2014 - March/April TFDA

F l o r i da

Dental

A ssoc i a t i on

TODAY’S FDA

FNDC Speaker Previews Fan Frenzy free courses

Creating a

Masterpiece

FNDC Exhibitor List

FNDC Sweet success

FNDC Dentistry in the Hall The community dental health coordinator

register at www.floridadentalconvention.com

mastering the fine art of dentistry  Choose from 93 lectures / 30 hands-on workshops  Earn up to 15 hours of FREE CE credits  Discounted hygiene and team courses  Administrative Mastery Series  More than 250 exhibiting companies  Nightly entertainment  Live Dentistry in the Hall

JUNE 12-14, 2014 | ORLANDO, FL G AY L OR D PA L M S R E S ORT & C ON V E N T ION C E N T E R VOL. 26, NO. 2 MARCH/APRIL 2014

the official meeting of the florida dental association

We KnoW DentIsts.

We KnoW Insurance.

Tip: When insuring your practice, it is important to know the coverages in your portfolio; so many things can change over the course of a year. Make sure you always do an annual review of your insurance portfolio.

Rick D’Angelo is an incredible insurance agent. He has familiarized himself with my business needs and always gets the job done. i recommend him to other dentists with insurance needs. As a member of the FDA, i feel that Rick’s expertise is an asset to our organization.

Dr. Martineau practices at Kingsway Dental in Sarasota.

Thank you, Andrew Martineau, DMD

Your Risk Experts Call Today and leT us help you!

800.877.7597 insurance@fdaservices.com www.fdaservices.com

A Member Benefit Since 1989

contents cover story

42

Behind the Scenes at FNDC

news

literary

10 news@fda

27 Letter to the Editor

17 House of Delegates Announcements

76 Book Review

20 House of Delegates 22 Board of Dentistry

features

columns 3

Staff Roster

5

President’s Message

30 FNDC2014 Speaker Preview — Dr. Ewoldsen

6 Legal Notes

34 FNDC2014 Speaker Preview — Dr. Becker

9 Information Bytes

36 FNDC2014 Speaker Preview — Ms. Carrie Millar

45 Diagnostic Discussion

42 Behind the Scenes at FNDC

64 Dental Staff: Creating the Ultimate

Doctor-patient Hygiene Exam

56 The Community Dental Health Coordinator 69 Health Care Reform: A Moving Target

scientific 60 Emergency Stabilization of an

Avulsed Central Incisor

80 Off the Cusp

classifieds 72 Listings

61 Oral Shield Use in a Post-trauma Patient

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

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

March/April 2014

Today's FDA

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Attention all ADA Federal Dental Service Members — FNDC2014 offers you:   

Reduced registration of $30 (a $395 value) Access to more than 25 hours of Free CE Member pricing on all continuing education

florida dental assocIation March/April 2014 VOL. 26, NO. 2

editor Dr. John Paul, Lakeland, editor

We recognize your sacrifice and service!

staff Jill Runyan, Director of Communications • Jessica Lauria, publications coordinator Lynne Knight, marketing coordinator

council on communications Dr. Thomas Reinhart, Tampa, chairman Dr. Roger Robinson Jr., Jacksonville, vice chairman Dr. Richard Huot, Vero Beach • Dr. Scott Jackson, Ocala Dr. Marc Anthony Limosani, Miami • Dr. Jeff Ottley, Milton Dr. Jeannette Hall, Miami, trustee liaison • Dr. John Paul, editor

board of trustees

Accelerate

your proFessionAl growth CFDDA islAnD getAwAy

April 24-27, 2014 • Puerto Rico Great Times, Great Profession “Let’s Make Memories” www.cfdda.org • 407.898.3481 lindaannelowell@gmail.com

ACDDA Cruise

aPRil 2014 www.acdda.org • 561.968.7714 • acdda@aol.com

wCDDA 2014 summer meeting

Aug. 8-10, 2014 • ritz-CArlton nAples, Fl Nine hours of continuing education credit Featured Programs: Meeting the Challenge of Change for Maximum Case Acceptance, Mark K. Setter, D.D.S., M.S.; HIV Awareness, Tom Robertson www.wcdental.org • 813.654.2500 • wc.dental@gte.net

2015 nwDDA AnnuAl meeting

2

Dr. Terry Buckenheimer, Tampa, president Dr. Richard Stevenson, Jacksonville, president-elect Dr. Ralph Attanasi, Delray Beach, first vice president Dr. William D'Aiuto, Longwood, second vice president Dr. Michael D. Eggnatz, Weston, secretary Dr. Kim Jernigan, Pensacola, immediate past president Drew Eason, Tallahassee, executive director Dr. David Boden, Port St. Lucie • Dr. Jorge Centurion, Miami Dr. Stephen Cochran, Jacksonville • Dr. Lee Cohen, Palm Beach Gardens Dr. Don Erbes, Gainesville • Dr. Don Ilkka, Leesburg • Dr. Jolene Paramore, Panama City Dr. Rudy Liddell, Brandon • Dr. Tom Ward, Miami Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Paul Miller, New Port Richey, treasurer • Dr. Bryan Marshall, Weekiwachee, treasurer-elect Dr. John Paul, Lakeland, editor

publishing information Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bi-monthly, plus one special issue, by the Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

FDA membership dues include a $10 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 2014 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, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

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, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; email address, fda@floridadental.org; website address, www.floridadental.org.

Advertising Information

Feb. 20-21, 2015 • the grand sandestin www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113 Advertising must be paid in advance.

For a complete listing, go to www.floridadental.org/fda-master-calendar.aspx.

For classified advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.977.9922, Ext. 7115.

Today's FDA

March/April 2014

www.floridadental.org

Contact the FDA Office

800.877.9922 or 850.681.3629 1111 E. Tennessee St. • Tallahassee, FL 32308

The last four digits of the telephone number are the extension for that staff member.

Executive Office

Florida National Dental Convention (FNDC)

Drew Eason, Executive Director deason@floridadental.org 850.350.7109

Crissy Tallman, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105

Rusty Payton, Chief Operating Officer rpayton@floridadental.org 850.350.7117

Elizabeth Bassett, FNDC Exhibits Planner ebassett@floridadental.org 850.350.7108

Graham Nicol, Chief Legal Officer gnicol@floridadental.org 850.350.7118

Ashley Liveoak, FNDC Meeting Assistant aliveoak@floridadental.org 850.350.7106

Judy Stone, Leadership Affairs Manager jstone@floridadental.org 850.350.7123

Mary Weldon, FNDC Program Coordinator mweldon@floridadental.org 850.350.7103

Accounting

Governmental Affairs

Jack Moore, Chief Financial Officer jmoore@floridadental.org 850.350.7137 Leona Boutwell, Bookkeeper – FDHF & A/R lboutwell@floridadental.org 850.350.7138 Deanne Foy, Bookkeeper – PAC & Special Projects dfoy@floridadental.org 850.350.7165 Tammy McGhin, Payroll & Property Coordinator tmcghin@floridadental.org 850.350.7139 Mable Patterson, Bookkeeper – A/P mpatterson@floridadental.org 850.350.7104

Communications and Marketing Jill Runyan, Director of Communications jrunyan@floridadental.org 850.350.7113 Lynne Knight, Marketing Coordinator lknight@floridadental.org 850.350.7112 Jessica Lauria, Publications Coordinator jlauria@floridadental.org 850.350.7115

Florida Dental Health Foundation (FDHF) Stefanie Dedmon, Coordinator of Foundation Affairs sdedmon@floridadental.org 850.350.7161

www.floridadental.org

Joe Anne Hart, Director of Governmental Affairs jahart@floridadental.org 850.350.7205 Alexandra Abboud, Governmental Affairs Coordinator aabboud@floridadental.org 850.350.7204 Casey Stoutamire, Lobbyist cstoutamire@floridadental.org 850.350.7202

Information Systems Larry Darnell, Director of Information Systems ldarnell@floridadental.org 850.350.7102 Lisa Cox, Database Administrator lcox@floridadental.org 850.350.7163 Ron Idol, Network Systems Administrator ridol@floridadental.org 850.350.7153

Member relations Kerry Gómez-Ríos, Director of Member Relations kgomez-rios@floridadental.org 850.350.7121

Kaitlin Alford, Member Relations Assistant kalford@floridadental.org 850.350.7100

Josh Freeland, Membership Assistant jfreeland@floridadental.org 850.350.7111

Christine Mortham, Membership Concierge cmortham@floridadental.org 850.350.7136

FDA Services 800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto Scott Ruthstrom, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 Carrie Millar, Agency Manager carrie.millar@fdaservices.com 850.350.7155 Carol Gaskins, Assistant Membership Services Manager carol.gaskins@fdaservices.com 850.350.7159

Porschie Biggins, Membership Services Representative pbiggins@fdaservices.com 850-350-7149

risk experts

Debbie Lane, Assistant Membership Services Manager debbie.lane@fdaservices.com 850.350.7157 Allen Johnson, Support Services Supervisor allen.johnson@fdaservices.com 850.350.7140 Angela Robinson, Customer Service Representative angela.robinson@fdaservices.com 850.350.7156 Jamie Chason, Commissions Coordinator jamie.peddie@fdaservices.com 850.350.7142 Kristen Barrett, Membership Services Representative kristen.barrett@fdaservices.com 850.350.7171 Marcia Dutton, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145

Dan Zottoli Atlantic Coast District Insurance Representative 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

Dennis Head Central Florida District Insurance Representative 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com

Joe Dukes Northeast & Northwest Insurance Representative 850.350.7154 Cell: 850.766.9303 joe.dukes@fdaservices.com

Joseph Perretti South Florida District Insurance Representative

Maria Brooks, Membership Services Representative maria.brooks@fdaservices.com 850.350.7144

305.665.0455 Cell: 305.721.9196

Nicole White, Membership Services Representative nicole.white@fdaservices.com 850.350.7151

Rick D’Angelo

Pamela Monahan, Commissions Coordinator pamela.monahan@fdaservices.com 850.350.7141

March/April 2014

joe.perretti@fdaservices.com

West Coast District Insurance Representative 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

Today's FDA

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President’s message Terry Buckenheimer, DMD

What Time of Year is It? It’s that time of year when I begin looking forward to the Florida National Dental Convention (FNDC). I can still remember the kids’ excitement when we would pull into the Marriott World Center in Kissimmee many years ago.

Their FNDC friends that they saw every year would be waiting for them — at the door, by the pool or at the game center.

It was a weekend of fun that they still remember.

Now, I am personally looking forward to June 12-14 when the FNDC takes place at the Gaylord Palms Resort in Kissimmee. And no, it’s not just because it signals the end of my year as president of the Florida Dental Association (FDA) and I can get back to having a more normal life. It’s because I’ve seen a sneak preview of the list of speakers and approved the budget that includes some fun and exciting events. There are opportunities available for my staff to improve their skills and even take some hands-on courses. There’s free pre-registration and up to 15 hours of free continuing education (CE) credits for our members. There are numerous events that will provide a fun and enjoyable experience for my family, friends and colleagues.

Gaylord Palms has in recent years improved their facilities to include newly decorated rooms, new pools (one kid’s pool that my children would have loved, but there are no grandchildren yet to enjoy it), and great entertainment venues www.floridadental.org

“ ”

There’s free pre-registration and up to 15 hours of free continuing education (CE) credits for our members.

and restaurants. It’s a star in the Marriott family of resorts and is a popular destination for people from all over.

Last year, the chairman and my good friend, Dr. Bert Hughes, along with his wonderful committee, put on a meeting that surpassed all expectations. His sense of providing what our members want led to a significant increase in attendance.

His attention to detail, the committee’s planning and the efficiency of our wonderful staff created a large increase in net income, which ultimately keeps your dues down.

There are two events that I want to bring to your attention. Thursday evening is the “Sweet Success” dessert reception where we recognize our Florida Dental Health Foundation programs and honor

our Project: Dentists Care (PDC) and Give Kids a Smile (GKAS) dentist volunteers. This year we are acknowledging all the volunteers who made our first Mission of Mercy (MOM) event such a success. Be there to enjoy the desserts and take part in karaoke with your friends.

The FDA Awards Luncheon will be held on Saturday from 11:30 a.m. to 1 p.m.

Instead of surprising our award winners at the House of Delegates meeting, we thought it was time to properly bestow these honors on the recipients. The award winners have dedicated much of their time and energy to the profession, and it is befitting to have their names known prior to this event so that family, staff and friends can share in the celebration and excitement. The Dentist of the Year, Leon Schwartz Lifetime Achievement Award, Leadership, Special Recognition and Service Awards will be distributed during the luncheon, with hopes that this tradition will continue for years to come.

The FNDC Committee has planned a meeting that will once again meet the needs of our members and, hopefully, surpass their expectations. I know I am looking forward to it — I hope to see you there!

Dr. Buckenheimer is the FDA president.

He can be reached at tlbdmd1@gmail.com.

March/April 2014

Today's FDA

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Legal Notes

Sexual Predators as Patients Graham Nicol, Esq.,

Health Care Risk Manager, Board Certified Specialist (Health Law)

Recently, a member called about treating a “sexual predator” as a patient.

He said he just didn’t feel comfortable around him and was so ill at ease he had lost objectivity. What to do?

Below are several issues, in no particular order, primarily intended to make you think through the practical and ethical implications of your decision rather than simply comply with the law: q Deal with the problem. Don’t ignore it or pretend you don’t know the patients’ criminal history, but avoid an irrational, emotional, knee-jerk reaction. q Recognize that different rules may apply if the sexual predator is your employee or a licensed health care worker rather than simply your potential or actual patient. Employment or licensure status presents additional issues not discussed in this article. q Note that Florida law refers to sex offenders, sexual predators, high-risk sexual predators, etc. as a technical

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area of criminal law. In general, it is enough for you to know that Florida requires identification, registration and monitoring of sex offenders. q If you’ve lost your objectivity and clinical judgment, then there is an ethical duty to avoid treatment. If you can’t safely treat the patient for whatever reason, then don’t. q If you decide to terminate the doctor/patient relationship, then properly notify the patient so that you do not “abandon” him or her.

Plan ahead for how you will handle dental emergencies. The FDA will soon publish a “how to” article on the members-only website on how doctors can terminate patients in Florida without being sued for abandonment. q Document your chart and preserve it properly. One purpose of risk management is simply to prove what happened. Official business records are admissible as evidence to prove that what was written down actually occurred. Normally, such evidence is excluded as “hearsay” but here, two exceptions may apply: business records and spontaneous occurrence (you are writing it down simultaneously with the action — in “real time”). q Document a legitimate business reason for your decision not to treat.

For example, if the patient inappropriately touched your dental assis-

tant, write it down. If he disrupted the flow of your office and required you to turn away other patients, document it. If you cannot accommodate the patient’s needs within your practice without incurring significant cost, document it. q Consider whether the patient is, or a plaintiff’s attorney could with a straight face allege that he is, a member of a protected class. Even convicted criminals have civil rights.

Does the patient have a “disability” under the Americans with Disabilities Act? Remember that your practice is probably a “place of public accommodation.” q Consider “patient dumping.” This is federal law specifically applicable to emergency departments in hospitals that accept federal funding. It means that certain providers cannot refuse to treat based, for example, on ability to pay or lack of insurance. If you practice in a hospital-based setting, think about the Emergency Medical Treatment and Labor Act (EMTALA), Florida requirements, and your hospital privileges. q While EMTALA doesn’t apply to private dental practices, recognize that the patient is a fellow human being and does need dental care. Note that this opposing ethical duty conflicts with the duty to avoid unsafe treatment due to your subjective disgust.

www.floridadental.org

Legal Notes

q Do not conspire with other dentists, but think through the ethics of warning them and/or law enforcement of this patient. Do not agree with business competitors in your geographic or specialty area of practice that this patient will be blacklisted or boycotted. Do not publish his/her name or picture in your local dental society newsletter. But consider as well whether other doctors or people are at-risk (hint: think domestic violence, vulnerable adults, children, etc.) and consider if you owe them a special duty of care. q Verify that your suspicions are in fact correct. Do not defame this patient by telling others unless you know (not just think) you have all the material facts. Just an Internet search is not enough. The Internet is full of lies and malicious gossip that cannot be trusted. If you are uneasy, check with the appropriate government database(s). A call to the vice department of the city police or county sheriff may be enough. If the patient is not from your area, consider the Florida Department of Law Enforcement, FBI data or information from the state attorney general. q Remember doctor/patient confidentiality and privacy rules. Remember, the Health Insurance Portability and Accountability Act (HIPAA) and Florida law create a legal duty for you to keep personal health information private and protected. For example, if this information was disclosed in a medical history or patient intake form rather than based exclusively on your intuition, do other rules apply?

www.floridadental.org

q Do not stereotype. Just because the patient is “creepy, wears really thick glasses and smells funny” proves nothing. We all know accountants and lawyers who meet this profile. q Run it by the health care risk manager of your medical malpractice and/ or general liability carrier. You are not filing a claim so there will be no impact on insurability or rate increases.

You are merely getting advice on how to manage the risk properly. q Guard against workplace violence.

Under the Occupational Safety and Health Administration (OSHA) and Florida law, you have a legal duty to avoid negligence in protecting the safety of your workers. If you think (or, with hindsight, as a reasonably prudent person should have thought) that this patient may turn violent, then document that you have taken appropriate safeguards to protect your staff. For example, do you have a problem with loitering? If yes, what have you done about it? Consider walking employees to the car and watching them drive away before you leave your premises. Do you need an alarm system? Video monitoring?

Pepper spray? Massive weaponry? A moat? We all have differing levels of risk avoidance/acceptance. q Recognize that you have a policy manual that prohibits sexual harassment of your staff by other employees or patients (business invitees). You do have an employee manual, don’t you?

What does it say? Follow your own rules.

q Think about any participating provider agreements you may have signed. Are you contractually obligated to treat this patient? q Note the difference between an arrest (probable cause to believe he has done the crime has been established) versus a conviction (it has been proved beyond a reasonable doubt that he did it). q If you know the patient should have registered as a sexual offender and has not, think about whether you have a legal or moral duty to notify law enforcement of the occurrence of a known or suspected crime. q Don’t require testing for AIDS or other STDs. Remember universal precautions negate the need for such testing. q Check city or county ordinances for specific information. While federal and Florida law do not give this patient special civil rights protection, local law might. Call the city attorney or county commission office if you’re unsure.

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.

Graham Nicol is the FDA’s Chief Legal Counsel.

March/April 2014

Today's FDA

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DENTISTRY

IN THE HALL Register now for one of these great courses held in our classrooms on the Exhibit Hall floor.

THURSDAY, JUNE 12 Patient-Specific, CAD/CAM Solutions for Single-Tooth to Full-Mouth Restorations (EX11) DR. LARS BOUMA 9 AM-12 PM  IMPLANTS CE CREDITS: 3 This lecture is fully sponsored

by DENTSPLY Implants.

FRIDAY, JUNE 13 LANAP and LAPIP: Laser-Mediated Periodontal Therapy (EX13) 10AM-12 PM  LASERS CE CREDITS: 2 This lecture is fully sponsored by Millennium Dental Technologies Buffering Local Anesthetic Hits Its Stride (EX23)

Using Cone Beam Technology to Enhance Your Practice and Provide Predictable Treatment Results (EX21) DR. RICK FERGUSON DR. ARTHUR ACKER 10 AM-12 PM  TREATMENT PLANNING  CE CREDITS: 2 This lecture is fully sponsored by Prexion.

Patient-Specific, CAD/CAM Solutions

for Single-Tooth to Full-Mouth Restorations (Repeat) (EX12) DR. LARS BOUMA 2-5PM  IMPLANTS  CE CREDITS: 3 This lecture is fully sponsored

by DENTSPLY Implants.

Paradigm Shift in Operative Dentistry: the Future of Dentistry is Now — Hard and Soft Tissue Operative Dentistry with Waterlase (EX22)

DR. MIC FALKEL 10 AM-12 PM  ANESTHESIA CE CREDITS: 2 This lecture is fully sponsored

by Onpharma Inc. Digital Dentistry: Technology and the Team (EX14) DR. GARY SEVERANCE 2-5 PM  TECHNOLOGY CE CREDITS: 2 This lecture is fully sponsored

by Henry Schein.

Growing Your Practice in the Internet Age (EX24) ALEX NUDEL 2-4 PM  PRACTICE MANAGEMENT  CE CREDITS: 2 This lecture is fully sponsored

by Patterson Dental.

DR. JOSE MARCANO 2-4 PM  LASER  CE CREDITS: 2 This lecture is fully sponsored

by BIOLASE.

SATURDAY, JUNE 14 Three Strategies to Boost Your Bottom Line (EX15) DR. CRISTINA SCHNEIDER 10 AM-12 PM ■ PRACTICE MANAGEMENT ■ CE CREDITS: 2 This lecture is fully sponsored

by Fortune Management.

Simplifying Dental Implant Placement with Computer Guided Surgery: Live Patient Surgical Placement (EX25) DR. RICK FERGUSON 10-11 AM IMPLANT & TREATMENT PLANNING  CE CREDITS: 1 This lecture is fully sponsored

by Implant Educators.

Treatment Planning and Creating a Million Dollar Smile Using Implant Overdentures (EX26) DR. ARTHUR ACKER 11 AM-12 PM IMPLANT & TREATMENT PLANNING  CE CREDITS: 1 This lecture is fully sponsored

by Implant Educators.

COURSES ARE FREE TO FDA MEMBER DENTISTS!

Thanks to our Sponsors!

Operatory sponsored by Patterson Dental.

Camera sponsored by MagnaVu.

Corporate Classroom sponsored

by Henry Schein Dental.

Information Bytes

Microsoft Ends Support for Windows XP

By Larry Darnell

Director of Information Systems

After 12 years, support for Microsoft Windows XP will end on April 8, 2014. Windows XP is a personal computer (PC) operating system still in use by 70 percent of all computer users. What does this mean for you, your office or your home computer?

It means it’s time to upgrade your operating system or purchase a new computer. After April 8, Microsoft will no longer provide security updates or technical support for Windows XP. Security updates patch vulnerabilities that may be exploited by malware and help keep users and their data safer. PCs running Windows XP after April 8 should not be considered to be protected. You simply should not put your practice or your home information at risk. Most PCs running Windows XP may not be able to run a newer Windows operating system like Windows 7 or Windows 8.1.

In that case, purchasing a new computer is one of your options. Some have made the decision to move to tablets like the Apple iPad or Samsung Galaxy instead of a new PC, and that may work in your situation.

Nevertheless, time is running out and you need to do something, or you may find your valuable asset is useless. Check what operating system you are using on your computers and take steps to remedy the situation as soon as possible. If you have questions about this, please feel free to email me and I will do my best to answer them.

Mr. Darnell can be reached at ldarnell@floridadental.org or 850.350.7102.

www.floridadental.org

“

What does this mean for you, your office or your home computer?

It means it’s time to upgrade your operating system or purchase a new computer.

” March/April 2014

Today's FDA

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news

@ fda

important news for FDA members

ADA Develops Dental Checklist for Patients, Health Law Navigators

credits! Conference will be held on April 3-5, just outside of Albuquerque, N.M.

The ADA has developed a tool to help patients choose the dental plans that are right for them. The checklist can also help the navigators appointed to help consumers negotiate the complexities of the new health care exchanges. The ADA is making the checklist available to its constituent societies, who are encouraged to use it any way they see fit, whether by printing copies and distributing them to state officials or reworking the text for their own publications. The checklist is available on the ADA website and can be found at http://www.ada.org/ sections/advocacy/pdfs/ACA_Market place_Checklist.pdf.

Healthy Smiles from the Start, a brand new prenatal and infant dental health education program, begins the first of a three-year project. This program was created by the Alliance with help from the ADA, Henry Schein Cares and Colgate for the purpose of educating young parents about the importance of oral health.

The AADA’s goal is to have incorporated these materials into at least 10 prenatal classes per state by the end of 2016. The materials are also a perfect addition to dental practice education materials.

In addition, please visit Mouthhealthy. org for consumer information about choosing a dental plan under the Affordable Care Act.

AADA has Big Plans for 2014 The Alliance of the American Dental Association (AADA) is excited to announce what they have planned for 2014 — a one of a kind Conference and the launch of Healthy Smiles from the Start.

During Conference 2014, Alliance members have a one-time opportunity to attend all events while enjoying a complimentary three-night stay at the Hyatt Regency Tamaya. Dentists attending with their spouse are eligible to receive eight FREE continuing education 10

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March/April 2014

Any questions you might have regarding either Conference 2014 or Healthy Smiles from the Start can be directed to the Alliance Director, Trish RubikRothstein at 312.440.2865 or Trish@AllianceADA.org. Your help in supporting the promotion of these projects is greatly appreciated!

ADA Paper Addresses Bringing Disease Prevention in Oral Health to Communities The American Dental Association (ADA) recently published its latest paper on oral health disparities in underserved populations. Prior papers were published as “Breaking Down Barriers.” The brand has now been changed to comport with the Action for Dental Health campaign.

Action for Dental Health: Bringing Disease Prevention into Communities is

the first of two that will address the importance of disease prevention. It focuses on a broad array of programs nationwide targeting tooth decay and gum disease, the two most prevalent dental problems, both of which are almost entirely preventable.

The ADA this year launched Action for Dental Health, a major campaign aimed at ending the dental health crisis affecting tens of millions of Americans. Action for Dental Health comprises multiple initiatives to address the complex barriers that impede millions of Americans from accessing adequate dental care.

These initiatives fall into three distinct areas: n Providing care now to people who

are suffering. That would include the elderly in nursing homes, children from low-income families, and the uninsured, who are more likely to visit an emergency room for relief from dental pain. n Strengthening the public/private

dental safety net to dramatically increase its capacity to deliver care. n Focus on disease prevention and

oral health education through community water fluoridation, the use of Community Dental Health Coordinators, stronger collaboration between dentistry and other health professions, and public health programs in schools and other public and private settings. www.floridadental.org

FDA Employee Title Change The Florida Dental Association (FDA) is pleased to announce that Crissy Tallman’s title as FNDC Convention Manager has been changed to DirecTallman tor of Conventions and Continuing Education. The change in title reflects the direction her department is undertaking with expanding its services beyond an annual meeting to hosting online continuing education (CE) programs, working with other departments who offer CE programming, and coordinating and developing a CE tracking system. Crissy wears a lot of hats, and this title is more reflective of the role she plays. Thank you, Crissy, for all you do!

Update on FDA Letter to AHCA on Encounter Fees In January, Florida Dental Association (FDA) president, Dr. Terry Buckenheimer, submitted a letter to the Agency for Health Care Administration (AHCA) outlining the FDA’s position regarding encounter fees. In response, the AHCA sent a letter explaining what efforts are underway to address the FDA’s request.

To read the full letter, go to http://bit. ly/1nyVkKg. The AHCA indicated that it has started to capture all dental services provided

www.floridadental.org

in a county health department (CHD) and federally qualified health center (FQHC). Based on language recently added to the Dental Services Coverage and Limitations handbook, these facilities are now required to document the correct dental code for each dental service provided during an encounter.

In response to Dr. Buckenheimer’s letter, this same requirement is now being added to the CHD and FQHC handbooks currently going through the rules promulgation process. In addition, the AHCA stated it is their goal that all dental services be employed in the most cost-effective manner. The FDA will continue to work closely with the AHCA in the coming months to enhance and improve the reporting of and access to dental services in Florida.

If you have any questions or need additional information, please contact Casey Stoutamire at cstoutamire@floridadental. org or 850.224.1089.

ADA: Chairside Screenings for Chronic Diseases Could Save the U.S. Health Care System Millions Screenings by dentists for the most common chronic medical diseases could save the American health care system as much as $102.6 million annually, according to a new study conducted by the ADA Health Policy Resources Center (HPRC). The findings were published Feb. 13 in the American Journal of Public Health. According to the Centers for Disease Control and Prevention (CDC),

7.8 percent of the U.S. population has undiagnosed hypertension, 2.7 percent has undiagnosed diabetes and 8.2 percent has undiagnosed high cholesterol. Screening for these conditions in dental offices could lead to savings of up to $102.6 million, or $33 per person screened, and healthier outcomes for patients.

There is potential for additional savings over the long term through prevention, health promotion, and early interventions that the study did not model.

According to the CDC, about half of all American adults suffer from chronic illnesses, which account for more than 75 percent of health care costs and 70 percent of deaths each year in the U.S. Chronic diseases are estimated to cost the country $153 billion annually in lost productivity.

Attend ADA 28th New Dentist Conference Registration is now open for the American Dental Association’s (ADA) 28th New Dentist Conference, which will be held July 17-19, 2014 at the Sheraton Kansas City Hotel at Crown Center in Kansas City, Mo. The conference offers up to 14 hours of top-notch continuing education, a full day of leadership development, the opening reception, breakfast and learn sessions, complimentary lunches and an awesome Friday night event at PBR Big Sky in the city’s famous Power and Light District — all for just $375 for ADA member dentists.

Please see news, 13

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Friday Night Fun!

Fan Frenzy is a family-friendly event featuring activities for all ages! There will be tailgate-themed food and games, entertainment and more.

Sport your team colors and show your support for your favorite team. Prizes will be awarded for the best dressed individual and best dental office team.

We hope you’ll join us for the tailgate party of the year! Everyone is invited and tickets are FREE – just select item “FAN” on your registration form.

Get into your team spirit!

Friday, June 13 7-10 pm

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And don’t miss the hands-on endo and implant workshops at UMKC School of Dentistry. The conference is geard to new dentists — those who earned a dental degree in 2004 or later — but there’s something for everybody, including dental students and dental society staff. Visit ADA.org/newdentistconf for more information and to register.

Legal FAQs Updated on Website The Florida Dental Association (FDA) website has been updated with new frequently asked legal questions. These questions and answers are an educational service of the FDA for members only,

and can be found at https://www.floridadental.org/FDA/legal-faq.aspx. They have been prepared by FDA legal staff based on years of experience; Florida Bar certification as an expert in health law; and AHCA licensure as a healthcare risk manager. However, health law constantly changes so do not rely on this site for legal, risk management or other professional services. Always promptly seek the advice of a qualified health law attorney or risk manager familiar with the facts of your particular situation. If you would like a referral to a health law attorney, please contact the FDA and we will assist you.

NSU Dental Student Elected ASDA Vice President Nova Southeastern University (NSU) College of Dental Medicine is proud to announce that Jason Watts, a third year dental student, was just elected ASDA vice president at the American Student Dental Association (ASDA) meeting in Anaheim, Calif.

“With my national involvement, knowledge and passion, I truly hope that if any local or state association needs student representation in any way, shape or form, you will not hesitate to contact me. It would be an honor and a pleasure to be more involved within my state,” Jason said of his newly-elected position.

Membership Concierge

MEET THE NEW FDA

CHRISTINE MORTHAM As the Membership Concierge, Christine helps FDA members take advantage of all the benefits the tripartite offers, and with a personal touch.

Just like a hotel concierge, she has a wealth of information to help you navigate your association. Call her with your questions!

800.877.9922 or 850.350.7136 cmortham@floridadental.org Christine Mortham

Dr. Casas was Selected as one of the Leading Physicians of the World by the International Association of Internists (IAI) in 2009.

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We KnoW FLooD insurance.

We KnoW Dentists.

Your Risk Experts 800.877.7597 insurance@fdaservices.com www.fdaservices.com Group & Individual Health • Medicare Supplement • Life Insurance • Disability Income • Long-term Care Annuities • Professional Liability • Office Package • Workers’ Compensation • Auto

As hurricane season approaches, it is important to make sure you have your flood policies in place.

The threat is real and flood insurance should be a consideration for all office owners regardless of where they are.

Remember, “low risk” does not mean “no risk.” Almost 25 percent of all flood insurance claims come from areas with minimal flood risk.

Call us today — 800.877.7597!

A Member Benefit Since 1989 A wholly owned subsidiary of the Florida Dental Association

House of Delegates Announcements

House of Delegates to Consider Bylaws Changes Pursuant to the bylaws of the Florida Dental Association (FDA), all members are hereby notified that the FDA House of Delegates (HOD) may be asked to consider amending the FDA bylaws regarding: reinstatement of lapsed membership membership dues waivers new name for FNDC Committee and Convention number of terms an individual can serve on GAC and whether the president may extend terms m whether each component is to be represented by two trustees and one alternate m m m m

The FDA’s Articles of Incorporation allow the FDA Bylaws to be amended by a two-thirds affirmative vote of the HOD, provided the proposed amendments are sent in writing to the membership of the association and postmarked at least 30 days in advance of the HOD session, or at any HOD session by a three-fourths affirmative vote provided the amendments were presented in writing to a previous session of the HOD and unanimous consent is given for their consideration.

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Pursuant to the bylaws of the Florida Dental Association, all FDA members are hereby notified that the FDA House of Delegates (HOD) may designate a dues increase and/or an assessment. At the time of publication, no increase or assessment has been reported; however, the FDA budget is scheduled to be discussed and approved by the HOD in its June 2014 annual session.

The House of Delegates will meet Friday, June 13 and Saturday, June 14, 2014 at the Gaylord Palms Hotel and Convention Center, in Orlando. The FDA encourages all members to seek information about these important matters from their component’s delegates to the HOD and trustees to the FDA Board of Trustees.

Dr. Michael D. Eggnatz FDA Secretary

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Awards Luncheon Saturday, June 14 •11:30 AM-1 PM

Gaylord Palms

Plan to attend this very special celebration luncheon that will recognize and honor our FDA President, Dr. Terry Buckenheimer, as well as the 2014 award recipients, including FDA Dentist of the Year!

Tickets are $35 per person or purchase a table of 10 for $300 — available on your FNDC2014 registration form.

President’s AwArd Dr. Terry L. Buckenheimer

sPeCiAL reCognition AwArds Dr. Nolan W. Allen Dr. Leo Cullinan Ms. Stefanie Dedmon Dr. Cesar R. Sabates

dentist of the YeAr Dr. Paul Miller J. Leon sChwArtZ LifetiMe serViCe AwArd Dr. James Walton III

LeAdershiP AwArds Dr. David Boden Dr. Sudhanshu “Sam” Desai Dr. Jolene O. Paramore Dr. Richard A. Stevenson

AAoMs robert V. wALker distinguished serViCe AwArd Dr. Larry W. Nissen

serViCe AwArds Dr. Gerald W. Bird Dr. Bertram Hughes Dr. Richard A. Huot Dr. Johnny Johnson Jr. Dr. Richard Mullens

AdA distinguished serViCe AwArd Dr. Robert T. Ferris

Fda sErvicEs & thE doctors company invitE you to Thursday, June 12 5-7 p.m.

Wrecker sporTs Bar Gaylord palms resorT

happy hour Enjoy complimEntary bEEr and winE. all dEntists and spousEs arE invitEd!

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mediation makes sense with the FDA Peer review Mediation Program MEDIATION VS. LITIGATION The Peer Review Mediation Program settles disagreements between patients and dentists more economically and efficiently than the legal system and is available only to FDA members.

This program is free of charge.

Only cases involving problems with actual treatment and procedures are eligible for mediation.

Mediation takes place at the local level, so problems can be resolved more effectively.

FOr MOrE INFOrMATION

about the FDA Peer review Mediation Program 800.877.9922 • fda@floridadental.org www.floridadental.org/peer-review

www.floridadental.org

Cases not eligible for the program include: malpractice litigation; formal regulatory investigations; disputes over dental fees; treatment that occurred more than 12 months before the patient’s last appointment with the dentist; and cases involving dentists who are not FDA members.

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e s u o s H e

House of Delegates

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By FDA Staff

On Jan. 24-25, the Florida Dental Association (FDA) House of Delegates (HOD) met at the Tampa Airport Marriott. The HOD discussed many issues, including the following business.

Dr. Terry Buckenheimer, 2013-2014 FDA president, reported on hiring Drew Eason as the new executive director; the image confusion associated with the FDA logo and the hiring of Moore Communications to develop a new FDA brand; the compensation review conducted by Merces Consulting Group; the accounting efficiencies review conducted by Carr Riggs Ingram; the strategic plan development being led by Michael Gallery; and the hiring of a new membership director and membership concierge. He noted that all of this effort is dedicated primarily to increasing FDA

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membership. Dr. Buckenheimer also recapped the FDA’s advocacy efforts with Gov. Scott, emphasizing the charitable care provided by the FDA and Sen. Jack Latvala’s introduction of the FDA’s non-covered services bill. He also mentioned the FDA’s involvement at the American Dental Association (ADA) leadership level and personally thanked Dr. Charles Norman for his assistance.

Dr. Buckenheimer, also the 17th District trustee, reported on the environmental scan conducted by the ADA in furtherance of the ADA strategic plan, which again focuses on membership. The ADA Board of Trustees is committed to the tripartite structure and aligning all three levels better. He cited using Aptify software as an example. He mentioned that the Dental Quality Alliance would make a presentation to the HOD. He also mentioned the efforts of the Dental Lifeline Network in Florida, the ADA Institute for Diversity in Leadership and the ADA New Dentist Committee. In closing, Dr. Buckenheimer thanked FDA members who serve as volunteers at the ADA level.

Report of the ADA President Dr. Charles Norman, ADA president, reported on the Power of Three initiative, which is designed to meet several goals, including improving membership. He mentioned that the number of dental patients in traditional dental plans has declined; adult patients have shown a decline while children patients have increased slightly.

The ADA percentage of market share is approximately 65 percent, and the amount of student loan debt is a serious issue. The number of students taking the Dental Admission Test has declined for the last two years. The ADA Center for Professional

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House of Delegates

Success is designed to provide guidance on practice management. One of the biggest problems is bringing together the tripartite into a single brand and Dr. Norman said that being on the same management software is crucial, as well as reducing the range of dues paid across the tripartite.

Approval of Component Designated Delegates and Alternates Dr. Ethan Pansick, speaker of the House, announced the slate and called for additional nominations. Since there were no other nominations, and without objection, Dr. Pansick declared nominations closed. Without objection, the slate was elected by acclamation.

Streamline Barriers to Membership The HOD amended the FDA bylaws to remove barriers to membership in the application process, in turn simplifying the membership application process.

Trustees as Voting Members of Councils The HOD adopted a resolution that state FDA line officers, trustees and/or alternate trustees may not be a voting member of an FDA council, but may serve only as a liaison to the council or as a consultant without a vote on the council. This limitation shall not apply to the FDA Council on Financial Affairs.

Encounter Fees in Public Health Settings The HOD adopted the following resolution. As the state transitions all Medicaid services to managed care, the FDA shall encourage the Agency for Health Care Administration (AHCA) to investigate reliance on the encounter fee by public health facilities. The FDA also will urge AHCA to evaluate the effectiveness and efficiency of dental treatment under this reimbursement system. In addition, the FDA will urge AHCA to revise the Florida Medicaid County Health Department (CHD) Clinic Services Coverage and Limitations Handbook to authorize and encourage CHDs to accurately report and appropriately bill for the dental services being provided. The FDA will urge AHCA to revise the Federally Qualified Health Center (FQHC) Services Coverage and Limitations Handbook to authorize and encourage FQHCs to accurately report and appropriately bill for the dental services being provided. Lastly, the FDA will urge AHCA to review and evaluate the treatment being rendered at CHDs and FQHCs.

Recording Individual Roll-call Votes in BOT Minutes The HOD adopted a resolution that the FDA Board of Trustees (BOT) continue its long-standing practice of recording individual votes on Board business and include these recorded votes in the BOT minutes, as well as HOD agendas.

Date of Next House of Delegates Meeting The next HOD meeting will be June 13-14, 2014 at the Gaylord Palms Resort and Convention Center.

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Board of Dentistry

Board of Dentistry

“

Feb. 21, 2014

By Ron Watson

FDA Contract Lobbyist, President of Watson Strategies

If you have not yet attended a BOD meeting, it is suggested that you take the opportunity to attend and see the work of the BOD.

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The Florida Board of Dentistry (BOD) met in Tallahassee on Friday, Feb. 21 from 7:30 a.m. until 11 a.m. The Florida Dental Association (FDA) was represented by FDA BOD liaison Dr. Don Ilkka and FDA lobbyists Ron Watson and Casey Stoutamire. Other FDA members in attendance included FDA presidentelect Dr. Rick Stevenson, Drs. Andy Brown and Mark Romer, and others.

Ten of the eleven BOD members were present, which included Dr. Joe Thomas, chairman; Drs. William Kochenour, Carol Stevens, Dan Gesek, Wade Winker and Leonard Britten; hygienists, Ms. Catherine Cabazon and Ms. Angie Sissine; and consumer members, Mr. Tim Pyle and Mr. Anthony Martini.

Dr. Robert Perdomo, vice chairman, was not in attendance.

The BOD voted unanimously to support the FDA’s priority legislative agenda for the 2014 Session. This support included: non-covered services (HB 31 and SB 86); keep dental separate (HB 27 and SB 340); public record exemption for the dental workforce survey (HB 457 and SB 520); student loan forgiveness (HB 621 and SB 344); and the reenactment of the health access license (SB 664).

There was a brief discussion on licensure for internationally-trained dentists. An application for credentials review by a dentist who trained at a non-accredited dental school was discussed and approved. This sparked a BOD discussion as to when the grandfathering period of students who were enrolled in a specialty program would officially end. That issue was referred to the BOD Rules Committee.

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Board of Dentistry

The next BOD meeting is scheduled for Friday, May 16, 2014 at 7:30 a.m. EDT in Jacksonville at the Hyatt Regency. The phone number to the Hyatt Regency is 904.588.1234.

Dr. Winker, chairman of the BOD Dental Records Task Force, included an updated draft version of Rule 64B5-17.002 Written Dental Records; Minimum Content; Retention in the supplemental agenda. The original task force draft rule caused a lot of controversy.

The majority of the FDA’s concerns were addressed in the new draft, with the sections most strongly objected to being removed; however, votes will still need to occur at the task force level on each individual proposed change. No discussion, description or detail was provided as Dr. Winker said there would need to be another task force meeting prior to a full BOD discussion.

BOD staff reminded all BOD members to make sure they renewed their license by the deadline of Feb. 28. A discussion then ensued about the difficulty of entering continuing education (CE) credits into the new electronic tracking system, and there was clear frustration with the renewal process being delayed.

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For the last several BOD meetings, many conscious sedation permit requests (normally approved by the Anesthesia Committee chairman) have come before the full BOD for review and discussion with the applicant. The focus has been on the overlap of these cases being conducted at the same time in many rooms. The BOD wants each case to be separate and distinct with full recovery prior to counting the next patient as an approved case.

However, all of the training programs are presently located outside of Florida and many do not require full recovery for the case to count as one of the 20 required in Florida.

one voluntary relinquishment settlement agreement. A BOD member objected and wanted the license to be revoked by the BOD and not let them voluntarily relinquish it. The BOD attorney explained that they both carry the same effect of law. There were a couple of below standard of care cases, as well as some that dealt with substance abuse.

There were only 12 disciplinary cases at this meeting and several were postponed or continued until the next meeting.

There was no consent calendar; therefore, each case was addressed individually.

Ron Watson is a contract lobbyist for the FDA and President of Watson Strategies and can be reached at watson. strategies@comcast.net.

One case was dismissed due to paperwork not being filed in a timely manner.

This case had proceeded to the administrative law judge, who recommended an order to dismiss the case. However, this is just a recommended order and the BOD had a chance to file exceptions to the findings of fact. These exceptions could have been considered by the BOD. However, the exceptions must be filed within 15 days and they were filed three days late, so no further information could be introduced before the BOD. Without the additional information, the BOD agreed with the recommended order to dismiss the case. Another dentist had five separate cases combined into

If you have not yet attended a BOD meeting, it is suggested that you take the opportunity to attend and see the work of the BOD. It is much better to be a spectator than a participant in BOD disciplinary cases.

The Remaining BOD Dates for 2014 are: n August 22, 2014, Orlando – Hyatt Regency International Airport (407.825.1234)

n November 21, 2014, location TBA

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Letter to the Editor

Letter to the Editor

By Dr. Paul Benjamin

In the January/February issue of Today’s FDA, Dr. Dan Henry wrote a wonderful article, “The Restorative Cycle in Dentistry.” He is truly a master clinician. As many of us know, gold foils are not being taught in most dental schools and many patients are now more concerned with esthetics — i.e., white restorations — than how long that “filling” will last. So while Dan is correct that nothing has the track record of longevity of gold, it is a hard sell to many of our patients — even those who can afford this fine restoration. But my reason for responding was not to compare the various types of restorative materials, nor to bring up the idea of replacement versus repairing of restorations to decrease that cycle. Instead, I would like to discuss something Dan did not mention. Maybe the best answer to the restorative cycle, whenever possible, is not to pick up a handpiece and drill, but to seal the tooth and try remineralzation instead. Sealants have a proven track record, but still only 40 percent of our colleagues use them on a routine basis.

We all know that the potential end to the restorative cycle could be the loss of a tooth. I believe that in the next decade, our profession will see more advancement in the medical treatment of dental disease in an attempt to circumvent

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that destructive cycle. So yes, once you determine that surgical intervention is indicated, by all means, use the best evidenced-based skills to make decisions consistent with the oral health needs of our patients. But in those early stages of dental decay, let’s think first to seal, and hopefully postpone touching that enamel with our bur for a lifetime.

References: Evidence-Based Clinical Recommendations for the Use of Pit-and-Fissure Sealants A Report of the American Dental Association Council on Scientific Affairs The Journal of the American Dental Association March 2008 vol. 139 no. 3 257-268 Bader JD, Shugars DA. The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries. J Evid Base Dent Pract 2006; 6:91-100 A 24-month evaluation of amalgam and resin-based composite restorations: Findings from The National Dental PracticeBased Research Network. McCracken MS, Gordan VV, Litaker MS, Funkhouser E, Fellows JL, Shamp DG, Qvist V, Meral JS, Gilbert GH; National Dental PracticeBased Research Network Collaborative Group. J Am Dent Assoc. 2013 Jun; 144(6):583-93.

Repair or replacement of defective restorations by dentists in The Dental Practicebased Research Network,Valeria V. Gor-

dan, DDS, MS, MS-CI et al., The Journal of the American Dental Association (June 1, 2012) 143, 593-601 Sealants for preventing dental decay in the permanent teeth. Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Cochrane Database Syst Rev. 2013 Mar 28;3:CD001830. doi: 10.1002/14651858.

CD001830.pub4.

Demarco FF, Correa MB, Cenci MS, Moraes RR, Opdam NJ. Longevity of posterior composite restorations: not only a matter of materials. Dental materials: official publication of the Academy of Dental Materials. 2012;28(1):87-101. Epub 2011/12/24.

Editor’s note: Views and conclusions expressed in all editorials, commentaries, columns or articles are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association. For full editorial policies, see page 2.

All editorials may be edited due to style and space limitations. Letters to the editor must be on topic and a maximum of 500 words.

Submissions must not create a personal attack on any individual. All letters are subject to editorial control. The editorial board reserves the right to limit the number of submissions by an individual.

Dr. Paul Benjamin is a general dentist in Miami and can be reached at Pteethgator@aol.com.

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Free Continuing Education FREE CE FOR FDA MEMBERS AT FNDC2014 THIS YEAR, YOU CAN EARN UP TO 15 HOURS OF FREE CE! AND, YOU CAN SAVE HUNDREDS OF DOLLARS AT THE SAME TIME!

THURSDAY, JUNE 12 Inspiring Your Team to Reach Its Full Potential ■ NC01 DR. IRWIN BECKER ■ 8-9 AM COMMUNICATIONS ■ CE CREDITS: 1 FREE FOR TEAM MEMBERS

Patient-Specific, CAD/CAM Solutions for Single-Tooth to Full-Mouth Restorations ■ EX11

DR. LARS BOUMA ■ 9 AM-12 PM ■ IMPLANTS ■ CE CREDIT: 3 This lecture is fully sponsored by DENTSPLY Implants.

Managing Risks in the Digital Age ■ C03

MS. SANDRA STRICKLAND ■ 9:15-10:15 AM COMMUNICATIONS ■ CE CREDITS: 1

Using Cone Beam Technology to Enhance Your Practice and Provide Predictable Treatment Results ■ EX21 DR. RICK FERGUSON ■ 10 AM-12 PM TREATMENT PLANNING ■ CE CREDITS: 2 This lecture is fully sponsored by Prexion.

Digital Dental Photography Basics ■ C12 DR. FRANK LOZANO ■ 10:30-11:30 AM SPECIAL INTEREST ■ CE CREDITS: 1

Oh Yes!

I T’S

FREE!

FRIDAY, JUNE 13 Win Every Season: The Keys to Team Success ■ NC08

MR. KIRK BERHRENDT ■ 8-9 AM ■ COMMUNICATIONS ■ CE CREDITS: 1 ■ FREE FOR TEAM MEMBERS

Buffering Local Anesthetic Hits Its Stride ■ EX23

DR. MIC FALKEL 10 AM-12 PM ANESTHESIA CE CREDITS: 2 This lecture is fully sponsored by Onpharma Inc.

LANAP and LAPIP: Laser-mediated Periodontal Therapy ■ EX13

10AM-12 PM ■ LASERS ■ CE CREDIT: 2

This lecture is fully sponsored by Millennium Dental Technologies

Growing Your Practice in the Internet Age ■ EX24 ALEX NUDEL ■ 2-4 PM PRACTICE MANAGEMENT ■ CE CREDITS: 2 This lecture is fully sponsored by Patterson Dental.

Digital Dentistry: Technology and the Team ■ EX14

DR. GARY SEVERANCE ■ 2-5 PM ■ TECHNOLOGY ■ CE CREDIT: 2 This lecture is fully sponsored by Henry Schein.

SATURDAY, JUNE 14

Aggressive Periodontitis: What Have We Learned So Far? ■ C16

Stress Busting with Humor ■ NC12

Understanding the Affordable Health Care Act ■ C15

Three Strategies to Boost Your Bottom Line ■ EX15

DR. LUCIANA SHADDOX ■ 1:30-2:30 PM PERIODONTICS ■ CE CREDITS: 1 MS. CARRIE MILLAR ■ 1:30-3 PM SPECIAL INTEREST ■ CE CREDITS: 1.5

Paradigm Shift in Operative Dentistry: the Future of Dentistry is Now — Hard and Soft Tissue Operative Dentistry with Waterlase ■ EX22

DR. JOSE MARCANO ■ 2-4 PM ■ LASER ■ CE CREDITS: 2 This lecture is fully sponsored by BIOLASE.

Patient-Specific, CAD/CAM Solutions for Single-Tooth to Full-Mouth Restorations ■ Repeat ■ EX12

MS. KELLI VRLA ■ 8-9 AM PRACTICE MANAGEMENT ■ CE CREDITS: 1 FREE FOR TEAM MEMBERS

DR. CRISTINA SCHNEIDER ■ 10 AM-12 PM PRACTICE MANAGEMENT ■ CE CREDITS: 2

This lecture is fully sponsored by Fortune Management.

Simplifying Dental Implant Placement with Computer Guided Surgery: Live Patient Surgical Placement ■ EX25 DR. RICK FERGUSON ■ 10-11 AM IMPLANT & TREATMENT PLANNING ■ CE CREDITS: 1 This lecture is fully sponsored by Implant Educators.

DR. LARS BOUMA ■ 2-5PM ■ IMPLANTS ■ CE CREDIT: 3

Treatment Planning and Creating a Million Dollar Smile Using Implant Overdentures ■ EX26

Yes, Hypnosis Really Works!

This lecture is fully sponsored by Implant Educators.

This lecture is fully sponsored by DENTSPLY Implants.

■ NC07

DR. STEVEN ROTH ■ 2:45-3:45 PM COMMUNICATIONS ■ CE CREDITS: 1

Help Your Patients Quit: Tobacco Treatment for the Dental Profession ■ C24

MS. AMY COBER ■ 4-5 PM ■ SPECIAL INTEREST ■ CE CREDITS: 1

DR. ARTHUR ACKER ■ 11 AM-12 PM IMPLANT & TREATMENT PLANNING ■ CE CREDITS: 1

Courses listed by time. Check your FNDC2014 registration Booket or go to www.Floridadentalconvention.com for more information. Many courses also are free for members of your staff. Courses are offered on a first-come, first served basis, so don’t wait to register!

Anal

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FNDC2014 Speaker Preview

Accelerating the Complete Denture Rehabilitation Process

By Nels Ewoldsen, DDS, MSD

Complete denture rehabilitation requires a series of clinical and laboratory steps completed over many hours. For reasons ranging from patient convenience to dentist and lab profitability, the search is on to shorten the process.

Advancements in silicone impressioning have eliminated preliminary impressions and custom trays, saving Ewoldsen clinical and laboratory steps. Using thermoplastic shape-retaining trays (Wagner Universal, Bigjawbone, LLC) or modifiable plastic trays (MassadTM, CMP Industries, LLC), fast-setting silicones produce detailed, border molded edentulous impressions in 1020 minutes1. Laser scanned final impressions eliminate master models. Virtual models with identified landmarks allow computer assisted designed (CAD) tooth setups, saving technician time. Many dentists, however, prefer the esthetics of manually arranged setups versus CAD. Manual setups can be expedited using the same reference landmarks CAD systems use.

This article presents tips for relating edentulous landmarks and orienting planes to tooth position. With these landmarks, guided arrangement of artificial teeth produces a trial denture prior to maxillo-mandibular relations, reducing the time spent with occlusion rims. Jaw relations, phonetic verification and esthetic previewing can then be combined into a single appointment.

Determination of Rest Position and Occlusal Vertical Dimension Occlusal vertical dimension (OVD) is easily estimated with the patient seated upright with their dominant hand held over their

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FNDC2014 Speaker Preview mouth, fingers touching at the knuckles, with the index finger knuckle touching the nasal base.

The index finger fills the space from columella to subnasale and the finger widths to the sub-mental midline of a jaw at rest closely approximates rest position2. Holding the jaw steady, the patient Fig. 1 – Lip measurement using removes their hand, DENTCATM lip ruler the clinician parts the patient’s lips and measures the space between maxillary and mandibular ridge crests. These measurements, minus 3-4 mm, represent OVD with the inter-arch distance defining available space for tooth setup. A lip meter is used to record the length of the upper and lower lips from the ridge crests helping guide the tooth selection process (Fig. 1).

Identifying the Occlusal Plane and Maxillary Arch Setup on Unmounted Master Model

Fig. 3 – The hamular notches and incisive papilla lie in the HIP plane closely approximating an ideal occlusal plane orientation. Minus balancing and compensating curves, the HIP plane lies 6-8 mm superior to the maxillary denture occlusal plane.

With loss of natural teeth, residual ridges change continuously with the exception of the incisive papilla, hamular notches and retromolar pads.

Measurements relating these stable features to tooth position are keys to CAD tooth arrangement software. Similarly, these measurements can be used by technicians for manual setups.

The hamular notches and incisive papilla (HIP) lie in a plane closely approximating the maxillary occlusal plane, minus compensating and balancing curves. A good starting point for most patients establishes the maxillary occlusal plane 6-8 mm inferior to the HIP plane (Fig. 3). The upper lip length and patient’s desired tooth display are indicators directing which value should be selected. It has been recognized that the fox line (inter-pupillary) and ala-tragus line are esthetic determinants of “level.” The HIP plane is consistent with the fox and ala-tragus

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lines for most patients replacing these measurements3-9.

With the patient not present, the best facial midline estimate is an extension of the midpalatal suture line (Fig. 2). An Fig. 2 – Extending the mid-palatal suture Alma Gauge mealine to approximate the facial midline sures vertical and horizontal distances (Fig. 4). The mesial-facial surfaces of the maxillary central incisors are 3-5 mm anterior to the incisive papilla, depending on desired tooth display and lip support. The setup is completed on a Type 4, extra hard wax baseplate following the edentulous arch form arranging maxillary teeth symmetrically. The lingual cusps of the maxilFig. 4 – Alma Gauge measures lary posterior teeth should vertical and horizontal dimenlie just slightly buccal to the sions relating anatomic landmarks to tooth position and posterior ridge crest. denture base thickness.

Completing the Mandibular Arch Setup on Unmounted Master Model

Fig. 5 – The preliminary mandibular occlusal plane is identified using the retromolar pad midpoints and lower lip length.

The mandibular occlusal plane intersects with points halfway, or slightly more than halfway, up the retromolar pads and the mandibular incisal edges (Fig. 5). The mandibular incisal edges should be at the level of the resting lower lip, determined using the lip meter. This measurement was obtained immediPlease see denture, 33

March/April 2014 Today's FDA

31

get to know rick D’angelo! your west coast district insurance representative Ten Years Helping FDA Members!

Rick graduated from Florida State University with a degree in Risk Management and Insurance in 2003. With a family background in insurance, Rick knew he wanted to stay in the insurance field. While in school, he interned at FDA Services, and when the position opened up in his home town, he could not pass up the opportunity. Rick has been assisting members of the Florida Dental Association in the West Coast District for more than 10 years. He is well versed in all lines of insurance, and enjoys helping his clients understand the products, as well as finding them the best coverage available while reducing their annual premiums.

Rick is married with three children and lives in the Tampa area. In his spare time, he enjoys time with friends and family, playing sports and being active in his church and community.

rick d’angelo

west coast District insurance representative 813.475.6948 • Cell: 813.267.2572 rick.dangelo@fdaservices.com

rick

The fDA will, At no chArge, forwArD An unsigneD contrAct on your behAlf to the ADA’s contrAct AnAlysis service. cAll the fDA – 800.877.9922.

before you sign ...

The ADA provides a Contract Analysis Service to members free of charge through their state dental society. This service offers analysis of third-party contracts (i.e., from managed care companies) and informs members in clear language about the provisions of the contracts so they can make informed decisions about the implications of participation.

For more information about Contract Analysis, go to http://www.floridadental.org/contract-analysis.

FNDC2014 Speaker Preview denture from 31

ately after OVD determination. Mandibular teeth should be set with posteriors over the crest of the ridge, slightly lingual to the crest of the ridge when the tongue permits. Mandibular incisors should be set so that their lingual surface aligns vertically over the ridge crest of a non-resorbed ridge and with their incisal edges directly above mandibular ridge crest. A 5-6 mm width of wax rim centered over the posterior ridge can be created in lieu of setting posterior teeth.

After completion of these steps, the maxillary trial denture is tried on. Phonetics determine maxillary incisor position2.

When the patient repeats fricative sounds, the dry portion of the lower lip contacts the teeth very near the wet-dry line. This confirms labial positioning and incisal length requirements.

Following this step the midline is confirmed, followed by the fox line and ala-tragus line. Customization of the maxillary anterior teeth can be done prior to assessing the mandibular trial denture.

The mandibular trial denture is inserted with the maxillary trial denture already in place. The patient is asked to touch the tip of the tongue to the back of the roof of the mouth and slowly close confirming simultaneous left and right side contact. After elimination of noted interferences, the patient repeats sibilant (“s”) sounds to confirm no tooth contact and no excessive air movement (hissing). Any tooth contact confirms freeway encroachment, hissing indicates excessive freeway space. After corrections have been made, a photo is taken and the patient is asked to close into a tongue-guided centric relation recorded in either silicone or wax before the case is sent to the laboratory with photos and instructions to finish.

Fig. 6 – A photograph captured from a face mirror reflection is an excellent laboratory and patient communication tool.

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While tooth arrangement prior to obtaining jaw relation records lacks precision regarding definitive positioning for a customized esthetic smile, it provides a great starting point for patient and den-

tist evaluation as well as laboratory communication. Reference points, photos and discussion with the patient holding a face mirror facilitate communication and understanding (Fig. 6).

Additional tips and techniques expediting the complete denture process and enhanced patient communication will be presented by the author at FNDC on June 13, 2014.

References:

Massad J, Davis WJ, Lobel W, June R, Thornton J. Improving the stability of maxillary dentures: the use of polyvinyl siloxane impression materials for edentulous impressions. Dent Today 2005 24(2): 118, 120-3.

Koller MM, Merlini L, Spandre G, Palla S. A comparative study of two methods for the orientation of the occlusal plane and the determination of the vertical dimension of occlusion in edentulous patients. J Oral Rehabil.

1992 19(4): 413-25.

Pound E, Murrell GA. An introduction to denture simplification. Phase II. J Prosthet Dent. 1973; 29(6): 598-607.

Owawa T, Koyano K, Suetsugu T. The relationship between inclination of the occlusal plane and jaw closing path. J Prosthet Dent 1996 76(6): 576-80.

Celebic A, Valentic-Peruzovic M, Kralijevic , Brkic H. A study of the occlusal plane orientation by intra-oral method (retromolar pad). J Oral Rehabil 1995 22(3): 233-6.

Isa ZM, Abdulhadi LM. Relationship of maxillary incisors in complete dentures to the incisive papilla. J. Oral Sci. 2012; 54(2): 159-63.

Guldag MU, Sentut F. Buyukkaplan US. Investigation of Vertical Distance between Incisive papilla and incisal edge of maxillary central Incisors. Eur J. Dent. 2008 2(3): 161-6.

Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a statistical and clinical analysis in different clinical situations. J Prosthodont 2008 17(7): 572-5.

Singh K, Lakshmi N, Agnihotri Y, Suvama SR, Sahoo S, Kumar P. Three dimensional analysis, to compare parallelism of occlusal planes to the hamular notch-incisive papilla plane in dentulous and edentulous subjects. Eur J Gen Dent. 2013 2(3) 286-91.

Dr. Ewoldsen has his own practice, Conservative Dental Solutions, in Waveland, Ind. He will be a speaker at FNDC2014, presenting his course, “An Accelerated Clinical Sequence for Exquisite Complete Dentures.” It will be held on Thursday, June 13, 2014 at 9:30 a.m. He can be reached at newoldsen@gmail.com.

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FNDC2014 Speaker Preview

A Powerful Experiential Lesson

By Dr. Irwin Becker

The human touch can make such an impact. As I attempt to piece together my experiences and observations while going through and recovering from open heart surgery, I hope to demonstrate the elements that make complex restorative dentistry akin to triple bypass surgery. The overwhelming first impression is how powerful touch can be to a Becker patient. Being so very fortunate to have certain physicians who routinely offered their caring, knowing and calming touch, I had gotten used to it.

But now I faced major and potentially dangerous surgery, and I really needed reassurance. When both the surgeon and cardiologist explained the process and expressed their confidence that my problem could be fixed, they also said these things with their hand on my shoulder and arm. They purposely reached out and connected with me. At that point, both Susie and I knew that I was going to be OK and that I didn’t have to worry about the outcome. And guess what? They were correct.

So often in teaching the philosophy of the dental practice, we emphasize the accuracy of explaining a procedure in a confident and knowing manner to the patient. But how often do we execute the unconscious act of touching the patient at the critical moment, the moment that would perfectly connect with the patient? And not only connecting physically, but emotionally and spiritually as well. Therefore, my first lesson is to remind you to be in the moment with your patient, so that when you do have something important to relay, you can empathize with them. If your mind is on something else, you can’t fake it. If you’re not sure of the precise way to explain the process, you can’t fake it. And if you just don’t deeply believe in your own confidence, you can’t fake that, either.

34 Today's FDA

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FNDC2014 Speaker Preview The second step that I noticed over and over again was how prepared my doctors were. The communications had been sent, read and discussed between the cardiologist and the surgeon, as well as between the surgeon and his incredible team. They had rehearsed and performed these kinds of procedures so many times that they were experts. It was so comforting to be wheeled into the pre-surgery suite and be handled by such a team. Need I also mention again that each team member also was present and understood the rationale of talking, touching, caring and even joking? Yes, leadership starts at the top and filters down through the entire team. I could tell that each member was emulating the examples set by the doctor.

How do you rate in both office team preparedness and specialist team preparedness? I believe in and attempt to practice this same kind of preparation. As you probably know, I like to meet with my specialist and technicians on a regular basis. I like to go over cases repeatedly so that the bond between us can continually grow. Later this year there will be an interdisciplinary team course featuring an incredible group of specialists who work closely with my son, Dr. Daren Becker. I feel so fortunate to be included in that course, which we are all excited about.

The kind of connections and communications they insist upon leads to the same preparedness I observed with my cardiac team. Why should there be any less preparedness involved with complex restorative dentistry?

One of the most common questions I hear from someone entering into a dental practice is, “How do I get my team on board?” Well, how did the cardiac surgeon get his team on board? At my first office visit, Susie and I walked through the door and saw a sign that read, “Director of First Impressions.”

And guess what? The first impression was fabulous. Everyone knew their role and seemed extremely confident. Each team member had already received all the information from the cardiologist. They talked to each other and knew the plan forward and backward. It actually began to seem straightforward and almost predictable. That’s when the doctor told me I was “fixable” and I would be good as new. So here are some thoughts to consider, when pondering how to get your team on board. n Have the right team. What does your patient think about your team? n Practice. Do you get some practice time during team meetings? n Set the correct example. Do you have a written mission/vision statement? Is it printed and published for everyone to

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see? Do you know it by heart, and is it the central theme of everything that happens in your office? Are you always setting the example of a leader within your vision statement?

When discussing things with your team, do you frequently talk about WHY things are done in a certain way?

From the surgical suites to the first critical care suite to the step down recovery suite, my nursing care was spectacular. I met some of the nicest, most caring and knowledgeable nurses who could have been selected to take care of me and my family, as they worked diligently to not only supply great technical care, but offered the highest interpersonal skills available. I loved each and every one of them and they made our hospital stay exceptional.

The last part of my learning experience happened unexpectedly.

Perhaps it was because prior to and during most of the hospital stay, our three grown children joined my wife and me. Bringing us together (just the five of us and no grandchildren) allowed us to laugh, cry and get to an emotional high point that we found incredible. It became evident that healing and loving are so closely attuned. Having my family near allowed me to focus on healing, which in turn allowed me to get extremely emotional.

Feelings were freely expressed; it was overwhelming for all of us to be part of something so powerful, and I enjoyed the clarity of those emotional peaks.

I would ask you to allow yourself to get in touch with your deepest feelings, certainly with your loved ones, and even consider offering more care and love to your patients so that those same in-depth feelings can be shared by you and your patients.

Since I am back to work and seeing my TMD and bite problem patients, I believe I have connected on an even deeper level than ever before. When you are more in touch with your own feelings, you can more readily get in touch with the patient’s feelings. I believe today, that being present and being in touch are additional keys to help our patients heal physically and emotionally. And who knows, perhaps even spiritually?

Dr. Becker is part of a group practice in Miami. He is one of the keynote speakers at FNDC2014, and will be presenting all day Thursday, June 12th. His keynote session, “Inspiring Your Team to Reach Its Full Potential” will be held first thing Thursday morning, followed by “The Latest Secrets about Occlusion and Your Practice Growth/Profitability.” His final course, “Increasing Big Case Acceptance through Office Team Utilization,” will be held in the afternoon. He can be reached at Irwin@irwinbecker.com.

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FNDC2014 Speaker Preview

Application Approved!

By Carrie Millar

FDA Services Agency Manager

Millar

One of the components of the Affordable Care Act (ACA) is that no individual can be declined, rated up, or have specific exclusions for health insurance coverage based on pre-existing conditions. Prior to 2014, that was the case for individual/family plans. If someone was sick, had a prior incident or any other indicators, the insurance companies would just decline them.

This limited options for a lot of people and forced them to stay on plans that they purchased years ago.

Flash forward to today and the options have increased. Individuals that were forced on to small group plans or kept their current high price plan for all these years can now shop for insurance without fear of being declined. While rates have not significantly decreased, the different plan types, networks and options have. With this new influx in options comes an increased need for research and professional advice before you purchase.

The best advice I can give to consumers shopping for insurance is to make sure they understand the benefits in and out of network, the size of the network and the true premium amount.

All of these need to be taken into account, with how the plan will be used. Sounds like a lot — it is!

Case Study: Dr. R. called FDA Services in December to discuss whether he should keep his current small group health insurance plan or dissolve the plan and purchase individual health insurance for himself and his family. His spouse has a pre-existing condition and they had been declined in the past for an individual plan. While he was researching his options,

36 Today's FDA

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FNDC2014 Speaker Preview

a different insurance agent sent him a proposal $300 cheaper than the proposal provided by FDA Services. So, I asked him the questions below: n Is the out-of-pocket maximum the same? n Does Rx go towards the out-of-pocket maximum? n Do office visits for specialists, X-rays and labs have a co-pay, with the deductible waived (meaning you do not need to meet your deductible first)? n Does the network include all hospitals and specialists you would prefer to see? n Is the plan Health Savings Account (HSA) compatible if it has a high deductible?

ON L I N E

CE THE EASY WAY

FREE CE CREDITS FOR FDA MEMBERS 24 HOURS a day Free clinical and practice management CE Go to www.floridadental.org.

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Florida Dental Association Questions? Call 800.877.9922

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In this situation, Dr. R. figured out that the savings cost much more in the long run. While the deductibles for the plans were the same, everything was not equal. The cheaper plan had double the out-of-pocket maximum, had co-pays only for primary care visits, and used a much smaller network (only in five counties). Additionally, by not being HSA compatible, Dr. R would also miss out on the tax benefit of contributing to his HSA. Fortunately for Dr. R., he was able to make an educated decision knowing all costs, instead of just looking at premium cost and being locked in for a whole year.

Ms. Millar is the FDA Services Agency Manager. She will be a speaker at FNDC2014, presenting her course, “Understanding the Affordable Health Care Act.” It will be held on Thursday, June 12, 2014 at 1:30 p.m. She can be reached at carrie.millar@fdaservices.com or at 850.350.7155.

NEW THIS MONTH! DR. ALAN FETNER Hot Topics in Implant Dentistry (EL31) Expires 1/30/2015 DR. MARC GOTTLIEB Jewels You Can Use on Monday: Restorative Techniques to Increase Your Productivity (EL30) Expires 1/30/2015 EVERY ISSUE OF TODAY’S FDA Earn online CE credit by taking a quiz on ”Diagnostic Discussion.”

SUPPORTED BY A GRANT FROM THE AMERICAN DENTAL ASSOCIATION

March/April 2014 Today's FDA

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Mastering the Fine art OF dentistry

with wOrld Irwin Becker, DDS experts in Kirk Behrendt their Field! Samuel B. Low, DDS, MS, MEd ReneĂŠ Graham, RDH, MEd Gerard Kugel, DMD, MS, PhD Tieraona Low Dog, MD Nader Sharifi, DDS, MS Kelli Vrla, CSP, CRM

Creating a

Masterpiece JUNE 12-14, 2014 | ORLANDO, FL G AY L OR D PA L M S R E S ORT & C ON V E N T ION C E N T E R the OFFicial Meeting OF the FlOrida dental assOciatiOn

REGISTRATION NOW OPEN! fREE PRE-REGISTRaTIoN foR fDa MEMBER DENTISTS!

FNDC2014 NeeDs VIP HosPItalIty Hosts Are you interested in spending time with an EXPERT in your field and receiving free CE credits?

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$180 Per NiGht!

A deal so great …

you should book your room before you tell your friends!

FDA members have the opportunity to host the speaker of their choice at the 2014 Florida national Dental Convention. Get to know an expert in your field and learn from them in a personal setting not available anywhere else. be an FnDC host and you will receive free tuition to the speaker’s lecture course. You also will receive a lunch voucher for Exhibit hall concessions — all while performing an invaluable service for the FDA! Call now (800.877.9922, Ext. 7103) and sign up to host your favorite speaker today. You also can sign up online at www. floridadentalconvention.com under “Education.”

gaylorD Palms

June 12-14, 2014 | orlanDo, fl Plus, free Parking!

FNDC2014 block of rooms at the Gaylord Palms now open!

• reserve your room at the specially negotiated fnDC2014 convention rate of $180 per night.

• To make your hotel reservation, go to www.floridadentalconvention.com or contact the hotel at 407.586.2000.

Get into your team spirit! new dentist reception Friday, June 13 • 6:30-8 p.m. join your colleagues at the wedding Pavillion All dental students, new dentists (graduates since 2004) and their spouse or guest are invited.

(atrium – gaylord Palms).

Fun, Food and drink

Complimentary appetizers & drink tickets thanks to our sponsor! brought to you by the Fda subcouncil on the new dentist

Keynote Speakers

This year the FNDC is helping you start your day right with presentations from keynote speakers every morning from 8-9 a.m. Grab your coffee and join your colleagues for an hour of learning and credit earning!

Our dynamic lineup of speakers will inspire you and share knowledge that will make a positive difference for you, your practice, your patients and your office staff.

THURSDAY, JUNE 12

FRIDAY, JUNE 13

SATURDAY, JUNE 14

DR. IRWIN BECKER

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KELLI VRLA

INSPIRING YOUR TEAM TO REACH ITS FULL POTENTIAL NC01

WIN EVERY SEASON: THE KEYS TO TEAM SUCCESS  NC08

STRESS BUSTING WITH HUMOR NC12

8-9 AM  PRACTICE MANAGEMENT CE CREDITS: 1 AUDIENCE: DENTISTS, ASSISTANTS, HYGIENISTS, ADMINISTRATIVE STAFF, LABORATORY TECHNICIANS, GUESTS

8-9 AM  PRACTICE MANAGEMENT CE CREDITS: 1 AUDIENCE: DENTISTS, ASSISTANTS, HYGIENISTS, ADMINISTRATIVE STAFF, LABORATORY TECHNICIANS, GUESTS

Get ready to take your production to new heights! See the latest research from some of the best dental practices in the world that THINK differently than other dentists.

Bring your team to this tremendously valuable course to see how great practices produce more every year without working more hours.

Statistics show we work one-third of our lives, sleep one-third of our lives, and spend the final one-third of our lives with home and hobbies. Stress from our work lives is now creeping over into our home lives and vice versa. There’s a healthy line of balance that needs to be drawn. This lecture can help you find your balance, so you can focus on moving over, under, around and through your daily challenges!

This festive delivery of hit-the-groundrunning skills will help enlighten you and your team.

8-9 AM  COMMUNICATION CE CREDITS: 1 AUDIENCE: DENTISTS, ASSISTANTS, HYGIENISTS, ADMINISTRATIVE STAFF, LABORATORY TECHNICIANS, GUESTS

We are only as good as our team allows us to be! This presentation will focus on answers to key questions about creating an effective team. Dr. Becker will discuss improving the amount and manner of communication — specifically the lack of intentional listening and conscious observation. When everyone is tuned into their own intuitive feelings about the team and the individuals who make it a working machine, they can achieve their full potential!

DON’T FORGET TO SET YOUR ALARM. THESE FREE SESSIONS ARE WORTH WAKING UP FOR!

 YES! IT’S FREE FOR FDA MEMBERS, THEIR TEAMS, LAB TECHNICIANS AND STUDENTS!  PLEASE PRE-REGISTER FOR THIS MEMBERS-ONLY BENEFIT.  ALL OTHERS, PRE-REGISTER FOR $25.

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FNDC Staff

...

the

Scenes

at

FNDC

Always behave like a duck – keep calm and unruffled on the surface but paddle like the dickens underneath.

Meeting professionals are often known for their calm demeanor in stressful situations. However, most I know subscribe to this quotation as we often feel as though we’re moving as fast as we can to keep 95 balls in the air at once. It’s a good sign when our attendees or bosses don’t realize we’re paddling so fast. During the three months prior to FNDC, the paddling becomes positively ferocious! I am so grateful to have three “ducks” working with me on FNDC. They make quick decisions, they take immediate actions and they do it all with a smile on their face. I hope you enjoy getting to know a little more about them!

— Crissy Tallman, CAE, CMP, Director of Conventions and Continuing Education 42 Today's FDA

March/April 2014

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FNDC Staff Mary Weldon, Program Coordinator What is the most challenging part of your job? The most challenging part of my job is working with the speakers for the current year as well as the following two years. On average, that’s about 150 speakers that I am constantly collecting information from. Trying to gather the information, and by a certain deadline, can definitely be tough when you are dependent upon others.

What do you like best about your job? One of the best things about my job is that it’s always changing. Every year I get to work with a new scientific chair on their particular program. The task may be the same, but the speakers, their topics and theme of the meeting is different from year to year. And as a bonus, the ladies of the FNDC department are awesome and the FNDC committee members equally as wonderful.

What are you looking forward to the most at FNDC2014? The entire FNDC department works hard all year for those three days in June when the convention takes place. I look forward to seeing it all come together and realizing the importance of the part I play in making it happen. I also enjoy meeting the speakers in person that I have only spoken on the phone to or emailed.

What do you do in your spare time? In my spare time, I am usually at a baseball park watching my younger son play.

I also enjoy FSU football in the fall and baseball in the spring.

And when there is a free weekend, I love the beach or just relaxing by the pool.

Elizabeth Bassett, Exhibits Planner What is the most challenging part of your job? I would have to say the most challenging part of my job is trying to get companies to sign up for booths in advance to make sure the Exhibit Hall gets filled. It’s also a challenge to try to accommodate all of them.

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What do you like best about your job? Every day is different … something is always happening and I’m never bored! I also truly enjoy working with the FNDC team.

They’re a great group and we have a lot of fun working together.

What are you looking forward to the most at FNDC2014? I am looking forward to seeing the whole Exhibit Hall come together and making it a great experience for all of our exhibitors!

What do you do in your spare time? I love to travel!

My brother and his family live in Cape Town, South Africa, so I try to get there to visit as often as I can. And, I enjoy spending time at my beach house on St. George Island with my close friends.

Ashley Liveoak, Meeting Assistant What is the most challenging part of your job? I’m still pretty new, so everything is exciting!

What do you like best about your job? The best part of my job would be our team. I get to help everyone on the FNDC team, so my todo list/tasks are constantly changing, and I love that!

What are you looking forward to the most at FNDC2014? I am looking forward to seeing everything come together at FNDC and meeting everyone. I am also looking forward to karaoke at the “Sweet Success” event. Whether it’s participating or watching, karaoke always guarantees a good time!

What do you do in your spare time? In my spare time, I love being outdoors with my husband and our fur babies. We love to go camping, fishing, biking and exploring new places.

Otherwise, you can find me selling Thirty-One Gifts or launching my photography business, Oak Lane Photography. I also enjoy making different things, such as wreaths. I love hosting, baking and scrapbooking.

Photo: FNDC2014 staff (left to right): Mary Weldon, Program Coordinator; Elizabeth Bassett, Exhibits Planner; Ashley Liveoak, Meeting Assistant; and Crissy Tallman, Director of Conventions and Continuing Education.

March/April 2014 Today's FDA

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What’s New?

There’s always someThing good happening aT FndC, buT FNDC2014 has a loT oF new FeaTures you won’T wanT To miss! 

Checking into the hotel on Wednesday or Thursday? Take advantage of printing your badges in the hotel lobby from 4-9 p.m. FNDC committee members will be on hand to assist you. As a bonus, you will receive a small appreciation gift for staying with us, here at the Gaylord Palms Resort & Convention Center.



Awards Luncheon – Plan to attend this very special celebration luncheon that will recognize and honor our FDA President, Dr. Terry Buckenheimer, as well as the 2014 award recipients, including FDA Dentist of the Year! Tickets for the event are $35 per person or purchase a table of ten for $300.



ACLS Renewal Course – Is it time to recertify? Our ACLS recertification course is the perfect choice for participants whose certification will be expiring soon, while our airway management course satisfies the recent Board of Dentistry CE rule.



Exhibitor Appointments – We know your time is valuable. This year, you now have the ability to schedule one-on-one sessions prior to the meeting with the exhibitors that you want to see at FNDC2014. Avoid long waits and get more business done in half the time! Appointments range from 10-15 minutes. As an added plus, attendees who complete six or more appointments over the three days will be entered to win one of five $200 American Express gift cards.



Operatory Displays in the Exhibit Hall – Whether you’re just browsing or in the market for some new equipment... The FNDC and Henry Schein have you covered. Come check out our dental operatory displays on the exhibit floor. Design team members will be on hand to help you choose how to create your own office masterpiece.



Enhancements to the FNDC Mobile App – You can now access course handouts, view your course and exhibitor appointment schedules, and verify your CEUs. Download the 2014 app now at www.floridadentalconvention.com!



Epcot® Night Out! – On Saturday from 4-9 p.m., enjoy an Evening at Epcot® with your colleagues, friends and family at Epcot® Night Out! Drive yourself or take advantage of the Gaylord Palms shuttle. Tickets are $59 and must be purchased online by June 11.

The Gaylord Palms atrium is a destination in itself!

And, now you can add the benefit of Marriott rewards to your stay.

Diagnostic Discussion

Diagnostic Discussion

By Drs. Nadim Islam and Indraneel Bhattacharyya

A 47-year-old African-American patient was admitted to the hospitalist service at the University of Florida Health Science Center three weeks prior. She presented there with a past medical history (PMH) of high blood pressure, asthma and thyroid cancer s/p partial thyroidectomy in 2005, as well as renal problems. She presented at the Oral and Maxillofacial Surgery Clinic at the University of Florida College of Dentistry (UFCD) with rapidly developing facial swelling, pain, aggressive sinusitis, and newly diagnosed gum and bone destruction in the left maxilla, left pre-maxilla and left zygoma (Fig. 1).

The patient denied using tobacco, in any form, alcohol or any recreational drug.

After careful evaluation of her PMH, previous hospital admission records and the present symptoms, the oral surgeons’ finding was aggressive sinusitis with osteomyelitis of the left maxilla and zygoma, most likely due to the etiology causing teeth Nos. 8-12, and 15 to test non-vital. It also mentioned that the same etiology is likely responsible for the mobile left maxillary alveolar segment including teeth Nos. 12 and 15. The CT and panoramic radiographs revealed a cloudy sinus (Fig. 2). They additionally stated that they were unsure of etiology of sinusitis and osteomyelitis, but had

ruled out any odontogenic cause. Their recommendation was further management of aggressive sinusitis and osteomyelitis per an otolaryngologist, including consideration for biopsy/cultures.

A biopsy was performed and the tissue specimen was placed in 10 percent formalin and submitted to the UFCD, Oral and Maxillofacial Biopsy Service in Gainesville, Fla. Microscopic examination revealed a decalcified specimen composed largely of fragments of non-viable bone and granulation and fibrous tissue.

The fragments of septic necrotic bone exhibit extensive peripheral resorption, bacterial colonization, and large areas of hemorrhagic and fibrofatty bone marrow. The most conspicuous feature of the specimen is areas showing necrosis containing numerous large, branching, mostly nonseptate hyphae (Fig. 3).

Question: Based on the extensive medical history and the clinical, radiographic and microscopic features pictured and described above, what is the most likely diagnosis?

Fig. 2

A. Actinomycosis B. Tuberculosis with Caseous Necrosis C. Wegener’s Granulomatosis D. Zygomycosis (Polymorphic Reticulosis) E. Midline Lethal Granuloma (Mucormycosis)

Please see discussion, 46

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Fig. 1

Fig. 3

March/April 2014

Today's FDA

45

Diagnostic Discussion discussion from 45

Diagnostic Discussion A. Actinomycosis Incorrect, but a good guess! The Actinomyces species are filamentous, branching, gram-positive anaerobic bacteria.

They are commonly found in tonsillar crypts, plaque and calculus, carious dentin, gingival sulci and perio pockets.

More than 50 percent of the cases of actinomycosis arise in the cervicofacial region. In the cervicofacial region, these organisms enter the tissue through an area of prior trauma, a periodontal pocket, non-vital tooth, extraction socket or infected tonsil. Once inside the tissue, these normally harmless organisms thrive in the microaeorophillic tissue environment and often cause very destructive lesions, as seen in our patient. However, the histologic features were not confirmatory for this diagnosis.

B. Tuberculosis with Caseous Necrosis Incorrect — but is a possible thought!

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. The disease is spread by direct person-to-person contact with airborne droplets from patients with active disease. Infection must be distinguished from active disease, and less than 5 percent of patients progress from infection to active disease. When they do progress, immunosuppression is often responsible.

In fact, immunosuppression of AIDS has a high risk for progression to active disease. TB can cause massive destruction of bone and soft tissue, as seen in this case, but the histologic characteristics of TB were not present.

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C. Wegener’s Granulomatosis Incorrect. Great guess! Wegener’s granulomatosis (WG) is an uncommon autoimmune multi-system characterized by a pathologic triad consisting of: 1) necrotizing granulomatous lesions in the upper or lower respiratory tracts, or both; 2) systemic vasculitis involving both small arteries and veins; and 3) necrotizing glomerulonephritis. The corresponding clinical presentation of the disease may consist of rhinitis, sinusitis, and/or otitis media in conjunction with cough and hemoptysis. Just as in this case, mid-face deformities may be seen with sinus involvement. The histologic criteria for diagnosis of WG include vasculitis, ill-defined granulomata, multinucleated giant cells and necrosis. None of these histologic findings were found in our case, but the clinical findings were a great fit!

D. Midline Lethal Granuloma (Polymorphic Reticulosis) Incorrect — but a really good guess from a clinical standpoint. Midline lethal granuloma is a rare clinically aggressive, nonrelenting destructive process of the palate and nose. Most cases probably represent a T-cell lymphoma, a particularly nasty type of lymphoma.

Interestingly, most tumors do not have the histologic features of lymphoma, but behave like an aggressive one. This lesion most often presents in adults and symptoms include nasal stuffiness and epistaxis, which is a great fit for this patient! The lesions may be localized to the hard palatal region or may be much more widespread. Swelling of the soft or posterior hard palate may precede deep, necrotic ulcer formation. These tumors often occupy a midline position, and enlarge and destroy palatal tissues, creating an oronasal fistula. Therefore, the clinical

features of this condition closely mimic those seen in our patient. The deciding factor is the biopsy, which does not support a diagnosis of lymphoma.

E. Zygomycosis (Mucormycosis) Correct. Zygomycosis is an opportunistic fulminant fungal infection and is referred to the angiotropic (blood vessel-invading) infection produced by the various Zygomycetes. This disease is sometimes referred to as mucormycosis, but the term zygomycosis is preferred.

Mycoses caused by members of the family Mucorales (and sometimes the family Entomophthorales) are generally acute and rapidly developing in debilitated patients. The disease is associated with the acidotic diabetics, malnourished children and severely burned patients. It is also seen with leukemia, lymphoma, AIDS and use of immunosuppressive therapy, such as corticosteroids. The infection typically involves the rhino-facial-cranial area, lungs, gastrointestinal tract, skin or less commonly, other organ systems.

Zygomycetes are primitive, fast-growing, terrestrial, largely saprophytic fungi.

Numerous spores may be liberated in the air which eventually is inhaled by the human host. The fungi spread through the bloodstream as it invades the vessels of the arterial system, causing embolization and subsequent necrosis of surrounding tissue.

Rhinocerebral zygomycosis is the most frequent presentation overall and classically affects diabetics with ketoacidosis.

Diabetics, especially with ketoacidosis, are specifically predisposed to this infection, not only because of the chemotactic defects of their polymorphic neutrophils, but also because mucor grows best in an acidic, hyperglycemic medium. Zygomycosis usually presents with facial and/

www.floridadental.org

Diagnostic Discussion or eye pain, bloody nasal discharge and a paranasal sinus infection. Rhinocerebral disease in acidotic patients usually results in death, often within a few days. The factors contributing to sinus involvement in patients with diabetes are multifactorial. Patients with diabetes have more microvascular disease, and in concert with the delicate architecture of the sinuses, often results in massive tissue destruction and local dissemination. Radiographically, opacification and destruction of the sinus wall similar to a sinus malignancy may be noted.

Persons with no underlying condition or diabetes represented more than 50 percent of all patients with zygomycosis.

The clinical features are compatible with a devastating malignancy, a fulminant infection and perhaps an immune disease such as Wegener’s granulomatosis. Microscopic examination reveals fragments of non-viable, often septic (covered with bacteria), bone. The most conspicuous feature of the specimen is areas containing numerous large, branching, mostly nonseptate hyphae. The hyphae branch haphazardly with many forming 90-degree angles. The hyphae are quite large and measure 5-25 microns in diameter.

Once the fungi are recognized, the diagnosis becomes quite evident.

The prognosis is grave, especially when the rhinocerebral area is involved in patients with uncontrolled diabetes.

Control of the diabetes, aggressive surgical debridement of involved tissue, and high doses of amphotericin B are recom-

mended. Prognosis depends upon the nature of the underlying disease of the underlying disease: • 75 percent for immunocompetent patients • 60 percent for diabetic patients • 20 percent for patients with other systemic disorders, such as cancer Magnetic resonance imaging of the head is determinant in establishing the extent of involvement and surgical planning.

Despite the therapy, prognosis usually remains poor with surviving patients facing aesthetic and functional challenges due to the massive tissue destruction.

There has been little change in the overall mortality during the past 40 years, since the introduction of amphotericin B.

References: Paultauf A. Mycosis mucorina. Arch Path Anat 1885; 102:543.

Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment.

Clin Microbiol Infect 2004; 10 (Suppl 1):3147.

Ribes, J. A., C. L. Vanover-Sams, and D. J. Baker. 2000. Zygomycetes in human disease. Clin Microbiol Rev. 13:236-301.

Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL Epidemiology and outcome of zygomycosis: a review of 929 reported cases, Clin Infect Dis. 2005 Sep 1; 41(5):634-53.

Schlebusch S, Looke DF. Intraabdominal zygomycosis caused by Syncephalastrum racemosum infection successfully treated with partial surgical debridement and high-dose amphotericin B lipid complex. J Clin Microbiol. 2005 Nov; 43(11):5825-7.

Walsh TJ, Hiemenz JW, Seibel NL, et al: Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases. Clin Infect Dis 1998 Jun; 26(6): 1383-96.

Anaissie EJ, Andres E, Bowden RA et al., Treatment of 21 cases of invasive mucormycosis with Amphoteracin B colloidal dispersion.

Eur J Clin Infect Dis 20 (2001), pp. 460–466.

Dr. Islam

Dr. Bhattacharyya

Diagnostic Discussion is contributed

by UFCD professors, Drs. Nadim Islam, Indraneel Bhattacharyya and Don Cohen, and provides insight and feedback on common, important, new and challenging oral diseases.

The dental professors operate a large, multi-state biopsy service. The column’s case studies originate from the more than 10,000 specimens the service receives every year from all over the United States.

Clinicians are invited to submit cases from their Dr. Cohen own practices.

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

Drs. Islam, Bhattacharyya and Cohen can be reached at MIslam@dental.ufl.edu, ibhattacharyya@dental.ufl.edu and dcohen@ dental.ufl.edu, respectively.

Anstadt MP, Hedge SS, Lowe JE, Spratt J, Tedder M, and Tedder SD. Pulmonary mucormycosis: results of medical and surgical treatment. Ann Thorac Surg 57 (1994), pp. 1044–1050.

Ferguson BJ. Mucormycosis of the nose and paranasal sinuses.

Otolaryngol Clin North Am 2000; 33:34965.

Continuing Education Opportunity You can now earn continuing education credit for reading Diagnostic Discussion articles! Visit the FDA website at www.floridadental.org and click “Online Education” under the “Benefits and Resources” tab for this free, members-only benefit. You will be given the opportunity to review this column and its accompanying photos, and will be asked to answer five additional questions. If you have questions about this opportunity, email FNDC Meeting Assitant, Ashley Liveoak at aliveoak@floridadental.org or call 800.877.9922.

Be sure you are logged in to the members-only side of www.floridadental.org to access the online CE.

Sweet Success

Thursday Night Rocks!

CELEBRATING OUR PROJECT: DENTISTS CARE, MISSION OF MERCY & GIVE KIDS A SMILE VOLUNTEERS

Thursday, June 12  7-10 PM  Gaylord Palms Atrium

What could be better than a night in the spotlight and chocolate? Join us as we honor our Project: Dentists Care, Florida Mission of Mercy and Give Kids a Smile volunteers with a night of fun.

Karaoke LIVE will be the centerpiece – YOU are the star of this show. Step into the spotlight, center stage, to jam with a LIVE band and backup singers who make everyone look like a ROCK STAR! Come enjoy the sweet desserts, fun entertainment and take a chance at stardom. Everyone is invited. Request your FREE ticket (SSS) while registering.

FDA MISSION OF MERCY A PROGRAM OF THE FLORIDA DENTAL ASSOCIATION

BOOTH 421

IN THE CENTER OF THE EXHIBIT HALL

VISIT US AT FNDC2014.

TOSS FOR A TOAST and win a bottle of wine.

Recruit a new member — bring them to the Member Benefits Center to sign up.

Ask all those burning questions about your FDA benefits, including the FDA professional liability program from The Doctors Company and other opportunities for great service and competitive pricing from FDA Services.

FLORIDA DENTAL ASSOCIATION • FDA SERVICES THE DOCTORS COMPANY FDA CORPORATE AFFILIATION PROGRAM VISIT US AT FNDC2014.

NE W

!

One aisle packed with savings especially for FDA members!

BOOTH 523 BOOTH 517 Insurance Provider Credentialing – In this new program, FDA members receive a 10 percent reduction on services from Insurance Credentialing Specialist (ICS). Complete one application and let ICS do the rest.

Contact: 561.422.9938 or www.insurancecredentialing.com.

BOOTH 415 Dental Supplies – FDA members get preferred pricing as negotiated by FDAS with average savings of 18-22 percent. Contact: 800.448.7323.

BOOTH 616 Dental Websites and Internet Marketing – FDA members have access to a complete, turnkey Internet solution at a discounted rate.

Contact: 877.484.7187 or visit http://www.officite.com/fda.

Go to www.fdaservices.com for more information.

Health-care Financing – financing for equipment, practice start-up or acquisition, practice debt consolidation and refinancing, and lines of credit for business supplies. Contact: 800.497.6076.

BOOTH 521 A Flexible Financing Program for Patients – CareCredit is a patient credit-card program that provides an alternative method for patients to pay for dental procedures. Contact: 800.839.9078 or www.carecredit.com.

BOOTH 515 Office Supplies – Offers members a variety of discounts and services, including prices 5 percent less than the Office Depot “Big-Book” catalog.

Contact: 850.273.0695 or email davidherold@officedepot.com.

BOOTH 514 Automated marketing & communications – Communicate with your patients, and generate new business. Includes automated email & text message appointment Contact: 800.210.0355 demandforce.com/fda

Exhibit Marketplace How many times have you felt torn between going to the Exhibit Hall and attending our invaluable CE sessions? To ease that dilemma, we’ve added dedicated Exhibit Hall hours each day from 11:30 a.m.-1:30 p.m. During this time, no educational sessions will take place.

NEW! Look for booth specials only available during FNDC2014 in the May/June issue of Today’s FDA. These discount offers are sure to improve your bottom line!

EXHIBIT HALL HOURS  Thursday, June 12 9:30 AM - 5:30 PM  Friday, June 13 9:30 AM - 5:30 PM  Saturday, June 14 9:30 AM - 2:30 PM Dedicated Exhibit Hall Hours 11:30 a.m.-1:30 p.m.

3M ESPE

A A-dec A. Titan Instruments Accelerated Wealth Accutron Inc. ACTEON North America ADS Florida LLC Advantage Technologies Advantica AFTCO Air Techniques Inc. AMD Lasers, A DENTSPLY International Company American Express OPEN Angie’s List Arminco Inc. Aseptico Inc. Aspen Dental Atlanta Dental Supply Atlantic Dental Sales Inc./Brewer Design

B

Bank of America Practice Solutions Bankers Healthcare Group Bayshore Dental Studio Belmont Equipment Benco Dental Bien-Air Dental Bioclear Matrix System by Dr. David Clark BioHorizons Implant Systems BIOLASE Biotec Bisco Dental Products BQ Ergonomics LLC Brasseler USA Bright Now! Dental/Smile Brands Inc.

C CareCredit Careington International Carestream Dental Centrix Inc. Chase Dental SleepCare Citibank CliniPix Inc. Coast Dental P.A. Colgate COLTENE Columbia Dentoform Crest Oral-B CustomAir CUTCO Cutlery

D Darby Dental Supply LLC Delta Dental Insurance Company Demandforce Inc. DenMat LLC Dental Access Mobile Clinics LLC Dental Care Alliance Dental Equipment Liquidators Inc. Dental PC Dental Sleep Solutions Dental USA Inc. DentalEZ Group DentalVibe DentaQuest DENTCA Inc. Dentegra Insurance Company DENTSPLY Caulk DENTSPLY Implants DENTSPLY International DENTSPLY Maillefer DENTSPLY Professional DENTSPLY Raintree Essix Glenroe DENTSPLY Rinn DENTSPLY Tulsa Dental Specialties Denttio-CamSight Designs For Vision Inc.

DEXIS Digital X-Ray Digital Doc LLC Doctor’s Choice Companies Inc. Doral Refining Corporation DoWell Dental Products Doxa Dental Inc. Dynamic Dental Partners Group

E efDA Training LLC Essential Dental Systems

F Florida Capital Bank Florida Combined Life FDA Services Inc. Forest Dental Products Inc. Fortress Insurance Company Fortune Management of Florida

G Garfield Refining Company Garrison Dental Solutions GC America Inc. Gems Insiders Circle Gendex Dental Systems Gentle Dental GlaxoSmithKline Great Expressions Dental Centers Greater New York Dental Meeting

H H2Ocean Inc. Hager Worldwide Hawaiian Moon Hayes Handpiece Repair Healthcare Professional Funding HealthFirst Heartland Dental Henry Schein Dental Henry Schein Practice Management Solutions Heraeus Kulzer Home Study Solutions Hu-Friedy Manufacturing Co. LLC

I i-CAT Imaging Sciences ICW International Implant Educators Inada Massage Chairs Infinite Therapeutics Instrumentarium/Soredex Insurance Credentialing Specialist Ivoclar Vivadent Inc.

FDA Services Inc. is a major sponsor of the Florida National Dental Convention.

SUPPORT THE COMPANIES THAT SUPPORT ORGANIZED DENTISTRY

K KaVo Kenwood/CGX Radios Kerr Corporation Kettenbach LP Kimberly-Clark Healthcare Knotty Floss LLC KOMET USA Kuraray America Inc.

L Lares Research Lasers4Dentistry/Technology4Medicine Laxmi Dental Lab USA LECOM School of Dental Medicine Lexicomp LIBERTY Dental Plan LumaDent Inc.

M Magic Massage Therapy Magnified Video Devices Inc. Market Connections Inc MASC Data Systems MCNA Dental Plans Medidenta Meisinger USA LLC Microcopy Midmark Corporation Milestone Scientific Millennium Dental Technologies Inc. Modular & Custom Cabinets

N Nevin Labs Newman & Marquez PA Nobel Biocare Nova Southeastern University NSK Dental LLC

O OCO Biomedical Office Depot Officite Onpharma Inc. OraPharma Inc. Orascoptic

P Paragon Dental Transitions Patterson Dental Pelton & Crane PeriOptix, a DenMat Company Philips - Sonicare & Zoom Whitening Piper Education & Research Center Planmeca USA Inc.

PNC Bank Precision Dx / Global Dental Solutions Prexion Professional Sales Associates Inc. Proma Propel Orthodontics Prophy Magic Prophy Perfect Pulpdent Corporation

Q QSI Dental

R

EXHIBITORS AS OF MARCH 18, 2014

V Vatech America Video Dental Concepts Vitamix VOCO America Inc.

W Wells Fargo Practice Finance

XYZ Xlear/Spry Yodle Zimmer Dental

RAMVAC Reliable Arts Dental Lab RFAmerica IDS RGP Inc. Rose Micro Solutions Royal Dental Group & Porter Instrument Co.

S Sales & Marketing Technologies Schumacher Dental Instruments SciCan Inc. SDI (North America) Inc. Sesame Communications Shamrock Dental Company Inc. SharperPractice Shofu Dental Corporation Sierra Dental Products Sirona Dental Smile Reminder Snap on Optics Specialty Appliances Orthodontic Laboratory StarDental Sun Dental Labs Sunrise Dental Equipment Sunset Dental Lab Superior Dental Design Services & Upholstery SurgiTel/General Scientific Corp.

T TD Bank TeleVox The Doctors Company The Paragon Program Tokuyama Dental America Inc.

U University of Florida College of Dentistry Ultradent Products Inc. Ultralight Optics U.S. Air Force Recruiting U.S. Army Healthcare Recruiting U.S. Navy Recruiting

MAKE AN APPOINTMENT! NEW THIS YEAR!  You now have the ability to schedule one-on-one sessions, prior to the meeting, with the exhibitors that you want to see at FNDC2014.  Appointments will range from 10-15 minutes so you can get more business done in half the time! Attendees will be able to search for products, find the company they would like to meet with at the show and request an appointment with that company.  Schedule appointments during your online registration or by visiting floridadentalconvention.com. Once appointments are confirmed, you can print your schedule of appointments or view them on the FNDC mobile app.  As an added plus, attendees who complete six or more appointments over the three days will be entered to win one of five $200 American Express gift cards.

Blue indicates a Member of the FDA Corporate Affiliation Program

CDHC

The Community Dental Health Coordinator A Valued New Member of the Dental Team

“

Jenna was able to take the role of the CDHC to a new level in her five weeks with us; there was not an outreach or educational opportunity that escaped her expertise, and it saved our staff countless hours of work.

By Dr. Jane Grover

Director of Council on Access, Prevention and Interprofessional Relations

In the quest to promote oral health to underserved populations, as well as navigate people into a dental home, a new member of the dental team has emerged.

A community dental health coordinator (CDHC) is a “connector” between populations of patients and a dental office. Their activities in connecting people to care have been documented both in the three-year pilot program conducted by the American Dental Association (ADA) and in several sabbaticals that have been done across the country. These professionals complete an online program and internship that typically lasts a little more than a year. CDHCs comply with the state dental practice act and work under the supervision of a dentist.

CDHCs may be dental hygienists, assistants or other health professionals. As of Fall 2013, the ADA’s CDHC project has graduated 34 students who are now working in eight states: Wisconsin, Montana, Pennsylvania, Arizona, Oklahoma, Texas, California and Minnesota.

”

­­— Dr. Richard Huot

The role of the CDHC is threefold: educating the community about the

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importance of dental health and healthy behaviors; providing limited preventive services, such as fluoride varnish, dental sealants and simple cleanings; and connecting the community to dental teams who can provide more complex care.

Experience of more than three years has shown us that case management and navigation are the significant areas where CDHCs have shown their tremendous value.

At first glance, many ask why “navigation” is needed in the dental care world.

Can’t people just pick up a phone and call a dental office? As a former dental director and clinician (for 12 years) in a community health center in Michigan, I can tell you from experience that it sounds easy, but in reality it is challenging. Every day in the health center, there would be at least one parent bringing in a child with a toothache who would exclaim, “I just found out about this place — I didn’t know you all were here!”

Jenna Linden graduated from the University of Minnesota in 2008 with a Bachelor’s degree in Dental Hygiene.

While working as a dental hygienist, she enrolled in the third class of the American Dental Association’s CDHC pilot program, receiving her training through www.floridadental.org

CDHC Rio Salado College and Arizona School of Dentistry and Oral Health.

During two short-term sabbaticals — one in Vermont and the other in Florida — Ms. Linden helped coordinate care for and provide oral health education to more than 2,800 people last year. As a CDHC, Ms. Linden addressed barriers to oral health by providing patient navigation for people who typically do not receive care for a variety of reasons — among them poverty, geography, language, culture, and a lack of understanding of oral hygiene and the importance of regular dental visits. There also are many patients with commercial dental insurance who are unsure of “how to find a dentist” or to find one who accepts their specific dental insurance, such as Delta, Aetna or Blue Cross.

So the question becomes obvious: How can we help busy, stressed out people “find” a dental home, while at the same time promote the value of oral health within the community? The answer is having someone linked to a community clinic or a private dental office working out in the community promoting preventive services to vulnerable populations and “connecting” them to dental care.

That person is a CDHC. Statistics tell us that only 53 percent (less in some states) of Medicaid-eligible children received a preventive visit in 2012. An interesting statistic shows that patients under age 21 with commercial insurance were also in that same percentile in a number of states. So, how can those folks be “navigated” into care? If someone is working directly with a community, describing dental services and navigating them into care, the use of a CDHC can significantly improve a private dental office or a community clinic.

www.floridadental.org

Photo Credit: Jessica Creagan, Hometown News

(Left to right) Dr. Richard Huot, Ms. Becky Garcia, site manager at the Fellsmere clinic, Mr. Moses Santos, medical outreach director at TCCH and Ms. Jenna Linden meet at the Treasure Coast Community Center in Vero Beach.

During her six-week sabbatical in Winooski, Vt., Ms. Linden helped about 1,300 people through a variety of programs designed to coordinate care with a non-profit private dental practice, Vermont Dental Care. In collaboration with the school district’s nurses and interpreters, she implemented a transportation program from schools to Vermont Dental Care to assist students and their families in overcoming language, work schedule and transportation barriers. She also coordinated dental screenings at the local senior center, taught dental health at nursing home in-services, located untapped financial resources and promoted oral health awareness at teen centers, women’s homes and community events.

Ms. Linden’s second sabbatical was at Treasure Coast Community Center, which is a Federally Qualified Health Center in Vero Beach, Fla. During her five-week stint, she reached more than 1,500 community members by coordinating referrals for high-risk pediatric patients, integrating medical and dental staff efforts for early education and prevention of dental disease, and educating pregnant mothers at a women’s care center. She also worked closely with the

Redlands Christian Migrant Association Head Start Program to educate families and staff members about prevention and access to dental care.

For CDHCs who have done sabbaticals, the results have been remarkable. They spent one to four months in community settings working with individuals within Head Start programs, elementary schools, assisted living facilities, hospital clinics and private practices. For the pilot phase of the program, more than 11,000 patients were impacted by a CDHC. “I feel so fortunate to be a part of the efforts to increase access to dental care by breaking down barriers and instilling healthy habits for a lifetime,” Ms. Linden said.

By connecting vulnerable populations to dental care, the CDHC is the new member of the dental team who can show that patient navigation is the key part of addressing access to dental care.

Dr. Grover is the American Dental Association’s Director of the Council on Access, Prevention and Interprofessional Relations.

She can be reached at groverj@ada.org.

March/April 2014

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Member Benefits

AT FNDC2014

Oh Yes!

I T’S

FREE!



FREE PRE-REGISTRATION FOR ALL FDA MEMBER DENTISTS!



FREE continuing education courses!

Throughout the course listings, you will see continuing education courses offered at no cost to YOU, the FDA member dentist. Some courses are sponsored by our exhibiting companies and are being held in two classrooms on the Exhibit Hall floor; others are in the traditional classrooms on the Ballroom Level. All of the free courses require advance registration and are on a first-come, first-served basis. Register early, as we anticipate that these seats will be filled during pre-registration.

These courses are the same, high-quality courses you have come to expect at FNDC. We are offering them as a member benefit to FDA member dentists who attend FNDC. Look through the registration guide and the registration form to see if one of these classes is of interest to you and then REGISTER IMMEDIATELY! At these prices, tickets won’t last!



FREE lunch on Thursday!

Any registered attendee who purchases course tickets for both a Thursday morning and Thursday afternoon course will receive a $15 lunch voucher — FREE. That’s right, purchase two courses on Thursday and we’ll buy your lunch. Lunch vouchers are good for lunch cash concessions in the Exhibit Hall on Thursday. There will be a selection of fresh sandwiches, salads and a hot blue plate special available during our dedicated Exhibit Hall hours from 11:30 a.m. to 1:30 p.m. Come, relax, visit some of the vendors and have lunch on us.



FREE self-parking for hotel guests!

After you’ve registered, don’t forget to make your hotel reservation at the Gaylord Palms Resort & Convention Center. Mention you’re with the FNDC to receive the $180 rate that includes FREE parking.

To make your hotel reservation, contact the hotel at 407.586.2000 or go to www.floridadentalconvention.com to make your reservation online.



58

GAYLORD PALMS HAS A SPECIAL ROOM RATE FOR FNDC2014!

$180/NIGHT

FREE Wi-Fi in your hotel room and on the classroom level!

We know you need to stay connected to the office and family back at home. Bring your laptop, iPad or cell phone and stay plugged in. Battery running low or just need a place to relax? Recharge in one of our Wi-Fi lounge areas.

Today's FDA

March/April 2014

www.floridadental.org

Get on the Bus! volunteer at fndc.

Project: Dentists Care and FNDC2014 have joined forces to help Florida’s foster kids.

During FNDC2014, Dentists, Hygienists, Assistants and Dental Students will have an opportunity to volunteer to provide pro bono treatment for a group of area foster children. Participants will receive continuing education credit for their efforts. Sign up early, as space is limited! The treatment vans, provided by the Orange County Health Department, Colgate Oral Pharmaceuticals and the Florida Baptist Convention, will be located on the trade show floor and will operate during Exhibit Hall hours.

To register as a volunteer, please check the box next to “Yes, I want to volunteer for PDC@FNDC,” on the registration form and choose a time: Thursday, June 12 – 9:30-a.m. to Noon or 1-4 p.m.; or Friday, June 13 – 9:30-a.m. to Noon or 1-4 p.m. You can also register online by searching for keyword “PDC” during course selection. Thank you for joining Project: Dentists Care and helping to make a child’s heart smile!

building partnerships to build healthy smiles

www.floridadental.org

March/April 2014

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59

Abstracts

Emergency Stabilization of an Avulsed Central Incisor

By Mark S. Coican, DMD, MS

On Sept. 5, 2004, the east coast of Florida was struck by Hurricane Frances. As part of the relief effort, the Federal Emergency Management Agency (FEMA) was alerted and dispatched a medical team to Holmes Regional Medical Center, a Level II Trauma Center in Melbourne, Fla. A Disaster Medical Assistance Team (DMAT) from North Carolina established a mobile medical facility with the emergency department to aid with the patient load.

A 53-year-old Caucasian male presented to the DMAT with facial trauma from being struck by a van door. He exhibited lacerations to the upper lip and chin Fig. 1 that were examined and sutured under local anesthesia. The patient also reported the upper right central incisor had avulsed; he immediately re-implanted it into the socket prior to arriving at the hospital.

Even though the patient reported minimal discomfort or mobility, the medical team was concerned over the possibility that the incisor would become dislodged and potentially aspirated (Fig. 1).

Clinically, the maxillary anterior dental segment was only minimally crowded, with the involved incisor well-seeded in the alveolus. No alveolar fracture was palpated and there

Fig. 2

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was minimal hemorrhaging. The method of choice to repair would be passive wire fixation with a light twist wire segment directly bonded to the anterior segment. However, due to the lack of dental facilities, this methodology was not available. As a creative option, 3-0 silk suture was used to secure the tooth until it could be definitively evaluated and treated by a general dentist. The re-implanted incisor was “slung� by two lengths of suture to create an apical force to maintain it in the socket.

(Fig. 2).

The free ends were threaded interproximately (Fig. 3) and tied around the surrounding abutments.

(Fig. 4) Post operative instructions included: eat a soft diet; avoid using the incisors; and, clean but not floss the area. An antibiotic (Keflex) and analgesic (Lortab) were prescribed. It was stressed that the Fig. 4 patient see the general dentist to initiate nonsurgical endodontics within seven to 10 days. He was also instructed to inform the dentist that the incisor had been avulsed in order to avoid dislodging it during later treatment. This protocol may provide an option for emergency traumatic dental fixation in other natural disasters or mishaps such as eartquakes, forest firest, and mountain climbing accidents.

Fig. 3

www.floridadental.org

Abstracts

Oral Shield Use in a Post-trauma Patient the lips outward.

A four-point fixation was accomplished around the neck area using tracheostomy ties (Fig. 2). Once in position, the shield prevented the teeth from biting the lip. In fact, the patient began to suck on the appliance and he tolerated the procedure well.

By Mark S. Coican, DMD, MS

A 17-year-old African-American male was involved in a severe motor vehicle accident and suffered from severe cranial trauma.

The patient remained in a persistent vegetative state following surgical intervention. A consult was requested by the intensive care unit staff to address a severe lip biting habit (Fig. 1). His surgeon requested placement of fixed orthodontic appliances and wire fixation. Since the patient was breathing via a tracheostomy, there was a concern over suffocation in the event of obstruction due to vomiting or fluid aspiration. The use of intermaxillary elastics for fixation was also discouraged due to the potential tooth movement from eccentric mandibular posturing.

A makeshift, conservative approach involved the use of a modified oral shield. A pacifier (Gerber) was used with the rubber portion removed to prevent him from chewing on and swallowing it.

The shield portion was positioned under the lips and over the teeth in order to reflect

Fig. 2

The staff was instructed to insert the appliance during the periods of arousal to avoid soft tissue trauma. Appliance care and daily hygiene protocols were reviewed. While hospital-based care is not a usual occurrence in private orthodontic practice, the orthodontist is in a position to be of value to the medical community.

Dr. Coican practices orthodontics in Palm Bay and can be reached at mscoican@excite.com.

Fig. 1

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Dental Staff

Ultimate Doctor-patient

Creating the

Hygiene Exam

By Karen Davis, RDH, BSDH

We’ve all felt frustrated! It seems like the exam portion of the hygiene visit often leads to increased stress. See if either of these scenarios sounds familiar: The clinical assistant and dental hygienist are getting anxious since it took forever to get the doctor into the hygiene appointment, and now it’s taking forever to get the doctor out …

The patient is frustrated after waiting 10 minutes beyond her appointment time for the doctor to complete a 60-second exam that costs $40 …

While there’s no easy fix to these common frustrations, there are steps to make the doctor-patient examination more valuable and less stressful for all concerned. But here’s a warning: Some of these concepts may take you out of your comfort zone, and some may require practice to go smoothly and feel natural.

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Here are a few strategies to help you create your own ultimate exam within the dental hygiene appointment.

1. Use screenings to determine diagnosis while practicing the art of prioritization.

In practice after practice, dental hygienists are desperately attempting to educate patients, change behavior, scale supraand subgingival calculus, remove all stain and plaque, perform and record periodontal evaluations, perform CAMBRA, update radiographs, apply fluoride, discuss restorative and esthetic concerns, and so on — all in one appointment that lasts 40-60 minutes, if the appointment starts on time! Sound impossible? It often is.

Learning the art of prioritization enables dental hygienists to proceed through various screenings to identify conditions, and then prioritize procedures for the day’s visit while treatment planning for subsequent visits. Mastering this concept

is good time management, and it helps determine appropriate services. Some patients scheduled for a prophylaxis actually present with evidence of active periodontal infection, so they may require additional diagnostic data to confirm a diagnosis and present a treatment plan. Additional services and procedures can be completed during subsequent visits, such as the use of a shade guide to discuss whitening options or implementing caries risk management strategies.

The challenge for many dental professionals is letting go of the idea that everything should be accomplished in one visit. When attempting to cram too much into one visit, patients may seem dazed as they exit the treatment room, and they may feel that things were rushed. Dental hygienists can refine the art of prioritization as they proceed through the various screenings, identify the priorities for today’s visit, and carefully treatment plan priority procedures for the next visit. Here’s an example of screenings used to identify priorities: www.floridadental.org

Dental Staff

m screening for any known sensitivity m medical history update, including risk assessments for disease m blood pressure screening m radiographic assessment to update or review previous films m oral cancer screening, including intra- and extraoral exam, and use of adjunctive screening technology, as indicated m periodontal screening, including an annual comprehensive periodontal assessment as recommended by the American Academy of Periodontology1, and salivary diagnostic tests, as indicated m caries management by risk assessment (CAMBRA), including caries detection technology and interventions to lower risk and implement remineralization strategies m restorative and esthetic screening, including identification of occlusal disease During data collection, priorities will begin to emerge that enable the clinician to provide treatment based upon diagnosis.

Sometimes what appears a priority based on a past clinical chart gets completely overridden by different priorities.

Here’s an example: Beverly’s chart states that at her next visit, the dental hygienist will provide the oral cancer screening using the adjunctive technology Identifi®.

It has been slightly more than two years since her bitewings were updated. However, Beverly arrives 15 minutes late and upon examination, the dental hygienist notices a very dry mouth and a fractured

www.floridadental.org

resin restoration. But Beverly’s biggest concern is to know more about Invisalign®. What are the highest priorities for the visit today? What does the dental hygienist defer to the next visit?

Decisions like this happen almost hourly with dental hygiene appointments. The answers are different depending on each situation, but unless one has developed the art of prioritization, this scenario leads to the dental hygienist trying to accomplish too much in one visit, and everyone feels rushed. One way to approach the scenario with Beverly is to recommend that the next restorative appointment include time to not only repair the broken resin, but to update and examine the bitewings and scan the patient for Invisalign®. If additional diagnostic information is required for consideration of Invisalign®, D0140, limited oral evaluation can also be used.

This enables the dental hygienist to streamline the priorities for today’s visit and meet the patient’s needs.

2. Identify candidates for more comprehensive examinations.

The most common examination provided during dental hygiene visits is the periodic oral evaluation, insurance code D0120. While that type of exam is often appropriate for continuous-care patients visiting for preventive or maintenance procedures, dental hygienists should identify when other types of exams are indicated.

Let’s look at a scenario where another exam would be beneficial. The dental hygienist sees Joseph, who inquires about tooth whitening, but upon examination,

the hygienist identifies several stained Class I restorations on Joseph’s upper anterior teeth and visible abfraction lesions and wear facets on his posterior teeth.

The dental hygienist uses an intraoral camera to take pictures of the stained resins, abfraction lesions and wear facets.

She presents the idea that in some cases, porcelain veneers are best for teeth like Joseph’s in the upper arch, while whitening is appropriate for the lower arch.

Telling the patient this may go as follows: “Joseph, what Dr. Jones generally recommends in a situation like yours is for the two of you to set aside time for her to perform a more detailed examination of your bite and determine which procedures are best to enhance your smile. There are actually several options available, so it would be advantageous to look carefully at your bite and determine what will give you the best outcome.”

During the dental hygiene appointment, she discovers that Joseph also presents with evidence of early demineralization, so her priority during the visit is to perform CAMBRA and implement strategies for remineralization. The patient is rescheduled to see the dentist for D0140 – limited oral evaluation, in which diagnostic casts are taken and occlusal disease is assessed. Joseph’s treatment plan includes porcelain veneers for Nos. 5-12, Philips Zoom® Whitening for the lower arch, and an occlusal guard to protect his smile. Using the D040 evaluation to gather current diagnostic information and discuss the pros and cons of various treatment options enables Joseph to make a well-informed decision about Please see ultimate, 66

March/April 2014 Today's FDA

65

Dental Staff for the doctor to immediately leave a procedure to examine a dental hygiene patient. The result? Everybody waits, and a domino effect takes place within the schedule. Notifying the doctor once data has been collected and treatment discussed enables the doctor to look for a natural break in a procedure and perform the exam. This approach requires dental hygienists to get in the habit of notifying the doctor after the data collection and clinical discussion, but prior to beginning instrumentation.

ultimate from 65

how best to enhance his smile. Table 1 presents three clinical oral evaluations as described by the ADA. Shown in italics are examples of when these types of evaluations would be advantageous in lieu of or in addition to the D0120 – periodic oral evaluation.

3. Don’t wait until the last five minutes of the appointment to give the exam.

Time management is a challenge when taking care of patients’ health needs, answering their questions and providing treatments within a wide range of clinical conditions. In most busy dental practices, waiting until the dental hygienist is completely finished before notifying the doctor for an exam almost guarantees you’ll run behind. It’s often impossible

4. Use visuals to replace wordy descriptions.

Patients will understand and retain information much better if audible and visual learning takes place together.

Instead of doing all of the talking (while working on the patient with sharp instruments), we should let “a picture speak a thousand words” for us. Intra-

oral pictures, before-and-after photos, educational pamphlets, radiographs, and periodontal charts help patients understand and desire recommended treatment. When looking at a picture together, ask, “Do you see the crack in your tooth?” or “Do you see the wear on this tooth where the enamel is gone?”

This will give patients a sense of ownership about their conditions. Sometimes dental professionals have a tendency to use terms that are too technical and describe more detail than most patients really need. Effective treatment enrollment takes place when both the patient and clinician see what’s going on in the patient’s mouth.

5. Sit the patient upright for communication.

If you have been a patient in the dental chair, you know how uncomfortable it can be to carry on a conversation with

Table 1: ADA Procedure codes, descriptions and examples of clinical scenarios for use of these evaluations in lieu of, or in addition to, the D0120 – Periodic evaluation.

ADA

Procedure

Brief

Example Example Example

Code

Description

D0140

limited oral evaluation – problem focused

specific problem or concern

patient with acute TMJ dysfunction

patient needing an esthetic work-up

patient presenting with peri-implantitis

D0150

comprehensive oral evaluation

new or established patients with changes in health or oral environment; thorough intra and extraoral evaluation

Existing patient with significant pending treatment that recently broke a tooth at the gum line.

Existing patient with numerous sites of active decay and multiple risk factors for caries.

Existing patient considering lower implant denture versus replacement of existing bridges.

D0180

comprehensive periodontal evaluation

new or established patients with periodontal risk factors; thorough oral, medical and health assessment

Existing periodontal patient who has generalized recession and multiple risk factors requiring more time for evaluation.

Existing patient who has never been diagnosed with periodontal disease, but has clinical evidence of pocketing and bleeding.

Existing patient missed periodontal maintenance care for more than a year and smokes a pack of cigarettes a day.

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www.floridadental.org

Dental Staff someone who is seated above you with protective barriers covering their face.

Studies have shown that as apprehension rises, listening ability diminishes.

Patients often begin their hygiene visit apprehensive about what you’re going to tell them. Laying them back in a supine position and adding sharp instruments to the scenario increases their potential for apprehension. Yet most clinicians begin to multitask and use the opportunity to educate patients. If you’re willing to pause, sit the patient upright to discuss possible treatment, educate them, and use visuals, you’ll find you actually have to say less because their ability to retain information is significantly greater with good eye contact and body positioning.

Sitting the patient upright also enables clinicians to become better listeners as patients feel more comfortable discussing their concerns.

6. Use a “triangle of communication” for the dental hygienist’s synopsis of findings.

When the dentist enters the hygiene treatment room for the exam, generally the first thing that happens is an exchange of social graces and an update about any concerns the patient may have. Often during the social graces, the hygienist is busy writing chart notes and is not part of the examination. Because it is important for the patient to hear the dentist ask the hygienist for his or her findings, the dentist might say something like, “So Cindy, how did everything look in Barbara’s mouth today?”

This is the dental hygienist’s cue to enter into a triangle of close communication between the patient, dentist and hygienist. The hygienist should give a brief description of diagnostic data, discuss

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potential treatment and listen to the patient’s response. An easy way to be consistent in delivery of this information is to remember the acronym DDR, which stands for data, discussion, and response.

Here is an example of the dental hygienist’s synopsis; notice the inclusion of DDR. “Barbara was a great patient today. The periodontal screening revealed several areas of localized periodontal infection in her mouth. Barbara is concerned because both of her parents lost their teeth around age 50 and she hopes to keep hers for a lifetime. We have discussed the benefits of periodontal therapy to stop the infection from progressing, and she is prepared to return for that treatment right away. In addition, Barbara still has tooth No. 19 that you previously placed a more secure restoration on, but because it is asymptomatic, she actually forgot about it. I have a new intraoral photo of that tooth that shows the vertical fracture lines, and she’d like your input on how urgent you think this condition is. Lastly, Barbara has experienced some generalized sensitivity, so we’ll apply fluoride varnish today and she is taking Fluoridex® home to begin daily use.”

The advantage of this “triangle of communication” is threefold: m The patient hears the dentist ask for the synopsis and value the dental hygienist’s input. m The hygienist and the dentist have a professional exchange of information about the patient, in front of the patient, ensuring that the patient hears the same synopsis. m The dentist knows the priorities for an examination to be thorough and concise.

In the scenario, did you notice the use of the patient’s name? This is another way to increase the attentiveness of the patient, as we all tend to pay attention when someone talks about us in our presence. Once the dentist confirms any diagnosis with the patient, ask for a directive about the time frame for the patient to proceed with treatment. The dental hygienist can cue the dentist by asking, “Dr. Jones, how soon would you recommend Barbara proceed with this treatment?” In the hand-off to an administrator for financial discussions, it is advantageous for the hygienist to repeat the time frame the doctor has recommended.

Having an ultimate experience requires planning and forethought, but the rewards of being deliberate about how we approach this important time allotment in the dental hygiene appointment can directly lower stress throughout the practice, increase the patient’s understanding, and most importantly, improve case acceptance to achieve the optimal clinical results we want for all our patients.

Comprehensvie Periodontal Therapy: A Statement by the American Academy of Periodontology. J Periodontol 2011.

1

Reprinted with permission by RDH Magazine.

Ms. Davis is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp. and serves on the review board for Dentalantioxidants.com. She can be reached at Karen@Karendavis.net.

March/April 2014 Today's FDA

67

Health Care Reform

Health Care Reform: A Moving Target

By Carrie Millar

FDAS Agency Manager

This is a general overview of the health care reform law as it relates to the small business dental practice. It does NOT attempt to cover the law’s provisions and should not be used as legal advice for implementation activities.

As this article goes to print, the conclusion of the first open enrollment period for individual health insurance on and off the marketplace (exchange) was exMillar tended to mid April.

However, considering the amount of executive policy changes that have occurred just prior to and during the open enrollment period, it could change again. Affordable Care Act (ACA) implementation has certainly been an unpredictable and uncertain journey.

It’s over though, right? All the uncertainties, all the unanswered questions, the seamless implementation of the ACA that was signed into law on March 23, 2010, have been hashed out. Smooth sailing from here. Not quite. There now seems to be even more rule/policy changes and uncertainties. I am going to attempt to explain the latest changes.

Can I keep my current plan? The

answer is, “It’s complicated.” For the second time during open enrollment, White www.floridadental.org

House officials announced on March 5, 2014 that you can keep your non-ACA compliant plan for two more years (it was previously announced in late November 2013, that you could keep your plan for one more year). This means that if your current plan is not grandfathered, it will be up to the carrier to decide if they will allow you to keep your plan for up to two more years. Grandfathered plans can keep their status for as long as the carrier allows.

When is open enrollment for 2015?

As of March 5, 2014, the open enrollment period will be from November 15, 2014 through February 15, 2015 for individual/family health insurance plans.

However, special enrollment periods are available to those who have a qualifying event. These include: losing group insurance, coming off a noncompliant plan, birth, divorce, adoption, loss of job, increase in income (losing Medicaid eligibility) and much more.

About FDA Services Inc. FDA Services (FDAS) is the wholly owned, for-profit insurance agency of the Florida Dental Association. FDAS is a full-service insurance agency and takes pride in managing the insurance portfolios of each and every client. Last year alone, FDAS contributed more than $969,000 to the FDA to help reduce membership dues.

quire 10 essential health benefits (EHB) be covered, which include pediatric dental and vision. Some carriers are integrating these into current plans, while other carriers are requiring the purchase of a separate pediatric dental/vision policy if you have children under the age of 19 on your plan.

My head is spinning, what should I do? Find an agent you trust and who

Does a business with more than 50 employees but less than 100 have to offer coverage to their employees?

is informed on all the new regulations.

Make sure you understand the benefits and network of your plan. There are many lower cost plans that look great on the benefit summary but have a very small regional HMO network.

Yes, but not until 2016. Recent changes to the employer rules have delayed the requirements for groups of 50-99 employees from 2015 to 2016. This gives them another year to avoid penalties if they do not offer coverage.

FDA Services’ experienced staff is ready to get to work for you. If you need a review of your current insurance policies, call FDA Services at 800.877.7597 or email insurance@fdaservices.com.

As a dentist, is it true I must have pediatric dental and vision on my plan? Eventually, yes, unless something

Ms. Millar can be reached at 850.350.

7155 or at carrie.millar@fdaservices.com.

changes. The ACA compliant plans re-

March/April 2014

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70

Today's FDA

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Opportunities

C lassified a dvertising

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72 Today's FDA March/April 2014

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ENDODONTIST. Currently practicing in another

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Please email your current CV to dlimousin.mbdo@gmail. com.

General Dentist Needed for Growing Practice. It takes a special type of person to be a dentist at Klement Family Dental Care. Our culture is built around care, honesty

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GENERAL DENTIST – NAPLES, FL. General Dentist –

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Seeking part time Orthodontic Associate to work Wednesday, Thursday and Friday. Must live within an

Please see classifieds, 74

hour of office. Experience preferred. Energetic and a heart for kids a plus! info@championorthodontics.com.

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March/April 2014

Today's FDA

73

Your Classified Ad Reaches 7,000 Readers!

Great Expressions Dental Centers has a current opening

Central Florida Healthcare, Inc. Dentist opportunities

for a full-time General Dentist in Jacksonville, FL. Our

available in Central Florida at established Community

Christie Dental has full time general dentist opportunity

dentists have the clinical freedom and autonomy enjoyed

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a General Dentist that appreciates the professional,

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education allowance. Future ownership is available and

@ 678.836.2226 or visit us on the web at www.

encouraged. Doctors in our group enjoy traditional

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classifieds from 73

doctor-patient relationships while practicing in a team

General Dentist in Port St. Lucie Needed. Great Expressions Dental Centers has a current opening for a part-time, 2-3 day/week, General Dentist in Port St. Lucie, FL. Our dentists have the clinical freedom and autonomy enjoyed in a traditional private practice

Full-time General Dentist Opportunities. Are you

without the additional financial or administrative burdens

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without the additional financial or administrative burdens

specialists; ability to achieve ownership in a timely

associated with practice management. When considering

manner without all of the burdens of operating and

a career with GEDC, Dentists can expect unlimited

growing a successful practice; maximization of individual

production based earnings, full benefits, malpractice

and professional potential. Ideal candidates will possess:

coverage, a stable patient base, and long-term practice

DDS/DMD from an accredited University and active

Associate Dentist (Orlando). Looking for Part-

or regional career growth. To learn more please call Ross

State Dental Board licensure; a strong sense of ethics

time Associate Dentist for Orlando, Florida area.

Shoemaker @ 678.836.2226 or visit us on the web at

and self, acting with integrity; willingness to be mentored,

Requirements: Must have DDS or DMD Degree from

www.greatexpressions.com.

coached and trained by fellow clinicians. hoeratha@

Accredited Dental School; License to practice in the State

pacificdentalservices.com.

of Florida and meet applicable State requirements; 2

environment that offers the opportunity to discuss clinical cases with peers and support for professional/ group development and growth. We are actively seeking fulltime Dentists for our amazing beachside practice in Cocoa Beach, FL! arobinson@amdpi.com.

Great Expressions Dental Centers has a current opening

One of a Kind Opportunity. Please contact Cindy Pritchett/Patterson Dental for ALL the information about several unique private solo practice opportunities in the Orlando area. (We respect all confidentiality requests.)

352.339.5326.

years or more experience; Bilingual (Spanish) a plus.

for a part-time, 1 day/week, Endodontist in Jacksonville,

Endodontist – South Daytona. Endodontist needed part-

FL. Our specialists have the clinical freedom and

time for modern, well-established private practice in

autonomy enjoyed in a traditional private practice

South Daytona. 2-3 days per month. Office specializes

FT Dentist Required. The first six months deduct expenses

without the additional financial or administrative burdens

in aesthetic dentistry and Invisalign. Email CV to:

and keep revenue. After that you enter into Lease or

associated with practice management. When considering

Seekingdentist@yahoo.com, or call: 386.295.5344.

we will be partners with you. No initial start-up fee. No

a career with GEDC, Dentists can expect unlimited production based earnings, benefits, malpractice coverage, a stable patient base, and long-term practice or regional career growth. To learn more please call Ross Shoemaker @ 678.836.2226 or visit us on the web at www.greatexpressions.com.

Part-Time Periodontist. Great Expressions Dental Centers has a current opening for a part-time, 1 day/ week, Periodontist in Jacksonville, FL. Our Periodontists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, Dentists can expect unlimited production based earnings, benefits, malpractice coverage, a stable patient base, and long-term practice or regional career growth. To learn more please call Ross Shoemaker @ 678.836.2226 or visit us on the web at www. greatexpressions.com.

ASSOCIATE LEADING TO PARTNERSHIP – BRADENTON, FLORIDA. Well-established high quality, fee for service,

djunca23@aol.com.

equipment necessary. Address: 8200-66th Street north Pinellas Park Florida. mitraezzati@hotmail.com.

restorative/prosthodontic and esthetic practice looking

General Dentist for busy offices in Palm Beach County.

for a highly skilled and motivated associate. Excellent

Laboratory on premises. zufi@comcast.net.

opportunity for the right person. scarlett@zkjvdental.com.

General Dentist Wanted – Great Team Environment!

The Carlson Dental Group is expanding. We are one of the most advanced dental practices in the country.

It’s a great place to work, look at our reviews on Google and Angie’s List. Our compensation is a salary based on experience and a bonus based on the total production of all the dentists. This encourages a team atmosphere and one of learning. Our first choice is someone who has had an Advanced General Residency

For Sale/Lease Dental Assisting School ready to go. Your staff does everything. Passive income. It is all there. Special Marketing module is included free that was additional to me. You will own the license and your territory. Easy. I have other ventures occupying my time. First reasonable buyer gets it. Please call now. 561.444.9565. Thanks.

but will consider someone who has two years of general

Priced For Immediate Sale. $69,000.00 (Negotiable)

practice experience. Look at our website and send us

Limited time. Absolutely reduced price for immediate

your resume and a cover letter of why you would fit into

sale. 3 OPS, in the most exclusive high-end area in

our practice. http://carlsondentalgroup.com/; sroe@

Naples. No active patients; must hire your own staff, and

carlsondentalgroup.com.

do marketing for new patients. View website for more details. www.NaplesFloridaDentalPracticeForSale.com; email: NaplesFloridaDental@yahoo.com.

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March/April 2014

www.floridadental.org

Beautiful, modern, fully equipped two operatory office

40,000 cars/day visibility at future stoplight, Sarasota.

Premiere Tampa Bay Practice. One of Tampa Bay’s

for specialist. Ideal for endodontist. Can be converted

Sarasota, University Health Park “one stop shop” health

Leading Dentists is retiring after 48 years. 5900 sq. ft.,

to three operatories. Large referral area. Great location

care campus, universityhealthpark.net, massive signage

ATTRACTIVE, newer facility with on-site laboratory. Must

in NE Broward county. Close to everything. Available

directly on corner of future stoplight, 40,000cars/day

see to appreciate! Dentrix, Dexis and i-CAT Classic. Very

immediately. Call 561.271.5340.

visibility, 3,000 patients/week presently flow through

knowledgeable staff willing to stay. General, Implant and

campus, fully built out suite, affluent area, perfect for

Restorative Practice. www.implantdentistrytampay.com.

dentist, orthodontist, endodontist, prosthedontist, etc.,

Contact Karen Davis 727.488.0217 or Morcie Smith

15 minutes from #1 ranked beach in USA, Sarasota

727.544.4385 or cell 727.254.9707.

A GENUINE OPPORTUNITY. A free standing dental office fitted with 8 treatment rooms ... 4 of which are equipped. A modern office available for lease with an option to buy in beautiful, historic and population exploding St Augustine. A US-1 location that has had

#1 mid-sized city in US for arts and culture. Call Don Harvey, MD at 941.724.3259.

Newly Built Dental Practice Downtown Miami. This “retail space,” “street level” build-out was freshly completed

patients going to for over 25 years. Retiring dentist ...

Beautiful Lakefront Property. Beautiful 2000 sf lakefront

less than 2 months ago. Large windows with heavy foot/

practice grossed 1.7M. rdixstaug@bellsouth.net.

office space available for custom build out. Adjacent

car traffic encompass this 1,600 sq ft space with an extra

to Endodontist. Ideal for Oral Surgeon or Periodontist.

1,000 sq ft basement. Located in the heart of Downtown

Contact Julie 813.654.3636 or julieh@aeoftb.com.

Miami, this modern practice is “turnkey” and selling “at

LOCATION Dental Office Priced to Sell or Lease. Dental Office For Sale at $325,000 ($100/sf) or Lease at

cost.” Has website, major marketing campaigns, and

14.00/sf. Property located at the Office Pavillion, Orange

Seminole County, FL (Sanford). Good opportunity to take

Park. 6 procedure rooms, 3 offices, 3 restrooms, 1

over thriving practice of 38 years with good patient flow.

laundry, 3 supply rooms, a lounge room, a waiting area,

Doctor retiring. Building and practice separate, but both

CENTRAL FLORIDA PEDO PRACTICE. Central Florida

check in/out and a lab. Property surrounded by beautiful

available. Gross income 5-600k. Listed for 330k. Three

Medicaid Based Pedo Practice. 9 Operatories in 3,800

trees. Up to 4,000 sf available. More info in LoopNet.

ops. Contact Dr. Roger Stewart, DMD 407.323.5340.

SF Office. Owner Retiring! Gross Rev. $1.2M+. Contact

Carmen Mantay – 904.553.5238, cm@hallmarkpartner. com.

Sarasota, FL – The #1 Beach Destination in the USA!

already 200 patient count. nhorst02@gmail.com.

Michael Finnan at 561.722.0787.

Established 30 year old practice with $302,000 Gross

CENTRAL POMPANO GENERAL PRACTICE. Small

New Tampa/Wesley Chapel active office for rent 3-4

and 95% collection rate. Solid 3 day hygiene program

General practice in nice professional building on

days/week to SPECIALIST. Fully equipped, active dental

with 1200 active patients – 25% PPO. Loyal and

US-1 central Pompano. Great potential as a “startup”

office including everything for rent 3-4 days a week to a

excellent hygienist and front desk secretary. 1100 sq.

practice! Gross Rev. $160K. Contact Michael Finnan at

SPECIALIST. General dentist treating pts at this location

ft. business condo unit also for sale. Owner retiring.

561.722.0787.

2 days/week as a satellite office. Excellent location, New

Contact Dr. Rotole at: rotoleswimsgood@verizon.net or

building, adjacent to 2 schools with high traffic, visibility

941.256.6903.

and ample parking in SE corner of Bruce B Downs and County Ln Rd. Can be used as main or satellite office 813.658.8892, drshayes@yahoo.com.

Book Review

Book Review minimum horizontal torque (the leading cause of attachment failure).

Basic Clinical Manual of Magnetic Overdenture Author: Hiroshi Mizutani, DDS Published by Quintessence Reviewed by: Leon Smith, DDS, MAGD

What do you do for the 72-year-old patient who presents in your office with the clinical crown of a mandibular canine broken off at the gingival level due to cervical caries? To top it off, it is an abutment for an otherwise well-fitting bilateral distal extension partial denture.

I know what I would want to do as the treatment plan: an implant. But let’s say your patient rejects this treatment plan either for financial, or, equally important, emotional reasons. A magnetic abutment might be an acceptable interim treatment plan, which will allow your patient to experience the clinical advantage of an overdenture by using their existing partial denture as a transitional appliance. This holds a certain appeal not only in total treatment time but financially as well. Magnetic attachments offer the maximum retention with

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Today's FDA

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Just to review, magnetic attachments have been on the market since the invention of rare earth magnets some 40 years ago. These early magnets had their limitations with relatively high intra-occlusal width and corrosion being the main ones. As a result, they fell out of favor after ZAGG attachments came on the market. The ZAGG attachments, however, have their own set of limitations. The thickness of the pre-cast keeper post being the primary one that comes to mind. Now it is true, one can shorten the keeper, but that significantly reduces the retention, thus increasing the failure rate.

So, it is with this in mind that I decided to review this manual. Have there have been improvements to magnetic attachments? Yes, indeed there have been.

First, the magnets are much smaller, and thus have reduced the space limitation problem. Secondly, the encapsulation is improved, greatly reducing corrosion.

Finally, and most importantly from my perspective, they have a superior pre-cast keeper. It is narrower than the ZAGG precast. Keeping in mind that length, not width, increases retention, this should be an improvement.

Now let’s talk about the manual itself.

The CD is better than the book. Let’s face it, dentists don’t read books, but

they do love to look at pictures. So do yourself a favor and go to the CD first.

It is always easier to see the procedures being performed in-vivo. Secondly, the manual does an excellent job with the laboratory side of the restoration process, which is every bit as important to the success of the case as the keeper placement. Finally, the price is right. At $30, it is just about the cheapest clinical textbook I can remember seeing.

Now, I am a frugal person (the word cheap might be a more accurate description). In a brief Internet search I found little in the way of visual learning aids for the Magfit system. Certainly, there is nothing that comes close to this manual.

While this is a shortcoming the manufacturer should address, it only enhances the need for the manual, should one want to use the system. They (the Aichi Steel Corporation) would be well served to at least reference the manual on their website.

If you are interested in using magnetic attachments either for the first time or again, buy this book. It will be money well spent for both for you and your lab man. Too bad the company doesn’t offer an online seminar for CE credits. I feel they would be well-served if they did.

Dr. Smith is a retired general dentist and can be reached at leonsmithdds@gmail.com.

www.floridadental.org

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www.floridadental.org

OFF the cusp John Paul, dmd, Editor

What’s in a Name?

“ ”

If my patients are that comfortable with me while sitting in my chair, I must be doing something right.

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Today's FDA

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I got my brochure describing the many wonderful opportunities at FNDC this year. I’m pretty excited that pre-registration is free. I remember back in the day, I used to sign up a free technician, usually a name like Johann Dough. I never had a tech with me, but I would wear the tech name badge, which eliminated walking through the exhibits hearing, “Doctor, Doctor, Doctor, Doctor …”

That got me thinking about dentists I was introduced to when I first started practicing. When you called them “Dr. Smith,” they would reply, “Dr. Smith is my father; call me John.” I figured they just didn’t want to feel old. I have come to understand that they just didn’t want to feel separate from the group.

Some folks get really attached to the first name “Doctor.” I walked into my operatory one day to hear a patient dressing down my assistant. Trying to be polite, my assistant had called the patient, “Mrs.” The patient held a Ph.D. and demanded she be called, “Doctor.” She tried to enlist me in her argument and asked, “Don’t you demand to be called doctor?”

I replied, “I never introduce myself as Dr. Paul. When I meet a new patient, I introduce myself as John Paul. It is obvious I am the doctor. Most of my patients call me, ‘JP,’ and some call me, ‘Doc.’ If my patients are that comfortable with me while sitting in my chair, I must be doing something right.”

This year, I realized I have achieved celebrity status where I need only use one name like Cher or Michelangelo. At the WCDDA winter meeting, there was a large board listing volunteer assignments.

Looking for my responsibility, I read down the list; Dr. Marshall Dr. Palo Dr. Bulnes JP Dr. Grassin Dr. Grimaudo …

They say the sweetest sound to anyone’s ear is their own name. I’m glad people feel comfortable enough to use mine.

Dr. Paul is the editor of Today's FDA. He can be reached at jpdentz@aol.com. www.floridadental.org

Any projected balance amounts or other projections shown herein are for illustrative purposes only.

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