of the posterior mandible. Furthermore, resorption of the adjacent roots and thinning of the cortical bone may be seen. Histologically, features of aggregates of multinucleated giant cells (Fig. 2a), distributed in vascular fibrous tissue with eosinophilic (pink), cuffing of small blood vessels may be seen in cherubism (Fig. 2b). In most instances, a conservative approach to treatment is suggested since most of the lesions regress spontaneously after puberty. By the fourth decade, most patients’ facial features and jaw lesions approach normalcy.

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20X Fig. 2b: Eosinophilic cuffing around small blood vessels (yellow arrow) within the stroma.

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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.

References: Kaugars GE, Niamtu J III, Svirsky JA: Cherubism: diagnosis, treatment, and comparison with central giant cell granulomas and giant cell tumors, Oral Surg Oral Med Oral Pathol 73:369–374, 1992.

Meng XM, Yu SF, Yu GY: Clinicopathologic study of 24 cases of cherubism, Int J Oral Maxillofac Surg 34:350-356, 2005.

Reichenberger EJ, Levine MA, Olsen BR, et al: The role of SH3BP2 in the pathophysiology of cherubism, Orphanet J Rare Dis 7(Suppl1):S5, 2012.

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.

Carvalho VM, Perdigão PF, Amaral FR, et al: Novel mutations in the SH3BP2 gene associated with sporadic central giant cell lesions and cherubism, Oral Dis 15:106–110, 2009.

Reddy V, Saxena S, Aggarwal P, et al: Incidence of central giant cell granuloma of the jaws with clinical and histological confirmation: an archival study in Northern India, Br J Oral Maxillofac Surg 50:668–672, 2012.

Stavropoulos F, Katz J: Central giant cell granulomas: a systematic review of the radiographic characteristics with the addition of 20 new cases, Dentomaxillofac Radiol 31:213–217, 2002.

Mankin HJ, Hornicek FJ, Ortiz-Cruz E, et al: Aneurysmal bone cyst: a review of 150 patients, J Clin Oncol 23:6756–6762, 2005.

Lo Muzio L: Nevoid basal cell carcinoma syndrome (Gorlin syndrome), Orphanet J Rare Dis 3:32, 2008.

Triantafillidou K, Zouloumis L, Karakinaris G, et al: Brown tumors of the jaws associated with primary or secondary hyperparathyroidism: a clinical study and review of the literature, Am J Otolaryngol 27:281–286, 2006.

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 DR. ISLAM Association to assist dental professionals in identifying quality providers of continuing dental education.

ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/ goto/cerp. *Resident in oral and maxillofacial pathology at the University of Florida College of Dentistry.

McVeigh T, Lowery AJ, Quill DS, et al: Changing practices in the surgical management of hyperparathyroidism — a 10-year review, Surgeon 10:314–320, 2012.

Neville, BW., Damm D.D., Allen, CM and chi, A.C (2016) Oral & Maxillofacial Pathology 4th Edition, WB Saunders, Elesvier.

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

Post an ad on the FDA Career Center and it will be published in our journal, Today’s FDA, at no additional cost! Today’s FDA is bimonthly; therefore the basic text of all active ads will be extracted from the Career Center on roughly the 10th of every other month (e.g., Jan. 10 for the Jan/Feb issue, March 10 for the March/April issue, etc). Please note: Ads for the Nov/Dec issue must be received no later than Nov. 1.

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

Endodontist – Miami. Overview: You've invested the time to become a great endodontist, now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an endodontist working in an office supported by Pacific Dental Services®, you can rely on a great number of referrals as you will be providing PDS®-supported owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an endodontist to have a career that will serve you for a lifetime. As a PDS-supported endodontist, you have the opportunity to work full-time or part-time, fantastic income opportunities and you'll work with an organization that cares about their people, their patients and their community. You won't have to spend your time navigating practice administration, scheduling, or any other administrative tasks. Instead you'll, set your hours and focus on your patients and your well-being. The Future: As an endodontist you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue our clinical excellence in the future. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/3fvXKMv. Dental Hygienist – Titusville. Dental Hygienist needed for a Family Practice of 30 years. This position is for full time with all benefits included. Our practice maintains strict guidelines established by the CDC for Covid protection. This is an amazing opportunity to work in a safe environment with a friendly staff and Dr. NOTES: 2 openings. Additional Salary Information: all benefits included. Go to careers.floridadental.org/jobs/13715989/dental-hygienist.

General Dentist Needed (Panhandle Area). Our supported offices in Tallahassee, Niceville, and Panama City are looking for a General Dentist to lead their clinical teams. The doctor must be able to provide the following services to their patients: crowns, endodontics, restoring implants, removable, restoration, Invisalign certified, extractions. NOTES: 3 openings. Go to careers. floridadental.org/jobs/13710290/general-dentist-needed-panhandle-area.

Dental Hygienist – Vero Beach. Hygienist needed for a quality oriented, patient- centered, progressive crown and bridge/restorative dental practice.

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3- 5 days per week. Full time position includes medical and PTO benefits.

Applicants must have skills and experience in all aspects of clinical dentistry including capturing clear, crisp radiographic diagnostic images, and digital charting adeptness. We are looking for a professional who is adept at working with a comprehensive periodontal program who is motivated to help our patients. Multi -tasking skills, flexibility, professionalism, and a desire to be a team member in a high-quality dental practice are all needed to be successful in this position. Ability to identify and communicate the importance of restorative dental needs to the patients is required. Eagle Soft Dental Management Software is considered a great asset. If you are self-motivated, a people person, and want to work in an outstanding health care environment then we would like to hear from you! NOTES: Additional Salary Information: Commission based. Go to careers.floridadental.org/ jobs/13707109/dental-hygienist.

Endodontist Position OPEN! – Tampa. We are a growing Endo office in Tampa, Florida and we are looking for a new Associate Doctor. We have all the latest in technology including CBCT in each office, Digital X-rays, Zeiss Microscopes, etc. We are looking for a motivated People-Person to join our team. We have the patients and need someone ASAP. Full time or Part-Time.

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The Villages/Ocala Area General Dental Practice For Sale with Real Estate.

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equipped. Could stay on part-time for the right buyer. $500k for practice and real estate. Go to careers.floridadental.org/jobs/13686503/the-villagesocala-area-general-dental-practice-for-sale-with-real-estate.

Oral Surgeon & Prosthodontist – Pembroke Pines. Oral Surgeon and Prosthodontist wanted to join a multispecialty practice in Broward County. Equity position available. Please contact us at 954.474.9660. NOTES: 2 openings.

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Space for Lease, South Florida. Looking for Pediatric Dentist or Specialist to share or sublease. Very favorable terms for first 6 month. Space is located in the heart of Wellington, Florida on SR7 441 in multi medical/dental and retail office plaza. Street frontage and high visibility on main floor with ample parking. Part-time use of office, flexible days. Fully plumbed over 2000 SF. Perfect for starter or second office. Rate negotiable. Go to careers.floridadental.org/jobs/13663323/space-for-lease-south-florida.

Dental Assistant (Full Time) – Panama City. We are looking for a full time Dental Assistant to join our team! Someone who wants to work in a fun, fast paced office. Must also be willing to cross train with all facets of the dental practice. Dental Assistant experience REQUIRED. Must be a team player.

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South Tampa, FL General Practice for Sale. New to the market in Spring of 2020 is an exciting practice just south of Tampa, FL. The practice is located in a free-standing building with over 6,000 SF to work with. Additionally, the real estate is also for sale, if desired. The current doctor has practiced in the community for over two decades and is ready to affiliate with a group for continued growth. With over 65 new patients per month, it’s clear to see the practice isn’t slowing down! For an overview of this practice south of Tampa Bay, read below: 17 operatories, 12,000 active patients, Collections of $3.9 million, Adjusted EBITDA $400,000, Real estate for sale. Ready to learn more and review the prospectus for this busy Manatee County practice?

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Orthodontist – Lake Nona. Overview: You’ve invested the time to become a great orthodontist. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in

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modern dentistry. As an orthodontist supported by Pacific Dental Services®, you can rely on a great number of referrals as you will be providing owner dentists the ability to pro-vide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an orthodontist to have a career that will serve you for a lifetime. As a PDS®supported orthodontist, you will have a balanced lifestyle, fantastic income oppor-tunities and you’ll work for offices that care about people, patients and their community. You won’t have to spend your time navigating practice administration. Instead, you’ll focus on your patients and your well-being.

The Future: As an orthodontist, you will receive ongoing training to keep you in-formed and utilizing the latest technologies and dentistry practices. PDS® is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue to provide clinical excellence in the future. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, nation-al origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic infor-mation, sexual orientation, veteran status, or military status. Apply here: bit.ly/2ChQF3E.

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off the cusp

PAYING THE COST TO BE THE BOSS JOHN PAUL, DMD FDA EDITOR

Dr. Paul can be reached at jpaul@bot.floridadental.org.

One of my pals has ascended to the office of Rotary District Governor (for those not in Rotary, that’s a pretty big deal) and I took the opportunity to congratulate him and thank him for his service. He replied, “You’re welcome and I’m glad to have you as one of my 1,800 new bosses.”

Who doesn’t want to be the boss? I always wanted to be the boss, sit in a soft chair behind a big desk and tell everyone what to do. That’s a 3-year-old’s view of the boss, but it seems like every step I take up the ladder reveals additional folks who might be my boss. I own my practice. I sign every one of my staff members’ paychecks and I get to assign them tasks, but who they are and how they work together determines a lot of what I get to do.

All those folks who sit in my operatory chair? They are my bosses. I may have the final say on how health care will be performed within the walls I rent, but the patients determine where I’ll be for many hours of my life.

Family? Definitely the boss. Letting patients tell me when to be at work provides the income that lets the family tell me what to fix to keep our life running forward and the children growing. I wonder if military generals or captains of industry have the same feelings but on a grander scale?

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The more experience I get, the more life becomes not a ladder, but a web. Reaching out to touch more lives provides more support. Up is not the only direction to success. There’s no position of king where someone is at the top of the pyramid commanding the lives of those below. Being a servant leader is what it’s all about. Finding the right bosses seems to be the key.

People who need my special set of skills to help them succeed and use their skills to do the same for others.

Y’all know my answer to “How you doin’?” is “Living the dream!” I followed that up last week by saying I was having a Joe Walsh weekend.

“On Saturday mornings we work in the yard, pick up the dog poop and hope that it’s hard. Just an ordinary, average guy.” Even the dog is my boss.

ANGUS

JOHN PAUL, DMD, EDITOR, TODAY'S FDA

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